J.Jpn. Surg. Soc.. 59(6): 990-1023, 1958
宿題報告
OPERATION ON THE ALIMENTARY TRACT AND THE POSTOPERATIVE DIGESTION AND ABSORPTION, WITH PARTICULAR REFERENCE TO THE PROBLEMS OF METABOLISM IN TOTAL GASTRECTOMIZED PATIENTS
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Professor of the 2nd Department of Surgery, Kyushu University Medical School Masanobu TOMODA |
It is a matter for congratulation that, thanks to the efforts of a large number of ourpredecessors and present members of this Association, total gastrectomy has come to be performed in an increasing number of cases, but the postoperative metabolism in such cases remains unclarified in many respects despite the efforts of numerous investigators.
The abnormal environment after the war when the food situation was at its worst afforded us with an ample opportunity of carrying out a systematic study of the facial edema and other symptoms of the agastric syndrome in many agastric patients. We were enabled as a result to see the hitherto unexplored reality of the syndrome. Our study of the pathologic physiology of agastric patients, based on the information thus gained and continued for the last 16 years, has led us to the following conclusions.
The metabolism is maintained nearly at its lowest physiological level and is not invariably abnormal in agastric patients living in a normal enviroment, but such patients are not sufficiently capable of adapting themselves to an abnormal environment and consequently suffer from metabolic disturbances and its sequela-a series of disorders which we were the first to point out under the name of agastric syndrome and which we have found it possible to prevent and cure after years of arduous work. Metabolic disturbance is induced in total -gastrectomized patients mainly because the food intake is reduced when the stomach as food reservoir is lost, and this reduction in the food intake and the postoperative decline in the absorption rate of food combined bring down the nutritional state of the patients. Therefore, it seems most important that agastric patients should be given at frequent intervals such a sort of food as is highly nutritious in a small volume. If kept out of an adverse environment and managed properly postoperatively, agastric patients survive for years, doing their daily work. Furthermore, it has been confirmed by our recent investigations that the metabolism is unexpectedly satisfactory in those who have survived total gastrecto my for years.
Formation of a substitute stomach, by which postoperative metabolism can be improved and a technical device, by which any possible in sufficiency of the esophagoenteroanastomosis and any possible postoperative stenosis can be prevented-these two surgical measures of our contrivance combined have bettered the immediate and late results of total gastrectomy. Now that no reliable early diagnosis of stomach cancer is possible, it is to be desired that total gastrecto my should be performed in full in the indications I have refered to above, namely for a stomach cancer in its more or less advanced stage, in order to improve the late results of an operation for gastric cancer.
(author's abstract)
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