Takase Makoto, Sumiyama Yoshinobu, Nagao Jiro
The Third Department of Surgery, Toho University School of Medicine, Ohashi Hospital, 2-17-6 Ohashi, Meguro-ku, Tokyo 153-8515, Japan.
Gastric Cancer. 2003;6(3):134-41. doi: 10.1007/s10120-003-0238-3.
Digestive and absorptive disorders may negatively influence patients' nutrition, thus resulting in weight loss after gastrectomy. A relationship thus seems to exist between the fat absorptive function and body weight after gastrectomy; however, so far there has been no evidence to prove this hypothesis. Therefore, in this study we evaluated fat absorption ability using a stable isotope, (13)C-trioctanoin, based on the range of the gastrectomy and the method of reconstruction, and we also determined the feasibility of this test.
Among patients who had undergone gastrectomy for gastric cancer, 40 patients who had been operated on between 1 and 3 years previously were evaluated. Ten patients had undergone the double-tract (DT) method, and 10 patients had received the Roux-en-Y (RY) method after a total gastrectomy. Twenty patients who had undergone the Billroth I (BI) method after a distal gastrectomy were the control group. In addition, 10 volunteers formed a healthy control group for the (13)C-trioctanoin test. We also examined other six factors related to nutrition after gastrectomy. RESULTS. The (13)C-trioctanoin test showed, in relation to the reconstruction procedure, the highest average peak of fat absorption in the BI group (which had food passage through the duodenum), followed by the average peak of fat absorption in the DT group and the RY groups. In a comparison of duration, at 60 min and 90 min after administration, the BI group and DT group showed a significantly higher level than the RY group. The peaking time (average time at peak level) showed a significant difference between the RY group and the other groups. The absorption amount at an early stage of absorption and the percent (%) dose showed a significant difference between the RY group and the other groups. The RY group had significantly lower fat absorption than the healthy controls.
According to this study, which evaluated fat absorption after different reconstructive procedures after gastrectomy, the procedure that accommodated for the passage of food through the duodenum showed better results for the absorption of medium-chain triglycerides, and the patients also showed a better physiological state.
消化和吸收障碍可能会对患者的营养状况产生负面影响，从而导致胃切除术后体重减轻。胃切除术后脂肪吸收功能与体重之间似乎存在某种关系；然而，迄今为止尚无证据证明这一假设。因此，在本研究中，我们根据胃切除范围和重建方法，使用稳定同位素（13）C-三辛酸甘油酯评估脂肪吸收能力，并确定该检测方法的可行性。
在因胃癌接受胃切除术的患者中，对40例在1至3年前接受手术的患者进行评估。10例患者采用双通路（DT）法，10例患者在全胃切除术后接受了Roux-en-Y（RY）法。20例在远端胃切除术后采用毕罗一世（BI）法的患者作为对照组。此外，10名志愿者组成了（13）C-三辛酸甘油酯检测的健康对照组。我们还检查了胃切除术后与营养相关的其他六个因素。结果。（13）C-三辛酸甘油酯检测显示，与重建手术相关，BI组（食物通过十二指肠）的脂肪吸收平均峰值最高，其次是DT组和RY组的脂肪吸收平均峰值。在持续时间比较中，给药后60分钟和90分钟时，BI组和DT组的水平显著高于RY组。峰值时间（达到峰值水平的平均时间）在RY组与其他组之间存在显著差异。吸收早期的吸收量和剂量百分比（%）在RY组与其他组之间存在显著差异。RY组的脂肪吸收明显低于健康对照组。
根据本研究对胃切除术后不同重建手术的脂肪吸收评估，允许食物通过十二指肠的手术在中链甘油三酯吸收方面显示出更好的效果，患者的生理状态也更好。
