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1.
激光房角穿刺对非穿透小梁手术后高眼压的治疗   总被引:1,自引:0,他引:1  
目的评价激光房角穿刺治疗非穿透小梁手术后眼压升高的临床疗效和安全性。方法以21例(23眼)开角型青光眼患者为研究对象作前瞻性研究,当非穿透小梁手术后眼压〉21mmHg时,即在手术部位行Nd:YAG激光房角穿刺。结果激光前平均眼压(25.1±2.4)mmHg,房角穿刺后1h的平均眼压降至(14.2±3.9)mmHg(P〈0.01)。激光后随访(10.5±4.1)个月,最后一次随访的平均眼压为(16.0±3.6)mmHg(P〈0.01)。并发症为浅前房、脉络膜脱离1眼,虹膜周边前粘连1眼。结论Nd:YAG激光房角穿刺能有效和安全地治疗非穿透小梁手术后小梁网-后弹力膜的房水低滤过状态,降低再次手术率。  相似文献   

2.
目的评价倍频Nd:YAG激光行激光周边虹膜成形术治疗残余性青光眼的有效性。方法 20例22眼残余性青光眼,使用倍频Nd:YAG激光行激光周边虹膜成形术,观察术后眼压、视力、杯盘比、前房深度、房角角度等指标变化情况。结果术后1个月、3个月、6个月眼压分别为(18.48±1.60)mmHg(1kPa=7.5mmHg)、(18.72±1.40)mmHg、(19.21±1.49)mmHg,与术前相比,差异均有统计学意义(均为P<0.05);术后6个月时杯盘比为0.59±0.22,与术前相比,差异无统计学意义(P>0.05);术后6个月时前房深度为(1.72±0.22)mm,与术前相比,差异无统计学意义(P>0.05);术后6个月时房角角度为(21.41±2.74)°,与术前相比,差异有统计学意义(P<0.05)。结论倍频Nd:YAG激光行激光周边虹膜成形术能有效降低残余性青光眼患者的眼压,手术简单易行,值得临床推广。  相似文献   

3.
目的:观察非穿透性小梁手术联合丝裂霉素及深层巩膜反折引流治疗开角型青光眼的临床效果。方法:对14例(18眼)开角型青光眼患者进行非穿透性小梁切除手术,术中联合应用丝裂霉素C及深层巩膜反折引流。观察手术前、后的眼压、视力、视野、前房(前房角)变化及手术后滤过泡情况。随访3~18mo。结果:术前平均眼压(33.96±8.16)mmHg(1mmHg=0.133kPa),术后眼压为(14.62±3.53)mmHg,手术前后眼压差异有显著意义(t=11.82,P<0.01)。手术前、后视力及视野无明显改变。术后16眼均形成滤过泡,其中I型6眼,Ⅱ型11眼,Ⅲ型1眼。结论:非穿透性小梁切除联合应用丝裂霉素及深层巩膜反折引流术是治疗开角型青光眼的一种安全、有效、便宜和具有可重复性的新治疗方式。  相似文献   

4.
目的 观察和分析非穿透小梁手术联合丝裂霉素C及深层巩膜反折引流治疗开角型青光眼的临床效果.方法 对12例16眼开角型青光眼患者行非穿透小梁切除手术,术中联合应用丝裂霉素C及深层巩膜反折引流.观察手术前、后的眼压、视力、视野、前房(前房角)变化及手术后滤过泡情况.随访3~18个月.结果 术前平均眼压(27.93±7.62)mmHg(1 kPa=7.5 mmHg),术后3个月时为(14.62±3.53)mmHg,手术前、后眼压差异有显著统计学意义(t=11.82,P<0.001).手术前、后视力及视野无明显改变.术后16眼均形成滤过泡,其中I型6眼,Ⅱ型9眼,Ⅲ型1眼.结论 非穿透性小梁切除联合应用丝裂霉素及深层巩膜反折引流术是治疗开角型青光眼的一种安全、有效、经济和具有可重复性的新治疗方式.  相似文献   

5.
目的评价非穿透性小梁手术联合丝裂霉素C治疗原发性开角型青光眼的临床效果.方法28例39眼原发性开角型青光眼,行非穿透性小梁手术联合术中应用丝裂霉素C.术后观察前房、滤过泡、眼内反应、眼压及视力等情况.随访6~12个月.结果眼压术后5~7天7眼在3.96~7.10 mmHg,其余太低测不出;术后1、3、6和12个月平均眼压分别为(12.34±3.81)、(14.68±3.73)、(15.75±4.14)和(17.13±6.15)mmHg,与术前相比差异有非常显著性(t值分别为16.08、14.89、13.83和10.24,P均<0.01).随访期间6眼眼压>21 mmHg,经术区激光周边虹膜成型或房角穿刺4眼恢复正常.术后早期全部可见滤过泡隆起,随访末期77.1%可见功能性滤过泡.并发症有小梁-后弹力膜穿孔、术区虹膜前粘连及小梁-后弹力膜纤维增生增厚.术后视力与术前相比均有不同程度改善.结论非穿透性小梁手术联合丝裂霉素C治疗开角型青光眼降眼压效果好,并发症少,是一种理想的手术方法.  相似文献   

6.
罗谦  程依琏 《国际眼科杂志》2011,11(12):2225-2226
目的:回顾总结非穿透性小梁切除联合透明质酸钠生物胶植入及丝裂霉素应用治疗开角型青光眼的疗效。方法:对20例24眼开角型青光眼施行非穿透性小梁切除手术,术中巩膜床植入透明质酸生物胶及应用丝裂霉素,术后随访12~36mo,观察眼压、视力、前房角、滤过泡等情况。结果:术后1,2,3a时眼压分别为16.32±5.25,17.28±5.70,18.26±5.20mmHg,与术前眼压35.52±7.6mmHg相比明显下降(P<0.01)。术后视力达到或高于术前水平22眼,视力下降2眼。术中、术后均未出现浅前房及前房炎症反应。24眼均有功能型滤过泡。结论:非穿透性小梁切除联合透明质酸钠生物胶植入及丝裂霉素应用能安全、有效地治疗开角型青光眼。  相似文献   

7.
目的 研究改良非穿透性小梁手术(NPTS)联合角膜基质透镜治疗开角型青光眼的临床效果及其术后随访中的作用。方法 回顾性病例对照研究。甘油冷冻保存角膜基质透镜[来源于临床治疗近视的飞秒激光微小切口角膜基质透镜切除术(SMILE)],在新疆四七四医院眼科就诊开角型青光眼患者。将2018年1月至2021年1月采用NPTS联合角膜基质透镜植入术治疗的45例(50只眼)设为观察组;将2006年1月至2007年1月采用NPTS联合透明质酸生物生物胶治疗的44例(50只眼)设为对照组。术后比较两组间视力、眼压、并发症及滤过泡形态,随访时间12个月评价综合临床疗效。随访时(1、3、6、12个月)进行眼前节照相、房角镜检查及超声生物显微镜(UBM)观察残留的小梁网-狄氏膜、巩膜池和滤过泡等情况,如果有滤过泡有包裹趋势,球结膜下5-氟尿嘧啶(5-FU)或行Nd:YAG激光房角穿孔术。结果 术前平均眼压:观察组(32.80±9.32)mmHg,对照组(33.00±8.34)mmHg,术后第1天眼压,观察组平均(8.53±2.70)mmHg,对照组平均(9.27±2.12)mmHg,其后观察组术后1 d、1周...  相似文献   

8.
目的:观察Q-开关Nd:YAG激光治疗闭角型青光眼的疗效。方法:收集212例236眼门诊及住院闭角型青光眼患者,其中原发性闭角型青光眼204例228眼,葡萄膜炎继发青光眼8例8眼,进行Q-开关Nd:YAG激光虹膜切除术,非接触压平眼压计测量眼压,观察Q-开关Nd:YAG激光虹膜切除术后临床效果。结果:随诊3~24mo,激光虹膜切除术治疗前眼压均值21.36mmHg,治疗后终末眼压均值19.25mmHg,眼压控制良好219眼,有效率92.8%,配合降眼压药物治疗,眼压控制正常11眼(4.7%),眼压升高6眼(2.5%),再次激光无效后行小梁切除术。激光治疗术后前房加深,房角有不同程度加宽,视野未明显改变。结论:Q-开关Nd:YAG激光虹膜切除术是一种治疗闭角型青光眼安全有效的方法。  相似文献   

9.
目的 评价掺钕钇铝石榴石(Nd:YAG)激光房角穿孔(laser goniopuneture,LGP)治疗改良黏小管切开扩张术(visco-canalostomy,VCO)后眼压升高的临床疗效及并发症.方法 选取VCO后高眼压的20例(23眼)原发性开角型青光眼患者为研究对象作回顾性分析.当VCO术后眼压>21 mmHg(1 kPa=7.5 mmHg)时,即在手术部位行LGP,观察术眼LGP术前、术后的眼压及术后并发症.结果 LGP术前平均眼压为(24.09±5.25)mmHg,术后1 h平均眼压降至(11.42±3.04)mmHg,激光后1周、1个月、3个月、6个月、12个月、24个月平均眼压分别为(12.32±2.54)mmHg、(12.43±2.52)mmHg、(12.96±3.42)mmHg、(14.52±2.70)mmHg、(15.04±2.92)mmHg、(16.20±3.06)mmHg,激光前后眼压比较差异有统计学意义(F=72.65,P< 0.01);术后3周1例(1眼)-过性低眼压性浅前房伴脉络膜脱离,术后随访12个月发现1例(1眼)发生虹膜嵌顿.术后24个月虹膜周边前粘连1例(1眼).结论 LGP能有效和安全地改善VCO后小梁网一后弹力膜的房水低滤过状态,降低眼压,降低再次手术率,是VCO的有效补充;LGP提高了VCO的远期手术成功率,是安全有效的治疗方式.  相似文献   

10.
Yin JF  Tong FF  Wu LL  Wu RY 《中华眼科杂志》2003,39(8):466-470
目的 观察深层巩膜切除联合激光小梁灼滤术治疗开角型青光眼的临床疗效。方法对 32例 (32只眼 )中、晚期开角型青光眼患者施行深层巩膜切除术 ,暴露Schlemm管外壁及残存的小梁网菲薄角膜缘组织 ,采取半导体激光器眼内用导光纤维 ,紧靠巩膜突前方小梁网角膜缘区域 ,直视下激光热灼击开 2或 3个圆形滤孔 ,滤孔直径 5 0 0 μm ,房水缓缓溢出。巩膜瓣缝合 1或 2针。术后观察患者眼压、眼内反应、滤过泡形态、前房角镜及超声生物显微镜 (UBM)检查结果。随访时间 4~ 2 4个月 ,平均 (7 94± 6 2 0 )个月。结果  32只眼术后早期前房形成良好 ,视力稳定。最终随访患者平均眼压 (14 86± 4 15 )mmHg(1mmHg =0 133kPa) ,明显低于术前 (2 9 6 8± 5 76 )mmHg ,差异有非常显著意义 (t=7 4 15 ,P <0 0 0 1)。术后 32只眼均形成明显弥散性滤过泡 ;随访期间 ,2 7只眼有功能性滤过泡 ,5只眼于术后 2~ 3个月功能性滤过泡消失。 2只眼术中虹膜轻微灼伤 ,出现前房一过性色素脱失和房水混浊 ;角膜与晶状体无激光性损伤。 2只眼术后眼压偏高 ,局部应用抗青光眼药物后眼压控制正常。结论 深层巩膜切除联合激光小梁灼滤术能有效降低眼压 ,无穿透性小梁切除术常见的严重并发症 ,是治疗开角型青光眼的有效术式之一。  相似文献   

11.
Purpose: This study aimed to investigate the safety and efficacy of Nd:YAG laser goniopuncture (LGP) in lowering intraocular pressure (IOP) after deep sclerectomy (DS). Methods: We reviewed the outcomes in 258 eyes of 258 consecutive patients who underwent DS or combined phacoemulsification and DS between August 2001 and December 2003. Mitomycin C was used during surgery in 192 eyes (74.4%). Results: Mean follow‐up was 40 ± 11 months after DS and 31 ± 12 months after LGP. Laser goniopuncture was performed in 173 eyes (67.0%). The mean interval between LGP and DS was 10.3 ± 8.7 months. The probability of LGP being performed was 63.1% (95% confidence interval [CI] 57.3–69.4) at 36 months after surgery. At 2 years after LGP, the probability of maintaining IOP < 15 mmHg with a 20% decrease from the pre‐laser IOP and no further glaucoma procedure or medication was 49.7% (95% CI 41.9–57.1). Iris covering the trabeculo‐Descemet’s membrane was the only factor significantly associated with the failure of LGP (hazard ratio 3.0, p < 0.001). Complications observed after LGP included peripheral anterior synechiae in 23 (13.2%), hypotony in seven (4.0%), late acute IOP rise in three (1.7%), delayed bleb leak in one and blebitis in two eyes. Argon laser iridoplasty was performed in 45 (26.0%) and needle revision in 41 (23.7%) eyes. Conclusions: ND:YAG laser goniopuncture is an effective procedure to further lower IOP after DS. An IOP of < 15 mmHg is achieved and maintained for ≥ 2 years in about 50% of cases after a single LGP procedure. There are potentially serious complications associated with the procedure. Regular gonioscopy is recommended following LGP to detect any occlusion of the goniopuncture by the iris.  相似文献   

12.
目的 研究非穿透性小梁手术(non-penetrating trabecular surgery,NPTS)联合透明质酸钠 凝胶或羊膜植入术治疗开角型青光眼的临床效果,并探讨前节OCT在NPTS术后随访中的作用.方法 临床病例自身对照研究.对2006年5月至2009年11月在温州医学院附属眼视光医院就诊的42例(48只眼)开角型青光眼患者进行NPTS联合透明质酸植入物或生物羊膜治疗,其中11只眼联合羊膜植入,37只眼联合透明质酸植入.术后观察视力、眼压、并发症及滤过泡形态.随访时间6~48月,平均(18.56±11.49)月.末次随访时进行前节OCT观察残留的小梁网-狄氏膜、巩膜池和滤过泡等情况.结果 术前最高眼压平均(38.38±10.60)mmHg,术后第1天眼压,平均(8.59±3.51)mmHg,末次随访眼压(19.91±9.28)mmHg,术后不同时间段眼压较术前相比均下降,差异有统计学意义(P<0.05).末次随访时视力与术前不变者36只眼(75.0%),视力下降者5只眼(10.4%),视力提高者7只眼(14.6%).末次随访时完全成功26只眼(54.2%),条件成功17只眼(35.4%),失败5只眼(10.4%).术后6只眼出现前房变浅,3只眼前房少许出血,均无明显前房炎性反应、持续性低眼压及脉络膜上腔出血等并发症发生.前节OCT可以清晰地观察到残留的小梁网-狄氏膜、巩膜池、巩膜瓣上液间腔、滤过泡壁厚度等.结论 NPTS联合透明质酸或生物羊膜植入物能较有效降低眼压,手术并发症少.前节OCT可以作为NPTS术后随访的一种安全无创的检查工具.
Abstract:
Objective To evaluate the effectiveness of non-penetrating trabecular surgery (NPTS)combined with reticulated sodium hyaluronate or amnion implant for open angle glaucoma and the value of anterior segment optical coherence tomography (AS-OCT) in the follow-up of NPTS. Methods NPTS was performed on 48 eyes of 42 patients, among whom 37 eyes with reticulated sodium hyaluronate implant, 11 eyes with amnion implant. Main outcome measures included visual acuity, intraocular pressure (IOP), filtering blebs and complications. The follow-up period was 6 to 48 months (mean 18.561 11.49 months). Anterior chamber OCT was undertaken to evaluate the rudimental trabecular reticulum-descement membrane, bleb and scleral cavity of the surgical site on the last follow-up time. Results The IOP was decreased from a mean preoperative value of (38.38±10.60) mmHg to a mean postoperative value of (8.59± 3.51) mmHg and (19.91± 9.28) mmHg on the first day and on the last visit respectively. Postoperative IOP at every visit point was lower than the preoperative value (P <0.01), 36 eyes (75.0%) remained stable visual acuity on the last visit compared with preoperative visual acuity, 5 eyes (10.4%) decreased and 7 eyes (14.6%) elevated. The complications such as inflammation, suprachoroidal hemorrhage and persistent hypotention were not observed except 6 flat chambers and 3 moderate anterior chamber hemorrhage. The completely successful rate on last visit was 26 eyes (54.2%),conditional successful rate was 17 eyes(35.4%)and failure 5 eyes(10.4%).The anterior segment OCT could be observed the rudimental trabecular reticulum-descement membrane,scleral cavity,suprascleral cavity and bled thickness,et al.Conclusions Non-penetrating trabecular surgery with reticulated sodium hyaluronate or amnion implant can effectively lower the IOP without severe complications.Anterior segment OCT is a safe and atraumatic tool for NPTS follow up.  相似文献   

13.
徐晋  梁亚  宗媛  袁志兰 《眼科》2010,19(5):337-339
目的对改良黏小管切开术(vcs)后高眼压的患者予Nd:YAG激光房角穿孔术(LGP)治疗,探讨其临床有效性及安全性。设计回顾性病例系列。研究对象改良VCS术后眼压升高,于表麻下行Nd:YAG激光房角穿孔术的26例患者(35眼)。方法对改良VCS术后随诊期间眼压高者在表麻下行Nd:YAG激光房角穿孔术。记录手术前后眼压、裂隙灯、房角镜、眼前节相干光断层成像(AS—OCT)检查结果,施行激光房角穿孔术的时间及手术成功率。主要指标眼压,房角镜、AS—OCT图像,激光时间。结果改良VCS术后平均眼压(23.3±8.2)mmHg,LGP术后平均眼压降至(17.6±6.3)mmHg。其中31眼(88.6%)眼压下降,4眼(11.4%)眼压升高。成功(眼压〈19mmHg,且较术前下降30%)15眼(42.9%)。长期随访(3个月~2年),15眼(42.9%)无须降眼压药物,20眼(57.1%)需联合降眼压药物才能降至靶眼压。2眼(5.7%)术后激光区域少量出血,l周后完全吸收。改良VCS术后3个月内行LGP者15眼(42.9%),3个月后行LGP者20眼(57.1%)。结论Nd:YAG激光房角穿孔术能有效降低改良VCS术后的眼压升高,安全性高,是其有效的补充。  相似文献   

14.
目的 观察YAG激光虹膜周边切开术联合非穿透性小梁切除术(NPDS)治疗单纯瞳孔阻滞型闭角型青光眼的疗效.方法 对2002年1月至2004年10月收治的21例(35只眼)单纯瞳孔阻滞型闭角型青光眼进行YAG激光虹膜周边切开术联合非穿透性小梁切除术,分析手术前后眼压的差异及术后各个随访期的手术成功率.随访期10~36月,平均(18.77±10.47)月.结果 术前平均眼压(25.57±4.92)mmHg,术后3月、6月、12月、24月和36月的眼压分别为(13.34±4.18)mmHg、(14.49±2.83)mmHg、(14.92±4.57)mmHg、(16.77±3.45)mmHg、(17.32±4.17)mmHg.术后3月、6月、12月、24月和36月的完全成功率分别为81.2%、78.1%、73.3%、69.0%、66.1%;部分成功率分别为82.4%、80.9%、74.7%、72.7%、70.1%.并发症有:微穿透6例,前房出血4例,低眼压3例,脉络膜脱离2例.结论 YAG激光虹膜周边切开术联合NPDS可作为治疗部分类犁的闭角型青光眼是安全有效地手术方式.  相似文献   

15.
We have devised a new glaucoma surgery combining deep sclerectomy with nonpenetrating trabeculectomy (NPT); we call this surgery advanced NPT. We evaluated intraocular pressure (IOP) control, postoperative complication and visual acuity after combined advanced NPT and phacoemulsification and intraocular lens implantation (combined surgery), and advanced NPT alone. The mean preoperative IOP for the trabeculectomy only group was 22.4 +/- 6.3 mmHg(bleb+), 23.0 +/- 4.9 mmHg(bleb-), and that of the combined surgery group was 18.1 +/- 4.5 mmHg(bleb+), 18.5 +/- 2.6 mmHg(bleb-). Mean postoperative IOP for the two groups were 13.0 +/- 2.3 mmHg(bleb+), 15.0 +/- 1.5 mmHg(bleb-) and 12.9 +/- 2.7 mmHg(bleb+), 13.3 +/- 2.4 mmHg(bleb-), respectively. After 15 months, the success probability for postoperative IOP control were 63%(bleb+), 23%(bleb-) in the advanced NPT only group (相似文献   

16.
目的 利用眼前节光学相干断层扫描(optical coherence tomography,OCT)观察正常眼压性青光眼(normal tension glaucoma,NTG)患者白内障手术后前房角形态和眼压的变化。方法 共有106例患者纳入本研究,其中单纯年龄相关性白内障患者67例67眼为对照组、NTG合并白内障患者43例43眼为观察组。2组患者均行白内障超声乳化吸出联合人工晶状体植入术治疗。在术前和术后1个月、6个月测量眼压、前节OCT检查房角,自动计算四个象限(颞侧、鼻侧、上方和下方)的中央前房深度(anterior chamber depth,ACD)、前房宽度(anterior chamber width,ACW)、房角开放距离 (angle open distance,AOD)、小梁虹膜空间面积(trabecular iris area,TISA)、房角隐窝面积(angle recess area,ARA)。比较手术前后两组患者眼压、房角参数的变化。结果 观察组术前眼压为(13.2±2.9)mmHg(1 kPa=7.5 mmHg),术后1个月、6个月眼压分别为(10.5±3.0)mmHg和(10.7±2.8)mmHg。对照组术前眼压为(12.4±2.8)mmHg,术后1个月、6个月眼压分别为(11.6±2.5)mmHg、(12.0±2.8)mmHg。观察组手术前后眼压比较差异有统计学意义(P<0.001)。两组患者手术后房角参数AOD、ARA和TISA均增加,房角参数的变化(颞侧ΔAOD500、ΔTISA500及鼻侧ΔAOD500、ΔARA500)与术后眼压变化呈线性相关。结论 白内障手术后可能改善房角参数,降低NTG患者的眼压。  相似文献   

17.
Nd:Yag goniopuncture after deep sclerectomy with collagen implant   总被引:9,自引:0,他引:9  
BACKGROUND AND OBJECTIVE: To study the need, the safety and the success rate of Nd:Yag goniopuncture in eyes that underwent deep sclerectomy with collagen implant. PATIENTS AND METHODS: The first 100 patients that underwent deep sclerectomy with collagen implant were prospectively followed. Deep sclerectomy with collagen implant is a non-penetrating filtering surgery which allows filtration of aqueous from the anterior chamber to the subconjunctival space through a remaining trabeculo-Descemet's membrane without opening the anterior chamber. Goniopunctures with Nd:Yag laser were performed at the site of surgery when the filtration through the trabeculo-Descemet's membrane was considered to be insufficient with elevated intraocular pressure. The laser treatment was performed using a Lasag 15 gonioscopy contact lens (CGA1). Goniopunctures were performed using the free-running Q-switched mode with an energy ranging from 2 to 4 mJ. RESULTS: Of 100 patients who underwent deep sclerectomy with collagen implant, goniopunctures with Nd:Yag laser were performed in 41 patients (41%). The mean time between deep sclerectomy with collagen implant and goniopuncture was 9.9 months +/-1.2 months (+/-SE). The mean IOP before laser treatment was 22.2 mm +/-7.0 mm Hg and decreased to 12.5 mm +/-5.8 mm Hg immediately after laser treatment and remained stable for the next 2 years of follow-up. The immediate success rate of goniopuncture was 83%. Choroidal detachment occurred in two patients (5%). CONCLUSION: Nd:Yag goniopuncture is an efficient and safe treatment for low filtration through the trabeculo-Descemet's membrane after deep sclerectomy with collagen implant.  相似文献   

18.
王涛  王宁利 《眼科》2007,16(1):37-39
目的研究选择性激光小梁成形术(SLT)治疗原发性开角型青光眼的安全性和有效性。设计回顾性病例系列。研究对象47例62眼早期原发性开角性青光眼患者。方法所有患者应用Q开关、倍频532 nm、Nd:YAG激光器(Selecta Duet型)行SLT治疗,范围下方房角180度,50个点,单脉冲能量0.5~1.4mJ。激光手术前后抗青光眼药物保持不变。随访12个月。主要指标眼压与并发症。结果在62眼中有72.5%眼压控制。SLT术前平均眼压(24.3±3.7)mmHg,手术后12个月的平均眼压(19.1±3.9)mmHg,眼压的下降差异有统计学意义(P<0.001)。所有病例在手术后1小时均出现轻度前房炎症反应,3天后消失。结论SLT治疗早期原发性开角型青光眼随访一年是安全有效的。(眼科,2007,16:37-39)  相似文献   

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