Liu Siyuan,Gui Zihao,Fan Xiangming,et al.Research progress on diagnosis and surgical treatment of long-term pulmonary valve regurgitation after tetralogy of fallot repair[J].Journal of Clinical Pediatric Surgery,2024,(08):789-795.[doi:10.3760/cma.j.cn101785-202312051-018]
法洛四联症术后远期肺动脉瓣反流的诊断与手术治疗研究进展
- Title:
- Research progress on diagnosis and surgical treatment of long-term pulmonary valve regurgitation after tetralogy of fallot repair
- Keywords:
- Tetralogy of Fallot; Postoperative Complications; Pulmonary Valve Regurgitation; Diagnosis; Surgical Management
- 摘要:
- 法洛四联症是小儿常见的紫绀型先天性心脏病,常导致患儿发绀与缺氧发作,出现蹲踞、心脏杂音、婴幼儿喂养困难、杵状指等表现,婴幼儿期进行外科根治手术可以解除法洛四联症的解剖畸形,然而术后远期可能出现肺动脉瓣反流、三尖瓣反流、残余右室流出道梗阻、主动脉根部扩张、心律失常和右心衰竭等并发症。由于法洛四联症的病理特点(肺动脉瓣发育不良/狭窄、术中跨瓣环补片的应用),患儿术后常合并肺动脉瓣反流且可长期无症状存活。本综述主要总结了目前法洛四联症根治术后出现肺动脉瓣反流的病理机制及诊疗进展,探讨肺动脉反流严重程度分级的临床检查手段、手术适应证及手术时机,分析外科肺动脉瓣置换术与经皮肺动脉瓣介入治疗之间的利弊,归纳总结更佳的临床诊疗策略,以期更好地改善患者的生命质量。
- Abstract:
- Tetralogy of Fallot is a common cyanotic congenital heart disease in children,often leading to symptoms such as cyanosis and hypoxic spell,squatting,heart murmurs,feeding difficulties in infants,and clubbing.Corrective surgery in infancy can alleviate the anatomical anomalies of tetralogy of Fallot. However,long-term postoperative complications may include pulmonary valve regurgitation,tricuspid valve regurgitation,residual right ventricular outflow tract obstruction,aortic root dilation,arrhythmias,and right heart failure.Due to the pathological characteristics of tetralogy of Fallot (pulmonary valve dysplasia/stenosis and the use of transannular patches),patients often coexist with postoperative pulmonary valve regurgitation and can survive asymptomatically for a long time.This review primarily summarizes the current understanding of the pathological mechanisms and treatment progress of pulmonary valve regurgitation after Tetralogy of Fallot repair.It discusses the clinical examination methods for grading the severity of pulmonary valve regurgitation,surgical indications and timing,and analyzes the advantages and disadvantages of surgical pulmonary valve replacement versus percutaneous pulmonary valve intervention,ultimately summarizing the better clinical treatment strategies to improve the quality of life for patients.
参考文献/References:
[1] Villafa?e J,Feinstein JA,Jenkins KJ,et al.Hot topics in tetralogy of Fallot[J].J Am Coll Cardiol,2013,62(23):2155-2166.DOI:10.1016/j.jacc.2013.07.100.
[2] Apitz C,Webb GD,Redington AN.Tetralogy of Fallot[J].Lancet,2009,374(9699):1462-1471.DOI:10.1016/S0140-6736(09)60657-7.
[3] 王辉山,李守军.先天性心脏病外科治疗中国专家共识(十):法洛四联症[J].中国胸心血管外科临床杂志,2020,27(11):1247-1254.DOI:10.7507/1007-4848.202007065. Wang HS,Li SJ.Chinese expert consensus on surgical treatment of congenital heart disease (10):tetralogy of Fallot[J].Chin J Clin Thorac Cardiovasc Surg,2020,27(11):1247-1254.DOI:10.7507/1007-4848.202007065.
[4] Townsley MM,Windsor J,Briston D,et al.Tetralogy of Fallot:perioperative management and analysis of outcomes[J].J Cardiothorac Vasc Anesth,2019,33(2):556-565.DOI:10.1053/j.jvca.2018.03.035.
[5] Loomba RS,Buelow MW,Woods RK.Complete repair of tetralogy of Fallot in the neonatal versus non-neonatal period:a meta-analysis[J].Pediatr Cardiol,2017,38(5):893-901.DOI:10.1007/s00246-017-1579-8.
[6] Heinisch PP,Guarino L,Hutter D,et al.Late correction of tetralogy of Fallot in children[J].Swiss Med Wkly,2019,149:w20096.DOI:10.4414/smw.2019.20096.
[7] 季巍,莫莹,罗毅.法洛四联症根治术后远期主要并发症及其微创化手术治疗[J].中国临床医生杂志,2021,49(9):1011-1016.DOI:10.3969/j.issn.2095-8552.2021.09.002. Ji W,Mo Y,Luo Y.Long term main complications and minimally invasive surgical treatment of tetralogy of Fallot after radical surgery[J].Chin J Clin,2021,49(9):1011-1016.DOI:10.3969/j.issn.2095-8552.2021.09.002.
[8] Hammett O,Griksaitis MJ.Management of tetralogy of Fallot in the pediatric intensive care unit[J].Front Pediatr,2023,11:1104533.DOI:10.3389/fped.2023.1104533.
[9] 王官玺,何凤璞,李守军.法洛四联症根治术后中远期常见并发症及治疗[J].中国分子心脏病学杂志,2018,18(2):2453-2456.DOI:10.16563/j.cnki.1671-6272.2018.04.015. Wang GX,He FP,Li SJ.The long-term common complications and its treatments after tetralogy of Fallot repair[J].Mol Cardiol China,2018,18(2):2453-2456.DOI:10.16563/j.cnki.1671-6272.2018.04.015.
[10] Menachem JN,Opotowsky AR.Pulmonary valve replacement in repaired tetralogy of Fallot:appropriate timing saves lives[J].J Am Coll Cardiol,2023,81(21):2086-2088.DOI:10.1016/j.jacc.2023.04.005.
[11] 李晓雪,王志远,金梅.法洛四联症根治术后中远期常见并发症的研究进展[J].心肺血管病杂志,2023,42(8):869-874.DOI:10.3969/j.issn.1007-5062.2023.08.019. Li XX,Wang ZY,Jin M.Research progress on common complications in the medium and long term after radical surgery for tetralogy of Fallot[J].J Cardiovasc Pulm Dis,2023,42(8):869-874.DOI:10.3969/j.issn.1007-5062.2023.08.019.
[12] Ylitalo P,Lehmonen L,Lauerma K,et al.Severe pulmonary regurgitation in adolescents with tetralogy of Fallot leads to increased longitudinal strain[J].MAGMA,2020,33(2):309-316.DOI:10.1007/s10334-019-00780-0.
[13] Wei XD,Li TG,Ling YF,et al.Transannular patch repair of tetralogy of Fallot with or without monocusp valve reconstruction:a meta-analysis[J].BMC Surg,2022,22(1):18.DOI:10.1186/s12893-022-01474-6.
[14] van der Ven JPG,van den Bosch E,Bogers AJCC,et al.Current outcomes and treatment of tetralogy of Fallot[J].F1000Res,2019,8(F1000 Faculty Rev):1530.DOI:10.12688/f1000research.17174.1.
[15] Mercer-Rosa L,Yang W,Kutty S,et al.Quantifying pulmonary regurgitation and right ventricular function in surgically repaired tetralogy of Fallot:a comparative analysis of echocardiography and magnetic resonance imaging[J].Circ Cardiovasc Imaging,2012,5(5):637-643.DOI:10.1161/CIRCIMAGING.112.972588.
[16] 张晓玲,彭瑛,饶莉.法洛四联症矫治术后肺动脉瓣反流的超声心动图评估进展[J].心血管病学进展,2018,39(3):316-319.DOI:10.16806/j.cnki.issn.1004-3934.2018.03.004. Zhang XL,Peng Y,Rao L.Echocardiographic assessment progress of pulmonary regurgitation after surgical repair of tetralogy of Fallot[J].Adv Cardiovasc Dis,2018,39(3):316-319.DOI:10.16806/j.cnki.issn.1004-3934.2018.03.004.
[17] Uebing A,Fischer G,Bethge M,et al.Influence of the pulmonary annulus diameter on pulmonary regurgitation and right ventricular pressure load after repair of tetralogy of Fallot[J].Heart,2002,88(5):510-514.DOI:10.1136/heart.88.5.510.
[18] Beurskens NEG,Gorter TM,Pieper PG,et al.Diagnostic value of Doppler echocardiography for identifying hemodynamic significant pulmonary valve regurgitation in tetralogy of Fallot:comparison with cardiac MRI[J].Int J Cardiovasc Imaging,2017,33(11):1723-1730.DOI:10.1007/s10554-017-1165-4.
[19] Lapierre C,Dubois J,Rypens F,et al.Tetralogy of Fallot:preoperative assessment with MR and CT imaging[J].Diagn Interv Imaging,2016,97(5):531-541.DOI:10.1016/j.diii.2016.01.009.
[20] Geva T,Sandweiss BM,Gauvreau K,et al.Factors associated with impaired clinical status in long-term survivors of tetralogy of Fallot repair evaluated by magnetic resonance imaging[J].J Am Coll Cardiol,2004,43(6):1068-1074.DOI:10.1016/j.jacc.2003.10.045.
[21] Bansal N,Gupta P,Joshi A,et al.Utility of Doppler echocardiography to estimate the severity of pulmonary valve regurgitation fraction in patients with repaired tetralogy of Fallot[J].Pediatr Cardiol,2019,40(2):404-411.DOI:10.1007/s00246-018-2045-y.
[22] Koestenberger M,Nagel B,Halb V,et al.Correlation of pulmonary regurgitation fraction and right ventricular ejection fraction in patients with tetralogy of Fallot[J].Clin Res Cardiol,2011,100(8):713-714.DOI:10.1007/s00392-011-0309-0.
[23] Holmes KW.Timing of pulmonary valve replacement in tetralogy of Fallot using cardiac magnetic resonance imaging:an evolving process[J].J Am Coll Cardiol,2012,60(11):1015-1017.DOI:10.1016/j.jacc.2012.05.026.
[24] Hoashi T,Kagisaki K,Meng Y,et al.Long-term outcomes after definitive repair for tetralogy of Fallot with preservation of the pulmonary valve annulus[J].J Thorac Cardiovasc Surg,2014,148(3):802-809.DOI:10.1016/j.jtcvs.2014.06.008.
[25] 叶文倩,顾燕,丁文虹,等.法洛四联症根治术后残余畸形的相关因素研究[J].心肺血管病杂志,2018,37(12):1099-1103.DOI:10.3969/j.issn.1007-5062.2018.12.016. Ye WQ,Gu Y,Ding WH,et al.Analysis of risk factors for residual malformations after total correction of tetralogy of Fallot[J].J Cardiovasc Pulm Dis,2018,37(12):1099-1103.DOI:10.3969/j.issn.1007-5062.2018.12.016.
[26] Stout KK,Daniels CJ,Aboulhosn JA,et al.2018 AHA/ACC guideline for the management of adults with congenital heart disease:executive summary:a report of the American College of Cardiology/American Heart Association Task Force on clinical practice guidelines[J].Circulation,2019,139(14):e637-e697.DOI:10.1161/CIR.0000000000000602.
[27] Baumgartner H,De Backer J,Babu-Narayan SV,et al.2020 ESC guidelines for the management of adult congenital heart disease[J].Eur Heart J,2021,42(6):563-645.DOI:10.1093/eurheartj/ehaa554.
[28] Marelli A,Beauchesne L,Colman J,et al.Canadian cardiovascular society 2022 guidelines for cardiovascular interventions in adults with congenital heart disease[J].Can J Cardiol,2022,38(7):862-896.DOI:10.1016/j.cjca.2022.03.021.
[29] Adamson GT,McElhinney DB,Lui G,et al.Secondary repair of incompetent pulmonary valves after previous surgery or intervention:patient selection and outcomes[J].J Thorac Cardiovasc Surg,2020,159(6):2383-2392.e2.DOI:10.1016/j.jtcvs.2019.06.110.
[30] Park CS,Lee CH,Lee YO,et al.Pulmonary valve repair late after right ventricular outflow tract reconstruction in children and adolescents[J].Interact Cardiovasc Thorac Surg,2010,10(6):906-909.DOI:10.1510/icvts.2009.231217.
[31] Parikh KN,Shah NC,Clark JB,et al.Pulmonary valve restitution following transannular patch repair of tetralogy of Fallot[J].Interact Cardiovasc Thorac Surg,2017,25(6):985-986.DOI:10.1093/icvts/ivx215.
[32] Cleveland JD,Wells WJ.The surgical approach to pulmonary valve replacement[J].Semin Thorac Cardiovasc Surg,2022,34(4):1256-1261.DOI:10.1053/j.semtcvs.2022.05.006.
[33] Kwon MH,Baird CW.Surgical valve choices for pulmonary valve replacement[J].Semin Thorac Cardiovasc Surg,2023,35(1):94-104.DOI:10.1053/j.semtcvs.2022.01.006.
[34] Banbury MK,Cosgrove DM 3rd,White JA,et al.Age and valve size effect on the long-term durability of the Carpentier-Edwards aortic pericardial bioprosthesis[J].Ann Thorac Surg,2001,72(3):753-757.DOI:10.1016/s0003-4975(01)02992-7.
[35] Nomoto R,Sleeper LA,Borisuk MJ,et al.Outcome and performance of bioprosthetic pulmonary valve replacement in patients with congenital heart disease[J].J Thorac Cardiovasc Surg,2016,152(5):1333-1342.e3.DOI:10.1016/j.jtcvs.2016.06.064.
[36] Freling HG,van Slooten YJ,van Melle JP,et al.Pulmonary valve replacement:twenty-six years of experience with mechanical valvar prostheses[J].Ann Thorac Surg,2015,99(3):905-910.DOI:10.1016/j.athoracsur.2014.10.034.
[37] 王官玺.法洛四联症根治术后肺动脉瓣返流未成年患者肺动脉瓣置换近中期结果.北京:北京协和医学院,2018.DOI:10.7666/d.Y3517563. Wang GX.Surgical pulmonary valve replacement in paediatric patients with repaired tetralogy of Fallot:outcomes in the current era[D]. Beijing:Peking Union Medical College,2018.DOI:10.7666/d.Y3517563.
[38] Kim ER,Lee C,Lee CH,et al.Long-term outcomes of polytetrafluoroethylene bicuspid pulmonary valve replacement[J].Ann Thorac Surg,2024,117(3):535-541.DOI:10.1016/j.athoracsur.2023.08.019.
[39] Allen BS,El-Zein C,Cuneo B,et al.Pericardial tissue valves and Gore-Tex conduits as an alternative for right ventricular outflow tract replacement in children[J].Ann Thorac Surg,2002,74(3):771-777.DOI:10.1016/s0003-4975(02)03767-0.
[40] 何凤璞.法洛四联症矫治术后肺动脉瓣返流干预方式、时机和指征的前瞻性队列研究.北京:北京协和医学院,2019.DOI:10.27648/d.cnki.gzxhu.2019.000161. He FP.Prospective cohort study on intervention methods,timing,and indications for pulmonary valve regurgitation after correction of tetralogy of Fallot.Beijing:Peking Union Medical College,2019.DOI:10.27648/d.cnki.gzxhu.2019.000161.
[41] Paech C,D?hnert I,Riede FT,et al.QRS width as a predictor of right ventricular remodeling after percutaneous pulmonary valve implantation[J].Pediatr Cardiol,2017,38(6):1277-1281.DOI:10.1007/s00246-017-1658-x.
[42] Westhoff-Bleck M,Girke S,Breymann T,et al.Pulmonary valve replacement in chronic pulmonary regurgitation in adults with congenital heart disease:impact of preoperative QRS-duration and NT-proBNP levels on postoperative right ventricular function[J].Int J Cardiol,2011,151(3):303-306.DOI:10.1016/j.ijcard.2010.05.064
[43] Gatzoulis MA,Till JA,Somerville J,et al.Mechanoelectrical interaction in tetralogy of Fallot.QRS prolongation relates to right ventricular size and predicts malignant ventricular arrhythmias and sudden death[J].Circulation,1995,92(2):231-237.DOI:10.1161/01.cir.92.2.231.
[44] Dorobantu DM,Sharabiani MTA,Taliotis D,et al.Age over 35 years is associated with increased mortality after pulmonary valve replacement in repaired tetralogy of Fallot:results from the UK National Congenital Heart Disease Audit database[J].Eur J Cardiothorac Surg,2020,58(4):825-831.DOI:10.1093/ejcts/ezaa069.
[45] 赵栋,杨克明,李守军.法洛四联症术后肺动脉瓣置换术的中期效果评价[J].中国胸心血管外科临床杂志,2021,28(4):404-408.DOI:10.7507/1007-4848.202004096. Zhao D,Yang KM,Li SJ.Evaluation of mid-term outcomes of pulmonary valve replacement surgery after repair of tetralogy of Fallot[J].Chin J Clin Thorac Cardiovasc Surg,2021,28(4):404-408.DOI:10.7507/1007-4848.202004096.
[46] 胡小松,杨克明,李守军,等.同种带瓣管道用于右心室流出道重建的中期效果[J].中国循环杂志,2016,31(4):385-388.DOI:10.3969/j.issn.1000-3614.2016.04.017. Hu XS,Yang KM,Li SJ,et al.Mid-term outcomes for the application of homograft valve conduits in right ventricular outflow reconstruction in patients with congenital heart disease[J].Chin Circul J,2016,31(4):385-388.DOI:10.3969/j.issn.1000-3614.2016.04.017.
[47] Cramer JW,Ginde S,Hill GD,et al.Tricuspid repair at pulmonary valve replacement does not alter outcomes in tetralogy of Fallot[J].Ann Thorac Surg,2015,99(3):899-904.DOI:10.1016/j.athoracsur.2014.09.086.
[48] Davlouros PA,Kilner PJ,Hornung TS,et al.Right ventricular function in adults with repaired tetralogy of Fallot assessed with cardiovascular magnetic resonance imaging:detrimental role of right ventricular outflow aneurysms or akinesia and adverse right-to-left ventricular interaction[J].J Am Coll Cardiol,2002,40(11):2044-2052.DOI:10.1016/s0735-1097(02)02566-4.
[49] Roubertie F,Séguéla PE,Jalal Z,et al.Tricuspid valve repair and pulmonary valve replacement in adults with repaired tetralogy of Fallot[J].J Thorac Cardiovasc Surg,2017,154(1):214-223.DOI:10.1016/j.jtcvs.2016.12.062.
[50] 中国医师协会心血管内科医师分会结构性心脏病学组,亚洲心脏病学会,国家放射与治疗临床医学研究中心.经导管肺动脉瓣置换术亚洲专家共识[J].中国介入心脏病学杂志,2023,31(6):404-412.DOI:10.3969/j.issn.1004-8812.2023.06.002. Structural Cardiology Committee of Cardiovascular Physicians Branch of Chinese Medical Doctor Association,Asian Society of Cardiology,National Clinical Research Center for Interventional Medicine.Asian expert consensus statement on transcatheter pulmonary valve replacement[J].Chin J Intervent Cardiol,2023,31(6):404-412.DOI:10.3969/j.issn.1004-8812.2023.06.002.
[51] Giugno L,Faccini A,Carminati M.Percutaneous pulmonary valve implantation[J].Korean Circ J,2020,50(4):302-316.DOI:10.4070/kcj.2019.0291.
[52] Meca Aguirrezabalaga JA,Silva Guisasola J,Díaz Méndez R,et al.Pulmonary regurgitation after repaired tetralogy of Fallot:surgical versus percutaneous treatment[J].Ann Transl Med,2020,8(15):967.DOI:10.21037/atm.2020.03.81.
[53] Virk SA,Liou K,Chandrakumar D,et al.Percutaneous pulmonary valve implantation:a systematic review of clinical outcomes[J].Int J Cardiol,2015,201:487-489.DOI:10.1016/j.ijcard.2015.08.119.
[54] Houeijeh A,Batteux C,Karsenty C,et al.Long-term outcomes of transcatheter pulmonary valve implantation with melody and SAPIEN valves[J].Int J Cardiol,2023,370:156-166.DOI:10.1016/j.ijcard.2022.10.141.
[55] McElhinney DB,Benson LN,Eicken A,et al.Infective endocarditis after transcatheter pulmonary valve replacement using the Melody valve:combined results of 3 prospective North American and European studies[J].Circ Cardiovasc Interv,2013,6(3):292-300.DOI:10.1161/CIRCINTERVENTIONS.112.000087.
[56] Ran LY,Wang WW,Secchi F,et al.Percutaneous pulmonary va-lve implantation in patients with right ventricular outflow tract dysfunction:a systematic review and meta-analysis[J].Ther Adv Chronic Dis,2019,10:2040622319857635.DOI:10.1177/2040622319857635.
[57] 刘倩倩,逄坤静.经皮肺动脉瓣置入术-现状和未来方向[J].中国循环杂志,2016,31(9):924-927.DOI:10.3969/j.issn.1000-3614.2016.09.023. Liu QQ,Pang KJ.Percutaneous pulmonary valve implantation:current status and future directions[J].Chin Circul J,2016,31(9):924-927.DOI:10.3969/j.issn.1000-3614.2016.09.023.
[58] Egbe AC,Vallabhajosyula S,Connolly HM.Trends and outcomes of pulmonary valve replacement in tetralogy of Fallot[J].Int J Cardiol,2020,299:136-139.DOI:10.1016/j.ijcard.2019.07.063.
[59] Hribernik I,Thomson J,Ho A,et al.Comparative analysis of surgical and percutaneous pulmonary valve implants over a 20-year period[J].Eur J Cardiothorac Surg,2022,61(3):572-579.DOI:10.1093/ejcts/ezab368.
[60] Breatnach CR,McGuinness J,Ng LY,et al.Procedural technique for hybrid pulmonary valve replacement in infants and small children[J].Eur J Cardiothorac Surg,2021,59(4):823-830.DOI:10.1093/ejcts/ezaa410.
[61] Suleiman T,Kavinsky CJ,Skerritt C,et al.Recent development in pulmonary valve replacement after tetralogy of Fallot repair:the emergence of hybrid approaches[J].Front Surg,2015,2:22.DOI:10.3389/fsurg.2015.00022.
[62] Stout KK,Daniels CJ,Aboulhosn JA,et al.2018 AHA/ACC guideline for the management of adults with congenital heart disease:a report of the American College of Cardiology/American Heart Association Task Force on clinical practice guidelines[J].J Am Coll Cardiol,2019,73(12):e81-e192.DOI:10.1016/j.jacc.2018.08.1029.
相似文献/References:
[1]刘钢高昕刘树立黄柳明王伟邵培侯文英张军李龙.胆道闭锁葛西手术后肝内胆管扩张的治疗与预后分析[J].临床小儿外科杂志,2010,9(03):0.
LIU Gang,GAO Xin,LIU Shu-li,et al.The managements and prognosis of intrahepatic biliary dilatation with biliary atresia after Kasai procedure[J].Journal of Clinical Pediatric Surgery,2010,9(08):0.
[2]潘静,郑永钦,佘锦标,等.胆道闭锁术后肝内胆管囊性扩张的诊治[J].临床小儿外科杂志,2008,7(04):0.
[3]李志富 张泽俊 连松. 儿童手术后肠套叠29例分析[J].临床小儿外科杂志,2011,10(04):308.
[J].Journal of Clinical Pediatric Surgery,2011,10(08):308.
[4]徐万华 杨志林 尹鉴淳 王浩. 有腹股沟区手术史的隐睾患儿诊疗分析[J].临床小儿外科杂志,2012,11(02):103.
[5]潘伟华 施诚仁 吴晔明 王俊. 儿童腹部实体肿瘤术后乳糜腹的处理[J].临床小儿外科杂志,2012,11(04):247.
[J].Journal of Clinical Pediatric Surgery,2012,11(08):247.
[6]仇杰 费忠化 刘宏生. 婴幼儿先心病术后并发纵膈气肿临床分析[J].临床小儿外科杂志,2012,11(04):260.
[J].Journal of Clinical Pediatric Surgery,2012,11(08):260.
[7]舒仕瑜,张智恩,陈功,等.先天性膈疝患儿手术后近期肺功能的临床观察[J].临床小儿外科杂志,2017,16(05):444.
[8]谢学良,明腾,邹勇,等.肺动脉瓣窦扩大在婴幼儿法洛四联症保留肺动脉瓣纠治术中的应用研究[J].临床小儿外科杂志,2017,16(05):469.
[9]黄文凯,李雪丽,张瑾,等.先天性巨结肠手术后近期并发症的发生率及危险因素分析[J].临床小儿外科杂志,2018,17(02):99.
Huang Wenkai,Li Xueli,Zhang Jin,et al.Prevalence and risk factors of the early complications after surgery of Hirschprung’s disease：a retrospective cohort study.[J].Journal of Clinical Pediatric Surgery,2018,17(08):99.
[10]冉旭东,徐永根,廖健毅,等.非胸腔镜辅助下Ｎｕｓｓ手术治疗儿童漏斗胸的临床研究[J].临床小儿外科杂志,2018,17(04):286.
Ran Xudong,Xu Yonggen,Liao Jianyi,et al.Clinical study of pectus excavatum by nonthoracoscopic assisted Nuss procedure.[J].Journal of Clinical Pediatric Surgery,2018,17(08):286.
备注/Memo
收稿日期:2023-12-21。
通讯作者:施旭聪,Email:shixc@zju.edu.cn