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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 investigate the whole process of ERCP by investigating the related parameters of ERCP in the field, and to provide the basic data for estimating the dose of patients by means of water phantom and measuring Dose Area Product (DAP). Methods Field survey recorded the relevant parameters of ERCP process equipment (mainly fluoroscopy time and the number of radiographs), and recorded equipment parameters as a projection condition, the water mode to replace the human body, measuring DAP. Results A total of 56 cases of ERCP were investigated. Among them, 49 cases (87.5%) had choledocholithiasis and 7 cases (12.5%) received stent implantation. The average fluoroscopic time ranged from 1.3 to 27.3 min with an average of (6.9 ± 6.0) min; the number of frames was from 0 to 14 frames with an average of (4 ± 3) frames; DAP ranged from 3.2 to 58.5 Gy · cm 2 with an average of 15.0 ± 12.9) Gy · cm ~ 2. Conclusion The time of fluoroscopy has a good correlation with DAP, r = 0.999, P <0.01; DAP caused by fluoroscopy is 96% in ERCP; fluoroscopy of biliary stents is slightly longer than that of common bile duct stones. Correspondingly, Biliary catheter placement DAP slightly higher than the common bile duct lithotomy. Due to the complexity of the operation and the operator’s proficiency, the patient’s DAP varies greatly.