In Vitro Study Of Balloon Dilatation Of Cystic Duct With Diameter Less Than 3.5mm

Objective:By using the expansion balloon to expand the cystic duct with an inner diameter of less than 3.5 mm,the expansion degree and influencing factors of the cystic duct were analyzed,which provided certain reference significance for transcystic duct approach.Methods:According to the inclusion criteria and exclusion criteria,the gallbladder specimens of laparoscopic cholecystectomy in our hospital from August 2022 to April 2023 were collected,and the clinical data of patients were collected: gender,age,body mass index,time of onset,previous cholecystitis attacks,etc.The cystic duct is found on an in vitro specimen and the inner diameter,outer diameter,and length of the cystic duct are measured.For the cystic duct with an inner diameter of less than 3.5mm,a small Olympus balloon with a maximum expansion diameter of6 mm and a length of 30 mm was used for 3 minutes to continuously dilate,and after the test,the cystic duct was separated from the gallbladder and immediately sent for pathological examination,and the pathological data of the postoperative gallbladder and the expanded cystic duct were collected.Results:The 38 patients included in the study were divided into successful expansion group and failed expansion group based on the visual and microscopic observation of the cystic duct after dilation.Successful expansion group: after the inner diameter of the cystic duct was expanded to 3.5mm,the wall of the cystic duct was not completely ruptured and the muscular layer and fibrous tissue layer of the cystic duct were observed under the microscope without fault tears;Dilation failure group: the inner diameter of the cystic duct cannot be expanded to 3.5 mm or expanded to 3.5mm,and the wall of the cystic duct is completely ruptured or at least one fault is torn on the muscular layer and fibrous tissue layer of the cystic duct under microscopic observation.Among them,31 cases were successful and 7 cases were unsuccessful.Statistical analysis of the relevant data of the two groups showed that the average inner diameter of the cystic duct before expansion(2.49±0.50)mm and the average thickness of the wall of the cystic duct(1.23±0.27)mm in the successful expansion group were significantly greater than the average inner diameter of the cystic duct before expansion(1.64±0.26)mm and the average thickness of the wall of the cystic duct(0.90±0.15)mm(P<0.05)in the successful expansion group and the expansion failure group.There was no significant difference between diabetes mellitus and previous episodes(P>0.05).When the inner diameter of the cystic duct is < 1.5mm,it is difficult for the cystic duct to expand to 3.5mm,which may not be suitable for surgery through the cystic duct approach;when the inner diameter of the cystic duct is 1.5mm≤ the inner diameter of the cystic duct is < 2.0mm,the success rate of expansion is 60%;when the inner <diameter of the cystic duct ≤ 2.5mm,the success rate of expansion is 91.7%;when the inner diameter of the cystic duct is ≥ 2.5mm,the success rate of expansion is 100%,which may be suitable for surgery through the cystic duct approach.Conclusions:1.For gallbladder ducts with an inner diameter of less than 3.5mm,the inner diameter of the cystic duct is an important factor affecting the success of its expansion.2.For gallbladder ducts with an inner diameter of less than 3.5mm,the thickness of the wall of the cystic duct is also a factor affecting the success of its expansion.