위전절제술후 재건술의 방법에 따른 영양상태에 관한 연구

Abstract

Malnutrition and weight loss after total gastrectomy is one of the major issue. In attempting to improve the nutritional status in these patients, many surgeons have tried to restore the duodenal passage as reconstructive procedure but debate has been continued. So we investi- gated weight change, postprandial serum secretin response and fecal fat amount to evaluate the esophagojejunoduodenostomy which was restored the duodenal passage. Dogs after total gastrectomy showed significant weight loss and all experimental animals except sham operation died between five and eight weeks after operation. Serum secretin con- centration after esophagojejunoduodenostomy increased significantly from a mean fasting value of 199+12.5pg/ml to a mean peak of 142+22.5pg/ml at 40 minutes and returned to fast- ing level at 120 minutes postprandially. But fasting and postprandial serum secretin concen- tration in patients following Roux-en Y esophagojejunostomy were fluctuated irregularly. The amount of fecal fat in esophagojejunoduodenostomy was 5.3+1.2gm/100gm stool, which was not different from that of control group but in Roux-en Y esophagojejunostomy it was 28.1+4. Lgm/100gm stool which was much higher than that observed in esophagojejunoduodenostomy and in control group. These results suggest that esophagojejunoduodenostomy is superior to Roux-en Y esopha- gojejunostomy in respect to pancreatic secretory function and fat absorption.