Clinical Effect And Application Of Natural Orifice Transluminal Soft Endoscopic Gallbladder-preserving Surgery

Part ? Comparative study of natural orifice transluminal soft endoscopic gallbladder-preserving surgery for preservation of gallbladder and laparoscopic cholecystectomy in the treatment of cholecystolithiasisObjective:Comparing the curative effect difference of transrectal or transgastric natural orifice transluminal soft endoscopic gallbladder-preserving surgery with traditional laparoscopic cholecystectomy(LC)in the treatment of cholecystolithiasis.Exploring the application prospects of transrectal or transgastric natural orifice transluminal endoscopic gallbladder-preserving surgery(NOTES)in order to provide a reference for choosing natural orifice transluminal endoscopic surgery(NOTES)and laparoscopic cholecystectomy(LC)in the treatment of cholecystolithiasis.Methods:Thirty patients who underwent transrectal or transgastric natural orifice transluminal soft endoscopic gallbladder-preserving surgery and thirty patients who underwent laparoscopic cholecystectomy(LC)in the Dongnan Affiliated Hospital of Xiamen University(the 909th Hospital of P.L.A)from December 2017 to December 2018 were analyzed retrospectively.According to the different operation method,divided the patients into the NOTES group and LC group.Through the comparative analysis of two groups of patients with operation time,blood loss,postoperative exhaust time,postoperative antibiotic use time,postoperative stay,hospitalization expense,use of postoperative analgesics,postoperative complications and mortality.Results:The blood loss in NOTES group was less than that in LC group,there was statistical difference between two groups(P<0.05).The postoperative exhaust time in NOTES group was longer than that in LC group,there was statistical difference between two groups(P<0.05).The use of postoperative analgesics and postoperative complications of these two groups had no statistical difference(P>0.05).The operation time in NOTES group was longer than that in LC group,there was statistical difference between two groups(P<0.05).The postoperative antibiotic use time and the postoperative stay in NOTES group was significantly longer than that in LC group,there was statistical difference between two groups(P<0.05).The postoperative complications between two groups had no statistical difference(P>0.05).There were no deaths in both groups.Conclusion:Transrectal or transgastric natural orifice transluminal soft endoscopic gallbladder-preserving surgery preserved the anatomical structure and physiological function of gallbladder.The surgery possesses the advantages of no need to place drainage,less bleeding,lower rate of incision,and no scar on the surface,which is more in line with the concept of minimally invasive surgery and worthy of further promotion in clinical practice.Part ? Experimental study of effecacy of gallbladder incision closure between medical adhesive and traditional metal titanic clipObjective:Through investigation the feasibility of closing gallbladder incision with medical adhesive,to improve the closure of gallbladder incision in transrectal or transgastric natural orifice transluminal soft endoscopic gallbladder-preserving surgery.Methods:Twenty fresh pig gallbladders were randomly divided into two groups,the experimental group and the control group.Both group were made a full-thickness incision at the junction of gallbladder base,surgical diameter 10-15mm.The experimental group close incision with medical adhesive,while the control group close incision with traditional metal titanic clip.The operation time of each group was recorded separately.After the operation,bile was injected to detect the leakage of fluid.In addition,pressurized leak tests were performed by a pressure detection device,and the gas leakage site was observed during the pressure measurement.The operation time,liquid leakage and bursting pressure of the two groups were compared and analyzed.Results:The mean gallbladder volume for medical adhesive group were 68.80±3.592 ml,mean incision length were 13.70±0.473 mm.while the mean gallbladder volume for metal titanic clip group were 66.00±4.432 ml.mean incision length were 14.50±0.619 mm,there was no significant difference in gallbladder volume and incision length between the two groups(P>0.05).The operation time of medical adhesive group was significantly shorter compared with metal titanic clip group(P<0.05).We achieved successful closure in all gallbladder defects,there was a trend toward higher burst pressure in the metal titanic clip group,but there was no significant difference in gallbladder volume and incision length between the two groups(P>0.05).Three out of twenty gallbladder tissue ruptured at the junction of gallbladder neck and gallbladder body,there were 2 in medical adhesive group and 1 in metal titanic clip group.Conclusion:1.After smearing with medical adhesive,the full-thickness gallbladder defects can be quickly closed with a certain burst pressure,which can provide the tension needed to heal the gallbladder incision.2.Medical adhesive close gallbladder incision is convenient and fast,which will not cause abdominal foreign body retention,and it is expected to become a closed gallbladder incision of new method.