Animal Experimental Study On Treatment Of Gallbladder Diseases By Embryonic Natural Orifice Transluminal Endoscopic Surgery

Objective:To explore the feasibility,safety and effectiveness of making animal models of gallbladder stones,cholecystectomy and gallbladder-preserving lithotomy.Part One Method: There were ten beagles of 13.72±0.96 kg.A 10 mm incision was made at the lower edge of the navel.The target organ was found under the guidance of the trocar and gallbladder surface mark on the abdominal wall.After proved to be gallbladder,it was suspended on the abdominal wall with two titanium clips and a rubber band to expose its free surface.A stone basket filled with two human gallbladder stones whose size were 6-10 mm,was inserted into the gallbladder following the lead of the gastroscope.The operation time was recorded.Before the operation and on the 1th,3rd,7th and 30 th days after the operation,blood was drawn for blood routine,C-reactive protein and liver function.Animals were executed to observe abdominal cavity and gallbladder.The gallbladder was sent for histopathological examination.Results: The median of operation times was 33.5min(25min-42min).There were no intraoperative compliments.The weight of animal was13.71±0.97 kg on the 30 th day after the operation,which was similar to that before the operation(P>0.05).The number of leukocytes and C-reactive protein on the 1th to 3rd day after the operation were much higher(P<0.05)while on 7th and 30 th day had no significant difference(P>0.05).Liver function of all animals were not affected by the operation.Anatomy showed that titanium clips were wrapped by the greater omentum and the incision on gallbladder healed well.There were no adhesions in the rest of the abdominal cavity.The gallbladder mucosa had edema and its wall was slightly thickened.There were two stones in the gallbladder and the average size was similar to that before the operation(P>0.05).Histological slices showed chronic cholecystitis.Conclusion:Using E-NOTES to establish animal models of gallbladder stones is simple and reliable,causing a little trauma to animals.Part Two Method:There were three beagles with gallbladder stones which were caused by high cholesterol diet.The results of lipoid-food test indicated that their gallbladders contracted well(contraction rate >30%).Gallbladder was found(by the method described in part one).An incision was made at the gallbladder wall and stones were removed with a stone basket.Detection was made for many times to make sure that all stones were removed.Intraoperative events and operation time were recorded.Properties of gallstones were observed.Before the operation and on the 1st,3rd and 7th day after the operation,blood was drawn for blood routine,C-reactive protein and liver function.The recurrence of stones and the function of the gallbladder was detected and tested by ultrasonography at three months and six months after operation.Results: Operation times were 78 min,82min and 67min(75.2±7.3min),respectively.The gallstones were brown lumps with hard texture.The number of stones were consistent with those before the operation and the size were similar.There were no complications during and after the operation.Umbilical incisions healed well and scars were small.The number of leukocytes increased on the 1st and 3rd day after the operation while on 7th day after the operation was similar to those before the operation.C-reactive protein and liver function were not affected by the operation.Ultrasonography showed there was no sign of stones and gallbladder function was good at three months and six months after the surgery.Conclusion:Gallbladder-preserving lithotomy by E-NOTES is feasible and safe and There is no recurrence of gallstones in a short period of time after the operation.Part Three Method: There were three beagles.Gallbladder was found(by the method described in part one).The gallbladder was separated by method of endoscopic submucosal dissection(ESD).After gallbladder bed was successfully peeled off,two titanium clips and a rubber band were utilized to suspend the gallbladder on the abdominal wall to fully expose the cystic duct and gallbladder blood vessels.They were clamped by titanium clips then cut off by the HOOK knife.Excised gallbladder and traction device were extracted with a snare.The time of separating the gallbladder bed,dissecting the gallbladder were recorded.Before the operation and on the 1th,3rd,and 7th days after the operation,blood was drawn for blood routine,C-reactive protein and liver function.Results: The time of separating the gallbladder bed were 75 min,80min and 68min(74.3±4.9min)and the time of dissecting the gallbladder were 110 min,116min and 105min(110.3±4.5min),respectively.Intraoperative hemorrhage was about 20-25 ml.There were no complications during and after the operation.Umbilical incision healed well and scar was small.Inflammation indicators increased on the 1th and 3rd day after the surgery while those were normal on the 7th.Liver function were not affected by the surgery.Conclusion: E-NOTES is feasible and safe to dissect the gallbladder and the scar is small.It is a better optional operation to choose.