1979 年 39 巻 5 号 p. 483-494
Sugar metabolism were studied upon twenty patients who were totally gastrectomized. They were survived for one year or more after operation for gastric cancer. Ten cases of partially gastrectomized patients and five healthy normal subjects were selected as control. Reconstruction after gastrectomy were performed with double tract method (in ten cases), jejunal interposition method (in three cases), Roux-en-Y method (in five cases), and other methods (in two cases) on totally gastrectomized patients and Billroth I method on all of partially gastrectomized patients.
Studies were performed upon oral glucose tolerance test (OGTT), intravenous glucose tolerance test (iv GTT), and oral xylose absorption test (OXAT) . Blood sugar, serum immunoreactive insulin (IRI), and xylose in urine were determined during those tests. The results were as follows ;
1) After OGTT, the blood sugar curve in the gastrectomized groups showed oxyhyperglycemic curve and this tendency was more dominant in the totally gestrectomized group. The IRI level reached its peak at thirty minutes in the totally gastrectomized group and began to fall thereafter, however, the IRI level reached its peak later in the partially gastrectomized group.
2) After iv GTT, the blood sugar levels were higher in the gastrectomized groups than in the healthy normal group. The blood glucose curve in the totally gastrectomized group was similar to that in the partially gastrectomized group. The IRI level in the totally gastrectomized group was lowest in the three groups.
3) After OXAT, although the xylose levels in urine in the three groups were in a normal range, there was slight difference in the blood xylose levels. Namely the blood xylose level in the totally gastrectomized group reached its peak earliest in the three groups.
4) Concerning the reconstructive methods after total gastrectomy, the blood sugar levels after OGTT reached their peak earlier in double tract method and jejunal interposition than in Roux-en-Y method. This seemed to be due to some factors in the intestinal tract, for instance, glucose absorption was accelerated by cibarian passing in the duodenum.
5) There was no significant change in the capacity of glucose tolerance among the totally gastrectomized patients combined with about resection of the pancreas.
6) Probablely, there is no possibility that repeated insulin hypersecretion following hyperglycemia after gastrectomy causes beta islet cell hypofunction and develops secondary diabetes.