Objective To compare the benefits and drawbacks of primary patch expansion versus pericardial tube right ventricular-pulmonary artery connection in patients diagnosed with pulmonary atresia with ventricular septal defect (PA/VSD). Methods A retrospective study was conducted on patients diagnosed with PA/VSD who underwent primary right ventricular-pulmonary artery connection surgery at our center between 2010 and 2020. Patients were categorized into two groups based on the type of right ventricular-pulmonary artery connection: a pericardial tube group and a patch expansion group. Clinical data and imaging findings were compared between the two groups. Results A total of 51 patients were included in the study, comprising 31 males and 20 females, with a median age of 12.57 (4.57, 49.67) months. The pericardial tube group included 19 patients with a median age of 17.17 (7.33, 49.67) months, while the patch expansion group consisted of 32 patients with a median age of 8.58 (3.57, 52.72) months. In both groups, the diameter of pulmonary artery, McGoon index, and Nakata index significantly increased after treatment (P<0.001). However, the pericardial tube group exhibited a longer extracorporeal circulation time (P<0.001). The reoperation rate was notably high, with 74.51% of patients requiring further surgical intervention, including 26 (81.25%) patients in the patch expansion group and 12 (63.16%) patients in the pericardial tube group. No statistical differences were observed in long-term cure rates or mortality between the two groups (P＞0.005). Conclusion In patients with PA/VSD, both patch expansion and pericardial tube right ventricular-pulmonary artery connection serve as effective initial palliative treatment strategies that promote pulmonary vessel development and provide a favorable foundation for subsequent radical operations. However, compared to the pericardial tube approach, the patch expansion technique is simpler to perform and preserves some intrinsic potential for pulmonary artery development, making it the preferred procedure.

[摘 要] 淋巴细胞活化基因-3（LAG-3，又称CD223），在调控T细胞功能和维持免疫稳态中发挥关键作用，被公认为继程序性死亡蛋白-1（PD-1）和细胞毒性T淋巴细胞抗原-4（CTLA-4）之后最具潜力的共抑制性免疫检查点。LAG-3在活化的T细胞和肿瘤微环境中的耗竭性T细胞（TEX）表面高表达，其抑制功能是肿瘤逃逸免疫监视的关键机制。与PD-1和CTLA-4相比，LAG-3在调控T细胞受体（TCR）信号强度、限制T细胞增殖及效应因子分泌方面具有独特的作用模式，因此被普遍认为是继PD-1和CTLA-4之后最具临床开发潜力的免疫检查点靶点之一。近年来，随着对LAG-3分子结构、胞外区配体相互作用[如主要组织相容性复合体Ⅱ类分子（MHCⅡ类分子）、纤维蛋白原样蛋白1（FGL1）等]以及胞内信号转导机制认识的不断深入，多种靶向LAG-3的单克隆抗体已进入临床研究阶段，并在与PD-1抑制剂联合治疗中显示出良好的应用前景。本文将系统地总结并探讨LAG-3的分子结构、配体相互作用和信号通路的分子机制，以及其靶向药物和临床疗法的最新研究进展和应用前景，旨在为LAG-3靶向疗法的深入研究和未来临床策略优化提供有力的参考。