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KMID : 0371319770190120009
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Journal of the Korean Surgical Society
1977 Volume.19 No. 12 p.9 ~ p.15
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The Insulin Test after Vagotomy
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吳龍柱/Oh, Y.J.
李善亮/白鳳壽/李?濟/李燦泳/Lee, S.R./Baik, B.S./Lee, B.J./Lee, C.Y.
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Abstract
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Since Hollander in 1946 described stimulation of gastric acid secretion by insulin hypoglycemia for intact vagal fibers to the stomach after vagotomy, the insulin test remains the most useful method to confirm the. incomplete vagotomies even though its interpretation for positive or negative response is very complex.
Therefore, the insulin test was performed in total 51 cases who underwent vagotomy with pyloroplasty for duodenal ulcer between 1973 and 1977 at National Medical. Center in Korea.
1) After the intravenous injection of regular insulin, 0.2 unit- per kg. B.W., an adequate level of hypoglycemia (blood sugar less than 50 mg%) was achieved in 87.9% (7/58). One case of shock due to insulin reaction was encountered and recovered after injection of hypertonic glucose solution.
2) The lowest blood sugar level, occurred at 30 min. after insulin injection in 72.5%, while
the PAO was delayed with 29.3% at 60 min, 29.3% at 90 min and 25.5% even at 120min.
3) Average reduction rate in B.A.O. after 3 types of vagotomy was 78% in highly selective
vagotomy; 58% in selective V. and 45% in truncal.V.
4) The late (above postop 3-months) insulin test presented more P.A.O. values, than thee earlier: (postop 2 wks.) test as the late test was more valuable to estimate the clinical status:
5) Applying Hollander criteria to the results, the positive response suggesting incomplete V. was 52.6% (20/38) in T. V., 37.5%(3/8) in sel V and 20%(1/5) in-H.S.V.
6) When the positive response by Hollander criteria was divided into early & late positive, according to Ross Kay, the early (+)cases was 28.8%(11/38) in T.V.,12.5(1/8) in sel. V and 20% (1/5) in H.S.V.,
7) In average B. W. (kg), age, lowest blood sugar level (mg%) or reduction rate(%) in blood sugar after insulin, there was no difference among the 3 response groups such as negative, late positive and early positive.
8) Average hourly volume (ml) of gastric secretion and HCL output (meq.)after insulin were increased in order of `early C+), late (+) and negative groups.
9)In follow-up study from 3 months to 2 years after insulin test, the ulcer-like clinical symptoms recurred in 46% of early (+) cases, 27% of late (+) cases and 3.7% of negative cases while the ulcer confirmed by, X-ray and gastrofiberscopy was only 2, cases among the all 51 cases. These 2 cases were all in the early positive group.
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