Abstract
The gastrointestinal hormones (gastrin, secretin, glucagon, insulin) and gastric juice (acidity, pH) were evaluated in 51 adult patients who received hepatectomy at the National Defense Medical College from April 1986 to April 1989. The patients were divided into the following four groups: 19 patients who received lobectomy or moreextended hepatectomy (major group), eight patients who received segmentectomy or more limited hepatectomy minor group), 11 patients with complicating cirrhosis (LC group), 18 patients who received both hepatectomy and pancreatoduodenectomy (HPD group). 1) Acidity of the LC group (pre-operation (pre-op) 58.0±5.0, post-operative day (POD) 1 40.5±33.2, 3POD 30.0±15.1, 5POD 39.0±12.1 mEq/1) was lower than that of the other three groups at POD1, 3, 5. 2) The pH of the LC group (pre-op 6.8±0.5, POD1 6.4±1.5, POD3 6.1±1.5, POD5 6.5±1.3) was higher than that of the other three groups at pre-op and POD1, 3, 5.3) The major, minor, and HPD group showed a post-operative decrease in the gastrin level, but the LC group (pre-op 30.0±3.0, PODI 25.7±10.7, POD3 39.0±9.5, POD5 31.7±15.6 pg/ml) showed a constant low level during the pre-and post-operative periods. 4) The secretin level increased similarly in each group with no significant difference between these groups, but the LC group showed the highest rate of increase of these four groups. 5) Glucagon showed a post-operative increase in all groups and the LC group (pre-op 210.3±150.5, POD1 372.5±326.3, POD3 325.0±163.0, POD5 400.0±293.0 pmol/ml) showed consistently higher glucagon levels than the other three groups during the pre-and post-operative periods. 6) The insulin level rose to its maximum point at POD1 in the minor, major, and HPD groups, but the major group reached its highest level at PODS or later. These results indicate that there was no hyperacidity or hypergastrinemia after hepatectomy, especially in liver-cirrhotic patients. To prevent a gastric hemorrhage after hepatectomy, we must pay more attention to improve the defense factors of the gastric mucosa than to suppress the secretion of gastric juice.
