内镜逆行胰胆管造影术(ERCP)中患者面积剂量乘积调查与分析

The Study of Radiation Exposure to Patients During ERCP

目的通过现场调查ERCP手术的相关参数,模拟ERCP手术的全过程,借助水模体,测量面积剂量乘积(Dose Area Product,DAP),为估算患者受照剂量提供基础数据。方法现场调查记录ERCP过程中设备的相关参数(主要是透视时间及摄片帧数),并以记录的设备相关参数为投照条件,用水模替代人体,测量DAP。结果共调查56例ERCP手术,其中胆总管结石取石49例(87.5%)、支架置入7例(12.5%)。透视时间为1.3~27.3min,平均为(6.9±6.0)min;摄片帧数为0~14帧,平均为(4±3)帧;DAP为3.2~58.5 Gy·cm^2,平均为(15.0±12.9)Gy·cm^2。结论透视时间与DAP有较好的相关性,r=0.999,P<0.01;透视导致的DAP在ERCP中占96%;胆管支架置入术的透视时间比胆总管取石术略长,相应地,胆管支架置入术的DAP略高于胆总管结石取石术。由于手术操作的复杂性和操作者的熟练程度的不同,导致患者的DAP差别较大。

Objective To provide basic data for estimating patient dose,dose area product was measured by simulating ERCP operation using the related parameters of field investigation and water phantom.Methods Measure the dose area product date by using the related parameters （mainly fluoroscopy time and photo frames） of field investigation and replacing human body with water model.Results A total of 56 cases of ERCP operation were investigated,including common bile duct stone extraction in 49 cases （87.5%） and stent placement in 7 cases （12.5%）.The range of fluoroscopy time was 1.3 ～ 27.3 min,the average was 6.9 ± 6.0 min;The range of photo flames was 0 ～ 14,the average frame was 4 ± 3;The range of DAP date was3.2 ～ 58.5 Gy · cm2,the average was 15.0± 12.9Gy · cm2.Conclusion There was a good correlation between fluoroscopy time and DAP,r =0.999,P 〈0.01;The proportion of fluoroscopy time was 96% in ERCP.The fluoroscopy time of biliary stent implantation was longer than that of lithotomy of common bile duct.Accordingly,the DAP of biliary stent placement was slightly higher than that of common bile duct stone extraction.The difference of the complexity of the operation and the proficiency of operator lead to the significant difference of DAP.