Imamura M, Takahashi M, Sasaki I, Yamauchi H, Sato T
First Department of Surgery, Tohoku University School of Medicine, Sendai, Japan.
Am J Gastroenterol. 1988 Apr;83(4):386-92.
The effects of an altered pathway of bile flow upon fat metabolism and gastrointestinal hormone release were investigated in patients undergoing biliary reconstruction procedures or external biliary drainage. After ingestion of a fat-enriched meal, patients with jejunal interposition hepaticoduodenostomy showed the same patterns as controls, with similar levels of plasma triglyceride and gastrointestinal hormones. On the other hand, patients with Roux-Y hepaticojejunostomy or external biliary drainage revealed the impairment of fat metabolism, although the response patterns were different. As for the changes in gastrointestinal hormones in the two groups, both gastric inhibitory polypeptide (GIP) and insulin levels were reduced, whereas glucagon-like immunoreactivity (GLI) levels rose, especially in the external biliary drainage group. It is considered that the disturbance of fat metabolism, in cases of internal or external biliary diversion, is closely related to change in GIP, insulin, and GLI release, in addition to the impairment of mixed micelle formation by bile and of hydrolysis by pancreatic enzymes.
在接受胆道重建手术或外引流术的患者中，研究了胆汁流动途径改变对脂肪代谢和胃肠激素释放的影响。摄入富含脂肪的餐后，行空肠间置肝十二指肠吻合术的患者与对照组表现出相同模式，血浆甘油三酯水平和胃肠激素水平相似。另一方面，行Roux-Y肝空肠吻合术或外引流术的患者尽管反应模式不同，但显示出脂肪代谢受损。至于两组胃肠激素的变化，胃抑制多肽（GIP）和胰岛素水平均降低，而胰高血糖素样免疫反应性（GLI）水平升高，尤其是在外引流组。据认为，在内外胆汁转流的情况下，脂肪代谢紊乱除了与胆汁混合微胶粒形成受损和胰酶水解受损有关外，还与GIP、胰岛素和GLI释放的变化密切相关。
