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

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

Abstract

Abstract:

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

Dianbao Yuan, Minghui Zhai, Na Wu, Huibin Gao. Endoscopic ultrasonography-guided gallbladder drainage in the treatment of low malignant obstructive jaundice: An animal experimental study[J]. Chinese Archives of General Surgery(Electronic Edition), 2022, 16(06): 412-416.

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References 18

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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

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

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

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

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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