T管膽道造影術(shù)

T-tubecholangiography

(PostoperativeT-tubecholangiography)2023-12-1pengzeWhat&When&Why?AT-tubecholangiogramisatypeofbiliarytractradiographicexaminationinwhichawater-solubleiodinatedcontrastmediumisinjectedintothebileductthroughanindwelling,T-shapedrubbertube.Thetubeisinsertedinthecommonbileductasaroutinepostoperativeproceduretoprovidedrainage.What&When&Why?TheoccasionothaveaT-tubecholangiogramis2weeksafteroperation,atthemeantimethesymptomisrelieved.Thepurposeistomakesurewhetherthereisareresidualgallstoneswithinthebiliarytree.3-5days6weeksAnnouncements

——Adversereactions↓

1.Allergyicreaction——contrastoriodine2.InflammatoryreactionTheintervalbetweenoperationandcholangiographyintraductalpressures,cholangiovenousrefluxhighviscosityofcontrastSpasmofOddis’sphincter

Announcements

——Thedetectionrate↑

1.theviscosityofcontrast2.thedifferentiationofbubble3.therangeofdevelopedbiletractPreparationandProcedureconsentform——contrastoriodineallergy↓1）MeglumineAdipiodoneInjection2）CompoundMeglumineDiatrizoateInjection3）IohexolInjection★對策：1）問詢既往2）碘過敏試驗3）之前注射皮質(zhì)醇/抗組胺藥★造影劑選擇：1）非離子型（低滲）2）濃度15%-20%（泛影葡胺）3）可混入抗生素（甲硝唑）？4）溫度★禁忌：碘過敏、孕婦、甲狀腺疾病等PreparationandProcedure2.nodietrestrictions(Nothingtoeatordrinkfor4hourspriortothetest.)3.ThepatientispositionedsupineontheX-raytable.AslightlyRPOpositioncanhelptoensuretheCBDisnotsuperimposedoverthepatient'sspine.Apreliminary/scoutimageoftheRUQshouldbeacquired.↑

PreparationandProcedure4.ThetipoftheT-tubeiscleanedwithantiseptic.↓5.TheT-tubeshouldberaisedandtappedtoensuretherearenoairbubbleslurkinginthetube.↑6.AbutterflyneedleshouldbeinsertedintotheT-tube.Thesyringeplungeriswithdrawntoremovebilefromwithintheduct.(optional)↓PreparationandProcedure7.Injectthecontrastmediumandobtaintheimageoftheentirebiliary.↑8.Iftheintrahepaticductsdonotfill,thepatientcanbetiltedtrendelenburgandfurthercontrastinjectedintotheT-tube.↑9.Atleast2viewsoftheentirebiliarytreeshouldberecordedbyspotfilm(DSI)Obliqueviewsareoftentaken.PostProcedureCarePatientcaneatanddrinknormally.Warnpatienttoadviseofanyitchingorrashpostprocedure.Patientshouldremaininhospitalforobservationforatleast24hourspostprocedure.IftheT-tubeisremovedattheendoftheprocedure,thewoundshouldbecheckedforbileleakagefor24hours.Complicationspersistentbiliaryfistula(rare)biliaryperitonitischolangitis可改善空間1