胃全摘術後の消化吸収障害に関する一考察

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The purpose of this study is (1) to estimate nutritional status after gastrectomy and (2) to evaluate whether malabsorption after gastrectomy is corrected or not by the administration of enzymatic preparation. The subjects selected for this study consist of 10 cases of total gastrectomy containing each 5 cases of double tract (D-T) and Rouz-en Y (R-Y) reconstruction, 6 cases of Billroth I (B-I) and 5 cases of Biliroth II (B-II) gastrectomy. Methods: 1) BT-PABA test; 0. 5g of BT-PABA and 50g of Sustagen dissolved in 250m1 of water were orally administered and urine was collected for 6 hrs. Urinary PABA was determined by Bratton & Marshall's method modified by Smith. 2) Fecal fat and nitrogen were measured by the method of van de Kamer and semimicroKjeldahl, respectively.Results were as follows;1)Though loss of the weight and increase of fecal fat and nitrogen were found in most of the cases, total protein and total cholesterol were normal. Serum carotene decreased in onethird of the cases.2)In BT-PABA test followed by intravenous administration of pancreozymin, urinary PABA excretion ratio increased in cases of D-T and B-I.3)In BT-PABA test with simultaneous administration of enzymatic preparation, urinary PABA excretion ratio increased in cases of D-T, R-Y, and B-I.4)On the enzymatic replacement therapy, fecal fat reduced in cases of R-Y, B-I and B-II. 5)In 13 cases out of 17 cases whose urinary PABA excretion ratio increased in BT-PABA test with simultaneous administration of enzymatic preparation, fecal fat reduced on the enzymatic replacement therapy.Conclusion: From these results, it was strongly suggested that decrease of intraluminal pancreatic enzymes was one of the important causes of malabsorption after gastrectomy, and enzymatic replacement therapy was useful for the treatment of malabsorption after gastrectomy.

胃全摘術後の消化吸収障害に関する一考察

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