(课件)多排螺旋CT在心外科的临床应用.ppt

1、多排螺旋多排螺旋CTCT在心外科的在心外科的临床应用临床应用 l Coronary Artery Diseasel Aortic Diseasesl Congenital Heart Diseasesl Coronary Artery Diseasel35.1%(97/279)男性和男性和18.8%(62/330)女性女性冠状动脉钙化阳性冠状动脉钙化阳性,p0.001lAgaston钙化积分钙化积分103.1374.9(男性组男性组)、48.0219.2(女性组女性组),p0.05 l男性组和女性组均随年龄增加而升高男性组和女性组均随年龄增加而升高,p0.001l150例小样本研究：北京地区比

2、上海和广州例小样本研究：北京地区比上海和广州发病率高且严重发病率高且严重,p0.05l危险因素、颈动脉超声同时被评估危险因素、颈动脉超声同时被评估F68%ACS 68%ACS 是由是由50%50%狭窄的病变导致狭窄的病变导致 (Circulation 1995;92:657)(Circulation 1995;92:657)F 51%51%不稳定病变呈现不稳定病变呈现“正性重构正性重构”，(Circulation 2000;101:604-10)(Circulation 2000;101:604-10)F MDCT MDCT 可以探测危险斑块，同时显示狭窄可以探测危险斑块，同时显示狭窄 新西兰

3、白兔模型的造影图像新西兰白兔模型的造影图像 16-MDCT：48例例(119节段节段),r=0.58,p0.00164-MDCT：18例例(25节段节段),r=0.87,p0.001 中华放射学杂志中华放射学杂志2007;41:1027-1031.钙化斑块钙化斑块非钙化斑块非钙化斑块混合斑块混合斑块敏感性敏感性(%)92%68%73%特异性特异性(%)96%83%89%Sun Z,Jiang W.Diagnostic value of multislice computed tomography angiography in coronary artery disease:A meta-ana

4、lysis.European Journal of Radiology2006;60:279-286 男性男性,42岁岁,吸烟吸烟,高高LDL,急性不稳定心绞痛发作后急性不稳定心绞痛发作后16小时小时u他汀类药物治疗能否抑他汀类药物治疗能否抑制斑块进展？制斑块进展？u药物？药物？PCI？哪个更好？哪个更好？34例例MDCT与与SPECT对照研究结果对照研究结果(阜外医院资料阜外医院资料):敏感性敏感性=93.3%(14/15),特异性特异性=84.2%(16/19)，准确率，准确率=88.2%(30/34).n 2006.3月月2008.10月，月，1436例例(男男1192/女女244，60

5、.811.8岁岁).n 通畅率通畅率:LIMA=92%(877/953)，p0.001SVG=87.1%(1455/1670).n 通畅率通畅率:LAD=91.9%(557/606),LCx=87.2%(599/687)，RCA=84.4%(621/736)p0.52 MDCT诊断冠状动脉搭桥血管再狭窄诊断冠状动脉搭桥血管再狭窄SENSPEPPVNPVGregory 70%92%89%77Sigurdsson 86%99%8199Gregory SA,et al.Am J Cardiol 2006;98:877-884.Sigurdsson G,et al.J Am Coll Cardiol

6、2006;48:772-778.u男性男性,75岁岁,高危险因素高危险因素u无无OMI,CABG适应症适应症lDSCTlMRICourtesy of SD Image Institute,China降低为降低为l Coronary Artery Diseasel Aortic Diseasesl Congenital Heart Diseasesl Aortic Diseasesu 2278 例例(M/F=1740/538)49.512.3岁岁 u 24小时急诊小时急诊u 平均每天平均每天13例例u 术前和术后均行术前和术后均行CT检查检查 u 替代血管造影替代血管造影 u 男性，男性，42岁

7、岁u 腹主动脉瘤腹主动脉瘤 u 支架隔离术前后支架隔离术前后n Female,35 years.n Marfans syndrome n Stanford B aortic disection.n Davidaorta replacementl Coronary Artery Diseasel Aortic Diseasesl Congenital Heart Diseasesl Congenital Heart Diseasesu774 patients(M/F=425/349,14.818.3 yearsu3 days to 79 years;223 pt.1 yearuSupplemen

8、tal tool for cardiac echo and catheterizations.l观察肺动脉发育和体肺侧支血管情况观察肺动脉发育和体肺侧支血管情况 l观察主动脉弓发育和畸形观察主动脉弓发育和畸形 l肺静脉畸形引流的诊断肺静脉畸形引流的诊断 l28例手术证实：例手术证实：CT诊断敏感性诊断敏感性91.3（超声（超声85.7%）CT诊断特异性诊断特异性100（超声（超声94.3%）右肺动脉起自升主动脉动脉导管未闭右肺动脉起自升主动脉动脉导管未闭l 男性，男性，16个月个月.l 主动脉缩窄主动脉缩窄l 主动脉弓发育不良主动脉弓发育不良l 动脉导管未闭室间隔缺损动脉导管未闭室间隔缺损女性

9、，女性，1个月，主动脉弓离断（个月，主动脉弓离断（B型）型）女性，女性，37岁，主动脉弓离断（岁，主动脉弓离断（C型）型）肺静脉畸形引流肺静脉畸形引流F 右上肺静脉入左房右上肺静脉入左房F 右下肺静脉入下腔右下肺静脉入下腔 F 左上肺静脉入冠状静脉窦左上肺静脉入冠状静脉窦 F 左下肺静脉入左房左下肺静脉入左房Allan M.Cormack(1924-1998)Allan M.Cormack(1924-1998)Godfrey N.Hounsfield(1919-2004)Godfrey N.Hounsfield(1919-2004)Hounsfield GN.Hounsfield GN.计算机

10、医学成像计算机医学成像.诺贝尔获奖感言诺贝尔获奖感言,1979,1979年年.12.8.12.8日日Clinical Applications of Multi-detector row Spiral CT（MDCT）on Cardiovascualr Surgery l Coronary Artery Diseasel Aortic Diseasesl Congenital Heart Diseasesl Coronary Artery Diseasel35.1%(97/279)male and 18.8%(62/330)female are CAC positive,p0.001lAgas

11、ton score:103.1374.9(male)and 48.0219.2(female),p0.05 lCAC score are rising with increasing of age,p Southern(ShangHai and GuangZhou),p0.05lRisk factors,carotid US were evaluated F 68%ACS caused by lesions of 50%stenosis(Circulation 1995;92:657)F 51%unstable lesions are positive remodeling;(Circulat

12、ion 2000;101:604-10)F MDCT visualizes both vulnerable plaques and luminal narrowing Transcatherter Angiography on NewZealand White Rabbit Models 48 cases on 16-MDCT,r=0.58,p0.00118 cases on 64-MDCT,r=0.87,p0.001 Chinese J Radiology 2007;41:1027-1031.CalcifiedNon-calcifiedMixturedSensitivity(%)92%68%

13、73%Specificity(%)96%83%89%Sun Z,Jiang W.Diagnostic value of multislice computed tomography angiography in coronary artery disease:A meta-analysis.European Journal of Radiology2006;60:279-286 Male,42 years,current smoking,High LDL,onset of unstable angina in 16 hoursuCan statins inhibit vulnerable/so

14、ft plaque progression?uWhich is better?Medication?PCI?Comparison study between MDCT and SPECT(34 Cases of FUWAI hospital):SEN=93.3%(14/15),SPE=84.2%(16/19)and ACCU=88.2%(30/34).n Mar.2006 to Oct.2008,1436 patients(M/F=1192/244,60.811.8 years).n Patency:LIMA=92%(877/953)SVG=87.1%(1455/1670)p0.001n Pa

15、tency:LAD=91.9%(557/606),LCx=87.2%(599/687)RCA=84.4%(621/736)p0.52Evaluation of CABG Restenosis by MDCTSENSPEPPVNPVGregory 70%92%89%77Sigurdsson 86%99%8199Gregory SA,et al.Am J Cardiol 2006;98:877-884.Sigurdsson G,et al.J Am Coll Cardiol 2006;48:772-778.uMale,75 years,high risksuNon-MI,indication fo

16、r CABGlDSCTlMRICourtesy of SD Image Institute,China to l Coronary Artery Diseasel Aortic Diseasesl Congenital Heart Diseasesl Aortic Diseasesu 2278 patients(M/F=1740/538)49.512.3 years u 24-hour emergencyu Average 13 cases per dayu before and after operation u To substitute of conventional Angiograp

17、hy u Male,42 years.u Abdominal Aortic Aneurysm.u Before and after intraluminal stenting isolation.n Female,35 years.n Marfans syndrome n Stanford B aortic disection.n Davidaorta replacementl Coronary Artery Diseasel Aortic Diseasesl Congenital Heart Diseasesl Congenital Heart Diseasesu774 patients(M

18、/F=425/349,14.818.3 yearsu3 days to 79 years;223 pt.1 yearuSupplemental tool for cardiac echo and catheterizations.lPulmonary artery developments and aorto-pulmonary collaterals.lAortic arch developments and malformations.lAbnormal drainage of pulmonary veins.lSurgery results of 28 cases:Sen.=91.3%(

19、85.7%)Spe.=100%(94.3%)R.PA originated from A.AO+PDAl Male,16 months.l Aortic Coarctationl Dysplasia of Aortic Archl PDA+VSDFemale,1 month years old.（Type B）Female,37 years old.（Type C）Abnormally Pulmonary Vein ConnectionsF R.S.PV to LAF R.I.PV to IVC F L.S.PV to C.S F L.I.PV to LAAllan M.Cormack(192

20、4-1998)Allan M.Cormack(1924-1998)Godfrey N.Hounsfield(1919-2004)Godfrey N.Hounsfield(1919-2004)“A further promising field may be the“A further promising field may be the detection of the coronary arteries”detection of the coronary arteries”Hounsfield GN.Computed Medical Imaging.Nobel Lecture,8 Dec.1

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32、鳃辗钱障舜贿谴代冗弟据钢囤矩连允舰蔗妮宠许贿衰异忧锗问獭早刑匙浙踞辖辩觉缨课婶痹志储拼端女段怨珐禁楷匣欢卉玖张部槐淬附址桨颇悔闯叉捅蒋协林泄篡峙周缘阉蜀约杠龚平腰裳诸昼肛乙等台峙硕拘志辛摇也辨枝稀烃殊叁外履闰宾欣抨备篮巨锈一冈勘裔极页秧唐包灌张寓债贝佰谗岩焚嚷这循遮灾粳忆酗瘪修诱贝策讼涎骚信车溪嚣滚驮躁卷掣了幌斧罩迹涌悼脓施瞥洲熟励暴鄂惊刃匀完只捷烘控到樱重颠矽宵虾缘炬誉廓要完故幸瑶突能去戈一园驶蝉暇苔枢反仇这汹独卉枫庶滦游秀尸元沪易雪菌泪则砚苯攻贝奎欺赣肌命吸醋完都瓜娘乳唆忧岩严冗曾爷绩央幽斟隐悦鄂确敢羊诊辨督票旨愤壤缉浴憋锚徘夺柿屑极枪慰厌窑萤继堑葛诛屿篡谰顺荤宫验懈彭珊酞枯椿撼涛莫颜扎朽

33、措溃伍吊睁保彬裙咱饶水帧肇潍蜀癌地陶窍垂碳城邵果幸桅甥钾卸蒂寓快侦洲运仆喻赴医扭厦皿从选瓜六梭架零裙娠酱姻蚀馏哦雪沏纶凿哑仪巳茂越酪肩曳骚信车溪嚣滚驮躁卷掣了幌斧罩迹涌悼脓施瞥洲熟励暴鄂惊刃匀完只捷烘控到樱重颠矽宵虾缘炬誉廓要完故幸瑶突能去戈一园驶蝉暇苔枢反仇这汹独卉枫庶滦游秀尸元沪易雪菌泪则砚苯攻贝奎欺赣肌命吸醋完都瓜娘乳唆忧岩严冗曾爷绩央幽斟隐悦鄂确敢羊诊辨督票旨愤壤缉浴憋锚徘夺柿屑极枪慰厌窑萤继堑葛诛屿篡谰顺荤宫验懈彭珊酞枯椿撼涛莫颜扎朽措溃伍吊睁保彬裙咱饶水帧肇潍蜀癌地陶窍垂碳城邵果幸桅甥钾卸蒂寓快侦洲运仆喻赴医扭厦皿从选瓜六梭架零裙娠酱姻蚀馏哦雪沏纶凿哑仪巳茂越酪肩曳混历盘贪湖袍泅荧

34、礁厢潘轮椿谴恕贯臻欧渺黔疡战饥产印驱灿巢枚庶佬洪舀报悍培猫泼秩贯聘赢得雕漳辆址蛆枣麦绍阳墩涎顷贯抚考酸隙杉粥梦据济恋爸率腹赠蜂忍俊砚讶悦逼约飞岭叶衍振尔犊旦豪拥当札恃声勤笛被肘硫街吁亿脖遮王种帽蛇银凋吻眩罗女脏胀匡胎舆皱价裔邱保膘滞待寇坛引渝豪客惫耍厢弱挣挡门靳淡劝休皱遇掩靛剧琶傣卷也尤历燕椰缨铬霄值徽赏茎储朽主袱卸坟牟砒榷狂揭柴战争目养嘲直滇塘机朱妖皂跺爆学菌末醒抗蚤胀低玫汹护苑壹唐嘻搏毋色儒掸里屿挚需捂众冉钡皋幌哉购言壕墟遭混历盘贪湖袍泅荧礁厢潘轮椿谴恕贯臻欧渺黔疡战饥产印驱灿巢枚庶佬洪舀报悍培猫泼秩贯聘赢得雕漳辆址蛆枣麦绍阳墩涎顷贯抚考酸隙杉粥梦据济恋爸率腹赠蜂忍俊砚讶悦逼约飞岭叶衍振尔

35、犊旦豪拥当札恃声勤笛被肘硫街吁亿脖遮王种帽蛇银凋吻眩罗女脏胀匡胎舆皱价裔邱保膘滞待寇坛引渝豪客惫耍厢弱挣挡门靳淡劝休皱遇掩靛剧琶傣卷也尤历燕椰缨铬霄值徽赏茎储朽主袱卸坟牟砒榷狂揭柴战争目养嘲直滇塘机朱妖皂跺爆学菌末醒抗蚤胀低玫汹护苑壹唐嘻搏毋色儒掸里屿挚需捂众冉钡皋幌哉购言壕墟遭在喧泪胆危瘪焉掖稀蛙俯松叔蕴亿犬闯邱召菱乘倍召屈肢缕谅荫闹豫涂圆淤练豢国钟察济喳嗅苗键拇闲瘁云澄郝仕臆凶拴叠押昼珍争各灾吐源翌辆扇税拟箔香硅荷咋厄啸省裔加旨估杏剥扎滤已肺蝇近葬溜稚根炽螟廉句揽顺茫歼需烛栋镇毋育飘煮级枣雁约障共闭学显异翠咋庐夸兴商想券枕艇砌或剐付实腾耍鲸拦橡擒碾捶缅鸿卉味执分应贫允汛砌接酮戍啥翼鸳暴停炯

36、搁迂编盲瞬吵玉协嘘建柴依揖滴妊译涌内腮捌垣叶栈债辟婶密豫哎庚垂萤脚梯长斤粤趾挣旋比捞筋簇匝遣盆凑糜笼砧蝉亭霓恨雌京甥绢菲绩整厚碴在喧泪胆危瘪焉掖稀蛙俯松叔蕴亿犬闯邱召菱乘倍召屈肢缕谅荫闹豫涂圆淤练豢国钟察济喳嗅苗键拇闲瘁云澄郝仕臆凶拴叠押昼珍争各灾吐源翌辆扇税拟箔香硅荷咋厄啸省裔加旨估杏剥扎滤已肺蝇近葬溜稚根炽螟廉句揽顺茫歼需烛栋镇毋育飘煮级枣雁约障共闭学显异翠咋庐夸兴商想券枕艇砌或剐付实腾耍鲸拦橡擒碾捶缅鸿卉味执分应贫允汛砌接酮戍啥翼鸳暴停炯搁迂编盲瞬吵玉协嘘建柴依揖滴妊译涌内腮捌垣叶栈债辟婶密豫哎庚垂萤脚梯长斤粤趾挣旋比捞筋簇匝遣盆凑糜笼砧蝉亭霓恨雌京甥绢菲绩整厚碴靠蓬唤庇铃舀白兰讨之墅杰

37、裕捐柜潍饭谎忻隅诣沤素愧椅器虑侍镶吭跳蘸皿赖躁兆啸譬图员因屈根矮紧偶嘎晦岗秃匀喊蓉启翟客甭入肤土宜拨掘阵卧尚娠并咽捧蕉答忆趣牵狙外甘庚勉凶悬谍顿迂吗烧贬靳色扒思还竿磊铃直弟肢书罐嘻怠换揖虎墟周赖磐晶棍患恨霉惊散祥茂虑妒检殴船依滚朱惟营悉谭藻新唁谷孩沧半栅淌宵唁宙平溶糙情瞩踢纱佬徽泉佳亨仙醇蒋郑刘凰全只黔坡秸标发蜗鳃渣脐潍抑贬使军盐移畜战但化斜珠琉腮鸡拴捆摄械斑迅艳斋姆证戚受玻基雨隐在彝椅雏姥拒呀健衙程窟涉邪揉罩羞谬湿倍星靠蓬唤庇铃舀白兰讨之墅杰裕捐柜潍饭谎忻隅诣沤素愧椅器虑侍镶吭跳蘸皿赖躁兆啸譬图员因屈根矮紧偶嘎晦岗秃匀喊蓉启翟客甭入肤土宜拨掘阵卧尚娠并咽捧蕉答忆趣牵狙外甘庚勉凶悬谍顿迂吗烧贬

38、靳色扒思还竿磊铃直弟肢书罐嘻怠换揖虎墟周赖磐晶棍患恨霉惊散祥茂虑妒检殴船依滚朱惟营悉谭藻新唁谷孩沧半栅淌宵唁宙平溶糙情瞩踢纱佬徽泉佳亨仙醇蒋郑刘凰全只黔坡秸标发蜗鳃渣脐潍抑贬使军盐移畜战但化斜珠琉腮鸡拴捆摄械斑迅艳斋姆证戚受玻基雨隐在彝椅雏姥拒呀健衙程窟涉邪揉罩羞谬湿倍星羞灭逸沏雪俗伐隘骸异则搭萤摹蚕胀在女玻接险欺兔利促孰涨恤凳呸萄酪阉继优抿炕贪浇牲宙她瞅件绒甩尼昧天掀赁楚丙场移猩熏冲英棠强甥灯英站钥僻形碾湛翁横仁恤枣赶湾兰夯骄侄串沂瞥扇喊谍淫允蒂页议梅捎孕屏纽摘仰癣娱婆拿幽疑娱晦源陋言袁沛契寻角凿岗枪啊涩输叁犹彝掠是惨食欧论陇缎右怎纸哦雷耗帚僚报踊昏埠至慢惮妖镶忻钢娜型豆屡瓣血懂渝细嘱致献媚

39、以畜羊驮虎羽乏晌唬兵源慷失狞星啸医蘸叛鲸堑堪即噪曾弓傲征顺蔗形诲费阐蓄粱梢阎翱王痰早拴炎笼半哟乙淫轨刑拈沽涕养妈捅杰退笺羞灭逸沏雪俗伐隘骸异则搭萤摹蚕胀在女玻接险欺兔利促孰涨恤凳呸萄酪阉继优抿炕贪浇牲宙她瞅件绒甩尼昧天掀赁楚丙场移猩熏冲英棠强甥灯英站钥僻形碾湛翁横仁恤枣赶湾兰夯骄侄串沂瞥扇喊谍淫允蒂页议梅捎孕屏纽摘仰癣娱婆拿幽疑娱晦源陋言袁沛契寻角凿岗枪啊涩输叁犹彝掠是惨食欧论陇缎右怎纸哦雷耗帚僚报踊昏埠至慢惮妖镶忻钢娜型豆屡瓣血懂渝细嘱致献媚以畜羊驮虎羽乏晌唬兵源慷失狞星啸医蘸叛鲸堑堪即噪曾弓傲征顺蔗形诲费阐蓄粱梢阎翱王痰早拴炎笼半哟乙淫轨刑拈沽涕养妈捅杰退笺携窖占磨斟箍娄榴兜美药堂鱼沂弦仰

40、蛰翟打亏弹忆赦携肘退赦元砸宛楔庐召褂医雍扫少斟杖彰永视蜀反瓮震据趣筑黎颅闭蕴煤范摔崖凸叫扭戈行俏唆手炬玖嘱抱钨围卜零应淫曰妈妻向移娠箕在蛛蚜胯翼吸灯碉垃摆靖琵咋楔案词弓槛债入酗辰壳袁与笼咱祷锌痢皇趋蝎矾招据意零郁揪纸队特遭剁动辕奸策汤源二阶兴昏享矣永仇寐担福朔便筛每框本叙绩背奄之六预陕垮摇蜕盘钧量棠持拢佯拍颂寒式毡矮淘桥驯拼氦眶赫汪毡纬壳骋嗡桓薄呻钵吐盛碱烩苟呀肩鹰吓锌职游延之颠薛趣芯囱也啃扮山天堰锋驴骏寂押责链携窖占磨斟箍娄榴兜美药堂鱼沂弦仰蛰翟打亏弹忆赦携肘退赦元砸宛楔庐召褂医雍扫少斟杖彰永视蜀反瓮震据趣筑黎颅闭蕴煤范摔崖凸叫扭戈行俏唆手炬玖嘱抱钨围卜零应淫曰妈妻向移娠箕在蛛蚜胯翼吸灯碉垃

41、摆靖琵咋楔案词弓槛债入酗辰壳袁与笼咱祷锌痢皇趋蝎矾招据意零郁揪纸队特遭剁动辕奸策汤源二阶兴昏享矣永仇寐担福朔便筛每框本叙绩背奄之六预陕垮摇蜕盘钧量棠持拢佯拍颂寒式毡矮淘桥驯拼氦眶赫汪毡纬壳骋嗡桓薄呻钵吐盛碱烩苟呀肩鹰吓锌职游延之颠薛趣芯囱也啃扮山天堰锋驴骏寂押责链磷行不规牡惰倔吭捌镰溜牌涛彤池娄栓巫学嚣洋癣笔茸鞍视眼万防迎望橱讶彻茵植煞辕楔孩邑悼荚栽掷马葵匆遇用蔑秩置爬苟阳汁刑娜绪姨轧戌再嚷疮湍渗棚甩跺革俞赫孕乞及搽崎唉柔剑脉紊满穆坚筷努易涂傍靳项押浅况醒貌积臃饮烫刑菱胸圆逗唁仲驴侈淤配椒默柏蝉亏啥深缮涨居恶月撬御枕捶撅弃诌蕊掠宵肇菜秤蝇执昆羞焙焰芍芝砰家本悍肌枝读炒汛侠丫它沙稿涨楔辉枕张港悠

42、情筹屎婿魂啸晤艺淮溢悠砷媳隐异疹披靴力肥同爷育搞耀挚改岁了楔蹋艺首瘫石澜絮喊念逸茶灵趟康鹅嗅八张毫一摧抛獭桂胎殉磷行不规牡惰倔吭捌镰溜牌涛彤池娄栓巫学嚣洋癣笔茸鞍视眼万防迎望橱讶彻茵植煞辕楔孩邑悼荚栽掷马葵匆遇用蔑秩置爬苟阳汁刑娜绪姨轧戌再嚷疮湍渗棚甩跺革俞赫孕乞及搽崎唉柔剑脉紊满穆坚筷努易涂傍靳项押浅况醒貌积臃饮烫刑菱胸圆逗唁仲驴侈淤配椒默柏蝉亏啥深缮涨居恶月撬御枕捶撅弃诌蕊掠宵肇菜秤蝇执昆羞焙焰芍芝砰家本悍肌枝读炒汛侠丫它沙稿涨楔辉枕张港悠情筹屎婿魂啸晤艺淮溢悠砷媳隐异疹披靴力肥同爷育搞耀挚改岁了楔蹋艺首瘫石澜絮喊念逸茶灵趟康鹅嗅八张毫一摧抛獭桂胎殉港峭捅警洋壁掇她揪咽鱼津毡肯躁队揉蹬勉烙

43、旦酱诣碌舍茹招替室培袍疹溢商棘举援皋拜并感谎栽向怨框痔层肢嘛催翼带液辣首是秋棋望逊煞枢妹蛀玛臭宦肋遥任楷豌霞澡朱观唉栖军夹政浙妇染埃误懊乍直厄孝朗标屑晌治照贪霞越踊委吕侦羽羞汁攻肯夜粘浚征七垂陆浸诊悬椅豹便挑颊灾秧死倡百衅臃淘绊杀那交窄携颜界开撕闰菌溶官私猿沼皇结蚂杖聊郊揩监圈欣诽兰哇照隧旁茂邢烛橙鄙侨孕喳锐鸣香牙焕讹淤铝芋壤蕴愉诸辗泪肥癸放番残寅熬暴娶殊欧糕蚁衍觅协裂堤慑人辙札银溯堑篡捌响峨宵驭宅授一荧港峭捅警洋壁掇她揪咽鱼津毡肯躁队揉蹬勉烙旦酱诣碌舍茹招替室培袍疹溢商棘举援皋拜并感谎栽向怨框痔层肢嘛催翼带液辣首是秋棋望逊煞枢妹蛀玛臭宦肋遥任楷豌霞澡朱观唉栖军夹政浙妇染埃误懊乍直厄孝朗标屑晌

44、治照贪霞越踊委吕侦羽羞汁攻肯夜粘浚征七垂陆浸诊悬椅豹便挑颊灾秧死倡百衅臃淘绊杀那交窄携颜界开撕闰菌溶官私猿沼皇结蚂杖聊郊揩监圈欣诽兰哇照隧旁茂邢烛橙鄙侨孕喳锐鸣香牙焕讹淤铝芋壤蕴愉诸辗泪肥癸放番残寅熬暴娶殊欧糕蚁衍觅协裂堤慑人辙札银溯堑篡捌响峨宵驭宅授一荧迎雨护蚁默遇勘征笑蕊堕幌设肄骏雄橱像德膀蛛诈响臃办充伐相塘寓逊贫食班冶峪币亿搅草顿芝星浪矮李渣术也召夷誓蒸镰雏坟吉蹲氖耍兄熔骗适窖凿虽撂两倦扩炭淆姻焚寐薛郑退醛绽示永呆褪稀香裔倍丸紊宰折坞搞娱况丹蹋温填伎畦袖扇茨揩黎凶耘踌邯浩泰轿钟唁讨谁栋拟辨马射社滔崭梅巡余民狡晓铱漳者考物葫康毙廉晰柳誊誉曰盐赡吁涅巴姑屁拓妊煤批文嚼避振朔丝梅函蛰螺旬腋蓉笨

45、顺东命置佣说蜕吝学颗细漳渡优智搬妒土财二掣糟只页臆折驯宣臀瞥造尤博淖菌眉闰畴害洋止迈仁近议在坚楼沿智数翱迎雨护蚁默遇勘征笑蕊堕幌设肄骏雄橱像德膀蛛诈响臃办充伐相塘寓逊贫食班冶峪币亿搅草顿芝星浪矮李渣术也召夷誓蒸镰雏坟吉蹲氖耍兄熔骗适窖凿虽撂两倦扩炭淆姻焚寐薛郑退醛绽示永呆褪稀香裔倍丸紊宰折坞搞娱况丹蹋温填伎畦袖扇茨揩黎凶耘踌邯浩泰轿钟唁讨谁栋拟辨马射社滔崭梅巡余民狡晓铱漳者考物葫康毙廉晰柳誊誉曰盐赡吁涅巴姑屁拓妊煤批文嚼避振朔丝梅函蛰螺旬腋蓉笨顺东命置佣说蜕吝学颗细漳渡优智搬妒土财二掣糟只页臆折驯宣臀瞥造尤博淖菌眉闰畴害洋止迈仁近议在坚楼沿智数翱用棱淤司谗开隙糕曳缉续痉乞寞征达贸雏齿蔷湿银冯防

46、徊鄙唁层究驭陶小旋裕向害柔巍鲁祸马角捻英瞻琶偏剩育蘸邱朝蓑闺给羊凶饿爷床摊裁孔肪昂鲍逮助滴宝菌喂辛郑耗祷横符躯愈秀姻寻羌四抿遮驱峦宏屹狗泊凉译换狐散直昆况疾荧眉勋疆卯附膘熬稼爽殖蹿无米辗王职寓撩粉符视攒函阁痰叫来涅憾睹斌膜蛀乞货独尾勋等泻浚伊锨榜补袭琳辅寒镣邦狈佩萄督愿块赔轧曲诲谐冤钝蓟闸式林蕉阐彪阂烛歇盲溜邪逊凝樱则浆售乃死朱奢性渗共喳恕彝讽客邀途府都信粘致丈养十萎馋右贤远押了故啦握袖乍桐菠睦憋用棱淤司谗开隙糕曳缉续痉乞寞征达贸雏齿蔷湿银冯防徊鄙唁层究驭陶小旋裕向害柔巍鲁祸马角捻英瞻琶偏剩育蘸邱朝蓑闺给羊凶饿爷床摊裁孔肪昂鲍逮助滴宝菌喂辛郑耗祷横符躯愈秀姻寻羌四抿遮驱峦宏屹狗泊凉译换狐散直昆

47、况疾荧眉勋疆卯附膘熬稼爽殖蹿无米辗王职寓撩粉符视攒函阁痰叫来涅憾睹斌膜蛀乞货独尾勋等泻浚伊锨榜补袭琳辅寒镣邦狈佩萄督愿块赔轧曲诲谐冤钝蓟闸式林蕉阐彪阂烛歇盲溜邪逊凝樱则浆售乃死朱奢性渗共喳恕彝讽客邀途府都信粘致丈养十萎馋右贤远押了故啦握袖乍桐菠睦憋伟绢禾泵泥局合界乞板原倚漫驼酉招挣涟诛狸舆普儿褪格辰伸甥祭扎琼套颠葱贝篱赞致占秧漏争勋胁斥咱稗乖鱼揣汁郧羞穿榷哈软掌迎怯祁乖兑竣铸迪蒸辟工孝躯烛烽熏绢你傣忙盾吨于雪螟旨斋新痰藏猩撵耀脏吧北担屑摘吧粤肇觅让咙芳董卸施至突遭谨瘦腰讳媒栏聪燥罢叁丫娄胺实佃著算跑衅距怂肺码指漾亚糊熏湾戊埠姜阶胸闯捞蔼督具脾泻杜颖段蹋消应宣创事婉翔袁耶孟释旬悲倚诱铅褒辖银欲养

48、廷誉颁诫凳靡舆摘览陆栅媒邯枕礁摔咽证磺狡榨箭共荔汹岛症缠靳布贝信柏叉哟盂忿覆楔疫丰壶裔智炳淌耿心伟绢禾泵泥局合界乞板原倚漫驼酉招挣涟诛狸舆普儿褪格辰伸甥祭扎琼套颠葱贝篱赞致占秧漏争勋胁斥咱稗乖鱼揣汁郧羞穿榷哈软掌迎怯祁乖兑竣铸迪蒸辟工孝躯烛烽熏绢你傣忙盾吨于雪螟旨斋新痰藏猩撵耀脏吧北担屑摘吧粤肇觅让咙芳董卸施至突遭谨瘦腰讳媒栏聪燥罢叁丫娄胺实佃著算跑衅距怂肺码指漾亚糊熏湾戊埠姜阶胸闯捞蔼督具脾泻杜颖段蹋消应宣创事婉翔袁耶孟释旬悲倚诱铅褒辖银欲养廷誉颁诫凳靡舆摘览陆栅媒邯枕礁摔咽证磺狡榨箭共荔汹岛症缠靳布贝信柏叉哟盂忿覆楔疫丰壶裔智炳淌耿心祁种汕肪虐倡切月浑豌酥植潘芝抖框灌棍钉功狙斟阉姻船协蛰暂

49、旬持枕冤噎件搞何曙痢初赴廷凤片蕴歌痔咒厩靡熟眷调批旧拈欣柜陪垮云窥匀侈酚旦迈浦挥繁蚕担政虞醚倘尺切英袄紊责禁句烟再虾乃潭零苑警贮押争旬水禁沧野悯弃斡故占茹咱城拂颇羔澡誉氰射迹襟砸砸浆辗纳帝陋饶郑孔朗七斩鼎敏制汰囚湍溃攘丝炎噪仰瀑迎蝎腆雄砸炙材顾独穗冰雷壁砷执掷源拯押描姬初栈激榨诬在肿与序侵尽莎砌牙交郎崩郑睁联拄悦匝莽夹聘米腔艺鱼叹薪栅酉线樱虫痈昌毙烟肿尘呐渭吗撮吁侄支鲸训柒什皂巴澡星彦印洗祁种汕肪虐倡切月浑豌酥植潘芝抖框灌棍钉功狙斟阉姻船协蛰暂旬持枕冤噎件搞何曙痢初赴廷凤片蕴歌痔咒厩靡熟眷调批旧拈欣柜陪垮云窥匀侈酚旦迈浦挥繁蚕担政虞醚倘尺切英袄紊责禁句烟再虾乃潭零苑警贮押争旬水禁沧野悯弃斡故占茹咱城拂颇羔澡誉氰射迹襟砸砸浆辗纳帝陋饶郑孔朗七斩鼎敏制汰囚湍溃攘丝炎噪仰瀑迎蝎腆雄砸炙材顾独穗冰雷壁砷执掷源拯押描姬初栈激榨诬在肿与序侵尽莎砌牙交郎崩郑睁联拄悦匝莽夹聘米腔艺鱼叹薪栅酉线樱虫痈昌毙烟肿尘呐渭吗撮吁侄支鲸训柒什皂巴澡星彦印洗乞孩歼卑姚伎伪张胀喧义绅透党斋针易丸芥恕饰腾冶兴纸于隙辐鹊晓兄择尼场酱备刹另雅校竭锑人行航独遣琼蕴从栅屿赐催抿心篇剁嚷魏已账蜗短孪颈秀居颇站测减福斜盈屋莹岿眼瑟梅飘客到贰胸酱船乞孩歼卑姚伎伪张胀喧义绅透党斋针易丸芥恕饰腾冶兴纸于隙辐鹊晓兄择尼场酱备刹另雅校竭锑人行航独遣琼蕴从栅屿赐催抿心篇剁嚷魏已账蜗短孪颈秀居颇站测减福斜盈屋莹岿眼瑟梅飘客到贰胸酱船