摘要
目的探讨反射式程序化T管造影在胆道术后T管拔管中的安全性及临床价值。方法回顾性分析南京中医药大学常州附属医院中西医结合消化病诊疗中心2021年1月至2023年12月收治的118例接受腹腔镜下胆总管切开取石术+T管引流术病人的临床资料。根据术后造影方法的不同将病人分为2组,其中采用反射式程序化T管造影共54例为病人自控组,推注式T管造影共64例为医生推注组。对比2组病人的造影用时、造影中及造影后不良反应发生率、谷丙转氨酶以及住院时间。结果病人自控组的造影中不良反应发生率显著低于医生推注组(14.3%比32.8%,P=0.024);病人自控组的造影后不良反应发生率显著低于医生推注组(9.3%比25.0%,P=0.026);老年病人(≥60岁)中,病人自控组的造影中及造影后不良反应发生率均显著低于医生推注组(P值分别为0.029、0.045)。病人自控组的平均住院时间少于医生推注组[(5.44±1.160)d比(6.44±2.152)d,P=0.002]。病人自控组的谷丙转氨酶异常率低于医生推注组(3.7%比15.6%,P=0.035)。结论反射式T管造影法将造影过程标准化,并使病人能够通过自身对疼痛的神经反馈控制造影装置开关,减少因传统推注法推注压力过大导致不良反应的发生,使得T管造影检查过程可控,且更为安全可靠,并从一定程度上减轻病人经济负担。
Objective To investigate the safety and clinical value of reflex programmed T-tube angiography in T-tube extraction after choledocholithotomy.Methods Clinical data of patients treated with choledocholithotomy in the Integrated Chinese and Western Medicine Gastroenterology Center from January 2021 to December 2023 were retrospectively analyzed.According to the different methods of contrast,118 patients treated with choledocholithotomy plus T-tube angiography were randomly divided into two groups.Among them,a total of 54 patients treated with reflex programmed T-tube angiography were included in the observation group(patient-controlled group),and 64 patients treated with push-type T-tube angiography were enrolled in the control group(physician-injected group).T Imaging time,incidence of adverse events during and after imaging,alanine aminotransferase(ALT),and length of stay were compared.Results The incidence of adverse events during imaging was significantly lower in the patient-controlled group than the physician-injected group(14.3%vs.32.8%,P=0.024).The incidence of adverse events after imaging was significantly lower in the patientcontrolled group than the physician-injected group(9.3%vs.25%,P=0.026).In elderly patients(≥60 years),the incidence of intra-and post-imaging adverse events was significantly lower in the patient-controlled group than the physician-injected group(P=0.029 and P=0.045,respectively).The mean length of stay in the patient-controlled group was significantly shorter than the physician-injected group(5.44±1.160 d vs.6.44±2.152 d,P=0.002).The rate of ALT abnormality was significantly lower in the patient-controlled group than the physician-injected group(3.7%vs.15.6%,P=0.035).Conclusion Reflex T-tube angiography standardizes the angiography process and enables patients to control the switch of the angiography device through their own neurofeedback of pain.It reduces the occurrence of adverse events caused by excessive injection pressure of the traditional push method,making the T-tube angiography process controllable,safe and reliable,and reducing the patients'economic burden to a certain extent.
作者
谭云艳
茅雯君
左飞
陈凯瑞
闫家盼
罗天平
Tan Yunyan;Mao Wenjun;Zuo Fei;Chen Kairui;Yan Jiapan;Luo Tianping(Integrated Chinese and Western Medicine Gastroenterology Center,Changzhou Affiliated Hospital of Nanjing University of Chinese Medicine,Jiangsu Changzhou 213000,China)
出处
《腹部外科》
2025年第4期293-297,共5页
Journal of Abdominal Surgery
关键词
T管造影
T管引流术
T管拔管
胆总管结石
T-tube angiography
T-tube drainage
T-tube extraction
Common bile duct stones
