Surgery for Obesity and Related Diseases最新文献_第3页

A review of brain structural and functional changes using MRI technology in patients who received bariatric surgery 利用核磁共振成像技术回顾减肥手术患者的大脑结构和功能变化。

IF 3.5 3区医学 Q1 SURGERY

Surgery for Obesity and Related Diseases

Pub Date : 2025-01-01 DOI: 10.1016/j.soard.2024.08.036

Hugo Sandoval Ph.D. , Benjamin Clapp M.D. , Laura E. O’Dell Ph.D. , Deborah J. Clegg Ph.D.

According to the World Health Organization, obesity is one of the most significant health issues currently because it increases risk for type 2 diabetes and cancer, heart disease, bone health, reproduction, and quality of living and it impacts approximately 500 million adults worldwide. This review analyzed the existing literature focusing on the effects of Metabolic and bariatric surgeries (MBS), including Roux-en-Y gastric bypass and sleeve gastrectomy on changes in brain function and anatomy using magnetic resonance imaging (MRI) technology. A PubMed search using the key words bariatric surgery and MRI conducted in December 2023 resulted in 544 articles. Our literature review identified 24 studies addressing neuroanatomic, neurophysiological, cognitive, and behavioral changes that occurred at different time intervals after different types of bariatric surgery. Our review of the literature found several reports indicating that MBS reverse neuroanatomic alterations and changes in functional connectivity associated with obesity. There were also reported improvements in cognitive performance, memory, executive function, attention, as well as decreased gustatory brain responses to food cues and resting state measures following bariatric surgery. There were instances of improved neural functioning associated with weight loss, suggesting that some neuroanatomic changes can be reversed following weight loss induced by bariatric surgery. Additionally, there were data suggesting that brain connectivity and metabolic health are improved following a bariatric surgical intervention. Together, the existing literature indicates an overall improvement in brain connectivity and health outcomes following bariatric surgery.

世界卫生组织指出，肥胖是当前最重要的健康问题之一，因为它会增加罹患 2 型糖尿病和癌症、心脏病、骨骼健康、生殖和生活质量的风险，影响着全球约 5 亿成年人。本综述利用磁共振成像（MRI）技术对现有文献进行了分析，重点研究代谢和减肥手术（MBS），包括Roux-en-Y胃旁路术和袖带胃切除术对大脑功能和解剖结构变化的影响。2023 年 12 月，我们在 PubMed 上以减肥手术和 MRI 为关键词进行了搜索，共搜索到 544 篇文章。我们的文献综述确定了 24 项研究，涉及不同类型减肥手术后在不同时间间隔内发生的神经解剖、神经生理学、认知和行为变化。我们的文献综述发现，有几篇报告指出，MBS 可逆转与肥胖相关的神经解剖改变和功能连接变化。还有报告称，减肥手术后，认知能力、记忆力、执行功能、注意力都有所改善，大脑对食物线索的味觉反应和静息状态测量也有所下降。有研究表明，神经功能的改善与体重减轻有关，这表明通过减肥手术减轻体重后，一些神经解剖学的变化是可以逆转的。此外，还有数据表明，在减肥手术干预后，大脑的连接性和新陈代谢健康状况会得到改善。总之，现有文献表明，减肥手术后大脑连通性和健康状况会得到全面改善。

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引用次数: 0

Outcomes of adolescent bariatric surgery: liver disease 青少年减肥手术的结果：肝脏疾病。

IF 3.5 3区医学 Q1 SURGERY

Surgery for Obesity and Related Diseases

Pub Date : 2025-01-01 DOI: 10.1016/j.soard.2024.08.040

Christine Brichta M.D., M.P.H. , Mark Fishbein M.D. , Justin R. Ryder Ph.D.

The prevalence of metabolic dysfunction–associated steatotic liver disease (MASLD) is increasing among children in the United States as pediatric obesity rates continue to rise. As such, metabolic and bariatric surgery (MBS) has become a more recognized option for treatment of obesity and has been recommended by the American Academy of Pediatrics. Although MBS is known to improve many obesity-associated comorbidities, such as hypertension and type 2 diabetes, less is known about its effect as a treatment for MASLD. This article reviewed the impact MBS has on the course of liver disease as measured by histopathology, serum markers, and radiographic imaging, among adolescents with severe obesity. Improvements were seen in alanine transaminase (ALT) liver enzymes, rates of hepatocyte steatosis, and degree of fibrosis on histopathology, and fat content in the liver on computed tomography and magnetic resonance imaging. Greater improvements in ALT were seen in patients with higher baseline values and/or a higher stage of biopsy-confirmed steatohepatitis. Biopsy-proven MASLD and metabolic dysfunction–associated steatohepatitis (MASH) have even been shown to disappear completely, but fibrosis does not completely resolve by 12 months post-MBS. To better understand the outcome of pediatric MASLD following MBS treatment, more longitudinal radiographic data and liver histology in patients with fibrosis would be informative beyond 12 months post-MBS.

随着小儿肥胖率的不断上升，代谢功能障碍相关性脂肪肝（MASLD）在美国儿童中的发病率也在不断增加。因此，代谢和减肥手术（MBS）已成为公认的治疗肥胖症的方法，并被美国儿科学会推荐使用。虽然众所周知代谢与减肥手术可以改善许多与肥胖相关的并发症，如高血压和 2 型糖尿病，但人们对其治疗 MASLD 的效果却知之甚少。这篇文章通过组织病理学、血清标志物和放射影像学测量，回顾了MBS对重度肥胖青少年肝病病程的影响。丙氨酸转氨酶（ALT）肝酶、肝细胞脂肪变性率、组织病理学纤维化程度以及计算机断层扫描和磁共振成像显示的肝脏脂肪含量均有所改善。基线值较高和/或活检证实的脂肪性肝炎阶段较高的患者，ALT 的改善幅度更大。活检证实的 MASLD 和代谢功能障碍相关性脂肪性肝炎（MASH）甚至可以完全消失，但纤维化在 MBS 术后 12 个月内不会完全消退。为了更好地了解小儿MASLD在接受MBS治疗后的结果，在MBS治疗后12个月后，对纤维化患者进行更多的纵向放射学数据和肝脏组织学检查将具有参考价值。

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引用次数: 0

Postoperative pulmonary complications in patients with chronic obstructive pulmonary disease undergoing primary laparoscopic bariatric surgery: an MBSAQIP analysis 接受初级腹腔镜减肥手术的慢性阻塞性肺病患者术后肺部并发症：MBSAQIP分析。

IF 3.5 3区医学 Q1 SURGERY

Surgery for Obesity and Related Diseases

Pub Date : 2025-01-01 DOI: 10.1016/j.soard.2024.08.032

Roberto J. Valera M.D. , Mauricio Sarmiento Cobos M.D. , Francisco X. Franco M.D. , Bakhtawar Mushtaq M.D. , Lisandro Montorfano M.D. , Emanuele Lo Menzo M.D., Ph.D., F.A.C.S., F.A.S.M.B.S. , Samuel Szomstein M.D., F.A.C.S., F.A.S.M.B.S. , Raul J. Rosenthal M.D., F.A.C.S., F.A.S.M.B.S.

Background

Recent research has shown beneficial effects of bariatric surgery (BaS) on the risk of developing acute exacerbations of chronic obstructive pulmonary disease (COPD). However, this patient population may be at increased risk of complications, especially postoperative pulmonary complications (PPC).

Objectives

To analyze the incidence of PPC in patients with COPD undergoing BaS.

Setting

Academic Hospital, United States.

Methods

We performed a retrospective analysis of the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database for patients aged ≥18 years undergoing laparoscopic sleeve gastrectomy and Roux-en-Y gastric bypass during 2015–2019. The primary outcome of the study was any PPC, defined as a composite variable including postoperative pneumonia, mechanical ventilation >48 hours and unplanned endotracheal intubation. A univariate analysis was performed to compare patients with and without COPD, and a multivariate logistic regression was performed to adjust for confounders. A subgroup analysis was performed to compare endpoints in patients with COPD with or without home oxygen requirements.

Results

A total of 752,722 patients were included in our analysis (laparoscopic sleeve gastrectomy = 73.2%, Roux-en-Y gastric bypass = 26.8%). PPC occurred in 2390 patients, 0.3% without COPD versus 1.3% with COPD (P < .001). Multivariable analysis confirmed that COPD independently increases the risk of PPC (OR = 1.7, CI = 1.4–2.1). Subgroup analysis showed that patients who are oxygen dependent had a much higher risk for PPC (2.4% versus 1.1%, P < .001).

Conclusion

PPC are higher among patients with obesity and concomitant COPD. Oxygen dependency confers an even higher complication rate. The risk and benefits of BaS in this population must be carefully addressed.

背景：最近的研究表明，减肥手术（BaS）对慢性阻塞性肺病（COPD）急性加重的风险有好处。然而，这类患者发生并发症的风险可能会增加，尤其是术后肺部并发症（PPC）：目的：分析接受巴氏手术的慢性阻塞性肺病患者的肺部并发症发生率：地点：美国学术医院：我们对代谢与减肥手术认证和质量改进计划数据库进行了回顾性分析，研究对象为2015-2019年期间接受腹腔镜袖带胃切除术和Roux-en-Y胃旁路术的≥18岁患者。研究的主要结果是任何 PPC，定义为复合变量，包括术后肺炎、机械通气 >48 小时和计划外气管插管。对患有和不患有慢性阻塞性肺病的患者进行了单变量分析比较，并进行了多变量逻辑回归以调整混杂因素。对有或无家庭供氧需求的慢性阻塞性肺病患者的终点进行了亚组分析比较：共有 752 722 名患者纳入我们的分析（腹腔镜袖带胃切除术 = 73.2%，Roux-en-Y 胃旁路术 = 26.8%）。2390名患者发生了PPC，其中无慢性阻塞性肺病的患者占0.3%，而有慢性阻塞性肺病的患者占1.3%（P < .001）。多变量分析证实，慢性阻塞性肺病会单独增加发生 PPC 的风险（OR = 1.7，CI = 1.4-2.1）。亚组分析显示，依赖氧气的患者发生 PPC 的风险更高（2.4% 对 1.1%，P < .001）：结论：肥胖并伴有慢性阻塞性肺病的患者发生 PPC 的风险更高。结论：肥胖并伴有慢性阻塞性肺病的患者发生 PPC 的几率更高，对氧气的依赖会导致更高的并发症发生率。必须仔细考虑在这类人群中使用 BaS 的风险和益处。

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引用次数: 0

Response to “Exploring the persistent questions regarding the long-term influence of bariatric surgery on psoriasis” 回应 "探讨减肥手术对银屑病长期影响的顽固问题"。

IF 3.5 3区医学 Q1 SURGERY

Surgery for Obesity and Related Diseases

Pub Date : 2025-01-01 DOI: 10.1016/j.soard.2024.10.012

Ali Hosseininasab M.D., Hesam Mosavari M.D., Foolad Eghbali M.D.

引用次数: 0

Risk of suicide after metabolic bariatric surgery: a meta-analysis of matched cohort studies and population-based studies 代谢减肥手术后的自杀风险：配对队列研究和人群研究的荟萃分析。

IF 3.5 3区医学 Q1 SURGERY

Surgery for Obesity and Related Diseases

Pub Date : 2025-01-01 DOI: 10.1016/j.soard.2024.10.014

Bei-Bei Cui M.D., Jun He M.D., Hong-Liang Yao M.D.

Background

Metabolic bariatric surgery (MBS) remains the optimal treatment for patients with severe obesity. However, concern is growing about the risk of suicide after MBS.

Objectives

To compare the risk of suicide in adult patients with obesity, treated with or without MBS.

Setting

University-affiliated hospital, China.

Methods

PubMed and Embase were searched through April 30, 2024. Eligible studies were matched cohort studies and population-based studies (PROSPERO ID: CRD42024561042). Effects were pooled using a random-effects model. Subgroup analysis was performed based on study type.

Results

A total of 3 matched cohort studies (4 matched cohorts) and 2 population-based studies, involving 114,615 adult patients with obesity treated with MBS (272 suicides) and 552,642 nonsurgery counterparts (622 suicides), met the selection criteria. Patients treated with MBS had a pooled hazard ratio (HR) of suicide of 2.12 (95% confidence interval [CI] 1.54−2.92, P < .01, I² = 24%) and a pooled risk ratio (RR) of suicide of 2.32 (95% CI 1.55−3.45, P < .01, I² = 58%) compared with those treated without MBS. In the subgroup analysis, relatively higher pooled HR (2.64 [1.84−3.77] versus 1.67 [1.32−2.12]) and RR (2.98 [2.02−4.41] versus 1.48 [.80−2.75]) were observed in the subgroup of matched cohort studies compared with the subgroup of population-based studies.

Conclusions

Adult patients treated with MBS are at more than double the risk of suicide than those treated without MBS in terms of both HR and RR. However, the absolute risk was low and did not warrant a general discouragement of MBS.

背景：代谢减肥手术（MBS）仍然是治疗重度肥胖症患者的最佳方法。然而，人们越来越关注代谢性减肥手术后的自杀风险：比较成年肥胖症患者接受或不接受代谢减重手术治疗后的自杀风险：地点：中国大学附属医院：方法：检索PubMed和Embase至2024年4月30日。符合条件的研究为匹配队列研究和基于人群的研究（PROSPERO ID：CRD42024561042）。研究结果采用随机效应模型进行汇总。根据研究类型进行分组分析：共有 3 项匹配队列研究（4 项匹配队列）和 2 项基于人群的研究符合筛选标准，涉及 114,615 名接受 MBS 治疗的成年肥胖症患者（272 人自杀）和 552,642 名未接受手术治疗的患者（622 人自杀）。与未接受 MBS 治疗的患者相比，接受 MBS 治疗的患者自杀风险比 (HR) 为 2.12（95% 置信区间 [CI] 1.54-2.92，P < .01，I2 = 24%），自杀风险比 (RR) 为 2.32（95% 置信区间 [CI] 1.55-3.45，P < .01，I2 = 58%）。在亚组分析中，与基于人群的研究亚组相比，在匹配队列研究亚组中观察到了相对较高的集合HR（2.64 [1.84-3.77] 对 1.67 [1.32-2.12] ）和RR（2.98 [2.02-4.41] 对 1.48 [.80-2.75]）：就HR和RR而言，接受MBS治疗的成人患者的自杀风险是未接受MBS治疗的成人患者的两倍多。然而，绝对风险较低，因此不建议普遍使用 MBS。

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引用次数: 0

Cartoon

IF 3.5 3区医学 Q1 SURGERY

Surgery for Obesity and Related Diseases

Pub Date : 2025-01-01 DOI: 10.1016/j.soard.2024.11.010

引用次数: 0

Assessing the reliability and validity of sleep assessments in patients seeking metabolic and bariatric surgery 评估对寻求代谢和减肥手术的患者进行睡眠评估的可靠性和有效性。

IF 3.5 3区医学 Q1 SURGERY

Surgery for Obesity and Related Diseases

Pub Date : 2025-01-01 DOI: 10.1016/j.soard.2024.10.016

Colleen C. Schreyer Ph.D. , Jessica K. Salwen-Deremer Ph.D. , Janelle W. Coughlin Ph.D. , Caroline Sanicola M.S. , Chelsea A. Taylor M.A. , Irina A. Vanzhula Ph.D. , Mary K. Martinelli Ph.D. , Genna F. Hymowitz Ph.D.

Background

More than 80% of patients seeking metabolic and bariatric surgery (MBS) report disturbance in sleep function. No studies have assessed the psychometric properties of sleep measures in MBS samples.

Objectives

This study assessed the reliability and validity of the Pittsburgh Sleep Quality Index (PSQI) and the Insomnia Severity Index (ISI) in a large sample of patients seeking MBS.

Setting

Two academic medical centers.

Methods

Measures of sleep (PSQI and ISI) and psychological functioning, including the Quick Inventory of Depressive Symptomatology (QIDS), were administered presurgically. Internal consistency was assessed with mean inter-item correlations and item-total correlations. Construct validity was assessed using confirmatory factor analyses (CFAs) based on models identified in the literature and by measuring convergent and discriminant validity.

Results

Participants (N = 939) were primarily female (83.4%) with a mean age of 41.7 (SD = 11.5) years and mean body mass index (BMI) of 47.5 kg/m² (SD = 8.5). CFAs indicated excellent fit for 2-factor solutions for the PSQI and ISI. Internal consistency for the PSQI and ISI were acceptable. Convergent validity was demonstrated by large correlations between the PSQI and ISI (r = .80, p < .001), and moderate correlation between the PSQI, ISI, and QIDS (rs > .50, ps < .001). The PSQI and ISI were moderately correlated with QIDS items assessing sleep function (P < .001), but correlations with items assessing appetite change were small (r < .10), demonstrating good discriminant validity.

Conclusions

Results support the reliability and validity of the PSQI and ISI for patients undergoing MBS.

背景：80%以上寻求代谢和减肥手术（MBS）的患者报告睡眠功能紊乱。目前还没有研究对代谢性肥胖样本中睡眠测量的心理计量特性进行评估：本研究评估了匹兹堡睡眠质量指数（PSQI）和失眠严重程度指数（ISI）在大量寻求代谢与减肥手术患者样本中的可靠性和有效性：两个学术医疗中心：方法：在手术前进行睡眠测量（PSQI 和 ISI）和心理功能测量，包括抑郁症状快速量表（QIDS）。通过平均项目间相关性和项目总相关性评估内部一致性。根据文献中确定的模型，通过确认性因子分析（CFAs）以及测量收敛性和鉴别性来评估结构效度：参与者（N = 939）主要为女性（83.4%），平均年龄为 41.7 岁（SD = 11.5），平均体重指数（BMI）为 47.5 kg/m2（SD = 8.5）。CFA表明，PSQI和ISI的2因素解非常拟合。PSQI 和 ISI 的内部一致性可以接受。PSQI 和 ISI 之间的相关性较大（r = .80，p < .001），PSQI、ISI 和 QIDS 之间的相关性适中（rs > .50，ps < .001），这些都证明了聚合有效性。PSQI 和 ISI 与 QIDS 的睡眠功能评估项目呈中度相关（P < .001），但与食欲变化评估项目的相关性较小（r < .10），显示出良好的判别效度：研究结果表明，PSQI 和 ISI 对接受 MBS 治疗的患者具有可靠性和有效性。

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引用次数: 0

Psychosocial outcomes after adolescent metabolic and bariatric surgery: a narrative review of the literature 青少年代谢和减肥手术后的社会心理结果：文献综述。

IF 3.5 3区医学 Q1 SURGERY

Surgery for Obesity and Related Diseases

Pub Date : 2025-01-01 DOI: 10.1016/j.soard.2024.09.003

Richard E. Boles Ph.D., Jaime M. Moore M.D., M.P.H.

The prevalence of severe obesity among adolescents continues to be a significant global concern. Metabolic and bariatric surgery (MBS) has increasingly shown to produce safe, efficacious, and durable effects on weight loss and related physical health complications, and evidence of psychosocial outcomes are beginning to mature. The revised American Society for Metabolic and Bariatric Surgery pediatric guidelines published in 2018 reported emergent data regarding key psychosocial outcomes, including mental health, disordered eating, and quality of life, although data were limited by small, short-term studies and often without comparison groups. The purpose of this narrative review was to expand the relevant findings regarding youth with severe obesity who receive MBS to further clarify the impact of surgery on psychosocial outcomes.

青少年严重肥胖仍然是全球关注的一个重要问题。代谢和减肥手术（MBS）已越来越多地显示出对体重减轻和相关身体健康并发症具有安全、有效和持久的效果，社会心理结果的证据也开始成熟。2018 年发布的美国代谢与减肥外科协会儿科指南修订版报告了有关主要社会心理结果的新兴数据，包括心理健康、饮食紊乱和生活质量，尽管数据受到小型、短期研究的限制，而且通常没有对比组。本叙述性综述的目的是扩展有关接受 MBS 的重度肥胖青少年的相关研究结果，以进一步阐明手术对心理社会结局的影响。

引用次数: 0

ASMBS literature review on the treatment of marginal ulcers after metabolic and bariatric surgery 关于代谢和减肥手术后边缘溃疡治疗的 ASMBS 文献综述。

IF 3.5 3区医学 Q1 SURGERY

Surgery for Obesity and Related Diseases

Pub Date : 2025-01-01 DOI: 10.1016/j.soard.2024.10.003

R. Wesley Vosburg M.D. , Abdelrahman Nimeri M.D. , Dan Azagury M.D. , Brandon Grover M.D. , Sabrena Noria M.D. , Pavlos Papasavas M.D. , Jonathan Carter M.D.

Marginal ulcers (MUs) encompass a group of mucosal disruptions and subsequent inflammatory changes and their sequala found after Roux-en-Y gastric bypass (RYGB) oneanastomosis gastric bypass (OAGB), and, less commonly, after biliopancreatic diversion with duodenal switch (BPD/DS) or single anastomosis duodeno-ileostomy with sleeve gastrectomy (SADI-S). Prevalence of MU after RYGB ranges from .6%–16%. This review summarizes the current knowledge about the treatment options available for MU after MBS for providers who treat them.

边缘溃疡（MUs）包括一组粘膜破坏和随后的炎症性变化及其后遗症，可在 Roux-en-Y 胃旁路术（RYGB）、单吻合胃旁路术（OAGB）后发现，也可在胆胰转流术伴十二指肠转换术（BPD/DS）或单吻合十二指肠回肠造口术伴袖状胃切除术（SADI-S）后发现，但较少见。RYGB 术后 MU 的发病率在 0.6%-16% 之间。本综述总结了目前有关 MBS 后 MU 治疗方案的知识，供治疗 MU 的医疗人员参考。

引用次数: 0

Assessment and medical management of weight regain after adolescent metabolic and bariatric surgery: a narrative review 青少年代谢和减肥手术后体重恢复的评估和医疗管理：叙述性回顾。

IF 3.5 3区医学 Q1 SURGERY

Surgery for Obesity and Related Diseases

Pub Date : 2025-01-01 DOI: 10.1016/j.soard.2024.10.008

Alaina P. Vidmar M.D. , Courtney E. Batt M.D. , Jaime M. Moore M.D., M.P.H.

Metabolic and bariatric surgery (MBS) in adolescents results in durable treatment of severe obesity and related complications for most. However, substantial weight regain can undermine long-term health benefits. There is no evidence-based standard of care for the medical management of weight regain after MBS in pediatrics or adults. This narrative review summarizes current pediatric evidence pertaining to the assessment and medical management of post-MBS weight regain, identifies gaps, and offers recommendations. A PubMed search was conducted through March 2024 and focused on adolescents after sleeve gastrectomy or Roux-en-Y gastric bypass. Domains included nutrition, activity, mental health, antiobesity medications, type 2 diabetes, hypothalamic obesity, and transition of care. In total, 600 articles were screened and 61 were included in this review. Recent consensus definitions for post-MBS weight regain have been established for adults but have not been validated in pediatrics. Limited, high-quality evidence was identified in the nutrition domain, where targets that may mitigate weight regain include adequate protein intake (≥60 g/d), absence of loss-of-control eating, and micronutrient sufficiency. Emerging data for post-MBS antiobesity medications in adults with/without diabetes and in adolescents with persistent obesity are promising. Large gaps include post-MBS interventions focused on physical activity and mental health. The overall quality of pediatric-specific evidence for the assessment and medical management of post-MBS weight regain is low. A standard definition of weight regain associated with health outcomes in pediatrics would be valuable. Clarifying risk and protective factors for weight regain can guide more precise risk stratification and treatment.

青少年代谢和减肥手术（MBS）对大多数严重肥胖和相关并发症的持久治疗。然而，体重的大幅反弹会破坏长期的健康益处。对于儿科或成人MBS后体重恢复的医疗管理，尚无循证标准。这篇叙述性综述总结了目前有关mbs后体重恢复的评估和医疗管理的儿科证据，确定了差距，并提出了建议。PubMed检索进行到2024年3月，重点关注袖式胃切除术或Roux-en-Y胃旁路术后的青少年。研究领域包括营养、活动、心理健康、抗肥胖药物、2型糖尿病、下丘脑肥胖和护理过渡。共筛选了600篇文献，其中61篇纳入本综述。最近对成人mbs后体重恢复的共识定义已经建立，但尚未在儿科得到验证。在营养领域发现了有限的、高质量的证据，其中可能减轻体重反弹的目标包括充足的蛋白质摄入（≥60 g/d）、饮食不失控和微量营养素充足。mbs后抗肥胖药物治疗有/无糖尿病成人和持续性肥胖青少年的新数据是有希望的。很大的差距包括以身体活动和心理健康为重点的mbs后干预措施。评估和医学管理mbs后体重恢复的儿科特异性证据的总体质量较低。对体重恢复与儿科健康结果相关的标准定义将是有价值的。明确体重恢复的危险因素和保护因素可以指导更精确的风险分层和治疗。

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引用次数: 0