闫朝武:全世界首例射频房间隔造口术(CURB术式)治疗左心衰竭得到成功
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">背景简介</strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;"><span style="color: black;">左心衰竭</span></strong><span style="color: black;">(Heart Failure,简<span style="color: black;">叫作</span>左心衰)<span style="color: black;">是由于</span>左室代偿功能不全<span style="color: black;">导致</span>,以肺循环淤血为<span style="color: black;">重点</span>特征,其发病率呈逐年<span style="color: black;">提升</span>趋势。<span style="color: black;">日前</span>治疗<span style="color: black;">办法</span><span style="color: black;">重点</span>以抗心<span style="color: black;">药品</span>为主。然而,经过优化<span style="color: black;">药品</span>治疗后仍有部分<span style="color: black;">病人</span>难以凑效,存在严重的胸闷、憋气等症状,<span style="color: black;">伴同</span>活动耐受力下降,严重影响了生活质量。<span style="color: black;">以上</span>症状的<span style="color: black;">显现</span>与左室舒张功能不全<span style="color: black;">引起</span>的左房-肺循环淤血<span style="color: black;">相关</span>,可<span style="color: black;">经过</span>经导管房间隔造口降低左房压力,改善左心衰的症状,从而<span style="color: black;">加强</span>活动耐量。近年来国际上已有多个临床<span style="color: black;">科研</span>证实了其疗效。</span></p><span style="color: black;"><span style="color: black;">日前</span>临床应用的房间隔造口术存在<span style="color: black;">许多</span><span style="color: black;">坏处</span>端:<span style="color: black;">1、</span>难以做到个体化<span style="color: black;">精细</span>造口;<span style="color: black;">2、</span>所造房间隔瘘口容易再闭塞;<span style="color: black;">3、</span>心脏内<span style="color: black;">移植</span>器械带来的潜在<span style="color: black;">危害</span>。针对这些问题,<strong style="color: blue;">阜外医院闫朝武教授提出了射频房间隔造口术(CURB术式),这一全新<span style="color: black;">办法</span>克服了传统术式的<span style="color: black;">坏处</span>端,能够<span style="color: black;">按照</span><span style="color: black;">病人</span>血流动力学指标“量身定做”瘘口,真正达到了<span style="color: black;">精细</span>治疗,所造瘘口保持<span style="color: black;">长时间</span>稳定开通,<span style="color: black;">处理</span>了“再闭塞”<span style="color: black;">困难</span>;手术安全性高,避免了心脏内<span style="color: black;">移植</span>器械的潜在<span style="color: black;">危害</span>。</strong>前期,闫朝武教授已将该<span style="color: black;">办法</span>应用在肺动脉高压<span style="color: black;">病人</span>的治疗中并<span style="color: black;">得到</span>成功,得到国际同行的认可(J Am Coll Cardiol. 2018;72:1873-1875),受邀在2019年欧洲心脏病学大会(ESC)做了该术式的专题发言,于2019年中国心脏病大会(CHC)上做手术演示。</span>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">2020年9月25日,闫朝武教授团队首次应用经导管射频房间隔造口术(CURB术式)治疗左心衰<span style="color: black;">病人</span>并<span style="color: black;">得到</span>圆满成功,术后<span style="color: black;">病人</span>血流动力学指标及临床症状均<span style="color: black;">得到</span>大幅改善,这进一步验证了该术式的临床疗效,<span style="color: black;">同期</span><span style="color: black;">亦</span>为此类<span style="color: black;">病人</span><span style="color: black;">供给</span>了一种全新的治疗<span style="color: black;">办法</span>(ClinicalTrials.gov ID: NCT04573166)。</span><span style="color: black;"><span style="color: black;">关联</span>病例资料如下:</span></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><strong style="color: blue;"><span style="color: black;">病例摘要:</span></strong></span><span style="color: black;"><span style="color: black;">病人</span>女性,66岁。主因反复胸闷、心悸4年,加重1月来诊。4年前于活动后<span style="color: black;">显现</span>胸闷、心悸伴憋气,偶有后背部<span style="color: black;">病痛</span>,<span style="color: black;">没</span>黑蒙及晕厥;1个月前症状加重,伴双下肢浮肿,活动耐力<span style="color: black;">逐步</span>下降。我院超声心动图及心脏磁共振<span style="color: black;">检测</span>提示“肥厚型心肌病”,临床诊断为“肥厚非梗阻型心肌病 心功能Ⅲ级(NYHA分级)”。予抗心衰<span style="color: black;">药品</span>治疗,但症状缓解不<span style="color: black;">显著</span>。为进一步<span style="color: black;">知道</span>病因并改善临床症状,经讨论后<span style="color: black;">意见</span>行左、右心导管<span style="color: black;">检测</span>及<span style="color: black;">选取</span>性冠状动脉造影术,<span style="color: black;">按照</span>术中左室舒张末期压力水平,决定<span style="color: black;">可否</span>行经导管射频房间隔造口术(CURB术式)。向<span style="color: black;">病人</span>及家属交代<span style="color: black;">关联</span>病情并签署知情同意书后,于2020年9月25日进行介入手术,术中<span style="color: black;">仔细</span>资料如下:</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><strong style="color: blue;"><span style="color: black;">冠状动脉造影</span></strong></span><span style="color: black;">:冠状动脉呈右<span style="color: black;">优良</span>型。左、右冠状动脉管腔通畅,未见狭窄及阻塞性病变。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><strong style="color: blue;"><span style="color: black;">左心导管<span style="color: black;">检测</span>(mmHg)</span></strong></span><span style="color: black;">:主动脉压力148/68(87);左室压力148/22(65),提示左室舒张末期压力<span style="color: black;">上升</span>;左室到主动脉连续测压<span style="color: black;">没</span>压差。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><img src="https://mmbiz.qpic.cn/mmbiz_png/hfau27COcrBGnhbXytbiaHENbr65zObas9oCTsJN2DODxZPkIVqVkhhBtGYF6xKOfHm5UPOYEBRZNQjwfbRCM5A/640?wx_fmt=png&tp=webp&wxfrom=5&wx_lazy=1&wx_co=1" style="width: 50%; margin-bottom: 20px;"></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><strong style="color: blue;"><span style="color: black;">图解</span></strong></span><span style="color: black;">:左心导管<span style="color: black;">检测</span>提示,左室舒张末期压力<span style="color: black;">显著</span><span style="color: black;">上升</span>,为22 mmHg。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><strong style="color: blue;"><span style="color: black;">右心导管<span style="color: black;">检测</span>(mmHg)</span></strong></span><span style="color: black;">:肺动脉压力44/17(27),提示轻度肺动脉高压;右房压力9/4(6)。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><strong style="color: blue;"><span style="color: black;">穿刺房间隔后左房测压(mmHg)</span></strong></span><span style="color: black;">:左房压力30/18(21),提示压力<span style="color: black;">显著</span><span style="color: black;">上升</span>;</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><strong style="color: blue;"><span style="color: black;">射频房间隔造口术前、术后心房压力变化:</span></strong></span></p><span style="color: black;">左心房平均压力 (mmHg)</span><span style="color: black;">右房平均压力 (mmHg)</span><span style="color: black;">压差 (mmHg)</span><span style="color: black;">术前</span><span style="color: black;">21</span><span style="color: black;">
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">6</p>
</span><span style="color: black;">
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">15</p>
</span><span style="color: black;">术后</span><span style="color: black;">11</span><span style="color: black;">
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">5</p>
</span><span style="color: black;">
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">6</p>
</span>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;"><span style="color: black;">术后临床症状</span></strong><span style="color: black;">:<span style="color: black;">病人</span>胸闷、憋气及背痛等症状均几近消失,运动耐受力大幅<span style="color: black;">加强</span>;</span><span style="color: black;"><strong style="color: blue;">术后心肺运动<span style="color: black;">实验</span></strong></span><span style="color: black;">:<span style="color: black;">病人</span><span style="color: black;">没</span>氧阈(AT)占百分预计值从术前67%<span style="color: black;">上升</span>至术后74%(正常值>80%)。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><img src="https://mmbiz.qpic.cn/mmbiz_png/hfau27COcrBGnhbXytbiaHENbr65zObass5YA4tAByxKPdFGjic7e3DZdMia3Rvh27j2Y9TvgVFPdrXHYGDKfS7vA/640?wx_fmt=png&tp=webp&wxfrom=5&wx_lazy=1&wx_co=1" style="width: 50%; margin-bottom: 20px;"></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><strong style="color: blue;"><span style="color: black;">图解</span></strong></span><span style="color: black;">:射频房间隔造口术<span style="color: black;">按照</span><span style="color: black;">病人</span>血流动力学参数进行个体化<span style="color: black;">精细</span>造口;红色箭头所示为扩张过程中球囊中央形成的“腰征”(左图),完全扩张后,“腰征”消失(右图)。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><img src="https://mmbiz.qpic.cn/mmbiz_png/hfau27COcrBGnhbXytbiaHENbr65zObasQPSwGLksfupGFnCGFR1Z2ueZPKdMHHicQRQ4UGCvwDWOumJGQ2g7icibA/640?wx_fmt=png&tp=webp&wxfrom=5&wx_lazy=1&wx_co=1" style="width: 50%; margin-bottom: 20px;"></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><strong style="color: blue;"><span style="color: black;">图解</span></strong></span><span style="color: black;">:射频房间隔造口术后,左房平均压力降低到正常水平。<span style="color: black;">病人</span>胸闷、憋气等症状即刻缓解,次日<span style="color: black;">病人</span>下地活动后,<span style="color: black;">困惑</span><span style="color: black;">数年</span>的胸闷、背痛等症状几近消失。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><img src="https://mmbiz.qpic.cn/mmbiz_png/hfau27COcrBGnhbXytbiaHENbr65zObasG8ia8uADZ6TWWYZwGq5WiadXfjTETQgjYEf3PdBftHS728CnLP1IiayMg/640?wx_fmt=png&tp=webp&wxfrom=5&wx_lazy=1&wx_co=1" style="width: 50%; margin-bottom: 20px;"></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><strong style="color: blue;"><span style="color: black;">图解</span></strong></span><span style="color: black;">:应用射频消融导管对瘘口边缘进行消融,从而<span style="color: black;">保证</span>瘘口稳定,<span style="color: black;">控制</span>其再闭塞。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><img src="https://mmbiz.qpic.cn/mmbiz_png/hfau27COcrBGnhbXytbiaHENbr65zObas5wIfzPdlaqhbSOeYyagia340bKv1TTBPVNLJPrqwof0VcK6Q4YDuF3w/640?wx_fmt=png&tp=webp&wxfrom=5&wx_lazy=1&wx_co=1" style="width: 50%; margin-bottom: 20px;"></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><strong style="color: blue;"><span style="color: black;">图解</span></strong></span><span style="color: black;">:术前<span style="color: black;">病人</span>双肺淤血重,术后双肺淤血<span style="color: black;">显著</span>缓解。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><img src="https://mmbiz.qpic.cn/mmbiz_png/hfau27COcrBGnhbXytbiaHENbr65zObasun7NPj4ricHLtMgYfMu7ke6KeibQib4x4YIUdQ6iacxt3h9ia2b4SxWJycA/640?wx_fmt=png&tp=webp&wxfrom=5&wx_lazy=1&wx_co=1" style="width: 50%; margin-bottom: 20px;"></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><strong style="color: blue;"><span style="color: black;">图解</span></strong></span><span style="color: black;">:超声心动图提示,术后<span style="color: black;">经过</span>所造房间隔瘘口,房水平可见左向右分流。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><img src="https://mmbiz.qpic.cn/mmbiz_png/hfau27COcrBGnhbXytbiaHENbr65zObas3eF5Jbx9sQXMkM9PqS1WXCbkkMdkneXwYvVFyKrt7npiageduVfw9bg/640?wx_fmt=png&tp=webp&wxfrom=5&wx_lazy=1&wx_co=1" style="width: 50%; margin-bottom: 20px;"></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><strong style="color: blue;"><span style="color: black;">图解</span></strong></span><span style="color: black;">:术前<span style="color: black;">病人</span>房间隔完整,术后房间隔制作出一边缘清晰的瘘口(红色箭头所示),其前后径约5mm。</span></p><img src="https://mmbiz.qpic.cn/mmbiz_png/hfau27COcrBGnhbXytbiaHENbr65zObasu090uLBA70yJdkufOm9MPo0JNMaJ0HZ1IMV6URN3X5JkW9QUIZqAog/640?wx_fmt=png&tp=webp&wxfrom=5&wx_lazy=1&wx_co=1" style="width: 50%; margin-bottom: 20px;"><img src="https://mmbiz.qpic.cn/mmbiz_png/hfau27COcrBGnhbXytbiaHENbr65zObasNRMlnQOBjEY08Exr1t3412I9JcRTomo8ScMiajibBpibNdhLVJZdZUibgw/640?wx_fmt=png&tp=webp&wxfrom=5&wx_lazy=1&wx_co=1" style="width: 50%; margin-bottom: 20px;"><img src="https://mmbiz.qpic.cn/mmbiz_png/hfau27COcrBGnhbXytbiaHENbr65zObasib0Ss3jQwgr3He26fNAucEvmTToFA8qG9yZeotNjh6SR6VQ9mHHlqNA/640?wx_fmt=png&tp=webp&wxfrom=5&wx_lazy=1&wx_co=1" style="width: 50%; margin-bottom: 20px;">
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><strong style="color: blue;"><span style="color: black;">图解</span></strong></span><span style="color: black;">:闫朝武<span style="color: black;">专家</span>、李世国<span style="color: black;">专家</span>、王建德<span style="color: black;">专家</span>等在进行手术操作。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><img src="https://mmbiz.qpic.cn/mmbiz_png/hfau27COcrBGnhbXytbiaHENbr65zObasKs5jiaibiaUlZ83eShiaRtk7vOdqEAbUib8nE6CP6NMmwR2hF019nDHtBAw/640?wx_fmt=png&tp=webp&wxfrom=5&wx_lazy=1&wx_co=1" style="width: 50%; margin-bottom: 20px;"></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><strong style="color: blue;"><span style="color: black;">图解</span></strong></span><span style="color: black;">:手术<span style="color: black;">构成</span>员合影。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><strong style="color: blue;"><span style="color: black;">射频房间隔造口术治疗左心衰竭的适应症</span></strong></span><span style="color: black;">:</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">(1)年龄≥18周岁;</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">(2)<span style="color: black;">知道</span>的慢性心力衰竭症状、体征,<span style="color: black;">药品</span>疗效欠佳伴NYHA 心功能分级III或IV级,<span style="color: black;">连续</span>3个月以上;</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">(3)超声心动图提示左室舒张功能减低;</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">(4)动脉收缩压≥90 mmHg;</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">(5)射血分数减低心力衰竭:LVEF20-40%伴左室舒张末期压力或PCWP≥18 mmHg; </span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">(6)射血分数保<span style="color: black;">留意</span>力衰竭:LVEF>40%伴左室舒张末期压力或PCWP≥18 mmHg;</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><strong style="color: blue;"><span style="color: black;">射频房间隔造口术的目的及<span style="color: black;">优良</span></span></strong></span><span style="color: black;">:</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">重点</span>目的:<span style="color: black;">经过</span>制造房水平左向右分流,从而降低左房压力,缓解双肺淤血,改善临床症状并<span style="color: black;">加强</span>运动耐受力。<span style="color: black;">另一</span>,<span style="color: black;">亦</span>可改善终末期心衰<span style="color: black;">病人</span>的血流动力学参数,为心脏移植<span style="color: black;">供给</span>过渡。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><strong style="color: blue;"><span style="color: black;"><span style="color: black;">重点</span><span style="color: black;">优良</span></span></strong></span><span style="color: black;">:个体化造口,<span style="color: black;">长时间</span>稳定开通,非器械<span style="color: black;">移植</span>。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><img src="https://mmbiz.qpic.cn/mmbiz_jpg/hfau27COcrBGnhbXytbiaHENbr65zObasXDnfoOpa8z2BhtwicQibgpspd60licE4iaHjrtPuaanzqFlYB5RLVLaUfA/640?wx_fmt=jpeg&tp=webp&wxfrom=5&wx_lazy=1&wx_co=1" style="width: 50%; margin-bottom: 20px;"></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">专家简介</strong></p><img src="https://mmbiz.qpic.cn/mmbiz_png/hfau27COcrCWq0a9qw37fjfqeia50FlJiccJUywOyN0ssGdFUqC5yHuO8Lu0PQoQg0aXJnbHLVeCG34Bu1nA3WpQ/640?wx_fmt=png&tp=webp&wxfrom=5&wx_lazy=1&wx_co=1" style="width: 50%; margin-bottom: 20px;">
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">闫朝武</strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">中国医学科学院阜外医院</p><span style="color: black;">毕业于中国医学科学院协和医科大学,医学博士。国家心血管病中心-阜外医院<span style="color: black;">专家</span>医师,硕士<span style="color: black;">科研</span>生导师,中华医学会心血管病学分会--结构性心脏病学学组委员,卫计委先心病介入培训基地导师,教育部科技<span style="color: black;">评估</span>与评审专家。从事心血管病影像诊断与介入治疗工作近20年。<span style="color: black;">善于</span><span style="color: black;">各样</span>先天性心脏病、瓣膜性心脏病及主动脉病变的影像诊断和介入治疗。独立完成各类心导管<span style="color: black;">检测</span>及心脏介入手术近万台,<span style="color: black;">尤其</span>是在<span style="color: black;">繁杂</span>结构性心脏病诊疗方面<span style="color: black;">累积</span>了丰富的临床经验。<span style="color: black;">持有</span>8项国际首创新技术,其中就<span style="color: black;">包含</span>本文<span style="color: black;">说到</span>的房间隔造口的全新术式:CURB(联合应用射频消融和球囊扩张),并在临床应用中<span style="color: black;">得到</span>成功,<span style="color: black;">处理</span>了<span style="color: black;">长时间</span><span style="color: black;">困惑</span>临床的房间隔造口再闭塞<span style="color: black;">困难</span>。</span>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">日前</span><span style="color: black;">得到</span>多项<span style="color: black;">研究</span>奖励,<span style="color: black;">包含</span>国家科学技术进步奖二等奖、高等学校科学<span style="color: black;">科研</span>优秀成果奖、华夏医学科技奖一等奖、中华医学会科技奖等等。负责国家自然科学基金等课题6项,参与其它<span style="color: black;">关联</span><span style="color: black;">科研</span>课题8项。<span style="color: black;">发布</span><span style="color: black;">科研</span>论文超过60篇(SCI论文18篇),其中以<span style="color: black;">第1</span>作者及通讯作者在国际权威心血管病杂志<span style="color: black;">发布</span>论文十余篇。<span style="color: black;">另外</span>还参与编写《结构性心脏病规范化防治--从指南到实践》、《先天性心脏病心导管术》、《疑难先天性心脏病介入治疗》、《心血管病磁共振诊断学》等多部学术论著。<span style="color: black;">日前</span><span style="color: black;">持有</span>国际首创的经导管室间隔穿刺系统,新型经导管主动脉瓣膜系统等多项PCT专利。</span></p><strong style="color: blue;">延伸阅读</strong><a style="color: black;">闫朝武:联合应用射频消融和球囊扩张房间隔造口术</a>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><img src="https://mmbiz.qpic.cn/mmbiz_jpg/hfau27COcrDxdwkrVhtVKCwFzq1wQh8T2fFkdsgbicXic3pW8fevAXuuv1EC330jc48uGQ0iaicPp718luR3Hibwvcw/640?wx_fmt=jpeg&tp=webp&wxfrom=5&wx_lazy=1&wx_co=1" style="width: 50%; margin-bottom: 20px;"></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">获取<span style="color: black;">更加多</span><span style="color: black;">新闻</span>,请点击</span><strong style="color: blue;">“阅读原文”</strong><span style="color: black;">下载</span><strong style="color: blue;">“严道</strong><strong style="color: blue;">医声APP”</strong></p>
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