Clinical diagnosis and treatment of children with late-onset congenital diaphragmatic hernia

doi:10.3877/cma.j.issn.1673-5250.2024.04.008

Objective

To investigate clinical manifestations，clinical diagnosis and treatment of children with late-onset congenital diaphragmatic hernia （CDH）.

Methods

A total of 74 children with late-onset CDH who were treated in the Department of Pediatric General Surgery and Thoracic Surgery，Shengjing Hospital Affiliated to China Medical University from January 2013 to December 2023 were selected as study subjects，and were included in study group，their mean age was 3.2 years old（1 month to 14 years old）；27，2，and 45 children with Bochdalek hernia，Morgagni hernia，and esophageal hiatal hernia （EHH），respectively.And another 67 neonates with CDH treated in the same hospital during the same period were selected as control and included in control group，their mean age was 1.3 d（0-28 d）；50，6，and 11 children with Bochdalek hernia，Morgagni hernia，and EHH，respectively.Clinical data of children between study group and control group，including clinical manifestations，CDH types，diagnosis and treatment characteristics were retrospectively collected and were compared by independent-samples t test，or chi-square test or correction for continuity chi-square test.As examination and treatment methods of EHH，Bochdalek hernia and Morgagni hernia were different，study group and control group were further divided into EHH subgroup 1（n=45）and BM subgroup 1（n=29），EHH subgroup 2（n=11）and BM subgroup 2（n=56）based on EHH children，Bochdalek hernia and Morgagni hernia children，respectively.The procedures followed in this study were approved by the Ethics Committee of our hospital（ Approval No.2018PS391K），and all guardians of children signed informed consent for clinical study.

Results

①CDH type of children with late-onset CDH：bochdalek hernia in 27 cases （36.5%）［right lateral hernia in 2 cases （2.7%），left lateral hernia in 25 cases （33.8%）］；2 cases （2.7%）were Morgagni hernias，and 45 cases（60.8%）were EHH.Clinical manifestations：18 cases （24.3%）had respiratory symptoms as the main manifestation，46 cases （62.2%）had digestive tract symptoms as the main manifestation［7 cases （9.5%）were diagnosed with growth retardation or anemia］，and 10 cases （13.5%）had no clinical symptoms related to CDH and were diagnosed during physical examination.Treatment methods：31 cases （41.9%）underwent minimally invasive surgery，3 cases （4.1%）underwent minimally invasive surgery+transfer to open surgery，and 40 cases （54.0%）underwent open surgery.Diagnosis methods：all 74 cases were diagnosed by digital X-ray of chest or abdomen and CT of chest or abdomen.And 61 cases （82.4%）also received upper digestive tract X-ray angiography，2 cases （2.7%）underwent complete X-ray barium enema examination，and 1 case （1.4%）underwent only X-ray b arium enema examination.6 cases （8.1%）underwent chest enhanced CT to assist in judging the activity of hernia contents.②There were no statistically significant differences in gender ratio，operation duration and postoperative feeding time between EHH subgroup 1 and EHH subgroup 2（P ＞0.05）.Diameter of diaphragm defect in EHH subgroup 1 was larger than that in EHH subgroup 2，and the difference was statistically significant （t=-2.71，P=0.009）.There were no statistically significant differences in gender ratio，diaphragm defect diameter and hernia sac between BM subgroup 1 and BM subgroup 2（P＞0.05）.However，rate of patch usage in BM subgroup 1 was lower than that in BM subgroup 2，and the operation duration，postoperative ventilator assisted ventilation duration and postoperative feeding time in BM subgroup 2 were shorter than those in BM subgroup 2，and all the differences were statistically significant（ χ²=4.08，P=0.043；t=3.36，P=0.001；t=2.85，P=0.006；t=5.51，P＜0.001）.

Conclusions

The lack of typical clinical manifestations in children with late-onset CDH often leads to delayed clinical diagnosis of the disease.The possibility of late-onset CDH should be fully considered in the differential diagnosis of children with respiratory d istress and gastrointestinal disorders.Imageological examinations are necessary in the differential diagnosis of every child with late-onset CDH.

Key words: Hernias，diaphragmatic，congenital，late-onset, Hernia，hiatal, Clinical research, Diagnosis，differential, Imageological examination, Auxiliary diagnosis, Child

表1 研究组74例迟发性CDH 患儿的CDH 发生部位及3种类型CDH（Bochdalek疝、Morgagni疝及EHH）患儿的临床表现与发病持续时间比较（例）

CDH类型	例数	嗳气、间断呕吐、腹痛	持续呕吐、腹痛	胸闷、呼吸困难、窘迫	咳嗽、发热	生长发育落后于同龄儿、贫血	合并其他系统畸形	无临床症状	发病持续时间
CDH类型	例数	嗳气、间断呕吐、腹痛	持续呕吐、腹痛	胸闷、呼吸困难、窘迫	咳嗽、发热	生长发育落后于同龄儿、贫血	合并其他系统畸形	无临床症状	＜1周	≥1周
Bochdalek疝
左侧	25	10	3	10	6	2	0	3	11	14
右侧	2	1	0	0	1	1	1	1	1	1
Morgagni疝	2	1	0	0	1	0	0	0	2	0
EHH	45	30	8	2	0	5	0	6	15	30
合计	74	42	11	12	8	8	1	10	29	45

表1 研究组74例迟发性CDH 患儿的CDH 发生部位及3种类型CDH（Bochdalek疝、Morgagni疝及EHH）患儿的临床表现与发病持续时间比较（例）

CDH类型	例数	嗳气、间断呕吐、腹痛	持续呕吐、腹痛	胸闷、呼吸困难、窘迫	咳嗽、发热	生长发育落后于同龄儿、贫血	合并其他系统畸形	无临床症状	发病持续时间
CDH类型	例数	嗳气、间断呕吐、腹痛	持续呕吐、腹痛	胸闷、呼吸困难、窘迫	咳嗽、发热	生长发育落后于同龄儿、贫血	合并其他系统畸形	无临床症状	＜1周	≥1周
Bochdalek疝
左侧	25	10	3	10	6	2	0	3	11	14
右侧	2	1	0	0	1	1	1	1	1	1
Morgagni疝	2	1	0	0	1	0	0	0	2	0
EHH	45	30	8	2	0	5	0	6	15	30
合计	74	42	11	12	8	8	1	10	29	45

图1 1例迟发性CDH 患儿（男性，10个月龄）胸部增强CT 急诊检查图及急诊胸腔镜下CDH 修补术图（图1A、1B：胸部增强CT 检查可见横切面及冠状面左侧胸腔内巨大囊性灶伴气液平形成，囊性灶内分隔，左肺组织明显受压，导致纵隔向右侧移位；胸腔内病灶未见确切强化；图1C：急诊胸腔镜下CDH 修补术，术中可见后外侧膈肌缺损较大，约为4 cm×3 cm，大部分小肠及部分结肠、脾脏自缺损处疝入胸腔）注：CDH 为先天性膈疝

图2 1例迟发性CDH 患儿（男性，2岁3个月龄）上消化道X 射线造影图及腹腔镜下CDH 修补术图（图2A、2B：上消化道X 射线造影可见含部分肠管于胸骨后缺损疝入胸腔；图2C：腹腔镜下CDH 修补术，术中可见部分结肠自胸骨后缺损入胸腔，缺损大小约为3 cm×2 cm）注：CDH 为先天性膈疝

图3 1例迟发性CDH 患儿（男性，7岁龄）上消化道X 射线造影、腹腔镜下EHH 修补术及腹腔镜下复发EHH 修补术图（图3A、3B：上消化道X 射线造影可见绝大部分胃自扩大的食管裂孔，疝入胸腔，局部受压变形、狭窄，胃形态转变为水平位，辅助诊断为迟发性EHH；图3C：腹腔镜下EHH 修补术，术中可见食管裂孔扩大，缺损大小约为4 cm×4 cm，约4/5胃疝入胸腔；图3D：腹腔镜下复发EHH 修补术，术中可见食管裂孔扩大，原固定线位于单侧膈肌角，胃全部反转进入胸腔内，黏连严重）注：EHH 为食管裂孔疝

表2 EHH 亚组1与EHH 亚组2患儿相关临床资料比较

组别	例数	性别［例数（%）］		膈肌缺损直径（cm， $\overset{ˉ}{x}$ ±s）	手术时长（min， $\overset{ˉ}{x}$ ±s）	术后进食时间（d， $\overset{ˉ}{x}$ ±s）
组别	例数	男	女	膈肌缺损直径（cm， $\overset{ˉ}{x}$ ±s）	手术时长（min， $\overset{ˉ}{x}$ ±s）	术后进食时间（d， $\overset{ˉ}{x}$ ±s）
EHH亚组1	45	27（60.0）	18（40.0）	4.7±1.5	185.6±70.6	5.4±1.9
EHH亚组2	11	7（63.6）	4（36.4）	3.5±1.2	212.2±50.9	6.1±1.6
统计量		χ²=0.02^a		t=-2.71	t=1.17	t=1.19
P值		0.902		0.009	0.247	0.240

表2 EHH 亚组1与EHH 亚组2患儿相关临床资料比较

组别	例数	性别［例数（%）］		膈肌缺损直径（cm， $\overset{ˉ}{x}$ ±s）	手术时长（min， $\overset{ˉ}{x}$ ±s）	术后进食时间（d， $\overset{ˉ}{x}$ ±s）
组别	例数	男	女	膈肌缺损直径（cm， $\overset{ˉ}{x}$ ±s）	手术时长（min， $\overset{ˉ}{x}$ ±s）	术后进食时间（d， $\overset{ˉ}{x}$ ±s）
EHH亚组1	45	27（60.0）	18（40.0）	4.7±1.5	185.6±70.6	5.4±1.9
EHH亚组2	11	7（63.6）	4（36.4）	3.5±1.2	212.2±50.9	6.1±1.6
统计量		χ²=0.02^a		t=-2.71	t=1.17	t=1.19
P值		0.902		0.009	0.247	0.240

表3 BM 亚组1与BM 亚组2患儿相关临床资料比较

组别	例数	性别［例数（%）］		膈肌缺损直径（cm， $\overset{ˉ}{x}$ ±s）	有疝囊［例数（%）］	使用补片［例数（%）］	手术时长（min， $\overset{ˉ}{x}$ ±s）	术后呼吸机辅助通气时间（h， $\overset{ˉ}{x}$ ±s）	术后进食时间（d， $\overset{ˉ}{x}$ ±s）
组别	例数	男	女	膈肌缺损直径（cm， $\overset{ˉ}{x}$ ±s）	有疝囊［例数（%）］	使用补片［例数（%）］	手术时长（min， $\overset{ˉ}{x}$ ±s）	术后呼吸机辅助通气时间（h， $\overset{ˉ}{x}$ ±s）	术后进食时间（d， $\overset{ˉ}{x}$ ±s）
BM亚组1	29	16（55.2）	13（44.8）	3.9±1.0	7（24.1）	1（3.4）	130.7±64.5	5.4±24.9	3.7±1.6
BM亚组2	56	38（67.9）	18（32.1）	3.9±1.1	22（39.3）	13（23.2）	190.9±99.7	42.0±89.6	6.5±3.0
统计量		χ²=1.33		t=-0.13	χ²=1.95	χ²=4.08^a	t=3.36	t=2.85	t=5.51
P值		0.249		0.894	0.163	0.043	0.001	0.006	＜0.001

表3 BM 亚组1与BM 亚组2患儿相关临床资料比较

组别	例数	性别［例数（%）］		膈肌缺损直径（cm， $\overset{ˉ}{x}$ ±s）	有疝囊［例数（%）］	使用补片［例数（%）］	手术时长（min， $\overset{ˉ}{x}$ ±s）	术后呼吸机辅助通气时间（h， $\overset{ˉ}{x}$ ±s）	术后进食时间（d， $\overset{ˉ}{x}$ ±s）
组别	例数	男	女	膈肌缺损直径（cm， $\overset{ˉ}{x}$ ±s）	有疝囊［例数（%）］	使用补片［例数（%）］	手术时长（min， $\overset{ˉ}{x}$ ±s）	术后呼吸机辅助通气时间（h， $\overset{ˉ}{x}$ ±s）	术后进食时间（d， $\overset{ˉ}{x}$ ±s）
BM亚组1	29	16（55.2）	13（44.8）	3.9±1.0	7（24.1）	1（3.4）	130.7±64.5	5.4±24.9	3.7±1.6
BM亚组2	56	38（67.9）	18（32.1）	3.9±1.1	22（39.3）	13（23.2）	190.9±99.7	42.0±89.6	6.5±3.0
统计量		χ²=1.33		t=-0.13	χ²=1.95	χ²=4.08^a	t=3.36	t=2.85	t=5.51
P值		0.249		0.894	0.163	0.043	0.001	0.006	＜0.001

［1］	陈佳俊，徐慧姣，蒋琴，等.外科治疗先天性膈肌发育异常疾病患儿的随访研究［J/OL］.中华妇幼临床医学杂志（电子版），2024，20（1）：1-8.DOI：10.3877/cma.j.issn.1673-5250.2024.01.001.Chen JJ，Xu HJ，Jiang Q，et al.Surgical treatment of children with congenital diaphragmatic dysplasia diseases：a follow-up study［J/OL］.Chin J Obstet Gynecol Pediatr（Electron Ed），2024，20（1）：1-8.DOI：10.3877/cma.j.issn.1673-5250.2024.01.001.
［2］	Perrone G，Giuffrida M，Annicchiarico A，et al.Complicated diaphragmatic hernia in emergency surgery：systematic review of the literature［J］.World J Surg，2020，44（12）：4012-4031.DOI：10.1007/s00268-020-05733-6.
［3］	Rivas JFG，Clugston RD.The etiology of congenital diaphragmatic hernia：the retinoid hypothesis 20 years later［J］.Pediatr Res，2024，95（4）：912-921.DOI：10.1038/s41390-023-02905-7.
［4］	Kitano Y，Lally KP，Lally PA.Late-presenting genetic diaphragmatic hernia［J］.J Pediatr Surg，2005，40（12）：1839-1843.DOI：10.1016/j.jpedsurg.2005.08.023.
［5］	袁翠霞，吴雨昊，赵录，等.不同手术方式治疗先天性膈疝的临床分析：一项单中心回顾性研究［J/OL］.中华妇幼临床医学杂志（电子版），2024，20（1）：18-24.DOI：10.3877/cma.j.issn.1673-5250.2024.01.003.Yuan CX，Wu YH，Zhao L，et al.Clinical analysis of different surgical modalities for the treatment of congenital diaphragmatic hernia：a single-center retrospective study［J/OL］.Chin J Obstet Gynecol Pediatr （Electron Ed），2024，20（1）：18-24.DOI：10.3877/cma.j.issn.1673-5250.2024.01.003.
［6］	Aprahamian A，Nouyrigat V，Grévent D，et al.Postnatal diagnosis of gastric volvulus revealing congenital diaphragmatic hernia［J］.Arch Pediatr，2017，24（5）：464-467.DOI：10.1016/j.arcped.2017.02.028.［Pub Med］
［7］	Chang PT，Taylor GA.Umbilical venous catheter malposition and errors in interpretation in newborns with Bochdalek hernia［J］.Pediatr Radiol，2015，45（7）：982-988.DOI：10.1007/s00247-014-3275-7.
［8］	Katsaros I，Katelani S，Giannopoulos S，et al.Management of morgagni's hernia in the adult population：a systematic review of the literature［J］.World J Surg，2021，45（10）：3065-3072.DOI：10.1007/s00268-021-06203-3.
［9］	Oppelt PU，Askevold I，Bender F，et al.Morgagni-Larrey diaphragmatic hernia repair in adult patients：a retrospective single-center experience［J］.Hernia，2021，25（2）：479-489.DOI：10.1007/s10029-020-02147-0.
［10］	梁靓，谭征，黄婷，等.新生儿先天性膈疝术后呼吸支持相关危险因素分析［J/OL］.中华妇幼临床医学杂志（电子版），2024，20（1）：9-17.DOI：10.3877/cma.j.issn.1673-5250.2024.01.002.Liang L，Tan Z，Huang T，et al.Risk factors of postoperative respiratory support in newborns with congenital diaphragmatic hernia ［J/OL］.Chin J Obstet Gynecol Pediatr（Electron Ed），2024，20（1）：9-17.DOI：10.3877/cma.j.issn.1673-5250.2024.01.002.
［11］	Tartar T，SaraξM，BakalÜ，et al.Bochdalek hernias in children with late presentation［J］.Turk Pediatri Ars，2018，53（4）：245-249.DOI：10.5152/turkpediatriars.2018.0039.
［12］	Al-Salem AH.Congenital hernia of Morgagni in infants and children［J］.J Pediatr Surg，2007，42（9）：1539-1543.DOI：10.1016/j.jpedsurg.2007.04.033.
［13］	Paoletti M，Raffler G，Gaffi MS，et al.Prevalence and risk factors for constitutional diaphragmatic hernia：a global view［J］.J Pediatr Surg，2020，55（11）：2297-2307.DOI：10.1016/j.jpedsurg.2020.06.022.
［14］	De A，Stein JE，Thompson M，et al.Persistent pneumonia in an infant.Keeping an open mind［J］.Ann Am Thorac Soc，2013，10（5）：514-517.DOI：10.1513/annalsats.201305-131cr.
［15］	Parlak A，Gurpinar AN.Laparoscopic repair of morgagni hernia in children［J］.J Laparoendosc Adv Surg Tech A，2022，32（7）：811-816.DOI：10.1089/lap.2021.0797.
［16］	Shin HB，Jeong YJ.Late presenting congenital diaphragmatic hernia misdiagnosed as a pleural effusion：a case report［J］.Medicine （Baltimore），2020，99（24）：e20684.DOI：10.1097/md.0000000000020684.
［17］	Comberiati P，Giacomello L，Camoglio FS，et al.Diaphragmatic hernia in a pediatric emergency department［J］.Pediatr Emerg Care，2015，31（5）：354-356.DOI：10.1097/PEC.0000000000000425.
［18］	Næss PA，Wiborg J，Kjellevold K，et al.Tension gastrothorax：acute life threatening manifestation of late onset congenital diaphragmatic hernia（CDH）in children［J］.Scand J Trauma Resusc Emerg Med，2015 Jun 24：23：49.DOI：10.1186/s13049-015-0129-8.
［19］	Kadian YS，Rattan KN，Verma M，et al.Congenital diaphragmatic hernia：misdiagnosis in adolescence［J］.J Indian Assoc Pediatr Surg，2009，14（1）：31-33.DOI：10.4103/0971-9261.44775.
［20］	Kumbhar S，Siddiqui S，Thakrar P.Avoiding misdiagnosis in postnatal presentation of congenital diaphragmatic hernia：a report of two cases and review of radiologic features［J］.Radiol Case Rep，2019，14（10）：1288-1292.DOI：10.1016/j.radcr.2019.07.016.
［21］	Rouse C，Schmidt L，Brock L，et al.Congenital diaphragmatic hernia presenting in a 7-day-old infant［J］.Case Rep Emerg Med，2017，2017：9175710.DOI：10.1155/2017/9175710.
［22］	Muien MZA，Jeyaprahasam K，Krisnan T，et al.Rare latepresentation congenital diaphragmatic hernia mimicking a tension pneumothorax［J］.Radiol Case Rep，2021，16（9）：2542-2545.DOI：10.1016/j.radcr.2021.06.024.
［23］	Bagłaj M.Late-presenting congenital diaphragmatic hernia in children：a clinical spectrum［J］.Pediatr Surg Int，2004，20（9）：658-669.DOI：10.1007/s00383-004-1269-5.
［24］	Elhalaby EA，Abo Sikeena MH.Delayed presentation of congenital diaphragmatic hernia［J］.Pediatr Surg Int，2002，18（5-6）：480-485.DOI：10.1007/s00383-002-0743-1.
［25］	马永钰，杨仕武，王舒钰，等.不同术式治疗婴儿食管裂孔疝的疗效分析［J/OL］.中华妇幼临床医学杂志（电子版），2024，20（1）：25-31.DOI：10.3877/cma.j.issn.1673-5250.2024.01.004.Ma YY，Yang SW，Wang SY，et al.Efficacy analysis of two surgical methods for treating infantile esophageal hiatal hernia ［J/OL］.Chin J Obstet Gynecol Pediatr （Electron Ed），2024，20（1）：25-31.DOI：10.3877/cma.j.issn.1673-5250.2024.01.004.
［26］	徐慧姣，陈佳俊，赖冠宇，等.先天性食管裂孔疝患儿临床诊疗研究［J/OL］.中华妇幼临床医学杂志（电子版），2024，20（1）：32-38.DOI：10.3877/cma.j.issn.1673-5250.2024.01.005.Xu HJ，Chen JJ，Lai GY，et al.Clinical diagnosis and treatment of children with congenital esophageal hiatal hernia［J/OL］.Chin J Obstet Gynecol Pediatr （Electron Ed），2024，20（1）：32-38.DOI：10.3877/cma.j.issn.1673-5250.2024.01.005.
［27］	Becmeur F，Jamali RR，Moog R，et al.Thoracoscopic treatment for delayed presentation of congenital diaphragmatic hernia in the infant［J］.Surg Endosc，2001，15（10）：1163-1166.DOI：10.1007/s004640090064.
［28］	Vandewalle RJ，Yalcin S，Clifton MS，et al.Biologic mesh underlay in thoracoscopic primary repair of congenital diaphragmatic hernia confers reduced recurrence in neonates：a preliminary report［J］.J Laparoendosc Adv Surg Tech A，2019，29（10）：1212-1215.DOI：10.1089/lap.2019.0122.

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