超声内镜引导下胆囊穿刺引流治疗低位恶性梗阻性黄疸的动物实验研究

doi:10.3877/cma.j.issn.1674-0793.2022.06.006

目的

基于动物实验模型，探讨超声内镜引导下胆囊穿刺引流术（EUS-GBD）在低位恶性梗阻性黄疸（MOJ）姑息治疗中的应用效果。

方法

纳入SPF级小型实验猪24只，均于腹腔镜下建立低位MOJ模型。按照随机数字表法将模型猪分为实验组和对照组，每组12只，实验组给予EUS-GBD治疗方案，对照组给予经皮经肝胆囊穿刺置管引流术（PTGBD）治疗方案。观察两组手术操作成功率、治疗效果、肝功能指标（总胆红素、直接胆红素、天冬氨酸转氨酶和丙氨酸转氨酶）水平变化及术后并发症发生情况。

结果

24只实验猪均成功建立低位MOJ模型。两组首次操作成功率和治疗总有效率差异均无统计学意义。术后7 d，两组肝功能指标水平均较同组术前明显降低（均P<0.05），但组间差异无统计学意义。实验组术后并发症发生率为25.0%（3/12），低于对照组的41.7%（5/12），但组间差异无统计学意义（P=0.667）；两组均无出血、穿孔及导管脱落发生。

结论

EUS-GBD治疗低位MOJ操作成功率高，能有效缓解MOJ的梗阻症状，改善肝功能，整体效果不亚于PTGBD。

关键词: 超声内镜, 胆囊穿刺引流, 恶性梗阻性黄疸, 操作成功率, 肝功能, 并发症

Objective

To investigate the effect of endoscopic ultrasonography-guided gallbladder drainage (EUS-GBD) in palliative treatment of low malignant obstructive jaundice (MOJ) based on animal experimental model.

Methods

A total of 24 SPF miniature experimental pigs were included, and the low MOJ model was established under laparoscopy. The model pigs were divided into experimental group and control group according to random number table method, with 12 pigs in each group. The experimental group was given EUS-GBD treatment, and the control group was given percutaneous transhepatic gallbladder drainage (PTGBD) treatment. The success rate of operation, therapeutic effect, changes of liver function indexes such as total bilirubin, direct bilirubin, aspartate aminotransferase, alanine aminotransferase, and postoperative morbidity were compared.

Results

The MOJ model was successfully established in 24 experimental pigs. There were no significant differences in the success rate of the first operation and the total effective rate between the two groups. On the 7th day after operation, the levels of liver function indexes in the two groups were significantly lower than those before operation in the same group (both P<0.05), but there was no significant difference between the two groups. The incidence of postoperative complications in the experimental group was 25.0% (3/12), lower than 41.7% (5/12) in the control group, with no significant difference between the two groups (P=0.667). No bleeding, perforation or catheter shedding were observed in both groups.

Conclusion

EUS-GBD has a high success rate in the treatment of low MOJ, which can effectively alleviate the obstructive symptoms of MOJ and improve liver function of patients, and the overall effect is superior to PTGBD.

Key words: Endoscopic ultrasonography, Gallbladder drainage, Malignant obstructive jaundice, Operation success rate, Liver function, Complications

表1 建模前后各时间点实验猪肝功能指标水平变化(n=24,±s)

项目	建模前	建模后第1周	建模后第2周	建模后第3周	建模后第4周
总胆红素(μmol/L)	19.6±3.1	48.3±12.3^a	99.5±24.8^ab	195.2±32.4^abc	312.8±40.5^abd
直接胆红素(μmol/L)	7.6±2.8	29.7±8.4^a	67.5±19.5^ab	98.4±27.2^abc	188.9±36.3^abd
天冬氨酸转氨酶(U/L)	36.4±5.2	64.5±9.6^a	103.2±18.4^ab	142.6±26.8^abc	220.5±33.7^abd
丙氨酸转氨酶(U/L)	38.9±6.2	51.6±11.3^a	69.2±16.7^ab	97.5±24.8^abc	141.3±31.4^abd

表1 建模前后各时间点实验猪肝功能指标水平变化(n=24,±s)

项目	建模前	建模后第1周	建模后第2周	建模后第3周	建模后第4周
总胆红素(μmol/L)	19.6±3.1	48.3±12.3^a	99.5±24.8^ab	195.2±32.4^abc	312.8±40.5^abd
直接胆红素(μmol/L)	7.6±2.8	29.7±8.4^a	67.5±19.5^ab	98.4±27.2^abc	188.9±36.3^abd
天冬氨酸转氨酶(U/L)	36.4±5.2	64.5±9.6^a	103.2±18.4^ab	142.6±26.8^abc	220.5±33.7^abd
丙氨酸转氨酶(U/L)	38.9±6.2	51.6±11.3^a	69.2±16.7^ab	97.5±24.8^abc	141.3±31.4^abd

表2 两组实验猪治疗效果比较[n(%)]

组别	n	显效	有效	无效	总有效
实验组	12	7(58.4)	4(33.3)	1(8.3)	11(91.7)
对照组	12	6(50.0)	4(33.7)	2(16.7)	10(83.3)
统计值			Z=-0.515		-
P值			0.671^a		1.000^b

表2 两组实验猪治疗效果比较[n(%)]

组别	n	显效	有效	无效	总有效
实验组	12	7(58.4)	4(33.3)	1(8.3)	11(91.7)
对照组	12	6(50.0)	4(33.7)	2(16.7)	10(83.3)
统计值			Z=-0.515		-
P值			0.671^a		1.000^b

表3 两组实验猪手术前后肝功能指标水平比较(±s)

组别	n	时间	TBIL(μmol/L)	DBIL(μmol/L)	AST(U/L)	ALT(U/L)
实验组	12	术前	313.4±41.2	189.6±35.4	221.3±31.5	142.5±32.3
实验组	12	术后7 d	165.5±28.8^a	86.8±24.9^a	103.6±22.7^a	69.2±19.8^a
		t₁值	10.123	8.228	10.501	6.432
		P₁值	<0.001	<0.001	<0.001	<0.001
对照组	12	术前	314.3±40.3	188.2±37.6	219.7±33.3	140.9±35.7
对照组	12	术后7 d	171.7±25.6^a	89.6±27.7^a	107.5±23.6^a	74.5±20.5^a
		t₁值	10.274	7.314	9.523	5.587
		P₁值	<0.001	<0.001	<0.001	<0.001
t₂值			0.557	0.260	0.413	0.644
P₂值			0.583	0.797	0.684	0.526

表3 两组实验猪手术前后肝功能指标水平比较(±s)

组别	n	时间	TBIL(μmol/L)	DBIL(μmol/L)	AST(U/L)	ALT(U/L)
实验组	12	术前	313.4±41.2	189.6±35.4	221.3±31.5	142.5±32.3
实验组	12	术后7 d	165.5±28.8^a	86.8±24.9^a	103.6±22.7^a	69.2±19.8^a
		t₁值	10.123	8.228	10.501	6.432
		P₁值	<0.001	<0.001	<0.001	<0.001
对照组	12	术前	314.3±40.3	188.2±37.6	219.7±33.3	140.9±35.7
对照组	12	术后7 d	171.7±25.6^a	89.6±27.7^a	107.5±23.6^a	74.5±20.5^a
		t₁值	10.274	7.314	9.523	5.587
		P₁值	<0.001	<0.001	<0.001	<0.001
t₂值			0.557	0.260	0.413	0.644
P₂值			0.583	0.797	0.684	0.526

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Endoscopic ultrasonography-guided gallbladder drainage in the treatment of low malignant obstructive jaundice: An animal experimental study

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Endoscopic ultrasonography-guided gallbladder drainage in the treatment of low malignant obstructive jaundice: An animal experimental study