胆道梗阻经皮肝穿刺胆道引流术患者辐射剂量的分析

Analysis of radiation dose in patients with malignant obstructive jaundice undergoing percutaneous transhepatic biliary drainage

目的探讨恶性梗阻性黄疸患者接受经皮肝穿刺胆道引流术(percutaneous transhepatic biliary drainage,PTBD)治疗的辐射剂量。方法选取2019年8月至2020年1月首都医科大学附属北京佑安医院接受PTBD治疗的恶性梗阻性黄疸患者67例,按照穿刺点不同,分为左侧引流组和右侧引流组;按照引流位置不同,分为外引流组和内引流组。分析比较患者接受治疗的辐射剂量。结果67例患者共进行67次PTBD治疗,左侧引流14例(20.9%),右侧引流53例(79.1%);外引流52例(77.6%),内引流15例(22.4%)。所有患者接受的辐射参数分别为透视时间6.7(0.5,34.5)min、剂量面积乘积(dose area product,DAP)4.6(0.4,111.2)mGy×m^(2)、有效剂量(effective dose,ED)0.70(0.06,16.70)mSv、累积剂量(cumulative dose,CD)240.1(75.1,1304.0)mGy和峰值皮肤剂量(peak skin dose,PSD)201.7(63.1,1095.4)m Gy。左侧引流组和右侧引流组的透视时间、DAP、ED、CD和PSD比较,差异均无统计学意义(P>0.05)。内引流组的透视时间明显长于外引流组[7.2(4.5,11.4)min比5.5(3.5,8.2)min],差异有统计学意义(Z=-2.608,P=0.020)。外引流组和内引流组的DAP、ED、CD和PSD比较,差异均无统计学意义(P>0.05)。结论恶性梗阻性黄疸患者在PTBD治疗中接受了较高的辐射剂量,应引起关注。术者应优化数字减影血管造影参数,以降低辐射剂量。

Objective To explore the radiation dose of patients with malignant obstructive jaundice treated by percutaneous transhepatic biliary drainage(PTBD).Methods A total of 67 patients with malignant obstructive jaundice who received PTBD in Beijing Youan Hospital,Capital Medical University from August 2019 to January 2020 were selected.The patients were divided into left side drainage group and right side drainage group according to different puncture points.According to the different drainage locations,the patients were divided into external drainage group and internal drainage group.The radiation dose parameters of the different groups were analyzed and compared.Results A total of 67 PTBD patients were treated 67 times,of which 14 cases(20.9%)had left drainage and 53 cases(79.1%)had right drainage,and 52 cases(77.6%)had external drainage and 15 cases(22.4%)had internal drainage.As for the radiation parameters received by all patients,the median fluoroscopy time was 6.7(0.5,34.5)min,the median dose area product(DAP)was 4.6(0.4,111.2)mGy×m^(2),the median effective dose(ED)was 0.70(0.06,16.70)mSv,the median cumulative dose(CD)was 240.1(75.1,1304.0)mGy and the median peak skin dose(PSD)was 201.7(63.1,1095.4)mGy,respectively.There were no significant differences in fluoroscopy time,DAP,ED,CD and PSD between the left drainage group and the right drainage groups(P>0.05).The median fluoroscopy time of the internal group was significantly longer than that of the external drainage group[7.2(4.5,11.4)min vs.5.5(3.5,8.2)min],and the difference was statistically significant(Z=-2.608,P=0.020).There were no significant differences in DAP,ED,CD and PSD between external drainage group and internal drainage group(P>0.05).Conclusions Patients with malignant obstructive jaundice treated with PTBD receive a higher dose of radiation.Operators should optimize the parameters of digital subtraction angiography to reduce the radiation dose.