| Animal experiment of endoscopic ultrasound guided gastrointestinal tract and temporary stent anastomosis Objective: Endoscopic ultrasound-guided temporary gastrointestinal tract anastomosis with the gallbladder is a challenging technique for endoscopists and requires a high level of skill.A very important reason for the endoscopic ultrasound-guided anastomosis of the digestive tract and the temporary stent of the gallbladder is that the gallbladder is easily collapsed.In order to solve this problem,we developed a retrievable puncture anchor traction(RPAT)method for endoscopic ultrasound-guided temporary anatomy of the digestive tract and gallbladder.We used a pig model to evaluate and compare the success rate,safety,and outcome of the RPAT method of endoscopic ultrasound-guided temporary stent anastomosis between the digestive tract and the gallbladder and the existing endoscopic ultrasound-guided method of temporary stent anastomosis of the digestive tract and gallbladder.The formation of the digestive tract-capsule fistula is the key to endoscopic access to the gallbladder during EUS-guided gallstone removal.The closure of the digestive tract-the gallbladder fistula is the key to the end of the EUS-guided gallstone removal procedure.The long-term condition after the closure of the digestive tract-the gallbladder fistula is the focus of this procedure.If the postoperative gallbladder and the digestive tract are very heavy,and even persist in adhesion to the surrounding area,the significance and necessity of this procedure need to be reconsidered.Conversely,if the postoperative gallbladder adheres to the digestive tract and surrounding tissues very lightly or even without adhesion,even if small crystals or precipitates appear in the bile,due to the good contraction function of the gallbladder,these crystals or precipitates may be discharged to avoid the formation of stones;For patients with recurrence of stones,whether it is re-analysis of the digestive tract and gallbladder stent or surgical resection will not have a great impact,then this procedure will also have broad clinical application prospects.Therefore,we will conduct a preliminary study of the formation and closure of the gallbladder-digestive fistula after endoscopic ultrasound-guided anastomosis of the digestive tract and the gallbladder;cholecystitis and gallstones are one of the more common clinical diseases in China.The rate is increasing year by year,affecting people's health.The research team further studied and reported the surgical procedure of gallbladder drainage and stone removal guided by EUS,which showed the feasibility and safety of this technique.The EUS guides the gallbladder to the temporary stent of the digestive tract.During the process of establishing the passage between the gallbladder and the digestive tract,the gallbladder and the digestive tract form a pathway.The inside of the digestive tract is not a sterile loop mirror.The bacteria enter the gallbladder through the pathway,which may affect the bacterial micro-ecology in the gallbladder.These can cause or aggravate cholecystitis and gallstones.Therefore,it is necessary to evaluate the postoperative gallbladder flora.Cultivate for in-depth research.Methods: Sixteen Bama miniature pigs(15-20 kg)were randomly divided into an experimental group(n = 8)and a control group(n = 8).The retrievable puncture anchor traction method was performed in the experimental group,and endoscopic ultrasound guided endoscopic ultrasound guided anastomosis of the gallbladder without a retrievable puncture anchor in the control group.Comparison and analysis of operative adverse events,wound healing and endoscopic ultrasound-guided succession of temporary stent anastomosis between the experimental group and the control group;Recoverable puncture anchors were used for Bama miniature pigs(15-20 kg)The traction method was performed to make the digestive tract and the temporary stent of the gallbladder anastomosis,and the formation of the gallbladder fistula of the digestive tract was observed.After the stent was removed,the gallbladder was taken for stone removal,and the closure of the digestive tract side of the fistula was observed.The anatomical observation of the long-term closure of the fistula was performed.The gallbladder mucosa and bile directly dissected from the untreated Bama mini-pig were used as the control group.Bima and gallbladder mucosa specimens collected before surgery were taken as preoperative group,and bile and gallbladder mucosa specimens collected at different times after stent removal were used as postoperative group.The experimental animals with good gallbladder function were selected under the guidance of EUS and the gallbladder bile was taken out.The digestive tract was anastomosed with the gallbladder stent.After the operation,the gallbladder was used to simulate the gallbladder,the gallbladder was removed,and the contrast agent was used to see the cystic duct.The animals were dissected for bile.Group the collected specimens and perform the following experiment: 1.16SrDNA was extracted from the gallbladder mucosa for high-throughput sequencing,and the changes of each group were compared.2.16SrDNA was extracted from bile for high-throughput sequencing,and the changes of each group were compared.Results: All endoscopic ultrasound-guided anastomoses of the digestive tract and the gallbladder were successfully performed in 8 animals in the experimental group(8/8;100%).However,in the control group,endoscopic ultrasound-guided temporary gastrointestinal tract anastomosis with the gallbladder was successfully performed on only four pigs(4/8;50%);the remaining four pigs were unsuccessful in stent release due to gallbladder collapse.Furthermore,endoscopic ultrasound guided death of the digestive tract and the temporary stent of the gallbladder failed;in the formation of the fistula,the formation of the fistula was relatively solid for 2-4 weeks,and the junction of the gallbladder was initially explored as a relatively weak position.In terms of fistula closure,the team initially found that the fistula was closed 24 to 48 hours after the stent was removed by postoperative gastroscopy.Postoperative animal anatomy found that the anatomy of the experimental animal at 1 month after stent extraction revealed a flaky adhesion scar between the gallbladder and the digestive tract,but we found that the gallbladder-digestive tract was found 4 months after stent extraction.A very thin scar band,6 months after stent removal,the experimental animal anatomy chamber found that the gallbladder-digestive tract anastomosis was smooth and non-adhesive;the gallbladder mucosal flora was based on the IonS5 TM XL sequencing platform,using single-end sequencing(Single-End)The method of constructing a small fragment library for single-ended sequencing.By cutting and filtering the Reads,an average of 78,102 reads per sample was obtained,and 73,517 valid data were obtained by quality control,and the quality control efficiency was 94.24%.The sequences were clustered into OTUs(Operational Taxonomic Units)with 97% identity(Identity),and a total of 7,057 OTUs were obtained,and then the OTUs sequence and the Silva132 database were species annotated.In the annotated results,there are 2,578(36.53%)OTU annotations to the genus level.The bile flora was cut and filtered by Reads,and an average of 77,458 reads per sample was measured.After quality control,73,312 valid data were obtained,and the quality control efficiency was 94.66%.The sequences were clustered into OTUs(Operational Taxonomic Units)with 97% identity(Identity),a total of 5,542 OTUs were obtained,and the OTUs sequence was then annotated with the Silva132 database.In the annotated results,there are 2,415(43.58%)OTU annotations to the genus level.Preoperatively,the flora of the gallbladder mucosa at the door level,we found that the dominant ones include Proteobacteria,Tenericumes,and Firmicutes;?-deformation dominated at the level Gammaproteobacteria,Mollicutes,Clostridia;dominant species at the target level are Xanthomonadales,Mycoplasmatales,Clostridiales;at the level of the family The dominant species are Xanthomonadaceae,Mycoplasmataceae,Desulfovibrionaceae;the dominant species at the genus level are Stenotrophomonas,Mycoplasma,and biliary Bilophila;the dominant species are Haemophilus_parasuis and Moraxella catarrhalis.While the bile flora is at the level of the door,we found that the dominant ones include Proteobacteria,Bacteroidetes,and Firmicutes;the gamma-proteobacteria(Gammaproteobacteria)is dominant at the level.,Bacteroidia,Bacilli;the dominant species at the target level are Enterobacteriales,Chitinophagales,Lactobacillales;the dominant species at the family level is Enterobacteriaceae(Enterobacteriaceae),Chitinophagaceae,Desulfovibrionaceae;dominant species at the genus level are Enterobacteriaceae,Dinghuibacter,Bilophila;The dominant species are Escherichia_coli,Pediococcus_pentosaceus,Pseudomonas_hibiscicola.Conclusion: The retrievable puncture anchor traction method helps to improve the success rate of endoscopic ultrasound guided digestive tract and temporary cholecyst stent anastomosis,and can reduce gallbladder collapse.Therefore,we believe that this method can be applied to the endoscopic ultrasound-guided temporary stent anastomosis of the gallbladder in the near future.In addition,the retrievable puncture anchor traction method will improve the safety of endoscopic ultrasound guided digestive tract and temporary stent anastomosis;endoscopic ultrasound guided digestive tract and gallbladder temporary stent anastomosis and closure of the anastomosis,digestive tract-The gallbladder fistula is firmly formed for 2-4 weeks,the closure time is 24-48 hours,and the long-term variable or even disappears after the fistula is closed.The endoscopic ultrasound guided digestive tract and gallbladder stent anastomosis and removal of the stent,before and after surgery The composition of the gallbladder mucosa and bile flora changed,and the flora in the gallbladder also changed continuously with time.However,the preoperative postoperative flora-related causes no increase in the activity of the stone,so the operation on the gallstone The effects of recurrence may be small.Clinical study of retractable puncture anchor traction method for endoscopic ultrasound guided gastrointestinal tract and temporary stent anastomosis Objective: To evaluate the therapeutic effect of retrievable puncture anchor traction method on endoscopic ultrasound-guided gastrointestinal tract and temporary stent anastomosis for gallbladder polyps,stones and other gallbladder diseases,and evaluate the safety and efficacy of the method.The safety and effectiveness of the method were analyzed by observing the clinical parameters of different methods of endoscopic ultrasound guided digestive tract and gallbladder anastomosis.Methods: Patients who underwent endoscopic ultrasonography guided laparoscopic and gallbladder temporary stent anastomosis from June 2014 to January 2019 were included in the study.The observation indicators were: length of anastomosis operation time,anastomotic position,anastomosis success rate,postoperative abdominal pain score(using visual analogue scale,VAS),and whether there was fever after surgery,postoperative complications.Statistical analysis was performed using SPSS Statistics 23.0(SPSS,Inc,Chicago,Ill,USA).Results: A total of 45 patients with gallbladder disease,such as gallbladder stones and gallbladder polyps,underwent endoscopic laparoscopic and cystic stent anastomosis in our hospital from June 2014 to January 2019.There were 16 males and 29 females.Among them,14 patients underwent retractable puncture anchor traction(RPAT)surgery as the experimental group,including 4 males and 10 females,and 31 patients who did not use the retractable puncture anchor(RPAT)operation as a control group.There are 12 males and 19 females.The technical success rate of the experimental group was 100%(14/14),and the clinical success rate was 100%(14/).14),while in the control group,the technical success rate was 87.1%(27/31),and the clinical success rate was 83.9%(26/31).In the experimental group,there were 7 cases of postoperative fever,9 cases of transient leukopenia,13 cases of postoperative fever and 18 cases of transient leukocytes in the control group.There were 7 cases of complications in the control group,including 1 case of abdominal infection and 2 cases of pneumoperitoneum,but none of them in the experimental group.The days of antibiotic use and postoperative fasting time in the experimental group were shorter than those in the control group(3.14 d vs 4.43 d,2.36 d vs 2.93d).Conclusion: In summary,the retrievable puncture anchor traction method EUS guided gastrointestinal and gallbladder anastomosis is a safe and effective,quick and easy operation,high success rate and low incidence of adverse events.This method can be applied to clinical endoscopic ultrasound-guided drainage of the gallbladder. |
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