| Project/Area Number |
63480296
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| Research Category |
Grant-in-Aid for General Scientific Research (B)
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| Allocation Type | Single-year Grants |
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| Research Field |
Digestive surgery
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| Research Institution | Hirosaki University |
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Principal Investigator |
SUGIYAMA Yuzuru Hirosaki University・Allied Medical Sciences Professor, 医療技術短期大学部, 教授 (40113807)
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| Co-Investigator(Kenkyū-buntansha) |
MORIYA Hirochi Hakodate Municipal Hospital・Division of General Surgery Head Surgeon, 外科, 医長
HADA Ryukichi Hirosaki University・School of Medicine Lecturer, 医学部附属病院, 講師 (50125457)
戸張 雅晴 青森市民病院, 医員
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| Project Period (FY) |
1988 – 1990
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| Project Status |
Completed (Fiscal Year 1990)
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| Budget Amount *help |
¥3,000,000 (Direct Cost: ¥3,000,000)
Fiscal Year 1990: ¥1,000,000 (Direct Cost: ¥1,000,000)
Fiscal Year 1989: ¥1,000,000 (Direct Cost: ¥1,000,000)
Fiscal Year 1988: ¥1,000,000 (Direct Cost: ¥1,000,000)
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| Keywords | Gallstone after (radical) gastrectomy (for cancer) / Gallbladder contractility / Bile composition / Bile acid / Infection of bile / Lithogenicity / 胃癌切除後胆石症 / 肝障害 / Lithogenicity / 胃切除後胆石症 / 胃切除後胆汁組成 / 胃切除後胆嚢運動 |
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| Research Abstract |
The incidence, incubation period and possible or related causes of gallstone (GS) formation after curative R_2 - gastrectomy for cancer were assessed in a group of 305 patients operated on between 1975 and 1986. The incidence of GS formation revealed by periodic ultrasonographic (US) examinations was 26.8% (81/305) for entire patients, 32.8% (38/116) for total gastrectomized and 22.8% (43/189) for subtotal gastrectomized patients. The patients with a duodenum-bypassing reconstruction incurred a significantly higher incidence (67/223, 30.3%) than those with a duodenm-passing procedure (14/82, 16.7%). The incubation period for GS formation was less than or equal to 6 years in most (70/86, 86.4%) of the patients complicated with this disease. Perioperative abnormal liver function tests were registered in 38/81 (46.9%) of the patients with GS, but only 20/224 (8.9%) of the GS free patients. The liver dysfunction might be important in the process of GS development. The gallbladder (GB) area
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measured by US increased after surgery and the GB contractility was impaired during the early postoperative days (1 month of surgery). These possibly caused bile stasis, one of the responsible factors for GS formation.
Alteration of the composition of gallbladder bile after gastrectomy was examined in chronically maintained dogs. Four mongrel dogs with simple external cholecystostomy were observed as controls. Seven dgos underwent external cholecystostomy and subtotal gastrectomy with wide resection of the omentums and truncal vagotomy, 3 of which were reconstructed by means of Billroth I (B-I) and remains 4 by Billroth II (B-II) procedure. Bile collection was repeated for as long as 12 months. Bile acids were quantified by gas chromatography. The collected bile was cultured for bacterial infection. TBA did not significantly differ among 3 groups of the dogs. An increase of DCA and decrease of CA was generally observed in both gastrectomized groups when compared with the comtrols. However, a reversal of these fractions, i. e., a decrease of DCA and increase of CA was also observed depending on the postoperative lapse. A remarkable increase of non-conjugated bile acids was recognized in both gastrectomized groups. Lithogenicity calculated was low for all of the three groups. In all but one control dog which died at 8 postoperative months, bile infection was noticed at 2 to 3 months of the surgery that lasted till they were sacrificed. Calcium bilirubinate stones developed in 1 of the 3 B- I gastrectomized and 2 of the 4 B-II gastrectomized dogs but none in the controls.
In conclusion, all of the above stated observations- increased secondary and non-conjugated bile acids, formation of calcium bilirubinate stones stones and persistent bile infection-lead to a speculation that bile infection plays an important role in the development of gallstone following a radical gastric resection for cancer. Less
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