Studies on the Alteration of Pancreatic Endocrine Function Accompanied with Glucose Intolerance and Nutritional Disturbance after Total Gastrectomy

Hideaki Chin, Michio Kaminishi, Yoshiaki Jojima, Hiromi Sano, Kuniaki Kushibiki, Masanori Kobayashi, Masaki Kawahara, Meirin Kyu, Mitsuru Yamakawa, Takeshi Oohara

Third Department of Surgery, School of Medicine, Tokyo University

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 HbA1 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/height²ratio) 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.

Key words
pancreatic endocrine function, total gastrectomy, glucose intolerance, nutritional disturbance

Reprint requests
Hideaki Chin Third Department of Surgery, School of Medicine, Tokyo University
3-28-6 Mejirodai, Bunkyo-ku, Tokyo 112 JAPAN

Accepted
October 9, 1991

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