t管胆道造影术.pptx

t t管胆道造影术管胆道造影术t管胆道造影术第1页What&When&Why?lA T-tube cholangiogram is a type of biliary tract radiographic examination in which a water-soluble iodinated contrast medium is injected into the bile duct through an indwelling,T-shaped rubber tube.lThe tube is inserted in the common bile duct as a routine postoperative procedure to provide drainage.t管胆道造影术第2页What&When&Why?lThe occasion ot have a T-tube cholangiogram is 2 weeks after operation,at the mean time the symptom is relieved.l The purpose is to make sure whether there is are residual gall stones within the biliary tree.l3-5 daysl6 weekst管胆道造影术第3页t管胆道造影术第4页t管胆道造影术第5页Announcements Adverse reactions 1.Allergyic reaction contrast or iodine 2.Inflammatory reactionThe interval between operation and cholangiography intraductal pressures,cholangiovenous refluxhigh viscosity of contrastSpasm of Oddis sphinctert管胆道造影术第6页Announcements The detection rate 1.the viscosity of contrast 2.the differentiation of bubble 3.the range of developed bile tractt管胆道造影术第7页Preparation and Procedure1.consent form contrast or iodine allergy 1）Meglumine Adipiodone Injection2）Compound Meglumine Diatrizoate Injection3）Iohexol Injectiont管胆道造影术第8页对策：对策：1）问询既往2）碘过敏试验3）之前注射皮质醇/抗组胺药造影剂选择：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：禁忌：碘过敏、孕妇、甲状腺疾病等t管胆道造影术第9页Preparation and Procedure2.no diet restrictions(Nothing to eat or drink for 4 hours prior to the test.)3.The patient is positioned supine on the X-ray table.A slightly RPO position can help to ensure the CBD is not superimposed over the patients spine.A preliminary/scout image of the RUQ should be acquired.t管胆道造影术第10页Preparation and Procedure4.The tip of the T-tube is cleaned with antiseptic.5.The T-tube should be raised and tapped to ensure there are no air bubbles lurking in the tube.6.A butterfly needle should be inserted into the T-tube.The syringe plunger is withdrawn to remove bile from within the duct.(optional)t管胆道造影术第11页Preparation and Procedure7.Inject the contrast medium and obtain the image of the entire biliary.8.If the intrahepatic ducts do not fill,the patient can be tilted trendelenburg and further contrast injected into the T-tube.9.At least 2 views of the entire biliary tree should be recorded by spot film(DSI)Oblique views are often taken.t管胆道造影术第12页Post Procedure CarePatient can eat and drink normally.Warn patient to advise of any itching or rash post procedure.Patient should remain in hospital for observation for at least 24 hours post procedure.If the T-tube is removed at the end of the procedure,the wound should be checked for bile leakage for 24 hours.t管胆道造影术第13页Complicationspersistent biliary fistula(rare)biliary peritonitis cholangitist管胆道造影术第14页