Harju E, Seppälä E, Isolauri J, Koivula T
Department of Clinical Sciences, University of Tampere, Finland.
Int Surg. 1988 Apr-Jun;73(2):78-81.
Intestinal absorption was examined using an oral galactose test in colon interposition patients with dumping (no. 4) and without symptoms (no. 5). Normal subjects (no. 5), and patients after total gastrectomy (no. 7) and gastric resection (no. 4) served as controls. Galactose is absorbed in the same way as glucose, but does not stimulate insulin secretion. Colon interposition patients presented abnormally rapid postprandial transit and absorption for 20 minutes after the meal. After this rapid phase, colon interposition patients with dumping demonstrated a strong decrease in absorption rate, whereas the asymptomatic patients presented a normal rate during the whole follow-up period. The elimination of galactose from the blood was studied in eight patients after intravenous infusion of galactose; the disappearance was linear during 10 to 30 min after injection and did not explain the differences in blood galactose levels in the oral galactose test. We suggest a reactive reflux back to the intra-abdominal colon graft loop in the avagotonic intestinal tract as the mechanism for the differences in absorption. The most likely reason for this is the rapid initial phase transit through the coloantral anastomosis and pyloroplasty. To normalize postprandial transit and absorption as much as possible after colon interposition, a short intra-abdominal colon graft loop anastomosed to the posterior proximal stomach is suggested.
采用口服半乳糖试验，对患有倾倒综合征的结肠间置患者（第4组）和无症状的结肠间置患者（第5组）进行肠道吸收检查。正常受试者（第5组）、全胃切除术后患者（第7组）和胃切除术后患者（第4组）作为对照。半乳糖与葡萄糖的吸收方式相同，但不刺激胰岛素分泌。结肠间置患者餐后20分钟出现异常快速的餐后转运和吸收。在这个快速阶段之后，患有倾倒综合征的结肠间置患者的吸收率大幅下降，而无症状患者在整个随访期间吸收率正常。对8例静脉输注半乳糖后的患者进行了血液中半乳糖清除的研究；注射后10至30分钟内，半乳糖清除呈线性，无法解释口服半乳糖试验中血半乳糖水平的差异。我们认为，在失张力性肠道中，向腹腔内结肠移植袢的反应性反流是吸收差异的机制。最可能的原因是最初快速阶段通过结肠窦吻合术和幽门成形术。为了在结肠间置术后尽可能使餐后转运和吸收正常化，建议将一段短的腹腔内结肠移植袢与近端胃后壁吻合。
