41 Cases Review In Endoscopic Ultrasonography-guided Stomach/duodenum-gallbladder Anastomosis And Endoscopic Gallbladder-preserving Cholecystolithotomy For The Treatment Of Gallbladder Stones And Postoperative Follow-up

Objective:To evaluate the efficacy of endoscopic ultrasound-guided gastroduodenal cholecystostomy and endoscopic cholecystolithotomy for the treatment of gallbladder stones,and to analyze the safety and efficacy of the treatment by observing various clinical indicators,and to conduct postoperative follow-up for the patients treated with this treatment.Methods:Continuous patients undergoing EUS guided gastroduodenal cholecystectomy and endoscopic cholecystolithotomy in our hospital from December 2014 to November2018 were selected.Observation indexes:(1)procedure of anastomotic stent implantation:technical success rate,operation duration.(2)laboratory examination: white blood cell count(3)postoperative conditions: abdominal pain score,fever,and postoperative complications.(4)operation process of endoscopic cholecystolithotomy: stent retention time,technical success rate,postoperative complications.(5)postoperative follow-up:symptoms such as dyspepsia and upper abdominal discomfort,duration of postoperative ursodeoxycholic acid,recurrence of stones,duration of recurrence,and surgical treatment.Results:A total of 41 patients(14 males and 27 females)were enrolled in this study,with an average age of 47.23±19.52 years.The success rate of EUS guided gastroduodenal cholecystectomy is 100%,and the technical success rate is 90.24%(37/41).The mean operative time of anastomosis was 35.28±8.31 minutes,followed by transient fever in19 cases and transient leukocyte elevation in 26 cases,abdominal pain score was 1.90±2.52,mean postoperative antibiotic use time was 4.05 ± 1.85 days,and mean postoperative feeding time was 2.70 ± 1.34 days.Postoperative abdominal infection occurred in 5 cases,and the infection was controlled after antibiotic treatment,without bleeding,pneumoperitoneum,bile leakage and severe abdominal infection complications.The success rate of endoscopic cholecystolithotomy was 100%,and the average duration of stent placement was 12.75 ± 3.45 days.The fistula was completely closed in 33 patients,and the healing of the fistula was delayed in 4 patients.The delayed closure rate of the fistula was 12.12%(4/33).Postoperative follow-up was conducted for the remaining 40 patients who underwent surgery,among which 3 patients were lost to follow-up,and 7 patients did not conduct postoperative review as required,with a review rate of 81.08%(30/37).Postoperative clinical response rate reached 84.38%(27/32).Gallbladder function was normal in 30 patients who underwent regular gallbladder function reexamination.The shortest duration of oral administration of ursodeoxycholic acid drugs after surgery was 0.5 months and the longest was 24 months.The recurrence rate of 7 patients with postoperative cholecystolithiasis was(23.33%,7/30),the earliest recurrence time was 3 months,and the median recurrence time was 6 months.For gender,age,postoperative medication,consistent way,stent indwelling time,whether the gallbladder polyps,whether the combining common bile duct stones,whether postoperative abdominal infection,whether in intraoperative use of sealing device,respectively,Fisher’s exact probability method was used to statistical analysis,besides whether to merge the gallbladder polyps factors,all P > 0.05,cannot think of differentgender,different age groups,different postoperative medication,different ways of anastomosis,stent indwelling time,whether the merger bravery manager,whether postoperative abdominal cavity infection,and whether in intraoperative use of sealing device of gallbladder stone recurrence statistical differences,P=0.031(< 0.05)for the presence or absence of gallbladder polyp,it can be considered that there is a statistical difference between the presence or absence of gallbladder polyp and the recurrence of gallbladder stone.One patient finally received surgical treatment,and the remaining patients chose to continue to take medicine for follow-up due to no clinical symptoms or small stones.Conclusion:Endoscopic ultrasound-guided gastroduodenal cholecystostomy and endoscopic cholecystolithotomy is a safe and effective method for the treatment of cholecystolithiasis.It has low recurrence rate,high clinical remission rate,strong repeatability and operability,and is the minimally invasive treatment method for preserving gallbladder function.