胃切除後の再建術式に関する実験的、臨床的研究
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概要
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Present study was undertaken to decide the reconstructive methods after gartrectomy for cancer which showed less postoperative changes in metabolism and physical conditions. Follow up study was performed on 234 patients who survived longer than one year after gastrectomy without recurrence of cancer. Gastrectomized dogs were also subjected to the studies on postoperative metabolism. General condition according to the patient's feeling and postoperative body weight change suggested that the reconstructive methods to route foods through the duodenum such as BI and interposition types of reconstruction were better than the other types. On the other hand, the general conditions, body weight change and volume of meal intake were revealed to be related more closely to postoperative metabolism in each reconstructive method than to postoparative digestion and absorption of nutrients, while the differences of route of foods passage induced clinical symptoms in partial gastrectomy less remarkably than in total gastrectomy. Any laboratory findings containing serum albumin, lipids and trace elements in gastrectomized patients showed the almost normal ranges in any reconstructive methods except some of patients with Roux Y type reconstruction. In carbohydrate metabolism in gastrectomized patients partial gastrectomy with both BI and Bn reconstruction and total gastrectony with interposition reconstruction showed the same responses in serum glucose, IRI and CPR. However, Roux Y reconstruction showed the quite different patterns which were similar to their responses in diabetes mellitus. In view of metabolic pattern and hormonal change like gastrin, secretin and IRG in the reconstructive methods, it is possibly conclude that BI and jejunal interposition types on the hand, and Bn and Roux Y types on the other hand, had similar characteristic each other and also that the former two is superior to the latter two.
- 神戸大学の論文