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Clinical significance of postoperative changes in ghrelin and body composition after gastrectomy

胃切除术后胃饥饿素及身体成分变化的临床意义

基本信息

批准号：
16591361
负责人：
KIYAMA Teruo
金额：
$ 2.24万
依托单位：
Nippon Medical School
依托单位国家：
日本
项目类别：
Grant-in-Aid for Scientific Research (C)
财政年份：
2004
资助国家：
日本
起止时间：
2004 至 2005
项目状态：
已结题

来源：
https://kaken.nii.ac.jp/en/grant/KAKENHI-PROJECT-16591361/
关键词：
gastrectomy body composition ghrelin appetite decrease of body fat

项目摘要

Ghrelin, which is mainly produced in gastric fundic gland, is one of the gastrointestinal hormones and stimulates appetite. Gastric fundic gland is located in the upper third of the stomach. So, proximal gastrectomy should be limited less than half of stomach due to reservation of stomach function. The aim of this study was to compare changes in serum ghrelin level and the body composition of patients undergoing proximal gastrectomy (PG), distal gastrectomy (DG), or total gastrectomy (TG).Patients and Methods : Gastric surgery was performed in the Nippon Medical School Hospital between 2003 and 2004 in 135 patients who had undergone PG (12), DG (70), and TG (53). Laparoscopy assisted proximal gastrectomy was reconstructed by esophago-residual stomach anastomosis (10) and double tract method (2). Changes in serum levels of ghrelin and the body composition were evaluated preoperatively, on postoperative day 14, and 1 year after surgery.Results : Operation time was 306 min in PG and 270 min in DG. Blood loss was 164g in PG and 124g in DG. Postoperative hospital stay was 10.4 days in PG and 10.1 days in DG. There was no difference between the two groups. Serum ghrelin level 6 months after surgery was 42±18fmol/ml in PG less than 67+37fmol/ml in DG (p<0.05). Body weight loss was 6.5±2.5kg in PG higher than 3.0±2.0 in DG (p<0.05). The fat composition (4.8±3.0kg) was decreased mainly in PG.Conclusion : Laparoscopy assisted gastrectomy caused early recover from surgical insults and the indication of LAG was expanded. Serum ghrelin was decreased after PG but higher than TG. Body weight loss after PG was higher than DG but less than TG. These results suggest that PG remains more than half volume of stomach which should maintain endocrine function and body weight. Further study should be necessary that preservation of the celiac branches of the vagus nerve might maintain gastric function, such as appetite, after gastrectomy.

生长素释放肽（Ghrelin）主要由胃底腺产生，是胃肠激素之一，具有刺激食欲的作用。胃底腺位于胃的上三分之一处。因此，为了保留胃功能，近端胃切除术应限制在胃的一半以下。本研究的目的是比较接受近端胃切除术 (PG)、远端胃切除术 (DG) 或全胃切除术 (TG) 的患者血清生长素释放肽水平和身体成分的变化。患者和方法：2003 年至 2004 年间，在日本医科大学医院对 135 名接受过 PG (12)、DG (70) 和 TG 的患者进行了胃手术 (53)。腹腔镜辅助近端胃切除术采用食管残胃吻合术（10）和双道法（2）重建。术前、术后第14天和术后1年评估血清生长素释放肽水平和身体成分的变化。结果：PG手术时间为306分钟，DG手术时间为270分钟。 PG 失血量为 164 克，DG 失血量为 124 克。 PG 术后住院时间为 10.4 天，DG 住院时间为 10.1 天。两组之间没有差异。术后 6 个月，PG 中的血清生长素释放肽水平为 42±18fmol/ml，低于 DG 中的 67+37fmol/ml（p<0.05）。 PG 中的体重减轻为 6.5±2.5kg，高于 DG 中的 3.0±2.0（p<0.05）。脂肪成分(4.8±3.0kg)减少主要是PG。结论：腹腔镜辅助胃切除术使手术损伤早日恢复，扩大了LAG的适应证。 PG后血清ghrelin降低，但高于TG。 PG后体重下降高于DG但低于TG。这些结果表明，PG 保留在胃体积的一半以上，这应该维持内分泌功能和体重。需要进一步研究，保留迷走神经的腹腔分支可能会在胃切除术后维持胃功能，例如食欲。