Yamasaki H, Tanemura M, Morimoto Y, Hashimoto J, Sakamoto T, Yamasaki Y, Kuwata K
Division of Surgery, Osaka Koseinenkin Hospital, Japan.
Nihon Geka Gakkai Zasshi. 1992 Nov;93(11):1384-9.
Fatty liver was often found concomitantly by the ultrasound during the follow up study of the gastric cancer operation. By ultrasound, development of postgastrectomy fatty liver was seen in 29 out of 176 patients (16.5%) with several gastrectomies. The number of the patients with postgastrectomy fatty liver was 12 out of 104 patients (11.5%) with distal partial gastrectomy with B-I reconstruction, while that was 17 of 72 patients (23.6%) with total gastrectomy with several reconstructions. The incidence of postoperative fatty liver change was significantly higher in the patients under 59 years old compared to the elders. Seventy-five g oral glucose test induced oxyhyperglycemia and hyperinsulinemia in patients with gastrectomy, especially with total gastrectomy. Integrated plasma insulin and triglyceride responses during first one hour in postgastrectomy patients were significantly higher than preoperative values. Moreover, plasma insulin and blood sugar in response to oral glucose test were significantly higher in patients with postgastrectomy fatty liver, compared to those in patients without fatty liver. These results suggested that the postgastrectomy fatty liver was resulted from the abnormality of the glucose metabolism.
在胃癌手术的随访研究中，经常通过超声检查发现脂肪肝。超声检查发现，176例行多次胃切除术的患者中有29例（16.5%）出现了胃切除术后脂肪肝。在104例行B-I重建的远端部分胃切除术患者中，有12例（11.5%）出现胃切除术后脂肪肝，而在72例行多次重建的全胃切除术患者中，有17例（23.6%）出现。与年长者相比，59岁以下患者术后脂肪肝改变的发生率明显更高。口服75克葡萄糖试验可导致胃切除患者，尤其是全胃切除患者出现高血糖和高胰岛素血症。胃切除术后患者在最初一小时内的血浆胰岛素和甘油三酯综合反应明显高于术前值。此外，与无脂肪肝的患者相比，胃切除术后脂肪肝患者口服葡萄糖试验后的血浆胰岛素和血糖明显更高。这些结果表明，胃切除术后脂肪肝是由糖代谢异常引起的。
