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From the Desk of Editor in Chief 总编辑的办公桌上
Pub Date : 2020-03-22 DOI: 10.3329/jss.v22i2.44232
Salma Sultana
Abstract not available Journal of Surgical Sciences (2018) Vol. 22 (2) : 142
《外科科学杂志》(2018)Vol. 22 (2): 142
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引用次数: 5
Marching to the eighth edition. What is new in the ajcc cancer staging system? 迈向第八版。ajcc癌症分期系统有什么新进展?
Pub Date : 2020-03-22 DOI: 10.3329/jss.v21i2.43897
Md. Mizanur Rahman
Abstract not available Journal of Surgical Sciences (2017) Vol. 21 (2) : 61-63
外科科学杂志(2017)Vol. 21 (2): 61-63
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引用次数: 0
Short-term outcome of Laparoscopic Appendicectomy and Open Appendicectomy in acute appendicitis- a comparative study 腹腔镜阑尾切除术与开放式阑尾切除术治疗急性阑尾炎的近期疗效比较研究
Pub Date : 2020-03-22 DOI: 10.3329/jss.v21i2.43899
Mashfique Ahmed Bhuiyan, M. A. Bashar, A. Rahman, Md Aminul Islam, Kazi Majharul Lslam, M. Murshed, A. Alam
Background: Appendectomy, though being performed by both open and laparoscopic methods, there is a lack of consensus regarding which is the most appropriate method. This study will document important variables and parameters to compare therapeutic benefit of laparoscopic Appendectomy (LA) and open Appendectomy (OA). Objective: The study aimed at comparing the short- term outcome of laparoscopic Appendectomy and open appendectomy in cases of acute appendicitis, in terms of postoperative pain and complications, hospital stay, recovery and return to normal activities. Methods: Whenever there was clinical suspicion of acute appendicitis, the patient was admitted to hospital, relevant history was recorded and clinical examination was conducted, necessary laboratory and imaging studies were performed and patient satisfying the inclusion and exclusion criteria was included in the study. The Appendectomy procedure was attended by the investigator and all relevant perioperative data were recorded. Results: Post-operative pain was mostly mild in LA group (40%), while in OA, it was mostly severe (38%) and moderate (34%). Postoperative complications were significantly higher in OA than in LA. Hospital stay was longer in OA (7.03 days) than LA (3.49 days). Early recovery and return to full normal activity was noted in LA (5.56 days) than in OA (11.26 days). Moreover, operative time was shorter in LA (56.37 min), than in OA (71.86 min). Conclusion: Laparoscopic Appendectomy have clear advantages over open Appendectomy in respect to short term results. Journal of Surgical Sciences (2017) Vol. 21 (2): 70-75
背景:阑尾切除术虽然采用开放和腹腔镜两种方法,但对于哪种方法最合适缺乏共识。本研究将记录重要的变量和参数来比较腹腔镜阑尾切除术(LA)和开放式阑尾切除术(OA)的治疗效果。目的:比较急性阑尾炎腹腔镜阑尾切除术与开放式阑尾切除术的近期疗效,包括术后疼痛和并发症、住院时间、恢复和恢复正常活动。方法:凡临床怀疑为急性阑尾炎的患者均入院,记录病史并进行临床检查,进行必要的实验室和影像学检查,并将符合纳入和排除标准的患者纳入研究。研究者参与了阑尾切除术,并记录了所有相关的围手术期数据。结果:LA组术后疼痛多为轻度(40%),OA组术后疼痛多为重度(38%)和中度(34%)。OA术后并发症明显高于LA。OA组住院时间(7.03 d)较LA组(3.49 d)长。LA患者(5.56天)比OA患者(11.26天)更早恢复并完全恢复正常活动。此外,LA的手术时间(56.37 min)短于OA (71.86 min)。结论:腹腔镜阑尾切除术在短期效果上明显优于开放式阑尾切除术。外科杂志(2017)Vol. 21 (2): 70-75
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引用次数: 0
Incidence of non biliary non alcoholic acute pancreatitis in a tertiary hospital 某三级医院非胆源性非酒精性急性胰腺炎发病率分析
Pub Date : 2020-03-22 DOI: 10.3329/jss.v21i2.43911
M. Rahman, Hma Rouf, Mahjabeen Rahman, M. Islam, Mohammad Ehasun Uddin Khan, F. Afroz
Background: Acute pancreatitis is an important cause of hospital admission with acute abdomen. It is responsible for significant morbidity and also mortality in patients. Objective: To determine the incidence of non-biliary nonalcoholic acute pancreatitis (Non A non B) and also to compare the incidence with alcoholic and biliary pancreatitis in the department of surgery of Chittagong Medical College Hospital, Bangladesh as well as with the developed countries Methods: This prospective study was carried on 75 patients of both sex having acute abdominal pain characteristic of acute pancreatitis and serum amylase >3 times normal, admitted in General Surgery wards in CMCH and supported by biochemical test during June 2008 to May 2010. Results: The mean (±SD) age was 36.1±15.4 years and 32.7±14.3 years in male and female group respectively (p>0.05) and maximum number was found in the age group of 20-30 years in both groups. Choledocolithiasis were 2(33.3%) and 7(21.9%) in male and female respectively evaluated by USG. Sludge in GB 1(16. 7%) in male and 7(21.9%) in female. Biliary ascariasis 3(50.0%) and 16(50.0%) in male and female respectively. Alcoholic was found 4(16.0%), Biliary 2(8.0%) and Non Alcoholic non Biliary 19(78.0%) in male patients. Biliary 32 (64.0%) and Non Alcoholic non Biliary 18(36.0%) in female patients. The difference was statistically significant (p<0.05). It was observed that the total patients were 75 among them Alcoholic was 4(5.3%), Biliary was 34(45.3%) and Non Alcoholic non Biliary was 37(49.3%) of study patients. Conclusion: Non-A non-B acute pancreatitis accounts for about a half - of all cases of acute pancreatitis and is significantly less frequent among female patients. Biliary pancreatitis was higher in female subjects. Bilio pancreatic ascariasis is 50.0% in both male and female subjects. Journal of Surgical Sciences (2017) Vol. 21 (2): 85-88
背景:急性胰腺炎是急腹症住院的重要原因。它是造成患者发病率和死亡率的主要原因。目的:了解非胆道性非酒精性急性胰腺炎(Non - A - Non - B)的发病率,并比较孟加拉国吉大港医学院附属医院外科的酒精性和胆道性胰腺炎发病率与发达国家的比较。本前瞻性研究选取2008年6月至2010年5月在中院普通外科病房就诊并有生化检查支持的75例以急性胰腺炎为特征的急性腹痛患者,男女均有,血清淀粉酶为正常的3倍。结果:男性和女性的平均(±SD)年龄分别为36.1±15.4岁和32.7±14.3岁(p < 0.05),且以20 ~ 30岁年龄组最多。USG检测男性胆总管结石2例(33.3%),女性胆总管结石7例(21.9%)。GB 1中的污泥(16)。男性占7%,女性占21.9%。胆道蛔虫病男3例(50.0%),女16例(50.0%)。男性患者酒精性4例(16.0%),胆道性2例(8.0%),非酒精性19例(78.0%)。胆道32例(64.0%),非酒精性非胆道18例(36.0%)。差异有统计学意义(p<0.05)。共75例,其中酒精性4例(5.3%),胆道性34例(45.3%),非酒精性非胆道性37例(49.3%)。结论:非甲非乙急性胰腺炎约占所有急性胰腺炎病例的一半,在女性患者中发生率明显较低。胆道性胰腺炎在女性受试者中较高。胆道胰腺蛔虫病男女患病率均为50.0%。外科杂志(2017)Vol. 21 (2): 85-88
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引用次数: 0
POSTOPERATIVE BLEEDING AFTER LAPAROSCOPIC GASTRIC-SLEEVE: WHAT OPTIONS DO WE HAVE? 腹腔镜胃袖术后出血:我们有什么选择?
Pub Date : 2020-01-24 DOI: 10.33695/JSS.V7I1.292
I. Slavu, Tulin Adrian, D. Păduraru, Socea Bogdan, Braga Vlad, Alecu Lucian
Laparoscopic sleeve gastrectomy is a relatively simple procedure, but the complications can quickly become life-threating. The aim of this study was to investigate based on our experience when is best to follow a conservative protocol in postoperative bleeding after sleeve gastrectomy. The study is retrospective, we identified a number of 150 cases of sleeve gastrectomy, of which 18 has postoperative bleeding.  A conservative approach with close observation (ultrasound, CT, Hb levels) was practiced in 10 cases and no surgical intervention was required.  The recommendations are as follows: The first and obvious recommendation is to stop anticoagulants. The perigastric drainage should drain, if Hb levels go down an nothing is coming through the drain consider other sources of bleed or try to reopen the blocked drain. A blood cloth developed around the bleeder may maintain the active bleed due to local fibrinolysis, in these cases, one should take into consideration guided drainage (ultrasound/CT) and monitor Hb levels afterward. The presence of a small perigastric collection without clinical manifestation should be left as such. Take into consideration reintervention if: signs of hypovolemia are present (tachycardia, hypotension, profuse sweating), Hb below 7g/dL. The patient's clinical state should always play an important role in decision making.
腹腔镜袖式胃切除术是一个相对简单的手术,但并发症很快就会危及生命。本研究的目的是根据我们的经验,探讨在袖式胃切除术后出血的最佳治疗方案。本研究是回顾性的,我们确定了150例袖胃切除术,其中18例术后出血。10例采用保守入路密切观察(超声、CT、Hb水平),无需手术干预。建议如下:第一个也是最明显的建议是停止使用抗凝剂。如果Hb水平下降并且没有任何东西通过排水管,则考虑其他出血来源或尝试重新打开堵塞的排水管。由于局部纤维蛋白溶解,在出血点周围形成血布可能维持活动性出血,在这种情况下,应考虑引导引流(超声/CT)并监测Hb水平。腹壁有少量积液而无临床表现,应不予理会。如果出现低血容量症状(心动过速、低血压、大量出汗)、Hb低于7g/dL,应考虑再干预。患者的临床状态在决策时应始终发挥重要作用。
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引用次数: 0
Complete mesocolic excision for right sided colonic carcinoma - Our Experience in tertiary care hospital 全肠系膜切除治疗右侧结肠癌——我们在三级医院的经验
Pub Date : 2019-11-17 DOI: 10.3329/jss.v21i1.43833
S. K. Mondal, Sharmistha Roy, M. S. Uddin, M. Murshed, Abul Bashar
Background: The concept of Complete Mesocolic Excision(CME) as a surgical techniquefor colonic carcinoma.was first introduced in the west in 2008. CME follows the sameprinciple as Total MesorectalExcision(TME) in rectal carcinoma. We have adopted this newtechnique since 2014. Objective: Here we describe the CME technique in open and laparoscopic right hemicolectomy,and our initial experience of the surgery. Methods: This is a prospective observational study. Data collected from 24 patientsadmitted under our care in BIR DEM General Hospital from January 2015 to January 2017with carcinoma caecum or ascending colon. Results: Out of 24 patients 14 patients opted for laparoscopic right hemicolectomy and 10patients choose open right hemicolectomy. In laparoscopic right hemicolectomy with CMEthe mean operating time was 152 minutes, amount of blood loss ranges 70-100ml.Number of lymphnodes removed enbloc with specimen 25-30(mean27). Distance oftumor from mesenteric margins at the point of vascular tie 11-15 cm. In open righthemicolectomy with CME mean operating time was 142 minutes, estimated blood loss120-300 ml, harvested lymph nodes within mesocolic envelop 24-31(mean27), anddistance of tumor from vascular tie is 9-15 cm. there is one major complication of uretericinjury. Histopathology shows resection margin are free of tumor in all except 2 cases. Conclusion: Right hemicolectomy with CME in both open and laparoscopic approach canbe easily adopted by general surgeons and colorectal surgeons who are performing'standard technique' or 'conventional technique' routinely for right hemicolectomy. Withthe encouraging results available from centers who are routinely performing CME incolonic surgery it is now considered as the new bench mark of quality of standard colonicsurgery. Journal of Surgical Sciences (2017) Vol. 21 (1) :15-18
背景:结肠全肠系膜切除术(CME)是一种治疗结肠癌的外科技术。2008年首次引入西方。CME与直肠癌全中直肠切除术(TME)遵循相同的原则。我们从2014年开始采用这种新技术。目的:本文介绍CME技术在开放和腹腔镜右半结肠切除术中的应用,以及我们的初步手术经验。方法:前瞻性观察性研究。数据收集自2015年1月至2017年1月我院收治的24例盲肠癌或升结肠癌患者。结果:24例患者中14例选择腹腔镜右半结肠切除术,10例选择开放式右半结肠切除术。腹腔镜右半结肠切除术加cmeb平均手术时间152分钟,出血量70 ~ 100ml。切除淋巴结数目与标本共25-30个(平均27个)。肿瘤距肠系膜边缘血管结点11- 15cm。开腹右结肠切除术伴CME,平均手术时间142分钟,估计失血量120-300毫升,结肠系膜内淋巴结清扫24-31(平均27),肿瘤离血管结的距离为9-15厘米。输尿管损伤有一个主要的并发症。组织病理检查除2例外,其余均无肿瘤。结论:普通外科医生和结直肠外科医生在常规右半结肠切除术中采用“标准技术”或“常规技术”,均可方便地采用开腹和腹腔镜下的CME右半结肠切除术。从常规实施CME结肠手术的中心获得的令人鼓舞的结果,它现在被认为是标准结肠手术质量的新基准。外科杂志(2017)Vol. 21 (1):15-18
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引用次数: 1
Primary Tuberculous Mastitis 原发性结核性乳腺炎
Pub Date : 2019-11-17 DOI: 10.3329/jss.v21i1.43834
R. Laila, S. Banu, J. Raihan
Background: Tuberculous mastitis is a rare entity in patients with mammary diseaseeven in countries where incidence of tuberculosis is high. In Bangladesh, TB is anendemic disease but breast tuberculosis is rarely reported. Its clinical patterns andtreatment strategies are changing day by day. Objective: To analyze the clinical presentations , diagnosis and treatment of tuberculousmastitis Methods: This is a prospective nonrandomized descriptive study to analyze clinicalpresentations, diagnosis and treatment of hundred (100) cases received care for tuberculousmastitis at the Chest Disease Hospital, Rajshahi, from July' 2012 to July' 2016.Diagnosis was made in all patients by cytological examination from suspected lesions,which revealed typical tuberculous lesions. Patient with some atypical presentationsand doubts in the diagnosis needed histopathological examination and Gene x-pert testto exclude idiopathic granulomatous mastitis and concomitant malignancy. Results: Most of the patients were within reproductive age. The disease affecting theright breast in fifty six patients (56%), left breast in forty three patients (43%) andbilateral in one patient (1%). Palpable lump were present in eighteen patients (18%),chronic discharging sinus with or without lump in thirty four (34%) and breast abscesswith or without discharging sinus in eighteen patients (18%),recent abscess drainagescar with lump in thirty patients(30).Medical therapy with anti-tubercular drugs ranging from 9 to 12 months with follow upmonthly was the mainstay of treatment. Surgical intervention reserved for selectedrefractory cases. Extension of anti-tubercular therapy from 9 to 12 or 18 monthsrequired in fifty-eight(58) patients on the basis of slow clinical response. Completeresolution obtained in 92 patients but residual tiny mass in eight patients confirmed byrepeated FNAC to be fibrotic. Conclusion: Treatment is simple but high index of suspicion is the cornerstone fordiagnosis. Journal of Surgical Sciences (2017) Vol. 21 (1) :19-23
背景:结核性乳腺炎是一种罕见的乳房疾病,即使在结核病发病率高的国家也是如此。在孟加拉国,结核病是一种地方病,但乳腺癌很少报道。它的临床模式和治疗策略每天都在变化。目的:分析结核性乳房炎的临床表现、诊断和治疗方法:这是一项前瞻性非随机描述性研究,分析2012年7月至2016年7月在Rajshahi胸病医院接受治疗的100例结核性乳房炎患者的临床表现、诊断和治疗。所有患者均通过疑似病变的细胞学检查诊断,发现典型的结核性病变。患者有一些不典型的表现和对诊断的怀疑,需要进行组织病理学检查和基因x-pert检查,以排除特发性肉芽肿性乳腺炎和伴随的恶性肿瘤。结果:患者以育龄者居多。右乳56例(56%),左乳43例(43%),双乳1例(1%)。可触及肿块18例(18%),有或无肿块的慢性排出性鼻窦34例(34%),有或无排出性鼻窦的乳腺脓肿18例(18%),近期脓肿引流性脓肿伴肿块30例(30)。抗结核药物治疗9至12个月,每月随访是主要治疗方法。手术干预保留用于选定的难治性病例。58例临床反应缓慢的患者需要延长抗结核治疗时间,从9个月延长至12个月或18个月。92例患者获得完全溶解,但8例患者经重复FNAC证实为纤维化。结论:治疗方法简单,但高怀疑指数是诊断的基础。外科杂志(2017)Vol. 21 (1):19-23
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引用次数: 0
Obituary 2015 讣告2015
Pub Date : 2019-11-14 DOI: 10.3329/jss.v19i2.44033
Md Ibrahim Siddique
Abstract not available Journal of Surgical Sciences (2015) Vol. 19 (2) : 89
外科杂志(2015)Vol. 19 (2): 89
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引用次数: 0
CRC Screening: Current Trend and Feasibility CRC筛查:当前趋势和可行性
Pub Date : 2019-11-13 DOI: 10.3329/jss.v19i2.43986
Rashidul Islam, S. H. Sheikh, A. Taher, S. Khatun, Ahsan Habib, G. Salauddin, T. Khan, Sudersona Saha Podder, B. Debnath
Colorectal cancer, a rising health concern of both east and west , can be prevented and it’s mortality can be reduced by screening all men and women of average risk  at the age of 50 years or older and  at an earlier age for  high risk group of colorectal cancer. Several tests are available for colon cancer screening, including fecal occult blood test (FOBT), flexible sigmoidoscopy, double-contrast barium enema, and colonoscopy. Direct and indirect evidence indicates that all the tests are effective, but they differ in their sensitivity, specificity, cost, and safety. The available evidence does not currently support choosing one test over another. In addition, other new colorectal cancer tests, such as virtual colonoscopy or stool-based molecular testing, have the potential to become important screening tests in the future. Journal of Surgical Sciences (2015) Vol. 19 (2) : 61-66
结直肠癌是东西方日益关注的健康问题,通过对50岁或50岁以上的所有平均风险男性和女性以及更早的年龄进行结直肠癌高风险群体的筛查,可以预防结直肠癌并降低其死亡率。有几种检查可用于结肠癌筛查,包括粪便隐血检查(FOBT)、乙状结肠镜检查、双对比钡灌肠和结肠镜检查。直接和间接证据表明,所有检测都是有效的,但它们在敏感性、特异性、成本和安全性方面存在差异。现有的证据目前不支持选择一种测试而不是另一种。此外,其他新的结肠直肠癌测试,如虚拟结肠镜检查或基于粪便的分子测试,有可能在未来成为重要的筛查测试。外科杂志(2015)Vol. 19 (2): 61-66
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引用次数: 0
Breast Conservation in Breast Cancer: A Bangladesh Experience 乳腺癌的乳房保护:孟加拉国的经验
Pub Date : 2019-11-13 DOI: 10.3329/jss.v19i2.43983
P. Akhtar, Syeeda Hasina Azam, S. K. Hasan, Z. M. Masud, N. Khatun, M. Hossain, L. Nahar, R. Sharif, A. Nafisa
Background: Breast cancer is one of the most common cancers in Bangladeshi women. Breast sacrificing treatment is still now the common practice in our country. Now a day’s breast conservative treatment is the standard treatment of breast cancer without compromising the survival. Objective: To observe local recurrence and distant metastasis free survival and overall survival of patients with breast cancer. Methods: Between January 1996 and December 2010, breast conserving treatment was carried out in 237 female patients with breast cancer in different Institutions of Bangladesh. Clinical staging was recorded by physical examination, relevant investigations as well as surgical records. Revised breast conserving surgery was carried out in those who had positive surgical margins or palpable disease. The patients with large but operable cancer or locally advanced cancer were treated by neoadjuvant chemotherapy followed by breast conserving surgery. Systemic adjuvant therapy (chemotherapy and or hormone therapy) and adjuvant radiotherapy were given in all patients. After completion of treatment, the patients were followed up with a standard protocol and data were compiled and analysed. Results: Among 237 patients who underwent breast conserving therapy 13 patients were excluded from the study for various reasons. Total 224 female patients with breast cancer who followed all the treatment schedules and attended for regular follow up were included in the study. They were between 22- 74 years of age, mean age 42.35 years; premenopausal 152 (68%). Sixty five percent (146 patients) was localized cancer (T1-2N0M0), 31.6% was regional cancer (T1-3N1M0), five cases were locally advanced stage (T4bN12M0) and two metastastatic cancer (T2-3N1M1).  All most all (98%) were Infiltrating duct cell carcinoma except four which were Intraductal carcinoma in situ (IDIS).  Estrogen and progesterone receptors were positive in 57% , HER2 positive (+++) in 24% of Patients. Lumpectomy/quandrentectomy with/without axillary clearance was done in 158 patients, revised breast conserving surgery in 53 cases, mastectomy in 8 cases and only biopsy done but no surgical treatment in five cases.Chemotherapy was given in 192 patients (86%); adjuvant 122 cases and neoadjuvant 70 cases. Hormone therapy in 182 patients. Radiotherapy: in 222 cases. Follow up period  was 4 years  to 19 years, median 10 years. Overall survival (OS) and disease free survival (DFS) was 84% and 70% respectively. Local recurrence occurred in 14(6%) cases and distant metastasis in 54 cases (24%). Conclusion: Breast conserving treatment was satisfactory for appropriate case selection and optimized therapy. Survival was no way worse than breast sacrificing treatment. Journal of Surgical Sciences (2015) Vol. 19 (2) : 55-60
背景:乳腺癌是孟加拉国妇女最常见的癌症之一。牺牲乳房治疗在我国仍是一种普遍的做法。现在一天的乳房保守治疗是乳腺癌的标准治疗不影响生存。目的:观察乳腺癌患者的局部复发、无远处转移生存率及总生存率。方法:1996年1月至2010年12月,对237例女性乳腺癌患者在孟加拉国不同机构进行保乳治疗。通过体格检查、相关调查及手术记录记录临床分期。改良保乳手术适用于手术切缘阳性或可触及疾病的患者。对于可手术的大肿瘤或局部晚期肿瘤,采用新辅助化疗后保乳手术治疗。所有患者均给予全身辅助治疗(化疗和/或激素治疗)和辅助放疗。治疗完成后,采用标准方案对患者进行随访,并对数据进行整理和分析。结果:在237例接受保乳治疗的患者中,13例因各种原因被排除在研究之外。共有224名女性乳腺癌患者参与了这项研究,她们遵循了所有的治疗计划,并定期接受了随访。年龄22 ~ 74岁,平均42.35岁;绝经前152例(68%)。146例(65%)为局部癌(t1 - 2n1m0), 31.6%为局部癌(T1-3N1M0), 5例为局部晚期癌(T4bN12M0), 2例为转移性癌(T2-3N1M1)。除4例导管内原位癌(IDIS)外,其余均为浸润性导管细胞癌(98%)。57%的患者雌激素和孕激素受体阳性,24%的患者HER2阳性(+++)。158例患者行乳房肿瘤切除术/双肾切除术伴/不伴腋窝清除,53例行改良保乳手术,8例行乳房切除术,5例仅行活检但未行手术治疗。化疗192例(86%);辅助122例,新辅助70例。182例患者接受激素治疗。放疗:222例。随访4 ~ 19年,中位随访10年。总生存率(OS)和无病生存率(DFS)分别为84%和70%。局部复发14例(6%),远处转移54例(24%)。结论:保乳治疗效果满意,病例选择合理,治疗方法优化。生存并不比牺牲乳房的治疗更糟糕。外科杂志(2015)Vol. 19 (2): 55-60
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引用次数: 0
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Journal of Surgical Sciences
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