術式別にみた胃切除術後骨代謝障害に関する研究

Abstract

To study the effect of surgical procedures on metabolic bone disease (MBD) after gastrectomy, the incidence of MBD was examined with Microdensitometry in 210 gastrectomized patients. In 97 (46.2%) of 210 patients MBD was found. The incidence in female patients was significantly higher than in males (p<0.01). The incidence did not correlate with the length of time after gastrectomy, age group or primary diseases. In relation to extent of gastrectomy, MBD in patients with total gastrectomy was significantly higher than in those with distal gastrectomy (p<0.05). In relation to reconstructive procedures, MBD in patients with pylorus preserving gastrectomy (PPG) was significantly lower than in those with Birrloth-Ⅰ (B-Ⅰ) or Birrloth-Ⅱ (B-Ⅱ) (p<0.05) ; MBD in patients with pylorus preserving nearly total gastrectomy (PPNTG) was significantly lower than in those with Roux-en-Y (R-Y) or interposition (I.P) (p<0.05). The level of serum alkalinephosphatase in patients with PPG was significantly lower than the level in those with B-Ⅰ or B-Ⅱ (p<0.01). The level of serum calcium in patients with PPNTG was significantly higher than level in those with R-Y or I. P (p<0.05). The calcitonin level in patients with total gastrectomy was significantly higher than the level in patients with distal gastrectomy or subtotal gastrectomy (p<0.05). This study reveals that the incidence was low in the procedure involving a small extent of gastric resection and in reconstructive procedures with pyloric preservation, such as pylorus preserving gastrectomy or pylorus preserving nearly total gastrectomy. It is concluded that metabolic bone disease after gastrectomy is attributable to physical and chemical decrease in digestive and absorptional function influenced by gastrectomy.