J.Jpn. Surg. Soc.. 58(8): 1250-1265, 1957
PROTEIN METABOLISM AFTER TOTAL GASTRECTOMY
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Second Surgical Department, Kyushu University School of Medicine (Director: Dr. M. Tomoda) Hisateru OKADA |
Serum proteins after total gastrectomy were measured 71 times in 36 cases during postoperative period varying from about one month to 11 years and 3 months. The mean concentration of total protein was 6.45 g/dl, that of albumin 3.19 g/dl, and the A/G ratio 0.99. Mild hypoproteinemia was caused in a majority of the 36 cases, and edema in 11 (30.5%). The latter condition was prodused sometimes after operation ; it was a transitory, and not lasting, condition in most cases, occurring frequently when the patients were placed in abnormal environmental circumstances. This edema, occurring after total gastrectomy roughly in conformity with the changes in the concentration of serum proteins, appeared to result from hypoproteinemia in these patients.
The intake-excretion study of protein after total gastrectomy in 13 cases showed that fecal nitrogen loss per day averaged 2.1 gm when food containing little fat had been ingested, and 2.7 gm when 50 to 80 gm butter had been ingested. It was thus seen that a high-fat diet tends to increase the disturbance of protein absorption, even in case causes no diarrhea, after total gastrectomy. Fecal nitrogen loss per day occurring after fat intake in cases of total gastrectomy was varied according to the method used for the operation, averaging 3.7 gm, 2.5 gm, and 1.8 gm according as it was performed by esophago-jejunostomy (in 5 cases), esophago-duodenostomy (in 3 cases), and Tomoda's method (in 5 cases). The figures show that the absorption of protein ·was little disturbed by high-fat diet in cases subjected to Tomoda's method.
The stenosis at the site of anastomosis between the esophagus and intestine, which decreases food intake and appears to play an important part in the development of hypoproteinemia after total gastrectomy, was noted in 2 of 6 cases after esophagoduodenostomy (end-to-end), but not in any of 35 cases after esophago-jejunostomy and Tomoda's method. End-to-side anastomosis was found better than end-to-end anastomosis in total gastrectomy, in that the former caused no stenosis at the site of anastomosis.
It is to be noted that the recent advances in surgical techniques and in the postoperative care have remarkably reduced the incidence of edema among total gastrectomized patients.
(author's abstract)
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