Кисты желчных протоков: взгляд на проблему и собственный клинический опыт
Клинические рекомендации
Дата публикации: апреля 12, 2019
Ключевые слова
кисты желчных протоков
кистозная патология
кисты холедоха
панкреатохолангиография
малигнизация кист
кистозная патология
кисты холедоха
панкреатохолангиография
малигнизация кист
Как цитировать
Брехов Е. И., Калинников В. В., Сычев А. В. Кисты желчных протоков: взгляд на проблему и собственный клинический опыт // Кремлевская медицина. Клинический вестник. 2019. Т. № 1. С. 5-13.
Аннотация
Обобщен опыт изучения проблемы диагностики и хирургического лечения кист желчных протоков многих исследователей, а также представлены результаты 24 собственных наблюдений. Клиническая картина у пациентов с вышеуказанными поражениями скудна и неспецифична. Поэтому при подозрении на кисты желчных протоков требуется тщательное обследование гепатопанкреатобилиарной зоны для определения характера и типа заболевания, топографо-анатомических параметров и возможных осложнений. Однако окончательный диагноз устанавливается только после гистологического исследования. Радикальным методом лечения является хирургическая операция. Характер и объем вмешательства зависит от типа кист. Полное удаление кистозных образований с адекватным дренированием для декомпрессии желчных путей является «золотым стандартом» у данной категории больных. В последующем все перенесшие операцию нуждаются в периодических осмотрах с целью выявления возможной малигнизацииЛитература
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2. Mорозов Д.А., Гусев A.A., Пименова E.С. Кисты желчных протоков: современные аспекты хирургического лечения и клиническое наблюдение редкого варианта. Вопросы современной педиатрии. 2015; 14(3): 412-415.
3. Черноусов A.Ф., Егоров А.В., Ветшев Ф.П., Вычужанин Д.В., Осминин С.В.. Хирургическое лечение кистозных заболеваний желчных протоков. Хирургия. 2016; 1: 85-92.
4. Alonso-Lej F, Revor WB, Passango DJ. Сongenital choledochal cyst, with a report of 2, and an analysis of 94 cases. Surg. Gynecol. Obstet. 1959; 108: 1-30.
5. Babbitt DP. Congenital choledochal cysts: new etiological concept based on anomalous relationships of the common bile ductand pancreatic bulb. Ann. Radiol. (Paris) 1969; 12(3): 231-240.
6. Babbitt DP, Starshak RJ, Clemett AR. Choledochal cyst: a concept of etiology. Am. J. Roentgenol. Radium. Ther. Nucl. Med. 1973; 119(1): 57-62.
7. Bismuth H, Krissat J. Choledochal cystic malignancies. Ann. Oncol. 1999; 10 (4): 94-98.
8. Chijiiwa K, Koga A. Surgical management and long-term follow-up of patients with choledochal cysts. Am. J. Surg. 1993; 165(2): 238-242.
9. Chijiiwa K, Tanaka M. Late complications after excisional operation in patients with choledochal cyst. J. Am. Coll.Surg. 1994; 179(2): 139-44.
10. Cosentino CM, Luck SR, Raffensperger JG, Reynolds M. Choledochal duct cyst: resection with physiologic reconstruction. Surgery. 1992; 112(4): 740-747;
11. Edil BH, Cameron JL, Reddy S, Lum Y, Lipsett PA, Nathan H et al. Choledochal cyst disease in children and adults: a 30-year single-institutional experience. J. Am. Coll. Surg. 2008; 206: 1000-1008.
12. Flanigan PD. Biliary cysts. Ann. Surg. 1975 ; 182(5):635-43.
13. Frampas E, Moussaly F, Léauté F, Heloury Y, Le Neel JC, Dupas B. MR cholangiopancreatography in choledochal cysts. J. Radiol. 1999; 80(12): 1659-1663.
14. Fu M., Wang Y., Zhang J. Evolution in the treatment of choledochus cyst. J. Pediatr. Surg. 2000; 35(9): 1344-1347.
15. Fulcher AS, Turner M.A. MR cholangiopancreatography. Radiol. Clin. North Am. 2002; 40: 1363-1376.
16. Hamada Y, Tanano A, Sato M, Kato Y, Hioki K. Rapid enlargementof a choledochal cyst: antenatal diagnosis and delayed primaryexcision. Pediatr. Surg. Int. 1998; 13(5-6): 419-421.
17. Hata Y, Sasaki F, Takahashi H, Tamura M, Ohkawa Y, Saji Y et al. Surgical treatment of congenital biliary dilatation associated with pancreaticobiliary maljunction. Surg. Gynecol. Obstet. 1993; 176(6): 581-587.
18. Howell CG, Templeton JM, Weiner S, Glassman M, Betts JM, Witzleben CL. Antenatal diagnosis and early surgery for choledochal cyst. J. Pediatr. Surg.1983; 18(4): 387-393.
19. Imazu M, Iwai N, Tokiwa K, Shimotake T, Kimura O, Ono S. Factors of biliary carcinogenesis in choledochal cysts. Eur. J. Pediatr. Surg. 2001; 11(1): 24-27.
20. Iwai N, Deguchi E, Yanagihara J, Iwai M, Matsuo H, Todo S et al. Cancer arising in a choledochal cyst in a 12-year-old girl. J. Pediatr. Surg. 1990; 25(12): 1261-1263.
21. Jilly JR. Total excision of choledochal cyst. Surg.Gynecol. Obstet. 1978; 146(2): 254-256.
22. Verbist BM, Ferrarini L, Briaire JJ, Zarowski A, Admiraal-Behloul F, Olofsen H et al. Anatomic observations and etiologic and surgical considerations in choledochalcyst. J. Pediatr. Surg. 1979; 14(3): 315-320.
23. Joseph VT. Surgical techniques and long-term results in the treatment of choledochal cyst. J. Pediatr. Surg. 1990; 25(7):782-787.
24. Kasai M, Asakura Y, Taira Y. Surgical treatment of choledochal cyst. Ann. Surg. 1970; 172(5): 844-851.
25. Kato T, Asakura Y, Kasai M. An attempt to produce choledochal cyst in puppies. J. Pediatr. Surg. 1974; 9(4):509-513.
26. Kato T, Hebiguchi T, Matsuda K., Yoshino H.: Action of pancreatic juice on the bile duct: pathogenesis of congenital choledochal cyst. J. Pediatr. Surg. 1981; 16(2): 146-151.
27. Katyal D, Lees GM. Choledochal cysts: a retrospective review of 28 patients and a review of the literature. Can. J. Surg.1992; 35(6): 584-588.
28. Kim SH, Lim JH, Yoon HK, Han BK, Lee SK, Kim YI. Choledochal cyst: comparison of MR and conventional cholangiography. Clin. Radiol. 2000; 55(5): 378-383.
29. Komuro H, Makino S, Tahara K. Choledochal cyst associated with duodenal obstruction. J. Pediatr. Surg. 2000; 35(8): 1259-1262.
30. Lipsett PA, Pitt HA, Colombani PM, Boitnott JK, Cameron JL. Choledochalcyst disease. A changing pattern of presentation. Ann. Surg. 1994; 220(5): 644-652.
31. Liu DC, Rodriguez JA, Meric F, Geiger JL. Laparoscopic excision of a rare type II choledochal cyst: case reportand review of the literature. J. Pediatr. Surg. 2000; 35(7):1117-1119.
32. Mackenzie TC, Howell LJ, Flake AW, Adzick NS. The management of prenatally diagnosed choledochal cysts. J. Pediatr. Surg. 2001; 36(8): 1241-1243.
33. Maning P, Polley T, Oldam K. Choledochocele: an unusual form of choledochal cyst. Pediatr. Surg. Int. 1990; 5: 22-26.
34. Marchildon MB. Antenatal diagnosis of choledochalcyst: the first four cases. Pediatr. Surg. Int. 1988; 3: 431-436.
35. Miyano T, Suruga K, Suda K. Abnormal choledochopancreatic oductal junction related to the etiology of infantile obstructive jaundice diseases. J. Pediatr. Surg. 1979; 14(1):16-26.
36. Miyano T, Suruga K, Suda K. Choledocho-pancreaticend to side anastomosis in dog as an experimental model ofcholedocho-pancreatic long common channel disorders. Jpn. J.Pediatr. Surg. 1981; 13: 525-531.
37. Miyano T, Yamataka A, Kato Y. Choledochal cysts: special emphasis on the usefulness of intraoperative endoscopy. JPediatr. Surg. 1995; 30(3): 482-484.
38. Miyano T, Yamataka A, Kato Y, Segawa O, Lane G, Takamizawa S et al. Hepaticoenterostomy after excision of choledochal cyst in children: a 30-year experience with 180 cases. J. Pediatr. Surg. 1996; 31(10): 1417-1421.
39. Oguchi Y, Okada A, Nakamura T, Okumura K, Miyata M, Nakao K et al. Histopathologic studies of congenital dilatation of the bile duct as related to an anomalous junction of the pancreatic biliary ductal system: clinical and experimental studies. Surgery. 1988; 103(2): 168-173.
40. Ohi R, Koike N, Matsumoto Y, Ohkohchi N, Kasai M. Changes of intrahepatic bile duct dilatation after surgery for congenital dilatation of the bile duct. J. Pediatr. Surg. 1985; 20(2): 138-142.
41. Ohi R, Yaoita S, Kamiyama T, Ibrahim M, Hayashi Y, Chiba T. Surgical treatment of congenital dilatation of the bile duct with special reference to late complications after total excisional operation. J. Pediatr. Surg. 1990; 25(6): 613-617.
42. Okada A, Nakamura T, Higaki J, Okumura K, Kamata S, Oguchi Y. Congenital dilatation of the bile duct in 100 instances and its relationship with anomalous junction. Surg. Gynecol. Obstet. 1990; 171(4):291-298.
43. O'Neill JA. Choledochal cyst. Curr. Probl. Surg. 1992; 29(6): 361-410.
44. Ono S, Tokiwa K, Aoi S, Iwai N, Nakanoin H. A bleeding tendency as the first symptom of a choledochal cyst. Pediatr. Surg. Int. 2000; 16(1-2): 111-112.4
45. Patel S, Sterkin L, Donahue PE, Young S. Congenital cyst of common bile duct: an unusual cause of obstructive jaundice. Surgery 1991; 109(3): 333-335.
46. Postema RR, Hazebroek FW. Choledochal cysts in children: a review of 28 years of treatment in a Dutch children's hospital. Eur. J. Surg. 1999; 165(12): 1159-1161.
47. Raffensperger JG. Swenson's Pediatric Surgery. Conn: Appleton & Lange; 1990: 665.
48. Reynolds M, Luck SR, Raffensperger JG. The valve conduit prevents ascending cholangitis: a follow-up. J. Pediatr.Surg. 1985; 20(6): 696-702.
49. Saing H, Tam PK, Lee JM, Pe-Nyun: Surgical management of choledochal cysts: a review of 60 cases. J. Pediatr. Surg. 1985; 20(4): 443-448.
50. Shamberger RC, Lund DP, Lillehei CW, Hendren WH. Interposed jejunal segment with nipple valve to prevent reflux in biliary reconstruction. J. Am. Coll. Surg. 1995;180(1): 10-15.
51. Soreide K, Korner H, Havnen J, Soreide JA. Bile duct cysts in adults. Brit. J. Surg. 2004; 91: 1538-1548.
52. Spitz L. Experimental production of cystic dilatation of the common bile duct in neonatal lambs. J. Pediatr. Surg. 1977;12(1): 39-42.
53. Suita S, Shono K, Kinugasa Y, Kubota M, Matsuo S. Influence of age on the presentation and outcome of choledochal cyst. J. Pediatr. Surg.1999; 34(12): 1765-1768.
54. Tadokoro H, Takase M. Recent advances in choledochalcysts. Open J. Gastroenterol. 2012; 2: 145-154.
55. Todani T, Watanabe Y, Narusue M, Tabuchi K, Okajima K. Congenital bile duct cysts: Classification, operative procedures, and review of thirty-seven cases including cancer arising from choledochal cyst. Am. J. Surg. 1977; 134(2): 263-269.
56. Todani T, Narusue M, Watanabe Y et al. Management of congenital choledochal cyst with intrahepatic involvement. Ann. Surg. 1978; 187(3): 272-280.
57. Todani T, Tabuchi K, Watanabe Y, Kobayashi T. Carcinoma arising in the wall of congenital bile duct cysts. Cancer. 1979; 44(3): 1134-1141.
58. Todani T, Watanabe Y, Fujii T, Uemura S. Anomalous arrangement of the pancreatobiliary ductal system in patients with a choledochal cyst. Am. J. Surg. 1984 May; 147(5): 672-676.
59. Todani T, Watanabe Y, Fujii T, Toki A, Uemura S, Koike Y. Congenital choledochal cyst with intrahepatic involvement. Arch. Surg. 1984; 119(9): 1038-1043.
60. Todani T, Watanabe Y, Toki A, Urushihara N. Carcinoma related to choledochal cysts with internal drainage operations. Surg. Gynecol. Obstet. 1987; 164(1): 61-64.
61. Todani T, Watanabe Y, Urushihara N et al. Biliary complications after excisional procedure for choledochal cyst. J. Pediatr. Surg. 1995; 30(3): 478-481.
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2. Mорозов Д.А., Гусев A.A., Пименова E.С. Кисты желчных протоков: современные аспекты хирургического лечения и клиническое наблюдение редкого варианта. Вопросы современной педиатрии. 2015; 14(3): 412-415.
3. Черноусов A.Ф., Егоров А.В., Ветшев Ф.П., Вычужанин Д.В., Осминин С.В.. Хирургическое лечение кистозных заболеваний желчных протоков. Хирургия. 2016; 1: 85-92.
4. Alonso-Lej F, Revor WB, Passango DJ. Сongenital choledochal cyst, with a report of 2, and an analysis of 94 cases. Surg. Gynecol. Obstet. 1959; 108: 1-30.
5. Babbitt DP. Congenital choledochal cysts: new etiological concept based on anomalous relationships of the common bile ductand pancreatic bulb. Ann. Radiol. (Paris) 1969; 12(3): 231-240.
6. Babbitt DP, Starshak RJ, Clemett AR. Choledochal cyst: a concept of etiology. Am. J. Roentgenol. Radium. Ther. Nucl. Med. 1973; 119(1): 57-62.
7. Bismuth H, Krissat J. Choledochal cystic malignancies. Ann. Oncol. 1999; 10 (4): 94-98.
8. Chijiiwa K, Koga A. Surgical management and long-term follow-up of patients with choledochal cysts. Am. J. Surg. 1993; 165(2): 238-242.
9. Chijiiwa K, Tanaka M. Late complications after excisional operation in patients with choledochal cyst. J. Am. Coll.Surg. 1994; 179(2): 139-44.
10. Cosentino CM, Luck SR, Raffensperger JG, Reynolds M. Choledochal duct cyst: resection with physiologic reconstruction. Surgery. 1992; 112(4): 740-747;
11. Edil BH, Cameron JL, Reddy S, Lum Y, Lipsett PA, Nathan H et al. Choledochal cyst disease in children and adults: a 30-year single-institutional experience. J. Am. Coll. Surg. 2008; 206: 1000-1008.
12. Flanigan PD. Biliary cysts. Ann. Surg. 1975 ; 182(5):635-43.
13. Frampas E, Moussaly F, Léauté F, Heloury Y, Le Neel JC, Dupas B. MR cholangiopancreatography in choledochal cysts. J. Radiol. 1999; 80(12): 1659-1663.
14. Fu M., Wang Y., Zhang J. Evolution in the treatment of choledochus cyst. J. Pediatr. Surg. 2000; 35(9): 1344-1347.
15. Fulcher AS, Turner M.A. MR cholangiopancreatography. Radiol. Clin. North Am. 2002; 40: 1363-1376.
16. Hamada Y, Tanano A, Sato M, Kato Y, Hioki K. Rapid enlargementof a choledochal cyst: antenatal diagnosis and delayed primaryexcision. Pediatr. Surg. Int. 1998; 13(5-6): 419-421.
17. Hata Y, Sasaki F, Takahashi H, Tamura M, Ohkawa Y, Saji Y et al. Surgical treatment of congenital biliary dilatation associated with pancreaticobiliary maljunction. Surg. Gynecol. Obstet. 1993; 176(6): 581-587.
18. Howell CG, Templeton JM, Weiner S, Glassman M, Betts JM, Witzleben CL. Antenatal diagnosis and early surgery for choledochal cyst. J. Pediatr. Surg.1983; 18(4): 387-393.
19. Imazu M, Iwai N, Tokiwa K, Shimotake T, Kimura O, Ono S. Factors of biliary carcinogenesis in choledochal cysts. Eur. J. Pediatr. Surg. 2001; 11(1): 24-27.
20. Iwai N, Deguchi E, Yanagihara J, Iwai M, Matsuo H, Todo S et al. Cancer arising in a choledochal cyst in a 12-year-old girl. J. Pediatr. Surg. 1990; 25(12): 1261-1263.
21. Jilly JR. Total excision of choledochal cyst. Surg.Gynecol. Obstet. 1978; 146(2): 254-256.
22. Verbist BM, Ferrarini L, Briaire JJ, Zarowski A, Admiraal-Behloul F, Olofsen H et al. Anatomic observations and etiologic and surgical considerations in choledochalcyst. J. Pediatr. Surg. 1979; 14(3): 315-320.
23. Joseph VT. Surgical techniques and long-term results in the treatment of choledochal cyst. J. Pediatr. Surg. 1990; 25(7):782-787.
24. Kasai M, Asakura Y, Taira Y. Surgical treatment of choledochal cyst. Ann. Surg. 1970; 172(5): 844-851.
25. Kato T, Asakura Y, Kasai M. An attempt to produce choledochal cyst in puppies. J. Pediatr. Surg. 1974; 9(4):509-513.
26. Kato T, Hebiguchi T, Matsuda K., Yoshino H.: Action of pancreatic juice on the bile duct: pathogenesis of congenital choledochal cyst. J. Pediatr. Surg. 1981; 16(2): 146-151.
27. Katyal D, Lees GM. Choledochal cysts: a retrospective review of 28 patients and a review of the literature. Can. J. Surg.1992; 35(6): 584-588.
28. Kim SH, Lim JH, Yoon HK, Han BK, Lee SK, Kim YI. Choledochal cyst: comparison of MR and conventional cholangiography. Clin. Radiol. 2000; 55(5): 378-383.
29. Komuro H, Makino S, Tahara K. Choledochal cyst associated with duodenal obstruction. J. Pediatr. Surg. 2000; 35(8): 1259-1262.
30. Lipsett PA, Pitt HA, Colombani PM, Boitnott JK, Cameron JL. Choledochalcyst disease. A changing pattern of presentation. Ann. Surg. 1994; 220(5): 644-652.
31. Liu DC, Rodriguez JA, Meric F, Geiger JL. Laparoscopic excision of a rare type II choledochal cyst: case reportand review of the literature. J. Pediatr. Surg. 2000; 35(7):1117-1119.
32. Mackenzie TC, Howell LJ, Flake AW, Adzick NS. The management of prenatally diagnosed choledochal cysts. J. Pediatr. Surg. 2001; 36(8): 1241-1243.
33. Maning P, Polley T, Oldam K. Choledochocele: an unusual form of choledochal cyst. Pediatr. Surg. Int. 1990; 5: 22-26.
34. Marchildon MB. Antenatal diagnosis of choledochalcyst: the first four cases. Pediatr. Surg. Int. 1988; 3: 431-436.
35. Miyano T, Suruga K, Suda K. Abnormal choledochopancreatic oductal junction related to the etiology of infantile obstructive jaundice diseases. J. Pediatr. Surg. 1979; 14(1):16-26.
36. Miyano T, Suruga K, Suda K. Choledocho-pancreaticend to side anastomosis in dog as an experimental model ofcholedocho-pancreatic long common channel disorders. Jpn. J.Pediatr. Surg. 1981; 13: 525-531.
37. Miyano T, Yamataka A, Kato Y. Choledochal cysts: special emphasis on the usefulness of intraoperative endoscopy. JPediatr. Surg. 1995; 30(3): 482-484.
38. Miyano T, Yamataka A, Kato Y, Segawa O, Lane G, Takamizawa S et al. Hepaticoenterostomy after excision of choledochal cyst in children: a 30-year experience with 180 cases. J. Pediatr. Surg. 1996; 31(10): 1417-1421.
39. Oguchi Y, Okada A, Nakamura T, Okumura K, Miyata M, Nakao K et al. Histopathologic studies of congenital dilatation of the bile duct as related to an anomalous junction of the pancreatic biliary ductal system: clinical and experimental studies. Surgery. 1988; 103(2): 168-173.
40. Ohi R, Koike N, Matsumoto Y, Ohkohchi N, Kasai M. Changes of intrahepatic bile duct dilatation after surgery for congenital dilatation of the bile duct. J. Pediatr. Surg. 1985; 20(2): 138-142.
41. Ohi R, Yaoita S, Kamiyama T, Ibrahim M, Hayashi Y, Chiba T. Surgical treatment of congenital dilatation of the bile duct with special reference to late complications after total excisional operation. J. Pediatr. Surg. 1990; 25(6): 613-617.
42. Okada A, Nakamura T, Higaki J, Okumura K, Kamata S, Oguchi Y. Congenital dilatation of the bile duct in 100 instances and its relationship with anomalous junction. Surg. Gynecol. Obstet. 1990; 171(4):291-298.
43. O'Neill JA. Choledochal cyst. Curr. Probl. Surg. 1992; 29(6): 361-410.
44. Ono S, Tokiwa K, Aoi S, Iwai N, Nakanoin H. A bleeding tendency as the first symptom of a choledochal cyst. Pediatr. Surg. Int. 2000; 16(1-2): 111-112.4
45. Patel S, Sterkin L, Donahue PE, Young S. Congenital cyst of common bile duct: an unusual cause of obstructive jaundice. Surgery 1991; 109(3): 333-335.
46. Postema RR, Hazebroek FW. Choledochal cysts in children: a review of 28 years of treatment in a Dutch children's hospital. Eur. J. Surg. 1999; 165(12): 1159-1161.
47. Raffensperger JG. Swenson's Pediatric Surgery. Conn: Appleton & Lange; 1990: 665.
48. Reynolds M, Luck SR, Raffensperger JG. The valve conduit prevents ascending cholangitis: a follow-up. J. Pediatr.Surg. 1985; 20(6): 696-702.
49. Saing H, Tam PK, Lee JM, Pe-Nyun: Surgical management of choledochal cysts: a review of 60 cases. J. Pediatr. Surg. 1985; 20(4): 443-448.
50. Shamberger RC, Lund DP, Lillehei CW, Hendren WH. Interposed jejunal segment with nipple valve to prevent reflux in biliary reconstruction. J. Am. Coll. Surg. 1995;180(1): 10-15.
51. Soreide K, Korner H, Havnen J, Soreide JA. Bile duct cysts in adults. Brit. J. Surg. 2004; 91: 1538-1548.
52. Spitz L. Experimental production of cystic dilatation of the common bile duct in neonatal lambs. J. Pediatr. Surg. 1977;12(1): 39-42.
53. Suita S, Shono K, Kinugasa Y, Kubota M, Matsuo S. Influence of age on the presentation and outcome of choledochal cyst. J. Pediatr. Surg.1999; 34(12): 1765-1768.
54. Tadokoro H, Takase M. Recent advances in choledochalcysts. Open J. Gastroenterol. 2012; 2: 145-154.
55. Todani T, Watanabe Y, Narusue M, Tabuchi K, Okajima K. Congenital bile duct cysts: Classification, operative procedures, and review of thirty-seven cases including cancer arising from choledochal cyst. Am. J. Surg. 1977; 134(2): 263-269.
56. Todani T, Narusue M, Watanabe Y et al. Management of congenital choledochal cyst with intrahepatic involvement. Ann. Surg. 1978; 187(3): 272-280.
57. Todani T, Tabuchi K, Watanabe Y, Kobayashi T. Carcinoma arising in the wall of congenital bile duct cysts. Cancer. 1979; 44(3): 1134-1141.
58. Todani T, Watanabe Y, Fujii T, Uemura S. Anomalous arrangement of the pancreatobiliary ductal system in patients with a choledochal cyst. Am. J. Surg. 1984 May; 147(5): 672-676.
59. Todani T, Watanabe Y, Fujii T, Toki A, Uemura S, Koike Y. Congenital choledochal cyst with intrahepatic involvement. Arch. Surg. 1984; 119(9): 1038-1043.
60. Todani T, Watanabe Y, Toki A, Urushihara N. Carcinoma related to choledochal cysts with internal drainage operations. Surg. Gynecol. Obstet. 1987; 164(1): 61-64.
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