一、睪丸(wan)疼(teng)痛小腹脹痛腰痛的(de)原因是(shi)
目前很多的(de)(de)男性在睪(gao)(gao)(gao)丸問題上(shang)都很痛苦，由于自身知道的(de)(de)知識欠(qian)缺，所(suo)以很多的(de)(de)男性會盲目的(de)(de)選擇治療的(de)(de)方法，從而(er)使沒(mei)有確(que)診(zhen)的(de)(de)病情(qing)更(geng)加的(de)(de)嚴重。引起引起睪(gao)(gao)(gao)丸疼(teng)痛的(de)(de)病因很多，但主要有睪(gao)(gao)(gao)丸扭轉、睪(gao)(gao)(gao)丸損(sun)傷(shang)、睪(gao)(gao)(gao)丸炎、睪(gao)(gao)(gao)丸缺血性疼(teng)痛。
一、睪(gao)(gao)(gao)丸扭轉。睪(gao)(gao)(gao)丸扭轉是陰(yin)囊(nang)內常見急癥之一。一般發(fa)病(bing)(bing)前幾(ji)小(xiao)時(shi)有(you)劇烈活動，或睪(gao)(gao)(gao)丸受(shou)過外力。睡眠或安靜時(shi)突然發(fa)生(sheng)睪(gao)(gao)(gao)丸劇烈疼痛，這是此病(bing)(bing)首發(fa)的癥狀，也是其主要診斷依(yi)據之一，部分病(bing)(bing)人伴有(you)惡心嘔吐、陰(yin)囊(nang)腫脹、觸(chu)痛明顯。
二、睪(gao)丸(wan)損(sun)傷。睪(gao)丸(wan)在陰(yin)囊(nang)內的(de)(de)活動性較大，且有(you)(you)堅(jian)韌的(de)(de)白膜保護，發生閉合性損(sun)傷的(de)(de)機(ji)會(hui)較小，睪(gao)丸(wan)損(sun)傷大多(duo)與遭(zao)受暴力、車禍等有(you)(you)關，受傷后睪(gao)丸(wan)劇烈疼痛(tong)伴惡心、嘔吐(tu)，甚至發生昏厥或休克，體(ti)檢時有(you)(you)睪(gao)丸(wan)腫脹、輪廓不(bu)清或陰(yin)囊(nang)淤(yu)血(xue)，壓(ya)痛(tong)明顯(xian)，B超和(he)CT不(bu)但有(you)(you)助于本病的(de)(de)診斷，而且可明確(que)睪(gao)丸(wan)損(sun)傷的(de)(de)部位和(he)范(fan)圍。
三(san)、睪(gao)(gao)丸(wan)缺血性(xing)疼痛(tong)。睪(gao)(gao)丸(wan)缺血性(xing)疼痛(tong)多(duo)見于老年(nian)人，疼痛(tong)較劇烈(lie)，活動(dong)時加(jia)重，休(xiu)息(xi)時緩(huan)解(jie)，前列腺液(ye)鏡(jing)檢正常，常因為(wei)睪(gao)(gao)丸(wan)動(dong)脈硬化(hua)(hua)致動(dong)脈狹窄(zhai)。睪(gao)(gao)丸(wan)動(dong)脈粥樣(yang)硬化(hua)(hua)往(wang)往(wang)是全身性(xing)血管病變的(de)局部表現(xian)，多(duo)為(wei)單側病變，左側較右側多(duo)見。
四、睪(gao)(gao)丸(wan)(wan)炎(yan)(yan)(yan)。睪(gao)(gao)丸(wan)(wan)位于(yu)陰囊內，左(zuo)右各一(yi)，睪(gao)(gao)丸(wan)(wan)分泌男(nan)性(xing)激(ji)素，對(dui)男(nan)性(xing)生殖器官的發育和成熟(shu)以及(ji)對(dui)男(nan)性(xing)第二性(xing)征的出(chu)現(xian)起重(zhong)要作用。引起睪(gao)(gao)丸(wan)(wan)炎(yan)(yan)(yan)的原因非常多，如(ru)流(liu)行性(xing)腮腺炎(yan)(yan)(yan)患者，可并發睪(gao)(gao)丸(wan)(wan)炎(yan)(yan)(yan)，出(chu)現(xian)睪(gao)(gao)丸(wan)(wan)疼(teng)痛(tong)、腫(zhong)大;淋病是目前發病率最(zui)高的性(xing)傳播疾病，嚴重(zhong)時可引起睪(gao)(gao)丸(wan)(wan)炎(yan)(yan)(yan);慢性(xing)前列腺炎(yan)(yan)(yan)也可引起睪(gao)(gao)丸(wan)(wan)疼(teng)痛(tong)，表現(xian)為單側疼(teng)痛(tong)，多為鈍痛(tong)或牽拉(la)痛(tong)，呈持續(xu)性(xing)，患者多為青壯年(nian)，老年(nian)人少見。
二、睪丸疼痛小腹脹痛腰(yao)痛的檢(jian)查有
目前很多(duo)(duo)(duo)的(de)男(nan)性在睪(gao)丸(wan)(wan)(wan)問題上都(dou)很痛(tong)(tong)苦，由于自(zi)身知(zhi)道的(de)知(zhi)識欠缺，所以很多(duo)(duo)(duo)的(de)男(nan)性會盲目的(de)選擇治療的(de)方法(fa)，從而(er)使沒有(you)確診的(de)病情更加的(de)嚴(yan)重。引起(qi)引起(qi)睪(gao)丸(wan)(wan)(wan)疼痛(tong)(tong)的(de)病因很多(duo)(duo)(duo)，但(dan)主要有(you)睪(gao)丸(wan)(wan)(wan)扭轉(zhuan)、睪(gao)丸(wan)(wan)(wan)損傷(shang)、睪(gao)丸(wan)(wan)(wan)炎、睪(gao)丸(wan)(wan)(wan)缺血性疼痛(tong)(tong)。
睪(gao)(gao)(gao)(gao)丸扭轉(zhuan)。睪(gao)(gao)(gao)(gao)丸扭轉(zhuan)是陰(yin)囊(nang)內常見急癥之(zhi)一(yi)。一(yi)般(ban)發病前(qian)幾(ji)小時(shi)有(you)劇(ju)烈活動，或睪(gao)(gao)(gao)(gao)丸受過外力。睡眠或安靜時(shi)突然發生睪(gao)(gao)(gao)(gao)丸劇(ju)烈疼(teng)痛，這(zhe)是此病首發的(de)癥狀，也是其主(zhu)要診(zhen)斷依據之(zhi)一(yi)，部分病人伴有(you)惡心嘔吐(tu)、陰(yin)囊(nang)腫脹、觸痛明顯(xian)。
在臨床上凡是見到睪丸脹痛，首先要(yao)看有無泌尿(niao)(niao)系統疾病的病史、臨床癥狀表現和體征;二要(yao)檢查血(xue)常(chang)規(gui)，尿(niao)(niao)常(chang)規(gui)，膀胱、前(qian)列腺(xian)、泌尿(niao)(niao)系超聲(sheng)檢查，以明確睪丸脹痛的部位(wei)、原(yuan)因和嚴重程度，為下一步治(zhi)療提(ti)供依據。
1、血(xue)常規檢查可見(jian)血(xue)白細胞增高，中性粒細胞增高;
2、尿(niao)液檢查;可見鏡下血(xue)尿(niao)和白血(xue)球;
3、急性(xing)期尿內可(ke)查到致病菌(jun)，必要時可(ke)作梅(mei)(mei)毒血清試(shi)驗(yan)，以除外梅(mei)(mei)毒瘤。
三、睪丸(wan)疼痛(tong)(tong)小腹脹痛(tong)(tong)腰(yao)痛(tong)(tong)的鑒別有
睪丸脹痛的鑒別診斷：
1、睪(gao)(gao)丸(wan)(wan)(wan)(wan)(wan)急(ji)性(xing)疼(teng)痛(tong)(tong)：睪(gao)(gao)丸(wan)(wan)(wan)(wan)(wan)疼(teng)痛(tong)(tong)多(duo)見(jian)于睪(gao)(gao)丸(wan)(wan)(wan)(wan)(wan)炎(yan)和損傷(shang)(shang)，睪(gao)(gao)丸(wan)(wan)(wan)(wan)(wan)炎(yan)除血(xue)(xue)行感染外，更常見(jian)的(de)是細菌經尿道逆行至附睪(gao)(gao)和睪(gao)(gao)丸(wan)(wan)(wan)(wan)(wan)，造成(cheng)附睪(gao)(gao)炎(yan)、睪(gao)(gao)丸(wan)(wan)(wan)(wan)(wan)炎(yan)，并(bing)發睪(gao)(gao)丸(wan)(wan)(wan)(wan)(wan)炎(yan)時，睪(gao)(gao)丸(wan)(wan)(wan)(wan)(wan)腫(zhong)(zhong)(zhong)大(da)，同時有(you)體溫增高、怕冷、頭疼(teng)、嘔吐及(ji)小腹疼(teng)痛(tong)(tong)，腫(zhong)(zhong)(zhong)大(da)的(de)睪(gao)(gao)丸(wan)(wan)(wan)(wan)(wan)疼(teng)痛(tong)(tong).。臨床可(ke)見(jian)附睪(gao)(gao)與睪(gao)(gao)丸(wan)(wan)(wan)(wan)(wan)腫(zhong)(zhong)(zhong)脹和疼(teng)痛(tong)(tong)。睪(gao)(gao)丸(wan)(wan)(wan)(wan)(wan)損傷(shang)(shang)時有(you)外傷(shang)(shang)史和局部的(de)腫(zhong)(zhong)(zhong)脹及(ji)淤血(xue)(xue)。劇烈運動(dong)或房事、暴(bao)力有(you)時可(ke)引(yin)起(qi)提睪(gao)(gao)肌的(de)強(qiang)烈收縮，從而使系帶過長(chang)的(de)睪(gao)(gao)丸(wan)(wan)(wan)(wan)(wan)發生扭轉并(bing)引(yin)起(qi)睪(gao)(gao)丸(wan)(wan)(wan)(wan)(wan)的(de)劇痛(tong)(tong)。由(you)于睪(gao)(gao)丸(wan)(wan)(wan)(wan)(wan)扭轉后(hou)阻斷(duan)了睪(gao)(gao)丸(wan)(wan)(wan)(wan)(wan)的(de)血(xue)(xue)液供(gong)應(ying)，所以睪(gao)(gao)丸(wan)(wan)(wan)(wan)(wan)除劇痛(tong)(tong)外并(bing)有(you)陰囊(nang)腫(zhong)(zhong)(zhong)大(da)、皮(pi)膚水腫(zhong)(zhong)(zhong)。相對(dui)來說，急(ji)性(xing)疼(teng)痛(tong)(tong)的(de)診斷(duan)比較容易。
2、睪丸(wan)(wan)慢性疼(teng)痛(tong)(tong)：輕(qing)者遷延日久。疼(teng)痛(tong)(tong)較(jiao)輕(qing)、泛化，具有(you)(you)放射(she)性疼(teng)，所以(yi)不容(rong)易判斷炎癥(zheng)的(de)(de)(de)(de)(de)確切(qie)部(bu)(bu)位。睪丸(wan)(wan)的(de)(de)(de)(de)(de)疼(teng)痛(tong)(tong)不一定與炎癥(zheng)的(de)(de)(de)(de)(de)輕(qing)重程度(du)成正比(bi)，有(you)(you)些人的(de)(de)(de)(de)(de)神(shen)經(jing)敏(min)感(gan)程度(du)很高，輕(qing)度(du)炎癥(zheng)就可(ke)引起較(jiao)嚴重的(de)(de)(de)(de)(de)疼(teng)痛(tong)(tong)感(gan);而有(you)(you)些人比(bi)較(jiao)遲緩，自我感(gan)覺就輕(qing)。有(you)(you)的(de)(de)(de)(de)(de)疼(teng)痛(tong)(tong)發生在性生活(huo)之后(hou)，這可(ke)能由于(yu)性興奮使生殖器和生殖腺高度(du)充血(xue)所致(zhi)。有(you)(you)的(de)(de)(de)(de)(de)疼(teng)痛(tong)(tong)系精索精脈(mo)曲張或其(qi)他部(bu)(bu)位的(de)(de)(de)(de)(de)疼(teng)痛(tong)(tong)放射(she)而來，如(ru)輸尿(niao)管結石引起的(de)(de)(de)(de)(de)睪丸(wan)(wan)放射(she)性疼(teng)痛(tong)(tong)，這時就要(yao)仔細鑒(jian)別真(zhen)正的(de)(de)(de)(de)(de)原(yuan)因以(yi)便有(you)(you)效的(de)(de)(de)(de)(de)對癥(zheng)處理。
3、睪丸觸(chu)痛(tong)：睪丸觸(chu)痛(tong)是淋病合并癥(zheng)精(jing)囊炎(yan)(yan)(yan)的臨(lin)床癥(zheng)狀(zhuang)的表現。淋病合并癥(zheng)精(jing)囊炎(yan)(yan)(yan)一般發(fa)生于(yu)急性(xing)尿道炎(yan)(yan)(yan)后，單側居(ju)多。有(you)低熱(re)，附睪腫大(da)疼痛(tong)，同側腹(fu)股溝和(he)下腹(fu)部有(you)反射抽痛(tong)，初起與睪丸界限清楚，漸(jian)漸(jian)不清，睪丸觸(chu)痛(tong)，腫大(da)，劇烈(lie)觸(chu)痛(tong)。
四、睪丸疼痛(tong)小(xiao)腹脹痛(tong)腰痛(tong)的緩解有(you)
睪(gao)(gao)(gao)(gao)丸(wan)(wan)急性(xing)疼痛(tong)(tong)(tong)(tong)：睪(gao)(gao)(gao)(gao)丸(wan)(wan)疼痛(tong)(tong)(tong)(tong)多見(jian)于睪(gao)(gao)(gao)(gao)丸(wan)(wan)炎(yan)(yan)和(he)損傷(shang)，睪(gao)(gao)(gao)(gao)丸(wan)(wan)炎(yan)(yan)除(chu)血(xue)行(xing)感染外(wai)，更常(chang)見(jian)的(de)(de)(de)是細(xi)菌經尿(niao)道逆行(xing)至附(fu)睪(gao)(gao)(gao)(gao)和(he)睪(gao)(gao)(gao)(gao)丸(wan)(wan)，造成(cheng)附(fu)睪(gao)(gao)(gao)(gao)炎(yan)(yan)、睪(gao)(gao)(gao)(gao)丸(wan)(wan)炎(yan)(yan)，并發(fa)睪(gao)(gao)(gao)(gao)丸(wan)(wan)炎(yan)(yan)時(shi)，睪(gao)(gao)(gao)(gao)丸(wan)(wan)腫(zhong)(zhong)大(da)，同(tong)時(shi)有體(ti)溫增高、怕冷、頭疼、嘔吐及(ji)小腹(fu)疼痛(tong)(tong)(tong)(tong)，腫(zhong)(zhong)大(da)的(de)(de)(de)睪(gao)(gao)(gao)(gao)丸(wan)(wan)疼痛(tong)(tong)(tong)(tong).。臨(lin)床可(ke)見(jian)附(fu)睪(gao)(gao)(gao)(gao)與睪(gao)(gao)(gao)(gao)丸(wan)(wan)腫(zhong)(zhong)脹(zhang)(zhang)和(he)疼痛(tong)(tong)(tong)(tong)。睪(gao)(gao)(gao)(gao)丸(wan)(wan)損傷(shang)時(shi)有外(wai)傷(shang)史和(he)局(ju)部(bu)的(de)(de)(de)腫(zhong)(zhong)脹(zhang)(zhang)及(ji)淤(yu)血(xue)。劇烈運動或(huo)房事、暴(bao)力有時(shi)可(ke)引起提睪(gao)(gao)(gao)(gao)肌的(de)(de)(de)強烈收縮，從而使系(xi)帶過長的(de)(de)(de)睪(gao)(gao)(gao)(gao)丸(wan)(wan)發(fa)生(sheng)扭轉并引起睪(gao)(gao)(gao)(gao)丸(wan)(wan)的(de)(de)(de)劇痛(tong)(tong)(tong)(tong)。由于睪(gao)(gao)(gao)(gao)丸(wan)(wan)扭轉后(hou)阻(zu)(zu)斷(duan)(duan)了睪(gao)(gao)(gao)(gao)丸(wan)(wan)的(de)(de)(de)血(xue)液供應，所以睪(gao)(gao)(gao)(gao)丸(wan)(wan)除(chu)劇痛(tong)(tong)(tong)(tong)外(wai)并有陰(yin)囊腫(zhong)(zhong)大(da)、皮膚(fu)水(shui)腫(zhong)(zhong)。相(xiang)對來說，急性(xing)疼痛(tong)(tong)(tong)(tong)的(de)(de)(de)診斷(duan)(duan)比較容易(yi)應在(zai)確定其(qi)病因的(de)(de)(de)基礎(chu)上進行(xing)對癥治療，一時(shi)查不(bu)(bu)出原因，則可(ke)做鎮(zhen)靜和(he)止(zhi)痛(tong)(tong)(tong)(tong)的(de)(de)(de)對癥治療。必要(yao)時(shi)可(ke)采(cai)用精索(suo)普魯卡因封閉治療，這樣可(ke)以阻(zu)(zu)斷(duan)(duan)神經痛(tong)(tong)(tong)(tong)的(de)(de)(de)痛(tong)(tong)(tong)(tong)源和(he)大(da)腦痛(tong)(tong)(tong)(tong)覺中(zhong)樞之間(jian)的(de)(de)(de)惡性(xing)循環。有些(xie)人(ren)稍有不(bu)(bu)適或(huo)根本沒有不(bu)(bu)適也能(neng)誘(you)發(fa)睪(gao)(gao)(gao)(gao)丸(wan)(wan)的(de)(de)(de)疼痛(tong)(tong)(tong)(tong)，這時(shi)完全是精神作(zuo)用在(zai)作(zuo)怪。有些(xie)人(ren)則把(ba)疼痛(tong)(tong)(tong)(tong)與手淫聯(lian)系(xi)起來，整(zheng)天背著沉重的(de)(de)(de)內(nei)疚的(de)(de)(de)思想負(fu)擔(dan)。殊(shu)不(bu)(bu)知過度焦慮、過分把(ba)注(zhu)意力集中(zhong)在(zai)性(xing)的(de)(de)(de)表現(xian)能(neng)力上反而會造成(cheng)精神性(xing)陽痿等(deng)性(xing)功能(neng)障礙。
腰(yao)(yao)(yao)疼(teng)原(yuan)致五種 腰(yao)(yao)(yao)疼(teng)原(yuan)：由(you)(you)于(yu)(yu)脊(ji)(ji)(ji)(ji)柱(zhu)骨(gu)關節及(ji)(ji)其周(zhou)圍(wei)軟組織(zhi)疾(ji)(ji)患所(suo)引(yin)起腰(yao)(yao)(yao)肌勞損、肌纖維織(zhi)炎(yan)(yan)(yan)及(ji)(ji)由(you)(you)挫傷(shang)(shang)(shang)、扭傷(shang)(shang)(shang)所(suo)引(yin)起局部(bu)(bu)損傷(shang)(shang)(shang)、血、水腫、粘(zhan)連肌肉痙攣等 腰(yao)(yao)(yao)疼(teng)原(yuan)二：由(you)(you)于(yu)(yu)脊(ji)(ji)(ji)(ji)椎(zhui)病變引(yin)起類(lei)風濕(shi)性(xing)脊(ji)(ji)(ji)(ji)椎(zhui)炎(yan)(yan)(yan)、骨(gu)質增癥、結(jie)核性(xing)脊(ji)(ji)(ji)(ji)椎(zhui)炎(yan)(yan)(yan)、脊(ji)(ji)(ji)(ji)椎(zhui)外(wai)傷(shang)(shang)(shang)及(ji)(ji)腰(yao)(yao)(yao)椎(zhui)間盤突等 腰(yao)(yao)(yao)疼(teng)原(yuan)三：由(you)(you)于(yu)(yu)脊(ji)(ji)(ji)(ji)髓(sui)脊(ji)(ji)(ji)(ji)椎(zhui)神(shen)經(jing)疾(ji)(ji)患引(yin)起脊(ji)(ji)(ji)(ji)髓(sui)壓迫癥、中國性(xing)脊(ji)(ji)(ji)(ji)髓(sui)炎(yan)(yan)(yan)、神(shen)經(jing)根炎(yan)(yan)(yan)、脊(ji)(ji)(ji)(ji)髓(sui)腫瘤(liu)等所(suo)引(yin)起腰(yao)(yao)(yao)疼(teng) 腰(yao)(yao)(yao)疼(teng)原(yuan)四(si)：由(you)(you)于(yu)(yu)內臟(zang)器官疾(ji)(ji)患所(suo)引(yin)起腎炎(yan)(yan)(yan)、泌(mi)尿(niao)系染、泌(mi)尿(niao)系結(jie)石(shi)、膽囊炎(yan)(yan)(yan)、膽囊結(jie)石(shi)、胰腺炎(yan)(yan)(yan)、胃及(ji)(ji)十二指腸球部(bu)(bu)潰瘍、前列腺炎(yan)(yan)(yan)、宮內膜炎(yan)(yan)(yan)、附件(jian)炎(yan)(yan)(yan)及(ji)(ji)盆(pen)腔炎(yan)(yan)(yan)等腫瘤(liu)引(yin)起腰(yao)(yao)(yao)骶部(bu)(bu)疼(teng)疼(teng)性(xing)病往往同伴(ban)相應(ying)婦科癥候 腰(yao)(yao)(yao)疼(teng)原(yuan)五：由(you)(you)于(yu)(yu)精神(shen)素所(suo)引(yin)起癔病患者能腰(yao)(yao)(yao)病主(zhu)訴并客(ke)觀體(ti)征或(huo)客(ke)觀檢查與主(zhu)觀敘述能理解剖及(ji)(ji)病理知識解釋種腰(yao)(yao)(yao)疼(teng)癔病種表
急性疼痛
多見于睪丸炎和損傷,睪丸炎除血行感染外,更常見的是細菌經尿道逆行至附睪和睪丸,造成附睪炎,睪丸炎,臨床可見附睪與睪丸腫脹和疼痛.睪丸損傷時有外傷史和局部的腫脹及淤血.劇烈運動或房事,暴力有時可引起提睪肌的強烈收縮,從而使系帶過長的睪丸發生扭轉并引起睪丸的劇痛.由于睪丸扭轉后阻斷了睪丸的血液供應,所以睪丸除劇痛外并有陰囊腫大,皮膚水腫.相對來說,急性疼痛的診斷比較容易.
慢性疼痛
輕者遷延日久.疼痛較輕,泛化,具有放射性疼,所以不容易判斷炎癥的確切部位.睪丸的疼痛不一定與炎癥的輕重程度成正比,有些人的神經敏感程度很高,輕度炎癥就可引起較嚴重的疼痛感;而有些人比較遲緩,自我感覺就輕.
有的疼痛發生在性
生活之后,這可能由于性興奮使生殖器和生殖腺高度充血所致.有的疼痛系精索精脈曲張或其他部位的疼痛放射而來,如輸尿管結石引起的睪丸放射性疼痛,這時就要仔細鑒別真正的原因以便有效的對癥處理.
不同原因引起的睪丸疼(teng)(teng)痛(tong)(tong)癥狀也有(you)(you)(you)(you)所不同.感染導致的患者睪丸疼(teng)(teng)痛(tong)(tong)較劇(ju)烈(lie).甚至如刀割樣,還會伴有(you)(you)(you)(you)發勢惡寒(han)等(deng)全身癥狀,這時候陰(yin)囊又紅(hong)又腫(zhong),觸碰睪丸則疼(teng)(teng)痛(tong)(tong)更(geng)加明顯(xian).當(dang)患有(you)(you)(you)(you)結(jie)核感染時,多伴有(you)(you)(you)(you)泌尿(niao)系統或其他(ta)部位的結(jie)核病史,表現(xian)為(wei)睪丸隱(yin)隱(yin)作痛(tong)(tong),小腹(fu)有(you)(you)(you)(you)墜脹(zhang)感并伴有(you)(you)(you)(you)陰(yin)囊腫(zhong)脹(zhang),嚴重時會流(liu)出膿液,當(dang)用(yong)手摸及這些病變部位時,有(you)(you)(you)(you)凹凸不平的結(jie)節,質(zhi)硬,并常常可(ke)與陰(yin)囊皮膚粘連.由(you)前列腺炎引起的睪丸疼(teng)(teng)痛(tong)(tong),多伴有(you)(you)(you)(you)會陰(yin)部墜脹(zhang)不舒服的感覺,還會有(you)(you)(you)(you)尿(niao)頻,尿(niao)急,尿(niao)痛(tong)(tong),排尿(niao)困難等(deng).
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