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1.
目的:观察激光光凝术治疗阈值前Ⅰ型和阈值期早产儿视网膜病变(ROP)的临床效果,分析光凝术后病变进展的影响因素。方法:回顾分析激光光凝治疗ROP患者46例89眼,其中阈值前Ⅰ型57眼,阈值期32眼。采用810nm激光对周边视网膜无血管区进行光凝治疗。根据光凝术后结果分为病变消退组和进展组。随访视网膜解剖结构和ROP病变的变化,分析ROP病变部位、病变程度、光凝点数量、机械辅助呼吸、败血症、新生儿肺炎等因素与光凝术后病变进展的相关性。结果:ROP89眼经激光光凝治疗后病变完全消退79眼(89%),病变进展10眼(11%)。光凝治疗ROP病变消退组与进展组比较,出生胎龄、出生体重、首次光凝校正胎龄差异无统计学意义(P=0.668,0.495,0.143)。病变进展组的Ⅰ区病变、阈值病变、急性进展性后极部早产儿视网膜病变(AP-ROP)、光凝点数量均较病变消退组明显增加,差异有统计学意义(P=0.035,0.017,0.000,0.031)。Logistic回归分析结果显示,AP-ROP与光凝术后病变进展有关(P=0.001)。AP-ROP患眼光凝术后病变进展的可能性是非AP-ROP患眼的12.167倍(95%CI:2.733~54.154)。结论:激光光凝术能有效控制早期ROP的病变进展,使大部分阈值前Ⅰ型和阈值期ROP病变完全消退。急性进展性后极部早产儿视网膜病变光凝术后容易发生视网膜脱离,是影响光凝术后疗效的最主要因素。  相似文献   

2.
目的 研究早产儿视网膜病变(ROP)发病情况及相关的危险因素,探讨其合理的筛查标准.方法 对出生体重≤2500g,胎龄≤37周患儿进行ROP筛查,并行相关因素分析.结果 共筛查275例符合条件的早产儿,发现ROP38例(13.82%);出生体重≤1500g组,~2000g组,~2500g组患病百分比有显著性差异(P<0.05);出生胎龄≤30周组,~32周组,≥33周组间ROP患病百分比有显著性差异(P<0.05);ROP早产儿的吸氧时间明显高于无ROP组(Z=5.292,P=0.000),需要机械辅助呼吸的早产儿发生ROP者较多(x2=30.597,P=0.000),多胎与单胎间发生ROP的差异无统计学意义(x2=0.748,P=0.387),ROP发病与出生胎龄、出生体重、吸氧时间、机械辅助呼口等因素相关.结论 出生体重越低,出生胎龄越小,吸氧时间较长,需要机械辅助呼吸的早产儿,ROP患病率越高.早产儿应及时检查眼底,尽早发现ROP.  相似文献   

3.
多胎早产儿视网膜病变的分析研究   总被引:2,自引:1,他引:2  
王志立  董应丽 《眼科研究》2008,26(3):228-230
目的 分析多胎早产儿视网膜病变(ROP)的发病率、危险因素及预后状况.方法 使用双目间接检眼镜对多胎早产儿36例、单胎早产儿90例进行眼底检查,结果 进行统计学分析,随访半年,观察预后.结果 多胎早产儿中,发现ROP 20例,发病率为55.6%,其中ROP 1期4例,ROP 2期6例,ROP 3期7例,均达到阈值病变,阈值病变占ROP的35%,其中双眼患儿5例,ROP 5期3例.ROP患儿出生体重为(1.21±0.36)kg(t=4.012,P<0.05);孕周为(30±3.5)周(t=2.56,P<0.05);吸氧时间为5~25 d,平均18 d;机械辅助呼吸患儿12例(χ2=7.33,P<0.05).上述指标与单胎ROP患儿比较,差异均有统计学意义.所有未达到阈值期的患儿、部分间接激光治疗术后患儿,视功能良好,但ROP 5期病例预后不理想.结论 孕周少、出生体重低、使用机械辅助吸氧是多胎早产儿ROP发病的高危因素.  相似文献   

4.
目的 探讨早产儿视网膜病变(retinopathy of prematurity,ROP)发病的临床特点及相关的危险因素.方法 筛查出生体质量≤2500 g、胎龄≤37周的315例早产儿,分析其ROP的临床特点.结果 315例(630眼)患儿中发生ROP42例(84眼,13.33%);ROP患儿胎龄为(29.79 ±2.29)周,非ROP患儿胎龄为(32.81±1.88)周,二者差异具有显著统计学意义(P<0.001);ROP患儿出生体质量为(1 440.00±359.57)g,明显低于非ROP患儿(1 863.65±347.38)g(P<0.001);吸氧患儿ROP 36例(18.27%)明显高于未吸氧惠儿6例(5.08%;X2=11.110,P=0.001);需要机械辅助呼吸的早产儿发生ROP者(29.47%)比不需机械辅助呼吸患儿(6.36%)多(X2=30.665,P=0.000);多胎6例(9.68%)与单胎36例(14.23%)间发生ROP的差异无统计学意义(X2=0.893,P=0.345).结论 ROP发病与出生胎龄、出生体质量、吸氧时间、机械辅助呼吸等因素相关.早产儿应及时行规范的眼底检查,尽早发现ROP,及时治疗.  相似文献   

5.
早产儿383例ROP筛查情况分析报告   总被引:1,自引:0,他引:1  
目的:分析泉州地区早产儿视网膜病变(retinopathy of prematurity,ROP)发病情况及高危因素.方法:回顾2010-10/2011-09在我院NICU及眼科门诊进行视网膜病变筛查的383例早产儿眼底情况,并进行汇总分析.结果:在筛查的383例早产儿中,发现ROP患儿53例(13.8%),均为双眼发病;其中阈值前Ⅰ型及阈值期病变光凝治疗22例(5.7%);发展为5期病变1例(0.3%);急进型2例(0.5%).数据显示ROP的发病率及严重程度与出生体质量及胎龄呈负相关;尤其出生体质量与ROP的发生关系密切.结论:低出生胎龄和体质量是ROP发生的根本性高危因素,对于低胎龄、低体质量的高危早产儿应规范进行眼底筛查.  相似文献   

6.
目的 比较多波长氩离子激光治疗急进性与阈值期或阈值前期早产儿视网膜病变(retinopathy of prematurity,ROP)的临床效果.方法 临床病例回顾性对照研究.对2008年5月至2010年12月在白求恩第一医院眼科接受氩离子激光治疗的48例(94只眼)患有ROP患儿的临床资料.将其分为两组,一组:急进性早产儿视网膜病变(AP-ROP)组;二组:阈值期或阈值前期早产儿视网膜病变组.将两组ROP患儿采用多波长氩离子激光治疗的疗效及两组间各相关因素进行比较研究.结果 48例(94只眼)患儿中18例(36只眼)为AP-ROP,治愈率88.89%;30例(58只眼)为阈值期或阈值前期ROP,治愈率94.83%,两组ROP患儿的治愈率比较差异无统计学意义(x2=1.17,P=0.286,P>0.05).两组间各相关因素比较,新生儿呼吸窘迫综合征(x2=11.27,P<0.05)及早产儿贫血(x2=7.27,P<0.05)两组间差异具有统计学意义.患儿的性别、胎龄、激光治疗时矫正胎龄、出生体重、败血症、新生儿肺炎、先天性心脏病等因素两组间差异无统计学意义.结论 氩离子激光治疗AP-ROP及阈值期或阈值前期ROP是安全且有效的,AP-ROP激光治疗治愈率较阈值期或阈值前期ROP低,新生儿呼吸窘迫综合征及新生儿贫血是影响ROP患儿激光光凝治愈率的危险因素.  相似文献   

7.
北京早产儿视网膜病变筛查和高危因素分析   总被引:6,自引:5,他引:6  
目的 了解我国早产儿视网膜病变(ROP)防治指南出台后,北京新 生儿监护病房(NICU)中ROP的 发病率和全身高危因素。方法 对2005年1月1日至2005年12月31日在北 京六家医院NICU 住院的胎龄≤34周或体重≤2000 g的早产儿进行ROP筛查,同时对其全身的情况进行记录 ,分析ROP发生的相关因素。结果 六家医院NICU符合筛查标准 并完成ROP筛查的患 儿639例中,发现ROP患儿69例,占10.8%。69例ROP患儿中,达到阈值或阈值前病变1型需要 进行眼底激光光凝治疗者23例39只眼,占3.6%。ROP发生的相关因素分析发现,出生体重越 低,出生孕周越小,ROP发病率越高。相关因素的Logistic回归分析结果表明,低出生体重 、贫血、呼吸暂停>20 s、缺血缺氧脑病和胎盘早剥是ROP形成的高危因素。结论 ROP防治指 南出台后,北京NICU中ROP发生率10.8%。低出生体重、贫血、呼吸暂停>20s,缺血缺氧脑 病和胎盘早剥是ROP形成的高危因素。  相似文献   

8.
目的了解我院早产儿视网膜病变(retinopathy of prematurity,ROP)的发病状况,并对其相关危险因素进行分析探讨。方法对2007年1月至2008年11月在我院出生的124例(248只眼)早产儿(出生体重≤2500g或胎龄≤35周)进行ROP的筛查。所有患儿瞳孔散大后,通过巩膜外顶压详细检查患儿视网膜情况。按照ROP国际分类法的规定记录检查结果。将患儿全身状况及吸氧、母孕期吸氧、先兆子痫、胎盘早剥等因素进行统计。结果 124例患儿全部完成了眼底筛查,在周边视网膜血管化或病变退化后终止随访。9例(13只眼)出现ROP,发生率分别占患儿例数和眼数的7.26%和5.24%。其中6例(8只眼)ROP患儿未达到阈值前病变,3例(5只眼)为阈值前Ⅰ型病变,此3例ROP患儿给予间接检眼镜视网膜激光光凝术。所有激光治疗患儿术后随访观察,直至膜病变静止、消退,均未出现视网膜脱离。母孕期吸氧、先兆子痫、胎盘早剥等因素与ROP发病无关。结论低体重是ROP发生的最重要因素。对早产儿适时进行ROP筛查,并对发现的ROP早期进行有效视网膜激光光凝术,可控制病变,降低早产儿的致盲率。  相似文献   

9.
目的 观察早产儿视网膜病变(ROP)患儿视网膜激光光凝治疗后的视网膜功能发育状况.方法 对30例患阈值期ROP并成功接受视网膜激光光凝治疗的早产儿(病例组)和30例无ROP早产儿(对照组)进行闪光视网膜电图(F-ERG)检查,记录视杆细胞反应、视锥细胞反应、最大混合反应及振荡电位.结果 与对照组比较,病例组视杆细胞反应...  相似文献   

10.
二极管激光光凝治疗早产儿视网膜病变   总被引:5,自引:1,他引:4  
目的 探讨二极管激光光凝治疗早产儿视网膜病变(retinopathy of prematurity,ROP) 的效果。 方法 68例出生时妊娠期不足32周、体重小于1500 g 的早产儿,出生后6~7周开始ROP检查,确诊ROP阈值病变后48 h内均给予经瞳孔二极管激光光凝治疗,激光光凝治疗后随访4~ 6个月。1只眼因激光光凝治疗后1个月发现局部视网膜脱离,给予巩膜环扎手术治疗。手术后随访3个月。确诊ROP阈值病变眼均在出生后4个月时进行屈光状态的散瞳检影检查。 结果 6例12只眼 发现ROP阈值病变。发生ROP阈值病变的年龄平均为生后(10±2.89)周 (6~14周)。经瞳孔二极管激光光凝治疗后,ROP解剖治愈(视网膜在位)率91.67%;巩膜环扎手术眼手术后随访视网膜在位。散瞳检影检查巩膜环扎手术眼屈光度为-14.50 D,其余11只眼等值球镜平均为(-2.89±-1.86) D。 结论 二极管激光光凝可成功地治疗ROP阈值病变。 (中华眼底病杂志,2003,19:96-98)  相似文献   

11.
Laser photocoagulation for stage 3+ retinopathy of prematurity   总被引:8,自引:0,他引:8  
Twenty-two infants with "threshold" stage 3+ retinopathy of prematurity (ROP) were entered into a prospective, randomized clinical trial to compare the efficacy of transscleral cryotherapy versus laser photocoagulation delivered by the indirect ophthalmoscope. Eighteen infants have been followed for at least 3 months. Fifteen of 16 eyes randomized to laser and 9 of 12 eyes randomized to cryotherapy showed regression. The results suggest that laser therapy is as effective as cryotherapy in the treatment of ROP (P = 0.285).  相似文献   

12.
PURPOSE: To study the efficacy of indirect diode laser photocoagulation and cryotherapy in prethreshold retinopathy of prematurity (ROP). METHODS: Thirty-six eyes of 18 premature infants less than 34 weeks gestational age and/or less than 1600 g birth weight with prethreshold ROP were prospectively randomized to treatment with either indirect laser photocoagulation or cryotherapy. Prethreshold ROP was defined as any stage of ROP in zone I with plus disease; or stage 3 with three or more contiguous clock hours or five or more total clock hours of involvement of retina in zone II with plus disease but less than threshold disease. Regression of the ROP was assessed for a minimum period of 6 months. RESULTS: Regression of ROP occurred in all 36 eyes (100%) in both groups. CONCLUSIONS: Excellent results are achieved if ROP is treated at the prethreshold stage with both indirect laser photocoagulation and cryotherapy. Although laser has definite advantages, cryotherapy can be considered as an alternative modality of treatment in developing countries due to economic reasons.  相似文献   

13.
目的 了解超低出生体重儿早产儿视网膜病变(ROP)发病情况,探讨其相关危 险因素。方法 回顾分析ROP筛查的出生体重不足1000 g早产儿共145例。其中,男性93例,女性52例;平均胎龄(28.5±2.0)周,平均出生体重(923.0±85.0) g。统计时,诊断以随访过程中出现的最重ROP病情为录入标准,双眼非对称病例以发病严重侧为录入标准。以是否发生ROP将患儿分为ROP组和非ROP组,ROP组患儿再分为轻症组和重症组。轻症组包括1、2期ROP,未达阈值的3期ROP,以及以上各期ROP发生的瘢痕病变;重症组包括阈值前1型、阈值、急进性后部型以及4、5期ROP。将胎龄>28周或≤28周、出生体重<750 g或≥750 g、胎数单胎或多胎、分娩方式顺产或剖宫产、性别男或女作为危险因素,运用SPSS 13.0进行统计学分析。结果145例出生体重不足1000 g的早产儿中,96例发生不同程度的ROP,占66.21%。其中,重症患儿59例,重症ROP发生率为40.69%。ROP组和非ROP组胎龄(χ2=15.021, P=0.000)、胎数(χ2=4.744,P=0.029)、分娩方式(χ2=11.848,P=0.001)间差异有统计学意义(P<0.05);轻症组和重症组胎龄间差异有统计学意义(χ2=7.588,P=0.006)。Logistic回归分析显示,仅胎龄与ROP的发生相关[Exp(B)=0.328 07,P=0.005 197]。结论 超低出生体重儿具有ROP发生率以及重症率高的特点。胎龄≤28周、顺产、多胎是ROP发病危险因素。  相似文献   

14.
PURPOSE: Our purpose was to determine the incidence of cataract after argon laser photocoagulation of the retina in infants with retinopathy of prematurity (ROP). METHODS: We reviewed medical records of 189 consecutive infants undergoing argon laser photocoagulation for acute ROP between 1993 and 1996. Birth weight, estimated gestational age at birth, chronologic and postconceptional ages at the time of treatment, ROP outcome, and the postoperative occurrence of cataract were recorded. RESULTS: A total of 374 eyes in 189 infants were treated for threshold ROP. Mean birth weight was 916 gm (range 480 to 2500 gm), mean postconception age at birth was 26.4 weeks (range 23.5 to 34 weeks), and mean postconception age at surgery was 36.2 weeks (range 33 to 47 weeks). A favorable anatomic outcome occurred in 90% of eyes. However, severe macular traction, macular fold, or retinal detachment developed in 10% of eyes. A total of four eyes (1%) had cataracts. Laser-induced cataracts were diagnosed in only two eyes. A third eye had a posterior subcapsular cataract that may or may not have resulted from the laser treatment. In a fourth patient a unilateral punctate opacity judged to be visually insignificant was noted at surgery but it was not progressive. All patients who had cataracts had a persistent tunica vasculosa lentis; however, there was no statistically significant difference in the incidence of cataract formation in eyes with persistent tunica vasculosa lentis compared with eyes without it (p = 0.057). CONCLUSION: Argon laser photocoagulation remains an effective alternative to transscleral cryotherapy in the treatment of threshold ROP. The incidence of cataract formation is approximately 1% and may be more likely to occur when persistent hyaloidal vessels are present on the lens.  相似文献   

15.
目的 观察早产儿视网膜病变(ROP)发生发展特点、危险因素及冷冻治疗疗效,探讨其合 理的筛查时机及治疗模式。方法 采用间接检眼镜合并巩膜压迫器加压 的方法对829例胎龄 ≤35周,体重≤2000g的早产、低体重儿进行ROP筛查;对32例阈值前病变Ⅰ型及阈值 病变患 儿行视网膜冷冻手术治疗。手术后随访3~16个月,以附加(plus)病变消退,血管嵴消退,冷冻斑形成,玻璃体视网膜出血吸收及无视网膜不良结构出现作为病情控制指标;若有病变遗漏区、血管嵴发展或附加病变不消退甚至加剧者则再次冷冻;若玻璃体积血不吸收,病情仍进展,发展 为视网膜皱 襞或脱离者则行玻璃体切割手术。结果 发现ROP86例172只眼。ROP各组与未发生ROP组吸氧时 间有显著性差异;出生体重≤1000 g、1001~1500 g、1501~2000 g的早产儿ROP发病比例 分别为69.56%、16.38%、4.14%;出生胎龄≤30周、31~32周、33~35周的早产儿ROP发病 比例分别为37.14%、10.43%、2.91%;单生子早产儿中ROP患病率为7.52%,双生子及 多生子早产儿中ROP患病率为20.22%。32例接受视网膜冷冻手术治疗的患儿,30例病情控制 满意, 2例病情发展为视网膜脱离,伴有后部附加病变,周边视网膜出血。32周内发病患儿 冷冻手术成功机 率高。 结论吸氧时间长、出生体重≤1000 g,胎龄≤30周ROP发病 风险显著增高,建议加强筛查。32周内发病或伴后部附加病变、周边视网膜出血的ROP患儿要严密随访;阈值前病变Ⅰ型及阈值病变行视网膜冷冻手术效果满意且安全。  相似文献   

16.
目的:观察早产儿视网膜病变(retinopathy of prematurity,ROP)阈值前病变I型及阈值病变的冷冻治疗疗效,探讨其合理的治疗时机及模式。方法:对胎龄≤35wk,质量≤2000g患儿进行ROP筛查,对阈值前病变I型及阈值病变进行冷冻治疗。结果:(1)共筛查829例符合条件的早产儿,发现早产儿视网膜病变患儿86例(172眼,占10.4%),如按照中华眼科学会制定的ROP筛查标准(出生胎龄≤35wk,质量≤2000g)则患病率为20.6%;其中4期6眼(3.5%),3期44眼(25.6%),发展快的2期14眼(8.1%),稳定或退行2期56眼(32.6%),1期52眼(30.2%);24眼有后部plus现象,58眼周边视网膜出血;50眼2区发病,122眼3区发病;32wk及以内发病的16眼,32~36wk发病的60眼,36wk及以后发病的96眼;(2)行冷冻手术32例(64眼),其中阈值前病变I型12例,阈值病变20例;24眼有后部plus现象;40眼周边视网膜出血;50眼2区发病,14眼3区发病;32wk及以内发病的16眼,32~36wk发病的36眼,36wk及以后发病的12眼;单生子21例,双生子10例,三生子1例;(3)30例病情控制满意;1例发展为后极部视网膜皱襞,周边视网膜脱离,最后行玻璃体切割手术;2例玻璃体出血,其中1例出血吸收,1例最后牵引性视网膜脱离;(4)3例术后短期角膜水肿,5例眼睑冻伤,2例玻璃体出血。结论:(1)后部plus现象、周边视网膜出血、2区发病、32wk内发病的ROP是高风险病变,病情发展迅速,往往需要行手术治疗;(2)对阈值前病变及阈值病变及时行视网膜冷冻术效果较满意且安全。  相似文献   

17.
目的 了解湖北地区早产儿视网膜病变(ROP)的发病情况以及相关影响因素。方法 2009年7月至2011年5月对出生胎龄<37周的313例早产儿的626只眼采用双目间接检眼镜和二代广角数码视网膜成像系统(RetcamⅡ)进行了ROP筛查。其中,男性200例, 女性113例。出生体重890~3500 g,平均出生体重(1977.37±497.03) g。出生胎龄26~37周,平均出生胎龄(33.13±2.44)周。根据筛查结果分为ROP组和无ROP组。所有ROP患儿均随访至视网膜完全血管化;如视网膜未能完全血管化则随访至视网膜情况稳定或进行激光光凝治疗。同时对两组间性别、出生胎龄、出生体重、妊娠年龄、分娩方式、试管婴儿、多胎妊娠、孕期吸氧、宫内缺氧、子痫、先兆流产、婴儿吸氧史、呼吸窘迫综合征、缺血缺氧性脑病、黄疸、蓝光照射治疗等相关因素进行统计学分析。结果313例626只眼中,ROP组52例87只眼,分别占早产儿人数及眼数的16.61%和13.90%。其中,急进性后部型ROP 2只眼;1期38只眼;2期36只眼;3期11只眼。无ROP组261人539只眼,分别占受检早产儿人数及眼数的83.39%和86.10%。接受激光光凝治疗20只眼。统计学分析结果显示,ROP组和无ROP组在出生胎龄(t=-4.348)、出生体重(t=-3.966)、婴儿吸氧史(χ2=9.05;比值比=3.403,95%可信区间1.475~7.854)间比较,差异有统计学意义(P<0.05)。性别、妊娠年龄、分娩方式、试管婴儿、多胎妊娠、孕期吸氧、宫内缺氧、子痫、先兆流产、呼吸窘迫综合征、缺血缺氧性脑病、黄疸、蓝光照射治疗两组比较,差异无统计学意义(P>0.05)。结论湖北地区ROP发生率为16.61%;出生胎龄、出生体重、婴儿吸氧史是影响ROP发病率的重要影响因素。  相似文献   

18.
The hypothesis that both perinatal events and stage of retinal development are important factors in determining the age at onset of retinopathy of prematurity (ROP) was tested by comparing gestational age at birth with postnatal and postconceptional age when ROP (using ICROP) was first seen. The study population consisted of 207 infants (111 placebo (P) treated, 96 vitamin E (E) treated) who developed ROP among a group of 914 premature infants (460 P, 454 E) enrolled in a randomised clinical trial of the effect of prophylactic use of vitamin E at pharmacological serum levels on incidence and severity of retinopathy. The mean postnatal age at onset of retinopathy was delayed in E treated infants compared with P treated infants by 1.4 weeks (t = 4.004, p < 0.0001). For both P and E treated infants postnatal age at onset of ROP (which reflects the state of retinal development at which birth insults occur) and postconceptional age at onset of ROP which defines state of maturity) were correlated with gestational age at birth. This suggests that both the event of premature birth and the extent of retinal development are important in determining when ROP will first be observed.  相似文献   

19.
BACKGROUND: Visual outcome studies have shown that laser photocoagulation may result in more favourable clinical outcomes than cryotherapy in threshold retinopathy of prematurity (ROP). Comparative refractive outcome studies have shown that patients treated with laser photocoagulation have less myopia than those treated with cryotherapy. We carried out a study to determine whether a difference in visual outcome or refraction exists in patients with threshold ROP who have been treated with cryotherapy vs. laser photocoagulation. METHODS: A retrospective cohort study was conducted comparing treatment results after at least 3 years of follow-up in patients with threshold ROP treated with cryotherapy or laser photocoagulation at a tertiary care children's hospital. Visual acuity and refraction were the outcomes studied. Covariates measured were sex, gestational age and birth weight. Analysis was performed with both bivariate analysis and multivariate models. RESULTS: Seventy-one eyes of 37 patients with threshold ROP were included in the study. Thirty-seven eyes received cryotherapy, and 34 eyes received laser photocoagulation. The mean spherical equivalent refraction was significantly lower in the cryotherapy group than in the laser photocoagulation group (-9.21 dioptres vs. -1.80 dioptres, p = 0.001). Patients in the cryotherapy group were more likely than those in the laser photocoagulation group to have against-the-rule astigmatism (odds ratio 6.86, p = 0.004). Laser photocoagulation did not significantly lower the frequency of an unfavourable visual outcome (visual acuity worse than 20/200) (p = 0.09). INTERPRETATION: Eyes with threshold ROP treated with laser photocoagulation were significantly less myopic and less likely to have against-the-rule astigmatism than those treated with cryotherapy.  相似文献   

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