263例儿童介入手术的辐射剂量研究

Research on radiation dose in 263 children’s interventional surgery

目的评估现阶段不同疾病类型的儿童介入手术患儿的受照剂量,并对临床中与辐射剂量相关的因素进行分析,以降低患儿的辐射剂量。方法回顾性的收集2019年7—9月济南某儿科三甲医院导管室手术间所进行的所有介入手术病例,记录患儿的个人情况及辐射剂量报告。结果纳入263例患儿中,血管瘤所占比例为27%、脉管畸形49%、母细胞瘤14%、先天性心脏病8%、其他疾病2%,剂量面积乘积(DAP)的中位数最大的为毛细血管畸形66.0 mGy·m^2、最小的为视网膜母细胞瘤0.6 mGy·m^2和淋巴管畸形0.02 mGy·m^2。累积剂量中位数最大的为毛细血管畸形4132.0 mGy、最小的为淋巴管畸形1.2 mGy。对具有分析意义的血管瘤、视网膜母细胞瘤和静脉畸形组进行组间比较,结果静脉畸形组和血管瘤组的DAP值表现均显著高于视网膜母细胞瘤组(P<0.05),静脉畸形组和血管瘤组间无显著差异性(P>0.05);血管瘤组的CD值表现均显著高于视网膜母细胞瘤组和静脉畸形组(P<0.05),视网膜母细胞瘤组和静脉畸形组间无显著差异性(P>0.05)。多因素回归分析手术中年龄(β=0.188,P<0.05)、体重(β=-0.185,P<0.05)、球管电压(β=0.565,P<0.05)、球管电流(β=-0.061,P<0.05)和光野大小(β=0.335,P<0.05)因素均会对患儿的受照剂量产生影响,脉冲时间和铜过滤与患儿受照剂量之间无统计学意义(P>0.05)。结论本研究总结了儿童介入手术的类型和比例,评估了每种介入手术的患儿受照剂量水平,患儿本体特性、设备的曝光参数与患儿辐射剂量相关,可用于儿童介入手术辐射剂量与防护的初步评估。

Objective To evaluate the radiation dose of interventional surgery for children with different disease types at present,and analyze the clinical factors related to radiation dose,so as to reduce the radiation dose of children.Methods From July to September 2019,all the cases of interventional surgery in the operating room of the catheter room of a third class hospital of a pediatrics hospital in Jinan were retrospectively collected,and their personal conditions and radiation dose reports were recorded.Results Among 263 children,hemangioma accounted for 27%,vascular malformation49%,blastoma 14%,congenital heart disease 8%,and other diseases 2%.The median of dose-area product(DAP)in different interventional surgery are as follows:the highest record was capillary malformation 66.0 mGy·m^2,the smallest was retinoblastoma(RB)0.6 mGy·m^2 and lymphatic malformation 0.02 mGy·m^2.The median of cumulative dose(CD)in different interventional surgery are as follows:the highest record was capillary malformation 4132.0 mGy,the smallest was lymphatic malformation 1.2 mGy.The significant IH,Rb and VM groups were compared.the results showed that the DAP values of VM group and IH group were significantly higher than RB group(P<0.05).and there was no significant difference between VM group and IH group(P>0.05).The CD value of IH group was significantly higher than that of RB group and VM group(P<0.05).There was no significant difference between Rb group and VM group(P>0.05).Multivariate regression analysis in the operation showed that age(β=0.188,P<0.05),weight(β=-0.185,P<0.05),tube voltage(β=0.565,P<0.05),tube current(β=-0.061,P<0.05)and field size(B=0.335,P<0.05)had effect on children’s irradiated dose.There was no significant difference between pulse time and copper filtration and children’s irradiated dose(P>0.05).Conclusion This study summarized the types and proportion of children’s interventional surgery,evaluated the radiation dose level of each kind of interventional surgery.The characteristics of children’s body and exposure parameters of equipment are related to the radiation dose of children,which could be used for the preliminary evaluation of radiation dose and protection of children’s interventional surgery.