Walther B, Clementsson C, Vallgren S, Ihse I, Akesson B
Dept. of Surgery, University Hospital, Lund, Sweden.
Scand J Gastroenterol. 1989 Apr;24(3):309-14. doi: 10.3109/00365528909093052.
The feasibility of using the triolein breath test to demonstrate fat malabsorption was evaluated in a prospective study of patients before and after total gastrectomy and Roux-en-Y reconstruction. Two of 11 patients had subnormal fat absorption before the operation, but 1 and 6 months after the operation 9 of 11 patients had subnormal fat absorption. Peak expiratory 14CO2 (median (range] at the three investigations was 3.9%/h (2.1-5.9%/h), 2.1%/h (1.4-4.5%/h), and 2.0%/h (1.2-6.0%/h), respectively. Patients who underwent a Nissen fundoplication were used as controls. They had normal fat absorption both before and after operation. Serum amylase was not appreciably affected by total gastrectomy and was similar to control values. In contrast, serum albumin decreased 1 month after gastrectomy and recovered after 6 months. In control patients pre- and post-operative albumin concentrations did not differ and were comparable to preoperative albumin values in the total gastrectomy group. The lowered fat absorption may be explained by duodenal bypass with decreased pancreatic stimulation, and it may in part explain the weight loss in patients operated on with total gastrectomy.
在一项对全胃切除及Roux-en-Y重建术前和术后患者的前瞻性研究中，评估了使用三油酸甘油酯呼气试验来证明脂肪吸收不良的可行性。11例患者中有2例在手术前脂肪吸收低于正常水平，但在术后1个月和6个月时，11例患者中有9例脂肪吸收低于正常水平。三次检查时的呼气末14CO2峰值（中位数[范围]）分别为3.9%/小时（2.1 - 5.9%/小时）、2.1%/小时（1.4 - 4.5%/小时）和2.0%/小时（1.2 - 6.0%/小时）。接受nissen胃底折叠术的患者作为对照。他们在手术前后脂肪吸收均正常。血清淀粉酶未受到全胃切除的明显影响，与对照值相似。相比之下，血清白蛋白在胃切除术后1个月下降，并在6个月后恢复。对照患者术前和术后的白蛋白浓度无差异，且与全胃切除组的术前白蛋白值相当。脂肪吸收降低可能是由于十二指肠改道导致胰腺刺激减少所致，这可能部分解释了接受全胃切除术患者的体重减轻。
