Hylander E, Ladefoged K, Nielsen M L, Nielsen O V, Thale M, Jarnum S
Scand J Gastroenterol. 1986 Nov;21(9):1137-43. doi: 10.3109/00365528608996434.
Bile acid metabolism was studied in 26 patients with a continent ileostomy (Kock's reservoir) and 32 patients with conventional ileostomy. All had been colectomized for ulcerative colitis. In patients with a continent ileostomy the 14C-glycocholic acid breath test showed increased pulmonary 14CO2 excretion as evidence of abnormal bacterial deconjugation of bile acids and increased faecal 14C excretion as evidence of bile acid malabsorption. Faecal bile acid excretion, determined chemically, and, by inference, bile acid synthesis were only moderately increased (median, 1.8 mmol/day). The disturbance of bile acid metabolism was similar to that found in 32 patients with conventional ileostomy, but more pronounced with higher faecal 14C. A significant difference was that no abnormal bacterial deconjugation took place in patients with conventional ileostomy, since their pulmonary 14CO2 excretion was subnormal. Stool mass was almost identical in the two groups, with median values of 665 and 663 g/day, respectively. Faecal fat excretion was normal in most in both groups. Thus bile acid metabolism is slightly more disturbed in patients with a continent ileostomy than in patients with conventional ileostomy. The resulting malabsorption was modest in both groups.
对26例采用可控回肠造口术（Kock贮袋）的患者和32例采用传统回肠造口术的患者的胆汁酸代谢情况进行了研究。所有患者均因溃疡性结肠炎接受了结肠切除术。在采用可控回肠造口术的患者中，14C - 甘氨胆酸呼气试验显示肺部14CO2排泄增加，这是胆汁酸细菌去结合异常的证据，粪便14C排泄增加，这是胆汁酸吸收不良的证据。通过化学方法测定的粪便胆汁酸排泄量，以及由此推断的胆汁酸合成量仅适度增加（中位数为1.8 mmol/天）。胆汁酸代谢紊乱与32例采用传统回肠造口术的患者相似，但在粪便14C含量较高时更为明显。一个显著的差异是，采用传统回肠造口术的患者未发生异常细菌去结合，因为他们的肺部14CO2排泄低于正常水平。两组患者的粪便量几乎相同，中位数分别为665克/天和663克/天。两组中大多数患者的粪便脂肪排泄正常。因此，采用可控回肠造口术的患者的胆汁酸代谢紊乱程度略高于采用传统回肠造口术的患者。两组由此导致的吸收不良程度均较轻。
