本文關(guān)鍵詞：股前外側(cè)區(qū)穿支血管三維重建與修薄皮瓣血供關(guān)系的研究　出處：《南方醫(yī)科大學(xué)》2007年博士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 旋股外側(cè)動脈 股前外側(cè)皮瓣 修薄皮瓣 血管三維重建 血管造影術(shù)

【摘要】： 修薄皮瓣的應(yīng)用是顯微外科的一個發(fā)展趨勢，削薄型股前外側(cè)皮瓣的應(yīng)用，近年來有所報道。但皮瓣削薄后，壞死率較高，尤其是修復(fù)頜面部洞穿性缺損、舌體再造等方面壞死率更高。目前，解決這一問題的焦點集中在針對皮瓣穿支動脈蒂的保護(hù)。應(yīng)用顯微解剖的方法修薄穿支血管蒂中央部半徑2cm內(nèi)的脂肪筋膜島，保護(hù)穿支蒂中央部份的分支免受損傷。這種顯微解剖的手術(shù)方法僅僅是保證血管蒂中央?yún)^(qū)域的供血，而如何保證削薄皮瓣中央?yún)^(qū)周圍區(qū)域或遠(yuǎn)離穿支血管蒂區(qū)的血供，尤其是如何預(yù)測削薄皮瓣的成活范圍，如何設(shè)計修薄皮瓣以保證其血運(yùn)，皮瓣能夠修到多薄多大?這些問題至今仍未解決，這也是削薄型股前外側(cè)皮瓣推廣應(yīng)用不夠的原因。 本課題以解剖學(xué)研究為基礎(chǔ)，應(yīng)用數(shù)字化成像技術(shù)、影像學(xué)手段，對不同厚度股前外側(cè)皮瓣的血管形態(tài)和功能作了研究；同時，應(yīng)用激光多普勒技術(shù)監(jiān)測皮膚血灌注量，探討了皮瓣遠(yuǎn)側(cè)和近側(cè)穿支血管、前后筋膜皮支、脂肪筋膜層血管交通等對皮瓣各區(qū)域皮膚灌注量的影響。 目的 1．觀測股前外側(cè)區(qū)體被組織穿支動脈的走行、吻合方式、立體結(jié)構(gòu)特點等，為臨床修薄皮瓣應(yīng)用提供形態(tài)學(xué)依據(jù)。 2．應(yīng)用數(shù)字化成像技術(shù)及影像學(xué)手段，觀察和測量股前外側(cè)皮瓣各層次的血管形態(tài)，探討皮瓣不同層次、不同區(qū)域血管的功能和皮瓣的血流方式、特點，為皮瓣修薄提供血管功能的參考依據(jù)。 3．觀測股前外側(cè)皮瓣不同層次血管交通對皮瓣不同區(qū)域皮膚灌注量的影響，探討皮瓣修薄后皮膚血流動力學(xué)的變化，為皮瓣修薄的可能厚度、范圍、手術(shù)方法提供參考依據(jù)。 4．探討和建立一種能夠保證修薄皮瓣血供，提高修薄皮瓣移植成功率的手術(shù)設(shè)計和手術(shù)方法，使之易于推廣應(yīng)用。 材料和方法 選用3例防腐固定處理的成人下肢標(biāo)本，2例成人新鮮尸體，4例成人新鮮下肢。所有標(biāo)本皮膚、軟組織無破潰及損傷。 1．明膠一氧化鉛動脈灌注：對2具新鮮全尸行股動脈一次性全身動脈血管灌注；4具新鮮下肢標(biāo)本進(jìn)行動脈血管灌注造影。血管造影后，冷卻保存。 2．巨微解剖：從外科層掀起股前外側(cè)區(qū)體被組織，標(biāo)志外徑為0.5mm的穿支血管，追蹤其來源、走行，解剖追蹤旋股外側(cè)動脈的分支、形態(tài)、走行、分布等解剖結(jié)構(gòu)，觀察股前外側(cè)區(qū)穿支動脈的立體網(wǎng)絡(luò)結(jié)構(gòu)和特點，以及各區(qū)域血管外徑，記錄和描述觀察數(shù)據(jù)和結(jié)果。 3．X線攝片(CR)：在股前外側(cè)區(qū)層次解剖和該區(qū)體被組織顯微層次解剖過程的每一步之后，行X線拍攝。 4．螺旋CT掃描：每一解剖步驟之后，利用16排螺旋CT對標(biāo)本進(jìn)行斷層掃描。 5．血管三維重建及可視化處理：把各個螺旋CT掃描數(shù)據(jù)集分別導(dǎo)入電腦，應(yīng)用Minic8.11軟件，分別重建各支穿支及其分支和相聯(lián)密切的微血管，并行可視化處理，觀察各穿支的分支分布情況以及穿支區(qū)域間吻合交通情況，各個穿支區(qū)域范圍。 6．患者5名，青年男性，年齡17-31歲，車禍傷致足踝部皮膚軟組織大面積缺損，行股前外側(cè)皮瓣游離移植修復(fù)足踝部皮膚軟組織缺損。 用Permed激光多普勒監(jiān)測儀監(jiān)測股前外側(cè)皮瓣皮膚的血流量。觀測前后筋膜支、脂肪筋膜層的交通支對皮瓣灌注的影響。 7．修薄型股前外側(cè)皮瓣的手術(shù)設(shè)計 根據(jù)本文研究成果，設(shè)計皮瓣修薄的手術(shù)方法，并應(yīng)用于臨床實踐，取得滿意效果。 結(jié)果 (一)股前外側(cè)區(qū)皮瓣修薄對皮瓣穿支血管三維重建的形態(tài)結(jié)構(gòu)的影響 1．皮瓣未修薄組和保留筋膜支的皮瓣修薄組 二者5支穿動脈三維重建的血管形態(tài)、結(jié)構(gòu)和分布范圍是一致的。5支穿動脈的三維血管形態(tài)均基本完整顯示股前外側(cè)區(qū)動脈血管構(gòu)造的鏤空立體結(jié)構(gòu)，直觀立體的顯示了皮瓣深層的筋膜支及其分出皮支，同時也顯示出較粗大的真皮下血管。逼真地再現(xiàn)了股前外側(cè)區(qū)下半呈“蜘蛛痣”或“蜘蛛網(wǎng)”樣的真皮下血管網(wǎng)結(jié)構(gòu)。 2．破壞筋膜支的皮瓣修薄組 皮瓣近側(cè)部各穿支其三維重建的血管形態(tài)，僅顯示出該穿支發(fā)出的筋膜支及其入皮動脈，而與入皮動脈相連的真皮下血管網(wǎng)未顯示，其范圍面積為：長度為后筋膜支的長度，寬度為入皮動脈的投影長度。 皮瓣遠(yuǎn)側(cè)部各穿支其三維重建的血管形態(tài)，不但顯示穿支及直接入皮動脈，而且清晰顯示真皮下血管網(wǎng)結(jié)構(gòu)(即完整顯示下半?yún)^(qū)血管“蜘蛛網(wǎng)”樣結(jié)構(gòu))，遠(yuǎn)側(cè)部各穿支血管的三維形態(tài)顯示的范圍均覆蓋整個下半?yún)^(qū)區(qū)域，面積約為16cm×12cm，下半?yún)^(qū)各穿支血管三維形態(tài)通過真皮下血管網(wǎng)有機(jī)地融合為一體，并相對獨立于相鄰區(qū)域。 (二)股前外側(cè)區(qū)皮瓣修薄過程的穿支動脈X線二維形態(tài)學(xué)的研究 1．皮瓣未修薄組 股前外側(cè)區(qū)體被組織未修薄前拍攝X線片，可見下行的前筋膜皮支及向后外下行的后筋膜皮支，以及在脂肪筋膜層、真皮下血管網(wǎng)的血管內(nèi)網(wǎng)絡(luò)結(jié)構(gòu)，各穿支動脈之間彼此吻合；前筋膜支與旋股外側(cè)動脈各穿支吻合，其終未端與膝上外側(cè)動脈穿支形成微細(xì)的吻合，后筋膜支終未端與股深動脈的穿支形成較為粗大的血管交通。股前外側(cè)區(qū)單穿支供血面積29.3cm~2～52.9cm~2不等，供血面積最大的單穿支是旋股外側(cè)動脈降支第一穿支，該穿支發(fā)出最長的后筋膜支，且后筋膜支發(fā)出較多的下行支，穿支區(qū)域間血管吻合的交通支較為粗大，多為真性吻合，且界線不易界定。因此，股前外側(cè)皮瓣切取的總面積大約為26cm～30cm×16cm～21cm范圍。 2．保留動脈筋膜皮支皮瓣修薄組的X線二維血管形態(tài) 旋股外側(cè)動脈近側(cè)穿支發(fā)出后筋膜支，并間隔發(fā)出下行分支，穿支區(qū)域血管形態(tài)呈現(xiàn)“綱目”樣結(jié)構(gòu)，穿支面積明確而狹長，面積約為長6～13cm×2～3cm。 旋股外側(cè)動脈遠(yuǎn)端穿支呈放射狀發(fā)出直接入皮動脈，形成“蜘蛛痣”樣結(jié)構(gòu)，入皮動脈在真皮下長直且粗大，穿支區(qū)域血管呈現(xiàn)“蜘蛛網(wǎng)”樣結(jié)構(gòu)。并可見較粗大入皮動脈在真皮下的走行時間隔發(fā)出返支的斷端，數(shù)量約5～7個，穿支供血面積約為12cm×10cm。 在X線片中，前筋膜支、最粗長的后筋膜支、遠(yuǎn)端粗大長直的真皮下血管三者在股前外側(cè)區(qū)的中遠(yuǎn)部形成一個明確的“三角形”血管形態(tài)結(jié)構(gòu)，呈現(xiàn)出股前外側(cè)區(qū)的動脈供血的主干，其供血面積約為22cm×12cm。 膝上外側(cè)動脈穿支區(qū)域與旋股外側(cè)動脈降支遠(yuǎn)端穿支的穿支區(qū)域間存在“阻塞性吻合”(即其血管吻合點為血管口徑變細(xì)處)。即這兩穿支區(qū)域間界線較為明確，而股深動脈穿支與后筋膜支間見較粗大的交通支，他們之間存在真性吻合。 3．股前外側(cè)皮瓣血管管徑測量結(jié)果 1組：股前外側(cè)近側(cè)區(qū)域真皮下血管管徑：0.29～0.41mm。 2組：股前外側(cè)遠(yuǎn)側(cè)區(qū)域直皮下血管管徑：0.65～0.68mm。 3組：前、后筋膜支起始部血管管徑：0.82～1.38mm。 4組：前、后筋膜支終未端血管管徑：0.65～0.81mm。 (三)高位皮動脈型股前外側(cè)皮瓣修薄的應(yīng)用解剖學(xué) 高位皮動脈的源動脈存在差異。高位皮動脈進(jìn)入皮瓣淺筋膜后，發(fā)出前、后筋膜支，前、后筋膜支在股前外側(cè)區(qū)中遠(yuǎn)部呈“根須”樣結(jié)構(gòu)，發(fā)出二級筋膜支淺出至真皮下血管網(wǎng)，二級筋膜支終未端在皮瓣中遠(yuǎn)部分布相對分散。X線片上見股前外側(cè)區(qū)遠(yuǎn)、近部真皮下血管網(wǎng)形態(tài)基本一致，管徑大小較均勻。 (四)股前外側(cè)皮瓣穿支動脈三維重建與可視化研究 1．旋股外側(cè)動脈各穿支動脈三維形態(tài)的比較 以旋股外側(cè)動脈各穿支動脈為起點行血管三維重建，可見它們的分布區(qū)域和可視化圖像是一致的。二者均可顯示前、后筋膜支和遠(yuǎn)側(cè)穿支區(qū)域的部分真皮下血管，同時也可顯示股深動脈穿支的血管形態(tài)。而股前外側(cè)區(qū)近側(cè)部和膝上外側(cè)動脈穿支區(qū)域未見顯示。股前外側(cè)皮瓣各穿支的主要血管交通吻合是一致的，主要供血區(qū)域也是一致，其范圍為旋股外側(cè)動脈降支遠(yuǎn)、近穿支前內(nèi)側(cè)2-3cm連線至股深動脈穿支區(qū)域。 2．旋股外側(cè)動脈高位皮動脈的血管三維形態(tài) 高位皮動脈穿支區(qū)域約30cm×20cm，中央?yún)^(qū)域血管密度較高，皮動脈穿支蒂位于中央?yún)^(qū)中上1／4處，周圍區(qū)域血管三維形態(tài)呈網(wǎng)絡(luò)狀。側(cè)面觀可見血管分支豐富，并見多級分支。 調(diào)整三維重建參數(shù)，可重建不同穿支動脈主要供血區(qū)域(解剖學(xué)供區(qū))和鄰近供血區(qū)域(動力學(xué)供區(qū))。 (五)股前外側(cè)皮瓣血管血液動力學(xué)初步研究 雙穿支蒂供血、夾閉筋膜支、阻斷脂肪筋膜層均對皮瓣皮膚灌注量有顯著影響。 (六)削薄型股前外側(cè)皮瓣臨床應(yīng)用體會(皮瓣設(shè)計與手術(shù)方法) 根據(jù)上述應(yīng)用基礎(chǔ)研究結(jié)果，在設(shè)計以近側(cè)穿支為蒂偏心型穿支蒂修薄皮瓣時，應(yīng)盡量保留穿支發(fā)出的后膜皮支，穿支蒂放在皮瓣近側(cè)。在穿支蒂遠(yuǎn)側(cè)2cm范圍內(nèi)斜坡修薄，遠(yuǎn)側(cè)區(qū)域僅保留真皮下2～3mm脂肪層；穿支蒂近側(cè)2cm范圍內(nèi)顯微鏡下去除大脂肪球，近側(cè)區(qū)域保留真皮下小顆粒脂肪層，這樣修薄后皮瓣周圍皮緣出血良好，移植后皮瓣成活良好。 結(jié)論 股前外側(cè)區(qū)穿支血管三維形態(tài)的結(jié)構(gòu)特點，有利于股前外側(cè)皮瓣修薄應(yīng)用。
[Abstract]:The application of thin flap is a development trend of microsurgery, using thin anterolateral thigh flap, flap in recent years have been reported. But after thinning, the necrosis rate is high, especially the repair of maxillofacial perforating defects, tongue reconstruction and other aspects of higher necrosis rate. At present, the focus of solving this problem focus on the protection for perforating artery pedicle flap. Methods the microsurgical repair of adipofascial perforator pedicled island thin central part within a radius of 2cm, protect the perforating branch pedicel central part from damage. But this method of microdissection is only to ensure that the central region of the vascular pedicle blood supply, and how to ensure the cutting area around the thin the central flap or away from the perforator branch area of blood supply, especially how to predict the cutting of thin flap survival area, how to design a thinning flap to ensure the blood supply of skin flap can repair how thin these problems to much? It is still unsolved. This is also the reason why the flaps of the thin anterolateral thigh flap are not popularized enough.
This subject is based on the anatomical study of digital imaging technology, imaging, vascular morphology and function of different thickness of anterior thigh lateral flap were studied; at the same time, the application of laser Doppler technique for monitoring the blood perfusion of the skin flap, distal and proximal perforator vessels before and after FFTNA, fat fascia on the skin flap of the regional traffic perfusion.
objective
1. observation of the perforating artery of the anterolateral thigh body, the way of the perforating artery, the way of anastomosis and the characteristics of the stereoscopic structure, provide the morphological basis for the application of the clinical thinning flaps.
2., using digital imaging technology and imaging methods, we observed and measured the blood vessel morphology of different levels of anterolateral thigh flap, explored the function of different levels, different areas of blood vessels and the blood flow pattern of flap, and provided reference basis for skin flap repair.
3., the effect of different levels of blood vessel traffic on the skin perfusion volume in different regions of the anterolateral flap of the observation stock, and to explore the changes of skin hemodynamics after skin flap repair, so as to provide reference for the possible thickness, scope and operative method of skin flap repair.
4. to explore and establish an operation design and operation method that can guarantee the blood supply of the thin skin flap and improve the success rate of the thin flap transplantation, so that it is easy to popularize and apply.
Materials and methods
3 adult cadaver specimens, 2 fresh adult cadavers and 4 adult fresh lower limbs, were selected and treated with antiseptic fixation. All specimens were skin and soft tissue had no rupture and injury.
1. gelatin litharge arterial infusion: 2 fresh cadaver femoral artery one-time systemic arterial perfusion; 4 fresh lower limb specimens of artery angiography. Angiography after preservation, cooling.
2. macromicrodissection: off the anterolateral tegumental tissue from surgical layer, mark diameter perforator 0.5mm, trace its origin, course, branch of anatomy, tracing the lateral circumflex femoral artery morphology, walking, distribution of anatomical structure, observe the anterolateral thigh perforators of the vertical structure and characteristics the network, as well as regional vascular diameter, record and describe observation data and results.
3. X ray photography (CR): after each step of the anterolateral thigh region and the microscopic anatomical process of the body, the X-ray film was taken.
4. spiral CT scan: after each anatomic step, the specimen was scanned with 16 rows of spiral CT.
5. vessels for 3D reconstruction and visualization processing: the spiral CT scan data set were introduced into computer, using Minic8.11 software, the branches and its branches were reconstructed and connected closely microvessel, parallel visual processing, observe the distribution of each branch and regional perforator perforator anastomosis traffic, each perforator region.
5 of 6. patients, young men, aged 17-31 years old, suffered from a large area of skin and soft tissue defects in foot and ankle caused by traffic accident. The anterolateral thigh flap was free to repair skin and soft tissue defects of ankle and foot.
The blood flow volume of the anterolateral thigh flap was monitored by Permed laser Doppler monitor. The effects of fascial branches and fascial branches on the skin perfusion were observed before and after the observation.
Surgical design of 7. thin anterolateral thigh flaps
According to the results of this study, the surgical method of skin flap repair was designed and applied to clinical practice, and satisfactory results were obtained.
Result
(1) the influence of the flap thinning on the morphological structure of the three-dimensional reconstruction of the perforating vessels of the flap
1. flaps in the unthinned and preserved fasciocutaneous flaps
Two 5 perforating artery reconstruction of vascular morphology, structure and distribution is consistent with the.5 team in the arterial vascular morphology were showed complete three-dimensional hollow three-dimensional structure of anterolateral femoral arterial vascular structure, visual display the deep fascia flap into branches and cutaneous branches, but also showed relatively large the subdermal vascular network. To realistically reproduce the vascular structure of anterolateral area is half the "spider" or "spider web" like leather.
2. skin flap repair group that destroys fascial branches
The proximal portion of the flap vascular morphology of each branch in the 3D reconstruction, only showing the perforating branches and enter a fascia cutaneous artery, which is connected with the cutaneous artery into the subdermal vascular network did not show the range of area: the length of posterior aponeurosis branch length, width of the projection length into the cutaneous artery.
Vascular morphology of distal portion of the perforator flap in the 3D reconstruction, not only shows the perforator and directly into the cutaneous artery, and clearly show the subdermal vascular network structure (i.e. the complete display "bottom half vascular spider web like structure), display three-dimensional morphology of distal part of the perforator range were covering half the area the whole area is about 16cm *, 12cm, the second half of the perforator 3D integrated organically subdermal vascular network through, and is independent from the adjacent area.
(two) the study of the X-ray two-dimensional morphology of the perforator artery of the anterolateral thigh flap
1 skin flap repair thin group
The anterolateral area was not tissue thinning radiographs before, after FFTNA visible down the front fascia cutaneous branch and the rear outer downward, and the fat fascia vascular network within the vascular network structure of leather, the perforating artery anastomosis; the front fascia and the branch of the lateral circumflex femoral artery the perforator anastomosis, end and lateral genicular artery perforator anastomosis after the formation of a fine, aponeurosis branch end form a relatively thick vessel traffic and deep femoral artery perforator. The anterolateral area of single perforator area 29.3cm~2 ~ 52.9cm~2 range, single perforator is the largest area of the descending branch of lateral circumflex femoral artery first the perforator perforator, issued after the longest branch and branch of the fascia fascia, a descending branch of perforator regional vascular anastomosis branches are more thick, more true and consistent, is not easy to define boundaries. Therefore, the anterolateral thigh flap. The total area is about 26cm to 30cm x 16cm ~ 21cm.
2. X-ray two-dimensional vascular morphology in the repair group of the cutaneous branch of the preserved artery fasciocutaneous branch
The lateral circumflex femoral artery proximal perforator fascial branches after the issue, and the interval down branch, regional perforator "plants" like structure, clear and narrow perforator area, an area of about 6 ~ 13cm * 2 ~ 3cm.
The lateral femoral circumflex artery perforator distal radial emitted directly into the cutaneous artery, the formation of "spider" structure into the cutaneous artery in the dermis under long straight and thick perforator regional vascular cobweb like structure. The coarse and visible cutaneous artery in the dermis under the travel time across the back ends of a one, about 5 ~ 7, perforator area is about 12cm * 10cm.
In X-ray, the front fascia, the long thick fascia, distal thick long straight subdermal vascular three in the anterolateral area of the distal part of the formation of a clear "triangle" vascular structure, showing the main artery of anterolateral femoral region, the blood supply area of approximately 22cm * 12cm.
The lateral superior genicular artery perforator region and lateral femoral circumflex artery descending "obstructive perforator branch anastomosis between the distal perforator region" (i.e., the point for vascular anastomosis vascular caliber thin section). The two branches of borderline between regions is relatively clear, but the deep femoral artery perforator and posterior aponeurosis branch communicating branch between the coarse the existence of true agreement between them.
Measurement of vascular diameter of 3. femoral anterolateral flaps
1 groups: subdermal vascular diameter of the anterolateral anterolateral femoral region: 0.29 to 0.41mm.
The 2 group: the direct subcutaneous vascular diameter of the anterolateral thigh region: 0.65 ~ 0.68mm.
3 groups: anterior, posterior fascial branch vascular diameter: 0.82 ~ 1.38mm.
The 4 groups: anterior and posterior fascia branch end end vascular diameter: 0.65 ~ 0.81mm.
(three) applied anatomy of the anterolateral thigh flap of the high cutaneous artery type
High cutaneous artery source artery. A high cutaneous artery into the differences between the superficial fascia flap, anterior, posterior aponeurosis branch, anterior, posterior aponeurosis branch in the anterolateral region of middle and far section was "roots" - like structure, a two class aponeurosis branch vascular network, two class aponeurosis branch end relative scattered in the middle and far section of the flap cloth. X-ray see anterolateral distal, proximal subdermal vascular network morphology is basically the same, the diameter is uniform.
(four) three-dimensional reconstruction and visualization of the perforating artery of the anterolateral thigh flap
A comparison of the three-dimensional morphology of the perforator arteries of the 1. lateral femoral circumflex artery
Each of the lateral femoral circumflex artery perforating artery reconstruction for the starting point for the regional distribution of blood vessels, visible and visual image which is consistent. The two can be displayed before, after some portion of the dermis fascial branches and distal perforator area under the blood vessels, but also can display the deep femoral artery perforator blood tube and anterolateral form. Area of the proximal portion and the lateral superior genicular artery perforator region no display. The main vascular transport of anterolateral thigh flap the perforator anastomosis is the same, the main blood supply area is consistent, the scope for the descending branch of lateral circumflex femoral artery, anterior medial 2-3cm even nearly wear line to the deep femoral artery perforator region.
The three-dimensional morphology of the high cutaneous artery of the 2. lateral femoral circumflex artery
High cutaneous artery perforator area is about 30cm * 20cm, the central region of the high density, skin perforator artery located in the central area in 1 / 4, the surrounding area form a three-dimensional vascular network. Side view visible vascular branches and rich, multi-level branch.
Three dimensional reconstruction parameters can be adjusted to reconstruct the main blood supply region (anatomical donor area) and adjacent blood supply region (dynamic donor area) in different perforating arteries.
(five) preliminary study on blood vessel hemodynamics of the anterolateral thigh flap
The double perforating pedicle supplied blood, clipped the fascia branch and blocked the fat fasciae, which had a significant effect on the skin perfusion.
(six) the experience in the clinical application of the thin anterolateral thigh flap (flap design and surgical method)
According to the application of basic research results, in the design of the proximal perforator perforator flap Dixiu thin eccentric type, should be kept out after perforator perforator on cutis, proximal perforator flap. On the far side of the range of 2cm slope thinning, the distal region only preserved subcutaneous fat layer of 2 ~ 3mm the proximal perforator; range of 2cm microscope removed big fat ball, the proximal region preserved subcutaneous fat layer of small particles, such as thinning flap around the edge of skin bleeding is good, after transplantation of flap was good.
conclusion
The three-dimensional morphological structure of the perforating vessels in the anterolateral thigh region is beneficial to the application of the anterolateral thigh flap.

【學(xué)位授予單位】：南方醫(yī)科大學(xué)
【學(xué)位級別】：博士
【學(xué)位授予年份】：2007
【分類號】：R322

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