Abstract
To investigate the altered pancreatic endocrine function accompanying glucose intolerance and nutritional disturbance after total gastrectomy, intravenous glucose tolerance tests were performed in three groups: preoperative patients with gastric cancer (group A), total gastrectomy combined with pancreatectomy (group B), total gastrectomy with pancreatic preservation (group C). The mean level of K (mg/dl. min) is 1.27±0.19 in group A, 0.76±0.2 in group B and 0.71±0.28 in group C. The mean level of T.I.I (μIU. dl/ml. mg) is 0.18±0.1 in group A, 0.01±0.05 in group B and 0.04±0.01 in group C. Glucose intolerance and reduced insulin secretion were observed not only in group B but also in group C. However, there were no major differences between groups B and C in other tests, excluding HbAl and HbA1C, so the disadvantage of total gastrectomy combined with pancreatectomy was not clarified. HbA1 and HbA1C, as indices of postoperative glucose intolerance, BMI (body mass index, weight/height2 ratio) and BWR% (body weight ratio, a comparison of pre-and postoperative weight), as indices of nutritional disturbance, are extremely useful indices. Moreover, these indices can be used as an index of the secretory capacity of insulin. In patients with diabetes mellitus, the grade of nutritional disturbance after total gastrectomy is more remarkable, and total gastrectomy with interposition reconstruction or with pancreatic preservation are recommended.
