Tam P K, Chan F L, Saing H
J Pediatr Surg. 1987 May;22(5):397-400. doi: 10.1016/s0022-3468(87)80256-7.
Because of their small body size, neonates can be placed in the plane of the CT scanner gantry (aperture diameter 70 cm) instead of across it. This direct sagittal scanning technique allows accurate delineation of surgical lesions, particularly midline ones, unobtainable with conventional axial imaging. In addition, the sagittal image provides a perspective of anatomic arrangement more familiar to the surgeon than that provided by axial sections and therefore allows for easier interpretation. In imperforate anus, sagittal CT identifies the blind rectal end by the meconium tissue interphase and therefore avoids the pitfalls of invertogram, which depends on the bowel gas pattern for interpretation. With this new approach, we correctly classified six cases of imperforate anus into high types (3) and low types (3), visualized the associated fistula and had knowledge of the exact distance of the blind rectal end from the skin level preoperatively. In tracheoesophageal fistula (2), sagittal CT demonstrated the air-filled blind pouch and fistula to allow preoperative classification and assessment of the gap distance. In sacrococcygeal teratoma (3) and laryngeal cyst (1), its use allowed an accurate assessment of possible extension of the lesion into neighboring structures. Our experience with direct sagittal CT scan therefore suggests that this new and noninvasive technique is a useful adjunct in the management of a variety of common neonatal surgical problems.
由于新生儿体型较小，可将其放置在CT扫描仪机架平面内（孔径直径70厘米），而不是横跨机架。这种直接矢状面扫描技术能够准确描绘手术病变，尤其是中线病变，这是传统轴向成像无法做到的。此外，矢状面图像提供的解剖结构视角比轴向切面更让外科医生熟悉，因此更易于解读。在肛门闭锁病例中，矢状面CT通过胎粪组织界面识别直肠盲端，从而避免了倒位造影的缺陷，倒位造影依赖肠内气体模式进行解读。采用这种新方法，我们正确地将6例肛门闭锁病例分为高位型（3例）和低位型（3例），可视化了相关瘘管，并在术前了解了直肠盲端距皮肤表面的确切距离。在食管气管瘘（2例）中，矢状面CT显示了充气的盲袋和瘘管，以便进行术前分类和评估间隙距离。在骶尾部畸胎瘤（3例）和喉囊肿（1例）中，使用该技术能够准确评估病变向邻近结构的可能扩展情况。因此，我们使用直接矢状面CT扫描的经验表明，这种新的无创技术在处理各种常见新生儿外科问题时是一种有用的辅助手段。
