T管造影-彭泽.ppt

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1、T-tubecholangiography(PostoperativeT-tubecholangiography)2011-12-1pengzeWhat&When&Why?AT-tubecholangiogramisatypeofbiliarytractradiographicexaminationinwhichawater-solubleiodinatedcontrastmediumisinjectedintothebileductthroughanindwelling,T-shapedrubbertube.Thetubeisinsertedinthecommonbileducta

2、saroutinepostoperativeproceduretoprovidedrainage.What&When&Why?TheoccasionothaveaT-tubecholangiogramis2weeksafteroperation,atthemeantimethesymptomisrelieved.Thepurposeistomakesurewhetherthereisareresidualgallstoneswithinthebiliarytree.3-5days6weeksAnnouncements——Adversereactions↓1.Allergyicrea

3、ction——contrastoriodine2.InflammatoryreactionTheintervalbetweenoperationandcholangiographyintraductalpressures,cholangiovenousrefluxhighviscosityofcontrastSpasmofOddis’sphincterAnnouncements——Thedetectionrate↑1.theviscosityofcontrast2.thedifferentiationofbubble3.therangeofdevelopedbiletractPrep

4、arationandProcedureconsentform——contrastoriodineallergy↓1）MeglumineAdipiodoneInjection2）CompoundMeglumineDiatrizoateInjection3）IohexolInjection★对策：1）询问既往2）碘过敏试验3）之前注射皮质醇/抗组胺药★造影剂选择：1）非离子型（低渗）2）浓度15%-20%（泛影葡胺）3）可混入抗生素（甲硝唑）？4）温度★禁忌：碘过敏、孕妇、甲状腺疾病等PreparationandProcedure2.nodietrestrictions(Nothingt

5、oeatordrinkfor4hourspriortothetest.)3.ThepatientispositionedsupineontheX-raytable.AslightlyRPOpositioncanhelptoensuretheCBDisnotsuperimposedoverthepatient'sspine.Apreliminary/scoutimageoftheRUQshouldbeacquired.↑PreparationandProcedure4.ThetipoftheT-tubeiscleanedwithantiseptic.↓5.TheT-tubeshould

6、beraisedandtappedtoensuretherearenoairbubbleslurkinginthetube.↑6.AbutterflyneedleshouldbeinsertedintotheT-tube.Thesyringeplungeriswithdrawntoremovebilefromwithintheduct.(optional)↓PreparationandProcedure7.Injectthecontrastmediumandobtaintheimageoftheentirebiliary.↑8.Iftheintrahepaticductsdonotf

7、ill,thepatientcanbetiltedtrendelenburgandfurthercontrastinjectedintotheT-tube.↑9.Atleast2viewsoftheentirebiliarytreeshouldberecordedbyspotfilm(DSI)Obliqueviewsareoftentaken.PostProcedureCarePatientcaneatanddrinknormally.Warnpatien