Roberts Kiera, Karpelowsky Jonathan, Fitzgerald Dominic A, Soundappan Soundappan S V
Department of Surgery, Children's Hospital at Westmead, Locked Bag 4001 Westmead, Sydney, NSW, 2145, Australia.
Sydney Medical School, University of Sydney, Sydney, NSW, Australia.
Pediatr Surg Int. 2019 Apr;35(4):509-515. doi: 10.1007/s00383-019-04450-z. Epub 2019 Feb 1.
Oesophageal atresia and tracheo-oesophageal atresia require surgical repair in early infancy. These children have significant disease-related morbidity requiring frequent radiological examinations resulting in an increased malignancy risk.
A single-centre, retrospective review was performed of radiation exposure in children with OA/TOF born 2011-2015. Medical records were reviewed to determine the number and type of imaging studies involving ionising radiation exposure enabling the calculation of the estimated effective dose per child over the first year of life.
Forty-nine children were included. Each child underwent a median of 19 (IQR 11.5-35) imaging studies, which were primarily plain radiography (median = 14, IQR 7-26.5). The overall median estimated effective dose per patient was 4.7 (IQR 3.0-9.4) mSv, with the majority of radiation exposure resulting from fluoroscopic imaging (median 3.3 mSv, IQR 2.2-6.0). 'Routine' postoperative oesophagrams showed no leak in 35/36 (97%) with the remaining study showing an insignificant leak that did not alter management.
Careful consideration should be given to the use of imaging in OA/TOF to minimise morbidity in these vulnerable infants. Oesophagrams in children without the symptoms of anastomotic leak or stricture should be discontinued. Standardisation of monitoring protocols with regard to radiation exposure should be considered.
食管闭锁和气管食管闭锁需要在婴儿早期进行手术修复。这些患儿有与疾病相关的严重发病率，需要频繁进行放射学检查，这导致恶性肿瘤风险增加。
对2011年至2015年出生的食管闭锁/气管食管瘘（OA/TOF）患儿的辐射暴露情况进行了单中心回顾性研究。查阅病历以确定涉及电离辐射暴露的影像学检查的数量和类型，从而计算出每个患儿在生命第一年的估计有效剂量。
纳入49名患儿。每个患儿接受的影像学检查中位数为19次（四分位间距11.5 - 35），主要是普通X线摄影（中位数 = 14，四分位间距7 - 26.5）。每位患者的总体估计有效剂量中位数为4.7（四分位间距3.0 - 9.4）mSv，大部分辐射暴露来自荧光透视成像（中位数3.3 mSv，四分位间距2.2 - 6.0）。36例“常规”术后食管造影中，35例（97%）未显示渗漏，其余检查显示渗漏不明显，未改变治疗方案。
对于OA/TOF患儿的影像学检查应谨慎考虑，以尽量减少这些脆弱婴儿的发病率。对于没有吻合口漏或狭窄症状的患儿，应停止进行食管造影。应考虑对辐射暴露监测方案进行标准化。
