J.Jpn. Surg. Soc.. 82(6): 575-586, 1981

---

Original article

INFLUENCES OF SURGICAL INTERVENTION ON INSULIN SECRETION IN PATIENTS WITH HEPATIC CIRRHOSIS. COMPARISON BETWEEN TRANSTHORACIC AND TRANSABDOMINAL SURGERY

To discriminate between the transthoracic and transabdominal approach for the direct surgical procedure of esophageal varices, the degree of glucose tolerance and insulin secretion were studied in four clinical groups before, during and after surgery (Group I : 7 non-cirrhotic patients with pulmonary lobectomy, Group II : 7 non-cirrhotics with gastrectomy, Group III : 6 cirrhotics with transthoracic cardiectomy, Group IV : 7 cirrhotics with left gastric caval shunt ; LGCS). Concerning hepatic circulation, effective hepatic blood flow (EHBF) and ICG-disappearance rate (K-ICG) were also studied simultaneously in 17 cirrhotic patients (8 with transthoracic cardiectomy, 9 with LGCS) by the hepatic vein catheter technique. From the aspects of glucose utilization, the glucose disappearance rate (K-Glucose), the maximum value of immunoreactive insulin (IRI max) and insulinogenic indices (⊿IRI/⊿BS) after intravenous glucose load were observed. The ratio of K-Glucose to each IRI max as the index of the degree of surgical diabetes was calculated in each groups ((%)K/IRI max, each preoperative value was expressed as 100).
The values of K-Glucose were similarly reduced after surgery in all groups. The insulin secretions (⊿IRI/⊿BS, IRI max) were increased in all groups after surgery, especially in transabdominal groups. The values of (%) K/IRI max decreased significantly (p＜0.05) after surgery in transabdominal groups (Group II : 58.2% of preoperative value at first postoperative day. Group IV : 46.1% , 61.2% at first and third postoperative day, respectively). The values of K-Glucose were all similarly reduced after surgery, therefore, the decrease of (%)K/IRI max in transabdominal groups indicates the substantial increase of insulin secretion in groups II and IV. The EHBF decreased significantly during surgery in patients with LGCS, the values of K-ICG of the patients with LGCS were also significantly decreased during, third and seventh postoperative days.
These data suggest that postoperative hyperinsulinemia together with diminished hepatic blood flow, that means surgical diabetic state,is found to be marked in the transabdominal groups. Thet ransthoracic approach is concluded to be a more beneficial route with low operative risk for the surgery of esophageal varices than the transabdominal one.

---

---

To read the PDF file you will need Adobe Reader installed on your computer.