哑铃样金属支架置入后内镜下胆囊取石术的动物实验(含视频)

Animal experimental study of endoscopic cholecystolithotomy after lumen-apposing metal stent implantation(with video)

目的通过动物活体实验探索内镜超声引导下哑铃样金属支架(LAMS)置入后胆囊取石的安全性与可行性。方法选择体重30~35 kg小型猪6头,静脉麻醉下经腹部开放手术于胆囊内分别置入直径0.8~2.0 cm无菌人结石2~4枚,缝合胆囊及腹腔。造模成功后内镜超声引导下置入LAMS。超细内镜经胃越过支架进入胆囊后寻找结石并取出。经内镜乳头括约肌切开术(EST)及经内镜胆道内支架引流术(ERBD)预防胆漏。再以普通内镜拔出LAMS,金属夹封闭胃壁创面。观察技术成功率、操作时间及并发症发生情况。结果5头猪在内镜超声引导下成功置入LAMS,超细内镜顺利进入胆囊,取石网篮取出直径小于1 cm结石,大结石经激光碎石后完全取出。操作总时间为87~128 min。术后观察无出血、穿孔、感染、胆瘘等并发症发生。另1头猪置入LAMS失败,由于先行EST加ERBD,造成胆囊体积缩小并远离胃腔,穿刺困难。结论内镜超声引导下经胃-胆囊置入LAMS后超细内镜取出胆囊结石技术安全可行,可为行胆囊切除术困难者提供一种新的治疗途径。

Objective To investigate the safety and feasibility of endoscopic cholecystolithotomy after endoscopic ultrasonography(EUS)-guided lumen-apposing metal stent(LAMS)implantation in animals.Methods Six miniature pigs of 30-35 kg were selected to laparotomy under intravenous anesthesia.Two to four sterile human stones with diameter of 0.8-2.0 cm were implanted in their gallbladder.After successful modeling,LAMS was implanted between the stomach and gallbladder under the guidance of EUS.Ultrafine endoscope was used to search and remove stones after passing the gastric stent into the gallbladder.Endoscopic sphincterotomy(EST)and endoscopic retrograde biliary drainage(ERBD)was performed to prevent bile leakage.And then ordinary endoscope was used to remove LAMS and close the wound.The success rate,operation time,and incidence of complications were analyzed.Results Five pigs were successfully implanted with LAMS,and the ultrafine endoscope entered the gallbladder smoothly.Small stones were removed from the stone basket,and large stones were completely removed after laser lithotripsy.The total operation time was 87-128 min.No postoperative complications such as bleeding,perforation,infection,or biliary fistula were observed.Failure in 1 pig was due to the first EST plus ERBD,resulting in rapid reduction of gallbladder volume and away from the gastric cavity leading to puncture difficulties.Conclusion Endoscopic cholecystolithotomy after EUS-guided LAMS implantation is safe and feasible,and may provide animal experimental evidence for potential therapeutic approach for patients with difficulty in cholecystectomy.