1994 Fiscal Year Final Research Report Summary
Influence of gastrectomy on the composition of bile and formation of gallstone
| Project/Area Number |
04454324
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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, School of Allied Medical Sciences, 医療技術短期大学部, 教授 (40113807)
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| Co-Investigator(Kenkyū-buntansha) |
MORIYA Hiroshi Hakodate Municipal Hospital, Division of General Surgery, Head Surgeon, 外科, 医長
HADA Ryukichi Hirosaki University, University Hospital, Lecturer, 医学部・附属病院, 講師 (50125457)
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| Project Period (FY) |
1992 – 1994
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| Keywords | Postgastrectomy gallstone disease / Gastrectomy methods / Bile composition / Reconstruction methods after gastrectomy / Bile acids / Biliary infection / External cholecystostomy / Prophylactic cholecystectomy |
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| Research Abstract |
For the higher incidence of gallstone (GS) following gastrectomy for cancer, we had performed, in selected cases, prophylactic cholecystectomy since the end of 1986. We had also employed pylorus-preserving gastrectomy (PPG) for the prophylaxis. No postgastrectomy GS (PGGS) was found among the PPG patients. To elucidate any possible mechanism for PGGS,we collected GB biles from PGGS patients during cholecystectomy and compared with GB biles obtained from patients at primary gastric cancer surgery (controls). The PGGs removed were classified as calcium bilirubinate variety. Bile infection was seen in most of the PGGS patients but in none of the controls. Chenodeoxycholate levels for the PGGS patients were significantly lower than those for the controls. Total bile acids, cholesterol, phospholipid, bilirubin and total calcium were also lower for the PGGS patients. Free bile acids (FBAs) were detected exclusively in the PGGS patients. These results suggested that bile infection may be involved in the lithogenesis.
We consecutively examined GB bile collected through external cholecystostomy of Billroth-I or -II gastrectomized dogs with truncal vagotomy. The analysis suggested that alterations in GB bile composition and formation of GS may be related to bile infection. To exclude the possibility of bile infection through the external cholecystostomy, GB biles were collected from 5PPG,6 Billroth-II and 6 control (sham operation) dogs by sterile GB punctire. Three of the 6 Billroth-II dogs incurred GS and 3/6 bile infection. FBAs were found in 6/6 Billroth-II dogs. The PPG and control dogs incurred neither bile infection nor GS.GBAs were detected only in 2/5 PPG dogs and in none of the controls. Alterations in other chemical constituents were more marked in the Billroth-II dogs.
Billroth-II gastrectomy may be more liable to bile infection and derangement of bile composition with a resultant higher incidence of PGGS.
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