Quantitative evaluation of reconstruction methods after gastrectomy using a new type of examination: Digestion and absorption test with stable isotope 13C-labeled lipid compound

被引：48

作者：

Makoto Takase

Yoshinobu Sumiyama

Jiro Nagao

机构：

[1] Third Department of Surgery, Toho University School of Medicine, Ohashi Hospital, Meguro-ku, Tokyo 153-8515

来源：

Gastric Cancer | 2003年 / 6卷 / 3期

关键词：

!sup]13[!/sup]C-Trioctanoin; Fat absorption test; Gastric cancer; Nonradioactive breath test; Reconstructive operation;

D O I：

10.1007/s10120-003-0238-3

中图分类号：

学科分类号：

摘要：

Background. Digestive and absorptive disorders may negatively influence patients' nutrition, thus resulting in weight loss after gastrectomy. A relationship thus seems to exist between the fat absorptive function and body weight after gastrectomy; however, so far there has been no evidence to prove this hypothesis. Therefore, in this study we evaluated fat absorption ability using a stable isotope, 13C-trioctanoin, based on the range of the gastrectomy and the method of reconstruction, and we also determined the feasibility of this test. Methods. Among patients who had undergone gastrectomy for gastric cancer, 40 patients who had been operated on between I and 3 years previously were evaluated. Ten patients had undergone the double-tract (DT) method, and 10 patients had received the Roux-en-Y (RY) method after a total gastrectomy. Twenty patients who had undergone the Billroth I (BI) method after a distal gastrectomy were the control group. In addition, 10 volunteers formed a healthy control group for the 13C-trioctanoin test. We also examined other six factors related to nutrition after gastrectomy. Results. The 13C-trioctanoin test showed, in relation to the reconstruction procedure, the highest average peak of fat absorption in the BI group (which had food passage through the duodenum), followed by the average peak of fat absorption in the DT group and the RY groups. In a comparison of duration, at 60 min and 90 min after administration, the BI group and DT group showed a significantly higher level than the RY group. The peaking time (average time at peak level) showed a significant difference between the RY group and the other groups. The absorption amount at an early stage of absorption and the percent (%) dose showed a significant difference between the RY group and the other groups. The RY group had significantly lower fat absorption than the healthy controls. Conclusion. According to this study, which evaluated fat absorption after different reconstructive procedures after gastrectomy, the procedure that accommodated for the passage of food through the duodenum showed better results for the absorption of medium-chain triglycerides, and the patients also showed a better physiological state.

引用

页码：134 / 141

页数：7

共 20 条

[1]

Rutenberg A.M., Seligman A.M., Fine J., Studies with radioactive iodized fat. I. Preparation of radioactive fat with observations on the absorption of fat following subcutaneous and intraperitoneal injection in dogs, J Clin Invest, 28, pp. 1105-1109, (1949)

[2]

Stanley M.M., Thannhauser S.J., The absorption and disposition of orally administered 131labeled neutral fat in man, J Lab Clin Med, 34, pp. 1634-1639, (1949)

[3]

Thannhauser S.J., Stanley M.M., Serum fat curves following oral administration of 131-labeled neutral fat to normal subjects and those with idiopathic hyperlipemia, Tr A Am Physician, 62, pp. 245-252, (1949)

[4]

Nakamoto T., Standard methods of 131I-triolein test and 131I-oleic acid test for fat absorption study, and their clinical investigation, Jpn J Gastroenterol, 65, pp. 363-382, (1968)

[5]

Schwabe A.D., Cozzetto F.J., Bennett L.R., Mellinkoff S.M., Estimation of fat absorption by monitoring of expired radioactive carbon dioxide after feeding a radioactive fat, Gastroenterology, 42, pp. 285-291, (1962)

[6]

Abt A.F., Von Schuching S.L., Fat utilization test in disorders of fat metabolism. A new diagnostic method applied to patients suffering with malabsorption syndrome, chronic pancreatitis, and arteriosclerotic cardiovascular disease, Bull Johns Hopkins, 119, pp. 316-330, (1966)

[7]

Kaihara S., Wagner H.N., Measurement of intestinal fat absorption with carbon-14 labeled tracers, J Lab Clin Med, 71, pp. 400-411, (1968)

[8]

Burrows P.J., Fleming J.S., Garnett E.S., Ackery D.M., Colin-Jones D.G., Bamforth J., Clinical evaluation of the 14C fat absorption test, Gut, 15, pp. 147-150, (1974)

[9]

Schoeller D.A., Schnider J.F., Solomons N.W., Watkins J.B., Klein P.D., Clinical diagnosis with the stable isotope 13C in CO 2 breath tests: Methodology and fundamental considerations, J Lab Clin Med, 90, pp. 412-421, (1977)

[10]

Watkins J.B., Schoeller D.A., Klein P.D., Ott D.G., Newcomer A.D., Hofmann A.F., 13C-Trioctanoin, a nonradioactive breath test to detect fat malabsorption, J Lab Clin Med, 90, pp. 422-430, (1977)

← 1 2 →