消化管手術後吸収不良症候群における脂質代謝に関する研究

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  • Metabolism of Fat in Postoperative Malabsorption

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Studies on 131I-triolein absorption in patients with various diseases revealed that malabsorption occured in many patients after gastrointestinal surgery. In patients with intestinal resection or anastomosis, gastrojejunostomy by Billroth II after gastrectomy resulted in more marked malabsorption than by Billroth I, and a severe one after total gastrectomy.<br>In patients with postoperative diarrhea, or malabsorption syndrome, chiefly of fat, total fatty acids and phospholipids in serum were measured; resection of stomach and small intestine brought about lowering of total fatty acids down to nearly 150mg/dl, whereas phospholipids were low in cases with Billorth II gastrectomy or cases with resection of the small intestine 3 years or more previously and high in cases with hemicolectomy. Studies of changes in each fatty acid showed only the same difference except in case of gastroilesotomy. Decrease of unsaturated fatty acids, particularly of linoleic acid, was seen, thereby ensuing a marked lowering of L/O ratio.<br>Total fatty acids in the liver and mucosa of terminal ileum of the dogs undergone various operations were measured. A prominent lowering of fatty acids was seen in the liver after resection of lower jejunum and upper ileum, and after resection of lower jejunum and total ileum. Fatty acids in the mucosa of terminal ileum were lowered in all cases not related to types of operation. In the liver stearic acid was high whereas oleic acid and palmitoleic acid were low. Stearic acid was high in the mucosa of terminal ileum. Oleic acid was not affected, but linoleic acid was raised, though to a minor extent, while palmitoleic acid was lowered. Further postoperative studies with dogs revealed that in the liver the amount of phospholipids was lowered to various extent in all cases not related to the types of resection. However, the amount was raised in the mucosa of terminal ileum, on the contrary, particularly in the two groups where total fatty acids were low. Cholesterol was definitely high in the liver, especially of the cases with upper gastrointestinal operation. A similar result was obtained in the mucosa of terminal ileum though changes were less marked than in the liver.<br>Changes in the amount of fatty acids, phospholipids and cholesterol in serum and in the liver and the mucosa of terminal ileum indicate that a significant change in the metabolism of fat is taking place in cases of postoperative malabsorption.<br>It is interesting that changes of serum fatty acids in postoperative malabsorption have similarity to that seen in the development of arteriosclerosis.

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