ǰλãҳ -
θгؽרҹʶ
ʱ:2014-5-22

ؼʡؽθгǺϼ
Keywords digestive reconstruction; gastric resection; anastomosis
1
1.1 θؽĻԭθгؽԼ
130 ʷBillroth 1881 ԶθгBillroth
ʽǺϡ1893 Roux Roux-en-Y Ǻʽ1896
Schlatter ȫθгʳܿճǺؽ1908
Volcker нθгʳθǺؽ󣬸ؽ
ʽӦ˶ؽʽΪֹͳһġѭ֤
ҽѧ߼֤ݵȷθгؽʽ
ֶؽĻԭͻѡȷġ
ʽӦѭĻԭ򣺣1Ǻϵİȫǵһλ
ǺϲλѪ˼ѡ͡ٵǺϿ2
ʳ桢ųĹܲзֹθʳ
Ĺܣ·3֤ھ
ԣθȵļ飩Halsted 100 ǰ
ƲԭЩԭҲθ
ϡҪѡǺϷǺ϶Ĺ졢
֯ܣʳܡλֱȱٽĤĤȣ
쳣Ӫ䡢򲡡衢㡢
ءԸĤסˮʱθı仯ص㣬ѡȫ
ġǺϷʽӦʹе
Լ֯Ӱ졢ҽԴ𺦣ӡǯЮ
֯Ĵˡˡϲϵ
֯ԷӦϮ΢˵Ǻϼ
θǺϲλ˳Ϻ޸
θǺϵĹǸΪӡؽ롢ʱ
ԵĶ̬̣ÿڵİաʶѴ
ἫظԤͽθϹ
½еģҺʡ
úӰ죬θϸԼȺʧȾ
вθǺʱӰ죬θ
䶯εĸţ߲֯ڵĴ̼仯ȣ
ǺϲλϲеӰ1ݡ޶ȵؼ
ӰǺʧܵأϸΧڹǷdzҪ
ġĿǰõθؽУԶθгBillroth
B-ʽBillroth B-ʽRoux-en-Y Ǻϣ
θгʳθǺϣȫθгRoux-en-Y Ǻϵ
ؽʱְθĽѧ
ǺϿ֯ϻӰϵȫֲء
ϼӰ죬ŬٺͷֹǺϿ©
Ѫխز֢ؽɹĹؼ
1.2 θгؽʽǺϷθг
ؽʽнθгҪʳθǺϡÿ
˫ͨȣٴʳθǺΪȫθг
ؽʽRoux-en-Y ÿճ˫ͨȣ
Roux-en-Y ǺٴΪӦõǺϷʽõ
ǺϷж˶Ǻϡ˲ǺϡǺϡϷ
ֹϺͻеǺϡֹϰθܱڵĶԺϷ
ʽнĤԺϷϡ϶˶ԺϷϷĤԺϷҪ
ĴAlbert-Lembertȫ㡢ϣ
Czerny Ϸϵ˫ϷȷУ
ǿˣٴ㷺Ӧá϶˶ԺϷϷҪGambee
Jourdan Olsen ͲϷLembert Halsted
Connell Gambee Jourdan Olsen ڵ
Ϸϼѣխ©ʵ͡еҪʹ
ǺLinear staplerĹԶ˶Ǻϣfunctional
end-to-end anastomosisFEEA˶ǺϺʹû
ǺǺϡFEEA ܶ϶˿Сף
ֱ߷ܲͬʿ֮ķϣͨ
÷߷ϻǺķǺǺϷ
Circular stapler ܵһ϶˲붤ͷһ
Circular stapler 롢ǺϵķOverlap
side-to-side ǺϷܵһڻ϶˿С
ףһܲڿСײֱиǺ
ϣַͨԶǺرյķʳθǺ
ʱѡFEEA Circular stapler ʳճǺʱ
ѡFEEA Overlap Circular stapler θʮָ
205
йʵ־2014 3 µ34 3
ǺʱB-񣩿ѡã1ǺϷFEEA θ
ʮָǺϵķ2Circular stapler B-ʽ
ѡside-to-side Roux-en-Y ѡside-to-side
circular stapler ϵķֶӦѧ
ѡá
1.3 θǺϲλ֯θǺϲλ
֯ϡ޸뾭Ƥ֯Ϲ̾йͬ
ѧڼ֢ڣѪֹѪ
ϸϸͷŶӡ֯
ӡ֯ڣ˺3~5 d˼άϸ
ֳԭ׷ڣͽԭԣëϸѪ
΢ѭڣܣѿ֯
ܽ׶ΡθǺҲѧڣ֯ѧ
ͳڣڸϸӡֳӵĵ
֯Ϲ̡ȻθжصĽѧθ
ҺĴڣеĹɼθ
Ǻϲλ޸ϡθǺϲλҪ
ڸѪܡܰ͹Ѫḻԭף
68%20%12%ڵĤ²СĤ
޸ƤϸֳɣθĹм㡢
Ĥάʽ޸ϡθǺʱIJ
޸ϵĹ̡ʵθǺϷ֮
ǾѾʶһ㡣1827 Lembert
ԭ򣺣1ĤĤϲϣ2Ĥ뽬Ĥ
ϲ֣3Ĥ뽬ĤϼѡθǺ
вԺǺҪĤ²ϰ
Ҫɫ
1.3.1 ֹǺϵ֯θǺϺijڣǺ
λĽڷߵ֯ѧϳַ
ߵԷӦϸԽߵIJ
ʶвͬӰ졣ڷߵѧϵĻ
3~5 d ǺϲλijάϸֳëϸѪԭ
׵IJӣϸˮ׼ˣĤƤ
Լ1 θǺϲλijϻɡ
ĽʱڡϷʽԺϵGambee
Albert-Lembert ǺϷǸΪǺϷ
1.3.2 еǺϵ֯ϻеǺϺθǺϲ
λֹǺƣǺ֯ѹ
եѪƻ΢СѭϰżõĽ
ĤĤλѪԽǺϿڵѪ
ٽ5~7 d֢ڹɵάڡڣԼ3
Ѫؽͻָθڸԡ
ǺǺڷǺϣܱڸֹ
ǺϵAlbert-Lembert ƣϹ̲ȫ
ͬڷǺʱĤΪѪҺѭͨϣͨѹ
ե֯дѪˣĤԼĤ
λѪؽʼϹ̡ǺʱӦ
쳣״̬µijλʵʩˮס֢λ
ϡȻ״̬µĿھϽǺϣ⳦ܵ˳
ѪƱȻ״̬ŤǺϺϻԳ
ĹܡɶԲӰ졣ǺǺϵ޸
dzⷭϵĹ̡ⷭǺϲλĤ
ԺϹ̣ⷭǺϵĽĤ
ȻϹ̡
2 θгؽļҪͲ֢ķ
2.1 θгʳθǺϽθгҪ
θϲڰθгȽϳõؽ
֣ʳθǺϷͼÿճʳθǺϷ
Ϊؽʽȫжһֱ
Ϊֹûи߼ѭ֤ҽѧ֤֤θ
гؽѷʽڣձĵ
оʾʳθǺÿճȣ
ߣ󲢷֢٣2ݡʳθǺϷʽж˶
Ǻϡ˲ǺϡθǺϲλθ϶ˡǰںͺڡ
ʳܲθǺϷʽƼӦö˶Ǻϻ˲Ǻ
ʽ˶ǺƼθ϶ʳǺϣ
ԱѪܣֲѪã˲ǺƼ
ʳθǰǺϣԤЧӦ
2.1.1 ǺϼҪ㣨1ʳ¶ΣעⱣ
񾭣ؼҵʳܽĤʳܽĤпʳθ
ϲĸĤɹ۲쵽ʰʳܽĤ
Եʳܷ˴ʳܽĤʳܼdz
ɣʳһ㲻ѣҲѪǰɣ
Ҫǰɺ͸֧dzжθ֧֧Ѱ
񾭺ʱʳܽĤӱ롣
ʳܽĤʳܽĤ֮Сθ
࣬չʳܽĤɿ񾭺ɡ2ȷ
θгΧȷӦڲԶ2~5 cm жθ
С࣬θѪܺθĤѪ֮жθࡣ
3ʳгΧһг2~3 cm ʳܡ
ǣҲҪλ֤ĸ
г4ֹϵļҪ㡣ƼʳθǺϿ
θǰСࣨͼ1aʳܶ϶1 cm Ԥ
θǺϿڲθ֮3-0 ߷5~6 룬Lembert
ϣǺϿںȫ㡢5 mm 3-0 ߡ
Albert ϡǰͬȫAlbert ϣ󽬼
Lembert ϣͼ1bһѡշߣͺ
Ϊ3-0 4-0Ϊ˿ǺﷴӦʸߣǺ
γˮ׺ͳѪ3ݡ5еǺϵļҪ㣺ʳ
ܶ϶Ǻͷ25 mmɰ߹̶ڲθǰ
пǺǺļڲθС2 cm
϶2 cm ᴩʳܶͷӣƼʳܲθǰ
ϣͼ1c۹رǺIJθǰпڣܼӹʳ
θǺϿڽ㡣
2.1.2 ǺϵԲߣ1ѡǺСҪʡ
206
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оʾʳθǺʱʹ25 mm Ǻܽ
󲢷֢ķʣ4ݡⲻǾԵģһҪ
ʳھСǺͺš2ʳ޽ĤҼ
УӦʳб죬ȫҪ֤Ĥ
Ĥ²ȫʱУֹѡǺϿ
ϴ󣬿ɽмŷϣʳܱǺϲΧθ
ڽϡӦӹ̷ϣͳѪ3
ֹļHis ǺͼijΣʳ
ʹŵĹ̶񾭣ųΡ4
ֹθܱжʳǰӦθ˻ʳܽ
ˣǺϽٽθ룬ǺϿ·10~
15 cm
2.1.3 ֢Ԥ봦
2.1.3.1 ǺϿխǺǰӦעθѪ
ֲθжѪɫӦгò֣
ǺϿڲλеǺʱӦѡ񾡿ܿھ
ֹǺʱӦѡշߣԼǺ
֢ʣ5-7ݡƼʹ3-0 ɱ֯ߣ8ݣ
Vicryl PlusʹϸΪ1/2 СԲ룬
޶ȼΧ֯ˡ˾
翪ʼʳʳǺϿڡڳ
Ͽխͨھ·ִǺϿڡ
ɾھھ
ǺϿխ9ݡ
2.1.3.2 ǺϿڳѪǺǰӦϸθĤ
޻ԳѪҪʱĤѪܡڷʳθ
ǰʱӦϸ޳Ѫ㣬Ҫʱӷ졣ǰ
ǺϺҲӦϸ顣еǺɺӦϸ
ǺϿ޳ѪθѪҺ
ȾθעȥغͱˮЧӦ
ھ飬ȷѪ㣬ھֹѪмбա
2.1.3.3 ǺϿ©ǺϿ©ǺϿڴ֯ȱӶ
θǻ쳣ͨ10ݡױǺϿ
©巢Ϊ2.1%4ݡǺӦþҽ
Լٲ֢ķ11ݡɻеǺϺ
ӦǺϻǷǺϻ
ǺϿ©ʱӦóǯбǺϿԶθǻ󣬾
θעǺϿɫɴӹ̷
ϣƷҪʱɷÿճӪܣ
Ӫ֧֡ǺϿ©Ӧʳ
ؼθҺڣͬʱǿӪ֧֡迹Ⱦҩ
ҺϸҩȾҩ
ͨɵȴ©ϡֲ
ҺӦB CT ´ŧǻԲܸ
ƣ12ݡ
2.2 ԶθгB-B-Roux-en-Y ǺԶθ
ǺϷҪB- ʽBillroth1881B- ʽ
Billroth1885Roux-en-YRoux1893Զθ
гؽĿǰļ͢ٴ
о13-15ݺMeta 16ݽԴɹʶΪ1Զ
θRoux-en-Y ǺϵԶЧڴͳ
B-ʽB-ʽǺϡθθ
ˣԶθгRoux-en-Y Ǻϣ
չθˣԶθгB-ʽ
ϡСθ񼰩ˣɿB-ʽǺϣ
B- ʽBraun ǺϻRoux-en-Y Ǻϡ
2ںϲ򲡵θˣԶθг󣬽
B- ʽRoux-en-Y Ǻϣ򲡵Ŀ
ƣ17ݡ3ƼʹǺؽŵڽ
֢ʣʡʱ䣬ڲ˻ָ18ݡ
ձо19ݽʾԶθУ
ʹǺؽʱ䣨14 vs. 25
minP= 0.02ͬʱ󲢷֢ʺʡ
2.2.1 B-ʽǺԶθг󣬽θʮָ
жԶǺϻ˲ǺϡжԶǺʱר齨齫
θСпڱպϣпʮָǺϣ
ж˲ǺʱɽθʮָǺϡʽ
ϼ򵥣ǺϺθӽ״̬
a. ʳθǺͼb. ֹϣ˲Ǻϣ c. еǺϣ˲Ǻϣ
ͼ1 ʳθǺ
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a. θʮָڽLembert b. θʮָȫAlbert c. θϲʮ
ָd.θʮָǰڵȫe.θʮָǰڵĽf. Jammer Ecke
θҶIJ֢
١
2.2.1.1 B-ʽǺϼҪ㣨1
ʮָпʮָ
ĺĤKocher пڣʮ
ָͷԽǺϿͬʱʮ
ָ࣬ӰѪ
ǺϿ©رӦʮָ
϶2ȷθгΧݲ䲿
λ;ֲǷչȷθг
λͬעⱣθѪ3ֹ
ϣθǺϿڵȷθ϶Сͷرգ
϶˱2.5 cm ǺϿڡθʮָǺϣθǺ
ʮָǺϿڶԺϣСཬǣߣ
ھԵ0.5 cm Lembert ϣ5~6 룬3-0
ߣȫAlbert ϣϷϻȫ
ϣ3-0 շߣͼ2abǰȫAlbert
ϻȫϣ3-0 շߣǰڽ
Lembert ϣϻȫϣ3-0 շߣͼ
2deJammer Ecke λķϣȫӦֶԺϣ
ʽ;ҲӦԶԺϷϣúɰʽ
ͼ2cf4еǺϣʮָж˺ɰϣ
ͷ̶θԶǺڽ̳
ʮָͷӡ3~4cm ֱ
иǺгθ϶˵Ľ3-0 ߼Ϸ
ϽĤ㣨ͼ3
2.2.1.2 ǺϵԲߣ1B-ʽǺʱӦע
ϿСǺϿϴǺϿ©
ӡԣӦпʮָูĤͬʱ
ʮָ򲿺ͷ֮θʮָ
ࡣθʮָ˶ǺϣγɵǺϿ
С19ݡǺϿǺϿ©ķջ
ӣ15ݡ2θʮָǺϿθС߼нǹ
СʱʱΪǺϿխԭѧ
ýϴھԲǺɼǺϿխ
ˮ׺θſӳٷ20ݡ3θжϷߺͲθʮ
ָǺ߽沿λ֮ΪΣǡ̾Ϣǡ
ǺϿ©ĺ÷λеļӹ̷Ҫġ
˴кɰϣҲڸôǺʱߴθǰ
ڡںʮָ3 㣬Լǿ˴4θʮ
ָӦڴǺϣǻеǺϣֹҴ
״Ӱθſա⣬ŤǺҲθſ
ԭ򡣣5еǺ϶ӦʱӦעѪֹǺ
ȱѪ
2.2.2 B-ʽǺϴʽθг󽫲θ
ճǺϣʮָжˡʹθ϶λü
СͬɷΪθǺϷθȫǺϷθС
ͼ3 ԶθгB-ʽǺϣеǺϣ
ͼ2 ԶθгB-ʽǺϣֹǺϣ
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᳦ǰ᳦
ͼ4 ԶθгB-ʽǺϣֹǺϣ
Ϸճ᳦λòͬΪ᳦ǰͽ᳦
󷨡ǽǺн᳦ǰθڿճ
ϣͬʱBraun Ǻϡʽŵг㹻С
θصǺϿ⣻ȱθճ
ϸıϵθԲ
֢϶࣬絨֭ҺθļԷθ
׵ȡ
2.2.2.1 B-ʽǺϼҪ㣨1жʮָ
ʮָĺĤKocher пڣʮ
ָͷλ趨ʮָгλ
ֱиǺжϡƼϷϼӹ̻
ʮָжˣԼʮָж©ķ2
θճǺ᳦ĹϵB-ʽͨн᳦ǰͽ᳦
θճǺϷʽͼ4᳦ϵճں᳦ϵĤ
״ϾθǺϣȾTreitz ʹ15 cm
ϵĤѿθϹ̶᳦ǰTreitz ʹ20~
25 cm ճ᳦ǰϾθǺϡǺϷʽý
˿ճԲθ˳䶯ǺϣǺϿˮƽλǺϡ
ֹǺϲAlbert-Lembert ϣ3-0 շߡе
ǺϣθñպϷг֮󣬾϶2 cm θ
ճǺϣθճСףиǺ
ϣֹϹرСףͼ53Braun ǺǷֹ
ۺʮָҺθ롢
֮ճǺϡֹ3-0 շ
Albert-Lembert ϣͼ4aеǺñպи
Ǻϣ3-0 շϡ
2.2.2.2 ǺϵԲߣ1᳦ǰǺϼBraun
DZҪģǽθǺʱȶԴ࣬
Braun Ǻ۵Ľ˿ճԶ˿ճθǺϿڷֱ
Լ15 cm 25 cm ΪѣõĿá2
պ᳦ϵĤѿ׺ͼ϶ֹܷγɡ3ǺϿڹ
׷㵹ۺǺϿڳС1.5~2.0 Ϊ
ˡ4ڻеǺϣڹرչͬǰһҪϸ
ǺϿ޻ԳѪҪʱֹѪֹ
ɺʱҲӦϸ޻ԳѪ
⣬ڿճΪμˣֹǺʱп
ǣпڹǺѡһճпھ
ӦСθ࿪ڡ5θӦǺϿ·
ڷǺϿڳѪ6ǵճ䶯Ӧ
עθ϶ߵķ򣬱ճȿڹߣ
θʳ
2.2.3 Roux-en-Y ǺRoux-en-Y ǺҲԶθ
гõǺϷʽʽԶθг󣬾
Treitz ʹ15~20 cm ϿճԶ˿ճθжԶ
˲ǺϣθǺϿԼ40~50 cm пճ˲
ǺʽŵڷǺϿ©ĸʽϵͣ
⣬ʽܽͷʳ׵ķʣ
Ա֤
2.2.3.1 Roux-en-Y ǺϼҪ㣨1ճȵȷ
ճȵλãTreitz ʹ15~20 cm Ϊϲ
λȷϿճϵĤѪλüѪܹԱԶ
ճθճǺϣͬʱ֤ǺϲѪˡ2
θճǺϣθС䲿ֱθǺϿڳ3~5 cmθճ
Ǻн᳦ǰ᳦
ѡθճý˶Դ
ǺϣֹǺϣAlbert-Lembert
ϣǰGambee ϣͼ6е
ǺϿɲB-ʽͬ
ҲԲθճ
ϣͼ7a3ճճǺϣθ
ճǺϿ40~50 cm ճճ
ϡֹǺϲúڽ
ϺȫϣǰGambee
ϣͼ6еǺϲñպϷ
ճǺϣ󽬼
ͼ7b4ϵĤļ϶رպ͹
᳦ߺ᳦ϵĤѿθ
Ϲ̶᳦ǰ߶ҪرС
ͼ5 ԶθгB-ʽǺϣеǺϣ
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ͼ7 ԶθгRoux-en-Y ǺϣеǺϣ ͼ8 ԶθгRoux-en-Y ǺϣϵĤѿ״
ϵĤ21ݣͼ8
2.2.3.2 ǺϵԲߣ1θճRoux-en-Y Ǻ
ij֢Roux ۺף21ݱRoux
>50 cm ䷢ӡˣRoux ȳһ
>50 cmǣҲܹ̣ӷԲθ
סʳ׷ʡRoux ۺٴ֢״ҪΪ
ϸ͡ʹĺŻ£ʳ֢״ء߿
ԳӪ½Լ30%ҡ
ҪеԵĹ裬ھӰѧθ
оҪֵڿЧ2θճ
ϲö˶ǺϵθͿճųͨһ
ֱϣԽθʳʡθճ
˲ǺϣڿճжθС֮䣬Ϸ2~3
룬Ա֤θͿճųͬһֱϡ3ճϲλ
ѪܵĴҪ֤ǺϲܵѪãͬʱҪ
֤ϵĤ4رս᳦ϵĤѿףǺϿ
θϡ
2.2.4 ֢Ԥ봦
1ǺϿխǺǰӦע
θںͿճʮָѪ
ԭͬ2
ϿڳѪǺǰӦϸ
θںͳĤ޻Գ
ѪҪʱĤѪܡ
ǿճһ㲻ж֧Ѫ
ܣѪϷḻڷǰ
ʱӦϸ޳Ѫ
㣬Ҫʱӷ졣ǰǺ
ҲӦϸ顣еǺʱ
ǰȴ15 s֯ѹ
եǺϡ˳
ӦϸǺϿ
Ѫθ
ѪҺȾθעȥغͱˮ
ЧӦھ飬ȷѪ㣬ھֹѪ
бա3ǺϿ©ڻеǺɺӦ
ǺϻǷǺϻǺϿ©
ʱӦóǯбǺϿԶθǻ󣬾θע
ǺϿɫɴӹ̷ϣƷ
ҪʱɷÿճӪܣӪ֧֡
ǺϿ©ԭǰͬ4ʮָж
©ʮָж©ǽΪصIJ֢֮һ
ֲԭȡϸʹĤӦ
ʮָж©ϣڸԤDzת
ءˣгʮָж˸
ϡʮָж©һõ
ǹؼˣҪʱB ¾ֲ̡
Чãֲ޻Һɸʳθѹ
ȾҩغӪֵ֧ȱƣһ3~4
a.ֱǰճС˲Ǻb.᳦ǰճԴ˲Ǻ
ͼ6 ԶθгRoux-en-Y ǺϣֹǺϣ
210
йʵ־2014 3 µ34 3
ͼ9 ȫθгRoux-en-Y Ǻ
ͼ10 ȫθгRoux-en-Y ǺʳܿճǺϣֹǺϣ
ҿϡֲҺԣ
ơнм޲Ϊʱֲ֯
֢ˮԣκͼ޲©ڵĴʩѳ
һᵼ¸صĺԤʮָж©1ע
ʮָжѪϹܻӰֲѪʮ
ָ򲿲࣬ӰжѪ2ճ
ȹᵼʮָжѹѣ
ȳȲ˹̡
2.3 ȫθгRoux-en-Y ǺȫθгؽĻ
ҪǼ㡢ȫ֤õĹȫ
θгؽʱӦע⳦ҺʳܷǺϿ
ȫԵı֤ǺϿ١ʱǺϿӰ
Сʳſպáܵıʳͨ·ȫθ
ؽҪRoux-en-Y ǺϷճ÷˫
ͨȡʳͨʮָɷֳʮ
ָж˹رաͨʳRoux-en-Y ǺϷͨʮ
ָĿճ÷Լ߼˵˫ͨȫθ
ؽĴԷʽΪRoux-en-Y ǺϷ
Roux-en-Y ǺϷȫθгؽıԼռ70%~
80%ҪԭǺϿ١㡢ǺϿ©յͣ
ʳ٣ʳáѡȫθг
ؽʽѡһЩѭ֤ҽѧֵ֤ý
1ؽԸƲӪ״̬õά
أ22ݡ2ʹǺؽ
Խ֢ʣʡ
ʱ䣻θʳܽϲ
ʹǺԱظ
˵ij̶Ⱥ
գ23ݡ3ԲԤ
չθˣʩйϢ
ȫθгIJˣӦѡ
Roux-en-Y ǺΪף25ݣ
ӹΪճ
ҪһʱӦڷ
ʼܷӳƣ24ݡ
Ŀǰѭ֤ҽѧ֤ݣǽ飺
ȫθгˣѡ
Roux-en-Y ǺϣƼTreitz
15~20 cm ϿճԶ˿ճ
ʳж˲Ǻϣʳܿճ
ϿԼ40~50 cm пճ˲
ϣͼ9a
2.3.1 Roux-en-Y ǺϼҪ
1ʳܶ϶˴áʳΧ
Ԥиϣúɰ
ǯθֱǯգʳܣ
ʳܶ϶Babcock ǯѳ֣붤
ͷ25 mm̶ͼ9b2ճϵĤϵλ
áTreitz ʹ20 cm λȷ϶Ͽճ
֤㹻ȵϵĤܡϾ·᳦ʱ
᳦ϵĤн᳦Ҳ࿪᳦ͨǰֱ
ᡣ3ʳܿճǺϡֹǺϣ˫ֱdzǯ̶ʳ
ճڼ뽬ϣȫϣǰȫ
ϣϣͼ10ڻеǺϣɿճ϶
Ǻ壬6 cm ճԵᴩ붤
ӣճʶȽţǺǺϣճǣɵ
խɿճɵ©裩ճжԼ
3 cm ֱиǺպиä2~3 cm
׵ʳ4ճճǺϣʳ
ճǺ40~50 cm ճճ˲ֹǺϻе
Ǻϣͼ9c
2.3.2 ǺϵԲߣ1еǺʳܿճʱӦע
𽫿ճϵĤijڼ룬ᵼǺϿڲ
ǺϿ©裻⣬ǺʱӦעϵĤ೦
ǣмɹ󣬷ǺϺŵij
ǺϿխʹǺ󣬽ʳܿճ
˲ǺϣԼٷ󲢷֢25ݡ2ʳܿճǺ
˱ճжˡж˹ᵼʳ
ʳܿճ˶ǺǺϿ©ʸߴ16%
50%ˣҪʳܿճ˶Ǻϡ3
ʳܿճǺϿڸӦһԹ۲
211
йʵ־2014 3 µ34 3
ҺڷǺϿ©һ棬Խǻ
Һۣһ̷ȾʴǺϿڣ
Ͽ©
2.3.3 ֢Ԥ봦1ǺϿڳѪͬǰ2
ǺϿխͬǰ
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