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1.
Ten normal horses had approximately 95% of the length of the large colon resected with a side-to-side anastomosis between right ventral and right dorsal colon performed with surgical stapling equipment. Four horses died shortly after surgery of colitis (1 horse) or failure of the TA 90 transection staple line (3 horses). Another horse died 4 months after surgery from disseminated streptococcal infection but had recovered well from the colon resection. Five horses survived long term (18 months) with no clinical evidence of adverse effects of the resection. Surviving horses had weight loss and soft fecal consistency for 3 to 12 weeks after surgery but returned to preoperative values within 12 months. At a second surgery 1 year later (5 horses) or at necropsy 4 months later (1 horse), fibrous omental adhesions were present over the transection staple line in four horses and over the anastomotic staple line in two horses. Omental adhesions to the everted staple line were moderate but not associated with any clinical sequellae. An incisional hernia was present in one horse. The anastomotic stomata measured between 8 and 9 cm, which was 60% of the size of the original surgically created stomata. Failure of the transection staple line occurred in the first three of five horses in which the procedure was attempted due to improper configuration of the staples or crushing of the tissue between the staples. Experience corrected this complication.  相似文献   

2.
The nutritional implications and adaptive processes resulting from resection of 75% of the length of the large colon in ponies were investigated. Ten ponies in good physical condition were divided into two groups: six in the experimental group and four in the control group. During the sixth postoperative month, two digestibility studies were conducted, and phosphate fractional renal excretion and serum biochemical profiles were determined in both groups. The ponies (N = 10) were euthanized six months postoperatively, and gross and histopathological examinations were performed. Results of the serum biochemical profiles, phosphate fractional renal extraction and digestibility studies showed no statistically significant difference between groups except for the serum phosphate concentration. However, large colon resection was associated with hypophosphatemia in three of the six ponies and produced an overall significantly lower phosphate concentration in the experimental ponies. This hypophosphatemia suggests that some dietary modifications may be needed postoperatively in ponies or horses undergoing this surgical procedure. Postmortem examination and histopathological examination failed to demonstrate differences between groups. Adaptive mechanisms, specifically mucosal hypertrophy or hyperplasia, were not observed.  相似文献   

3.
The effect of resection of 75% (length measurement) of the large colon in ponies was studied. Ten ponies in good physical condition were divided into two groups: group I consisted of the six experimental ponies and group II of four control ponies. Preoperatively and postoperatively for five months, ten clinicopathological parameters were determined: body weight, venous blood pH, plasma bicarbonate, total plasma protein concentration, serum electrolyte values (sodium, potassium, chloride), and fecal osmolarity. Subjective assessment of attitude and appetite revealed no difference between the groups or within groups at any time. Resection of a major portion of the large colon did not significantly influence the clinicopathological parameters evaluated. The hematocrit of the ponies in group I did decrease during the first postoperative month and this was attributed to whole blood loss associated with the resection procedures. The results of this investigation indicated that resection of 75% of the large colon in ponies is compatible with life.  相似文献   

4.
Nutritional alterations were evaluated in 9 horses before surgery and 3 weeks, 3 months, and 6 months (4 total trials) after sham operation (group 1; n = 3) or extensive large colon resection (group 2; n = 6). Feed and fecal analyses were performed to determine apparent digestion of dry matter, organic matter, crude protein, calcium, phosphorus, magnesium, potassium, manganese, zinc, copper, and iron, and true digestion of dry matter, organic matter, crude protein, total plant cell wall, hemicellulose, cellulose, and lignin. Additional fecal and metabolic variables included the percentage of fecal water (water in the feces), total fecal water, metabolic organic matter, metabolic crude protein, and metabolic nitrogen. A CBC and standard series of biochemical tests were performed. Large colon resection decreased (P less than 0.05) the true digestion of dietary crude protein and cellulose and apparent digestion of phosphorus, and it increased the fecal metabolic matter and water loss. Total fecal output increased 45% and total fecal water increased 55%. Phosphorus digestion was decreased (P less than 0.05) in group-2 horses, but effects of this were not detected on analysis of blood variables or on physical examination. Nevertheless, after extensive large colon resection, horses can regain body weight lost after surgery and have no overt physical changes when fed an alfalfa pellet diet that meets greater-than-maintenance requirements. Ad libitum water access is suggested, because these horses may have to consume 2 gal/day more than would normal horses.  相似文献   

5.
Hemangiosarcoma is a rare neoplasm of horses and hemangiosarcoma in young horses might behave differently than in mature horses. The purpose of this study was to identify the characteristics of hemangiosarcoma occurring in horses < or = 3 years of age. Medical records from 1982 to 2004 were searched for horses < or = 3 years of age with a histopathologic diagnosis of hemangiosarcoma. Eleven records were identified. Thoroughbred and Thoroughbred crosses predominated. Age ranged from 9 days to 3 years. All horses presented with cutaneous or leg swellings or joint effusion. Physical examination findings included tachycardia, fever, and depression. Laboratory abnormalities included anemia (5/11), hyperfibrinogenemia (4/11), hypofibrinogenemia (3/11), thrombocytopenia (2/11), and neutrophilic leukocytosis (1/11). Ultrasonographic and radiographic evaluation was not diagnostic in any case. Antemortem histopathologic diagnosis was obtained in 10 cases. Six of 11 horses were euthanized. Surgical resection was performed in 5 horses, 2 of which were later euthanized. Diagnosis was confirmed histologically at postmortem examination in all euthanized horses. Two cases resolved spontaneously. Early histopathologic diagnosis may allow cure if the mass is localized and amenable to surgical resection. In cases where the horse is medically stable, and masses are not interfering with quality of life, a period of observation may be warranted.  相似文献   

6.
Colopexy of the Left Large Colon to the Right Large Colon in the Horse   总被引:1,自引:0,他引:1  
Three colopexy techniques were examined in 11 normal horses to determine which would prevent recurrence of targe colon displacement and volvulus. The medial free band of the left ventral colon was sutured to the medial free band of the right ventral colon (technique A). The free band of the left dorsal colon was sutured to the free band of the right dorsal colon (technique B). In technique C, both the ventral and dorsal colon were sutured as in techniques A and B, and the pelvic flexure was sutured to the mesocolon between the right dorsal and right ventral colon. Absorbable (surgical gut) and nonabsorbable (polypropylene) suture material were compared.
One horse from each group was euthanized 2 weeks and 6 months after surgery. The position of the colon and the integrity of the colopexy were examined. At necropsy, attempts were made to produce displacement and volvulus of the colon. In the remaining horses, exploratory celiotomy 1 year after surgery was used to examine the integrity of the colopexy.
Although all horses initially lost weight after surgery, all but one began gaining weight 2 to 4 weeks later and had attained their preoperative weight by 6 months. The horse that continued to lose weight was euthanized 2 months after surgery. Numerous small colon, omental, and large colon adhesions were found at necropsy.
For all colopexy techniques, the colopexy adhesion remained short and intact at polypropylene suture sites. At surgical gut sites, the adhesion had lengthened by 6 months and was absent at 1 year. At necropsy, all colopexies prevented manual displacement of the large colon and volvulus of the colon at the sternal and diaphragmatic flexures. The colopexies did not prevent manual creation of volvulus at the base of the colon. Technique A was the easiest to perform.  相似文献   

7.
Objective— To report complications and survival after large colon resection and end‐to‐end anastomosis in horses with strangulating large colon volvulus. Study Design— Retrospective case series. Animals— Horses (n=73) with strangulating large colon volvulus. Methods— Records (January 1995 to December 2005) of horses that had large colon resection and anastomosis for strangulating large colon volvulus were reviewed for complications. Follow‐up data were obtained by telephone questionnaire at least 1 year postoperatively. Cox proportional hazards model was used for multivariate association with survival time. Variables included admission date, age, temperature, heart rate, packed cell volume, total plasma protein concentration, white blood cell count, breed, and sex. Significance was set at P<.05. Results— The most common postoperative complication was diarrhea. None of the 9 variables of interest were significant for survival. Short‐term survival rate (to discharge) was 74%. Overall survival rates at 1, 2, and 3 years postoperatively were 67.8%, 66.0%, and 63.5%, respectively. Four horses died of colic in the first year after surgery. All horses surviving long‐term (>1 year) returned to their intended use (37 brood mares, 2 racehorses, and 1 show horse) with no chronic problems related to the surgical procedure. Conclusion— None of the variables examined were associated with survival. Outcomes were similar to other large studies of surgical colic in the horse. Self‐limiting diarrhea is common after large colon resection and the prognosis for survival after hospital discharge is favorable. Clinical Relevance— Horses that survive the early postoperative period and are discharged after large colon resection and anastomosis have a good chance for long‐term survival with minimal negative impact on quality of life and use.  相似文献   

8.
OBJECTIVE: To report on the outcome of surgical treatment of acute abdominal crises in miniature breed horses. DESIGN: Retrospective case series of miniature horses presented to the University Veterinary Centre, Camden with an acute abdominal crisis. METHODS: Hospital records of all miniature horses that underwent ventral midline laparotomy for acute abdominal crisis between 1997 and 2001 were reviewed. The signalment, history, clinical signs, results of ancillary diagnostic procedures, location and type of intestinal lesion, treatment and outcome were retrieved from each case record. Long-term survival was determined by telephone interview of owners. RESULTS: Eleven miniature horses including five females and six males underwent ventral midline laparotomies for acute abdominal crisis during the study period. Ages ranged between 1 month and 19 years. Surgical findings included faecalith obstruction (seven horses), enterolith (one horse), strangulating lipoma of the descending colon (one horse), jejunal infarction (one horse), and caecal infarction (one horse). Long-term survival rate (minimum 12 months post surgery) was 55%. Six of eight horses with simple intraluminal obstructions survived, while the three horses with gastrointestinal lesions associated with vascular compromise were euthanased either at surgery (caecal infarction), or postoperatively, due to complications (strangulating lipoma of the descending colon, jejunal infarction). Postoperative complications in this study included impaction of the descending colon (two horses), diarrhoea (two horses), peritonitis (one horse), hyperlipaemia (two horses), incisional infection (two horses) and abdominal adhesions (one horse). Hyperlipidaemia was present in five of seven horses in which serum triglycerides were measured at presentation. CONCLUSIONS: Simple intraluminal obstructions of the large intestine were frequently encountered during exploratory laparotomy in miniature horses presented for acute abdominal crises, and their surgical treatment was associated with a good prognosis. In contrast, this study suggested that abdominal pain associated with vascular compromise of gastrointestinal tissues in miniature horses was associated with a poorer prognosis, consistent with reports in other horse breeds. Possible contributing factors to faecalith formation, including poor quality roughage, dental disease, and inadequate water consumption, should be recognised and avoided in miniature horses. Serum triglyceride concentrations should be measured in miniature horses presented for acute abdominal pain. If elevated, nutritional supplementation should be provided.  相似文献   

9.
Four horses (aged 1 to 18 years) with no apparent respiratory or cardiovascular abnormalities underwent thoracotomy and partial resection of a cranial lung lobe. A stapling instrument was used. Pulmonary function testing prior to and 30 days following surgery showed no significant change in inspiratory or expiratory resistance, compliance, or work of breathing. Postoperative complications consisted of a mild pneumothorax in all horses and localized incisional infection in two horses. All horses displayed a temporary decrease in forward motion of the forelimb on the operated side. Postmortem examination was performed 30 days after surgery; pleural thickening and adhesions between the lung and thoracotomy site were found. The excisionai margin of each cranial lobe was straight with slight puckering due to multiple surgical wire staples. Adjacent tissue collapse and compression were confined to an area no greater than 1 cm from the staples. Beyond this compression, the remaining lung at the surgical site was histologically normal. Subsequently, one horse suffering from recurrent episodes of clinical signs attributed to pleuropneumonia underwent left thoracotomy and partial lung resection followed by a right thoracotomy 48 days later. The horse's condition improved postoperatively, and he was able to undergo normal conditioning and racing.  相似文献   

10.
The purpose of this project was to attempt restoration of abduction of a recently denervated left dorsal cricoarytenoid muscle in the horse by anastomosing the first cervical nerve to the abductor branch of the left recurrent laryngeal nerve. Ten horses were used in the study. In six horses the left recurrent laryngeal nerve was transected and ligated while the ventral branch of the left first cervical nerve was anastomosed to the abductor branch of the left recurrent laryngeal nerve. The remaining four horses also had the left recurrent laryngeal nerve transected and ligated but had no nerve anastomosis performed. Each horse was evaluated preoperatively, and at one week, three and six months after surgery, by endoscopy and determination of upper airway resistance. The endoscopy was performed with the horses breathing room air and while breathing 10% carbon dioxide. All ten horses showed endoscopic signs of complete laryngeal hemiplegia immediately postoperatively. Starting at three months postoperatively clonic movements of the left arytenoid cartilage were observed in four of the six reinnervated horses but not in the sham operated horses. At the sixth postoperative month five reinnervated horses had clonic movements of the left arytenoid cartilage. The comparison of upper airway resistance measurements before surgery and at one week, three and six months after surgery showed no significant differences in either control or experimental horses. Following euthanasia at six months postoperatively, the left and right dorsal crioarytenoid muscles were compared for evidence of reinnervation. No significant difference in weight was noted in the reinnervated horses but the left dorsal cricoarytenoid muscle weighed less than the control horses.  相似文献   

11.
Light microscopy, morphometry, and scanning electron microscopy were used to examine the mucosal morphologic features of 7 intestinal specimens (3 from the small intestine; 4 from the large intestine) from each of 8 horses 1 year after sham operation (group 1; n = 3) or extensive large-colon resection (group 2; n = 5). Qualitative light microscopic examination did not reveal differences between groups, but morphometry revealed significantly (P less than 0.05) greater intercrypt area and distance in horses with colon resection and this was most pronounced in the cecum and remaining right ventral and dorsal colon. Crypt area and depth were similar for horses with colon resection and sham operation (P greater than 0.05). Qualitative evaluation of the scanning electron micrographs revealed more prominent crypt orifices in the large intestine of horses with colon resection. The larger intercrypt distance in the colon of horses with resection was not an obvious feature of the qualitative evaluation of the surface with scanning electron microscopy. Small intestinal morphologic features were variable and significant differences were not detected between horses with sham operation and colon resection. Horses adapted to extensive large-colon resection within 1 year by increasing the absorptive (intercrypt) surface area of the remaining large intestine.  相似文献   

12.
Background –  Equine sarcoidosis may present as a generalized or localized exfoliative dermatitis and/or as a granulomatous inflammation of multiple organs. Objectives –  To report the clinical signs, diagnosis, treatment and outcome for 22 horses with histologically confirmed sarcoidosis. Animals –  Twenty‐two horses of different breeds, between 3 and 17 years of age. Methods –  Diagnosis was based on clinical signs and histopathological findings. Results –  The following three forms of equine sarcoidosis were identified: generalized (13.6%), partially generalized (18.2%) and localized (68.2%). High‐dose systemic corticosteroids were used as the initial treatment in all three forms, followed by lower doses for a variable number of weeks. No local treatment was prescribed. Case outcome was variable; one of three cases of generalized sarcoidosis was euthanized immediately and the remaining two were euthanized after 2–3 months of unsuccessful treatment; all four cases of partially generalized sarcoidosis deteriorated despite treatment and were euthanized after 3.5–12 months; two cases with localized disease showed no response or insufficient response to treatment and were euthanized; four cases recovered fully with or without treatment, and one showed partial recovery without treatment; and eight cases improved whilst receiving prednisolone but required continuous low doses to maintain remission. Conclusions and clinical importance –  Recognition of the different forms of sarcoidosis based on history, clinical appearance and histopathology assisted in making an informed choice between treatment and euthanasia and prevented unnecessary local treatment. Equine sarcoidosis should be included in the differential diagnosis of a localized exfoliative dermatitis of unknown origin.  相似文献   

13.
Objectives: To determine (1) the short‐ (to hospital discharge) and long‐ (>6 months) term survival, (2) factors associated with short‐term survival, and (3) the perioperative course for horses with resection and anastomosis of the descending colon. Study Design: Multicentered case series. Animals: Horses (n=43) that had descending colon resection and anastomosis. Methods: Medical records (January 1995–June 2009) of 7 equine referral hospitals were reviewed for horses that had descending colon resection and anastomosis and were recovered from anesthesia. Retrieved data included history, results of clinical and clinicopathologic examinations, surgical findings, postsurgical treatment and complications, and short‐term survival (hospital discharge). Long‐term survival was defined as survival ≥6 months after hospital discharge. Results: Of 43 horses, 36 (84%) were discharged from the hospital. Twenty‐eight of 30 horses with follow‐up information survived ≥6 months. No significant associations between perioperative factors and short‐term survival were identified. Lesions included strangulating lipoma (n=27), postfoaling trauma (4), infarction (4), intraluminal obstruction (2), and other (6). Common postoperative complications included fever and diarrhea. During hospitalization 7 horses were euthanatized or died because of septic peritonitis (3), endotoxemia (3), and colic and ileus (1). Conclusions: Descending colon resection and anastomosis has a favorable prognosis for hospital discharge and survival ≥6 months. The most common cause of small colon incarceration was strangulating lipoma. Clinical Relevance: Complications include postoperative fever and diarrhea but the prognosis is good after small colon resection and anastomosis.  相似文献   

14.
Each of 3 digestion trials (3 forage diets) was performed on 2 groups of horses 6 to 12 months after sham operation (group 1; n = 3) or large-colon resection (group 2; n = 5). Diets were alfalfa pellets, alfalfa hay, and grass hay. Feed and fecal analyses were performed to determine apparent digestion of dry matter, organic matter, and crude protein and true digestion of dry matter, organic matter, crude protein, total plant cell wall, hemicellulose, cellulose, and lignin. Additional fecal and metabolic variables determined were percentage of fecal water, total fecal water, metabolic organic matter, metabolic crude protein, and metabolic nitrogen. Large-colon resection decreased the digestion of plant cell wall because of decreased digestion of cellulose in alfalfa pellet and grass hay diets, but not in alfalfa hay diet. Insufficient digestible energy and/or protein from grass hay was obtained by horses with colon resection, and significant (P less than 0.05) weight loss was observed. Voluntary intake was significantly (P less than 0.05) increased by horses with colon resection. Of the diets studied, alfalfa hay was the most appropriate forage diet, compared with average grass hay and alfalfa pellet diet, for horses after extensive large-colon resection. Additionally, horses with colon resection may have higher levels of feed intake than do horses without colon resection.  相似文献   

15.
OBJECTIVE: To determine if morphologic evaluation of intraoperative biopsies of the large colon could be used to accurately predict outcome in horses with large colon torsion. STUDY DESIGN: Clinical study. ANIMALS: Fifty-four horses with large colon torsion. METHODS: A full-thickness biopsy was collected from the pelvic flexure of the ascending colon after correction of naturally occurring colonic torsion. Morphologic changes were evaluated and graded for interstitial tissue to crypt ratio (I:C ratio), percentage loss of superficial and glandular epithelium, and the degree of hemorrhage and edema. These variables were then used to predict survival. RESULTS: Morphologic variables could be used to correctly predict survival or death in 51 horses (P < .0001). This corresponded to a sensitivity of 95.1% (82.2%-99.2%; 95% CI) and a specificity of 92.3% (62.0%-99.6%; 95% CI). Of 6 horses that had colonic resection, 5 survived; an accurate prediction of outcome based on morphologic criteria was made for each horse. CONCLUSIONS: Interpretation of changes in colonic morphology can be used to accurately predict postoperative survival in horses with large colon torsion. CLINICAL RELEVANCE: Use of frozen colonic tissue sections is a rapid, reliable, and relatively inexpensive method for assessing morphologic damage associated with large colon torsion during surgery. Intraoperative evaluation of pelvic flexure biopsies can aid in the prediction of survival and guide surgical judgment as to the need for colonic resection.  相似文献   

16.
Acquired incarcerated inguinal hernia: a review of 13 horses   总被引:2,自引:2,他引:0       下载免费PDF全文
The case records of 13 horses with acquired incarcerated inguinal hernia in January-August 1983, were reviewed. Nine cases were in stallions. The remaining four involved eventration 5-48 hours following castration. Ages ranged from 1-17 years. Horses showed a variable degree of colic. Bowel was felt to pass through the internal inguinal ring on rectal examination in most cases. The physical features of the scrotum varied considerably. Resection of ischemic jejunum and/or ileum was necessary in three horses. Two horses were euthanized at surgery (one with bilateral ischemic jejunum, one with bowel perforation), and a further horse on day 16 postsurgery following development of multiple adhesions. All stallions were castrated. Follow-up for 6-24 months (mean 12.7) disclosed that all ten discharged horses were alive and healthy (recovery rate 77%).  相似文献   

17.
Moderate to severe ulcerative colitis of the right dorsal colon was diagnosed by necropsy or by exploratory celiotomy and biopsy in 13 horses with a primary clinical complaint of either colic, diarrhea, or weight loss. Clinical signs varied from acute fulminating diarrhea (possibly with fever), colic, dehydration, endotoxic shock and death, to a chronic condition manifested by mild intermittent colic up to several months in duration, and weight loss with or without mild diarrhea. In a large percentage of the horses, those affected had been hypovolemic and received nonsteroidal anti-inflammatory drugs (NSAID) or had received inappropriately high doses of phenylbutazone before the onset of illness. Experimental treatment of two horses with high doses of a phenylbutazone oral paste preparation (6 gm once daily for 5 days) and limitation of their water intake to approximately one half of maintenance requirement (for 5 days) resulted in reproduction of ulcerative colitis involving only the right dorsal colon, which was apparent at necropsy examination 11 and 15 days after initiation of drug use. It was concluded that localized ulcerative lesions in the right dorsal colon may be a previously unreported manifestation of toxicity due to the administration of NSAID.  相似文献   

18.
Between 1985 and 1993, nine dogs with spinal cord tumors were treated postoperatively with cobaltradiation at North Carolina State University-Veterinary Teaching Hospital. Total doses ranged between 33.3–48.0 Gy given in 10–12 fractions of 3–4 Gy over a four week period. Five dogs were euthanized due to recurrence of the tumor or neurologic signs and two dogs were euthanized due tounrelated problems. Two dogs were alive but lost to follow-up at 12 and 25 months. Survival time ranged from 6.5–70.0 months. Median survival time (95% confidence interval) was 17 (12–70) months. Results of this study suggest decompressive surgery followed by irradiation can be an effective treatment for dogs with spinal cord tumors.  相似文献   

19.
During a 28 month period, 82 horses with clinical signs of abdominal pain were examined for left dorsal displacement of the large colon (LDDLC) using percutaneous ultrasound. Left dorsal displacement of the large colon was diagnosed when a gas echo dorsal to the spleen obliterated the dorsal splenic border, or when the colon was observed lateral to the spleen. In 42 horses, ultrasound confirmed a diagnosis of LDDLC and 40 horses had no evidence of LDDLC. There were five false negative results and no false positives. In four horses with LDDLC, the colon was displaced between the spleen and body wall; three of these colic episodes resolved with medical therapy and the fourth required a celiotomy to relieve a sand impaction. The remaining 38 horses had a renosplenic entrapment; surgical correction was elected in 4 horses, 21 horses were corrected by a nonsurgical rolling procedure, 12 were corrected at surgery after an unsuccessful rolling attempt, and one was corrected by rolling but required surgery later because of an additional lesion. Percutaneous abdominal ultrasound was a valuable aid in the diagnosis of LDDLC and in confirming correction of the displacement after a nonsurgical rolling procedure.  相似文献   

20.
Fecal excretion of a particulate marker, ytterbium (Yb), was evaluated in 9 horses before surgery and 3 weeks, 3 months, and 6 months (4 trials) after sham-operation (group 1; n = 3) or extensive large colon resection (group 2; n = 6). Fecal excretion curves of total Yb excretion, loge Yb excretion, % Yb excretion, loge % Yb excretion, and cumulative % Yb excretion were evaluated, and kinetic analysis was performed on the loge Yb excretion curves to detect mixing pools and to calculate the fractional rate of particulate passage, turnover rate, and pool size. Calculations were performed to determined transit time, mean overall retention time, adjusted mean retention time, peak time, and disappearance time. Values were statistically analyzed to determine differences between groups and among trials (P less than 0.05). Group-2 horses had significantly shorter transit, peak, and mean overall retention times, compared with preoperative values and with values for group-1 horses. Two mixing pools were identified: a slower emptying pool of 5.7% hour-1 (k1) and a faster emptying pool of 12.3% hour-1 (k2). The rate of passage from the first pool (k1) was not altered by colon resection, and was interpreted as being most influenced by the cecum. In further support of this interpretation, the capacity of the k1 pool approximated the capacity of the cecum (17 L). The capacity of the k1 pool significantly expanded by 6 months in the resected horses. the rate of passage from the second pool (k2) significantly increased initially after colon resection (3 weeks and 3 months), but returned to preoperative values by 6 months.(ABSTRACT TRUNCATED AT 250 WORDS)  相似文献   

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