Preliminary study on the efficacy of lacrimal duct reconstruction with pedicled conjunctival flap in the treatment of severe lacrimal canalicular obstruction with conjunctivochalasis

AIM:To determine the efficacy and safety of pedicled conjunctival lacrimal duct reconstruction in the treatment of severe obstruction of superior and inferior lacrimal canaliculi with conjunctivochalasis.METHODS:This study was per formed as a retrospective analysis of patients who received conjunctival dacryocystorhinostomy with pedicled conjunctival flap reconstruction combined with tube intubation due to severe superior and inferior lacrimal canalicular obstruction with conjunctivochalasis from January 2019 to October 2019.The clinical data included the degree of preoperative epiphora and postoperative relief,preoperative examination of lacrimal duct computed tomography and ultrasound biomicroscopy,postoperative evaluation of lacrimal duct function by chloramphenicol taste and fluorescein dye disappearance test,etc.Syringing was carried out to determine the reconstruction and patency of the lacrimal duct.RESULTS:All 9 patients(9 eyes)had severe canalicular obstruction with conjunctivochalasis.The patients included 4 males and 5 females aged between 47–65y with an average age of 52.2±6.7y.At 3mo follow-up,the tube was removed and the patients were followed for a further 3mo.After tube removal,6 patients showed no epiphora.These patients also had positive chloramphenicol tastes and normal fluorescein dye disappearance test results.Two patientshad epiphora.Also,syringing showed partial patency of the reconstructed lacrimal duct.One patient had no improvement in epiphora with negative chloramphenicol taste and fluorescein dye disappearance test results and obstruction of the reconstructed lacrimal duct.The total effective rate of the operation was 8/9,with no serious complications.CONCLUSION:Pedicled conjunctival lacrimal duct reconstruction conjunctival dacryocystorhinostomy is safe and effective for superior and inferior canalicular obstruction with conjunctivochalasis.

Comparative study of bacterial status from conjunctival sac of the elder Qiang minority and Han people with dry eye in Sichuan,China

AIM: To compare the status of bacteria in the conjunctival sac from the elder Qiang minority and Han people with dry eyes in Sichuan, China. METHODS: Total of 54 elder Qiang people with dry eyes (108 eyes) were examined by cluster sampling. In the similar habitation region of Han people, 80 (160 dry eyes) Han people were analyzed as the control group. The bacteria was separated from the inferior palpebral conjunctiva, then inoculated on blood plate for 48 hours and identified. RESULTS: Totally 24 strains of bacteria were cultured in either Qiang minority or Han c populations with 3 strains of them existed in both ethnic groups. The commonest bacteria in conjunctival sac in two ethnic groups were non-pathogenic bacterium. The composition of Corynebacterium in Han people (54.1%) was significantly higher than that in Qiang minority (27.4%) (chi(2)=11.6721, P=0.0006). The percentage of Sphingomonas Paucimobilis in Qiang people was higher than that in Han people (chi(2)=18.6442, P=0.0000). However, there was no significant difference between Qiang minority and Han people either in bacterial positive rate in conjunctival sac, or the composition of bacteria species and strains, or the composition of staphylococcus epidemids between two ethnic populations. CONCLUSION:There was no significant difference of bacterial positive rate in conjunctival sac from the elder of Qiang minority and Han people with dry eye, but the species of bacteria were different.

Biomaterials for tarsal plate reconstruction and our innovative work

Large tarsal plate defect reconstruction is one of the most challenging tasks for plastic surgeons.Based on our practical work and literature review,the techniques and postoperative results of the preserved sclera,ear cartilage,and acellular dermal matrix(ADM)as tarsal plate substitutes were investigated.Two cases were reviewed.Case 1 was a 22-year-old female who had total loss of the right lower eyelid.Ear cartilage(23 mm25 mm)was implanted under the expanded skin during the forehead skin-expanding procedure to form a skin-cartilageexpander capsule compound structure for lower eyelid reconstruction.Case 2 was a 7-year-old boy with a unilateral divided nevus.The lid and conjunctiva of the lower eyelid were invaded.A piece of ADM(12 mm4 mm)was used to repair the tarsal plate defect(12 mm3 mm).The conjunctiva of ADM was covered by itself.An orbicularis oculi myocutaneous flap was used for anterior lamella reconstruction.In case 1,the compound tissue survived and supported the lower eyelid,the lid margin was clear,and the structure was complete over a 1-year follow-up.The aesthetic appearance of the eyelid improved after depilation.It is the first clinical research on the expander capsule as eyelid conjunctiva.In case 2,the conjunctiva completely covered the superior ADM,and the transplant merged with the surrounding tissues without complications after 5 months.The preserved sclera has the longest application history as a tarsal plate substitute.However,it should be preserved in an eye bank and transplanted with conjunctiva repair.Ear cartilage is an autologous tissue that requires conjunctival reconstruction.Our clinical practice was the first to prove the possibility of the expander capsule as eyelid conjunctiva.It is feasible to prefabricate the skin-tarsal conjunctiva complex during the skin expansion procedure.Allogeneic ADM is a common clinical material with advantages of good biological histocompatibility,supportive strength,conjunctivalization,and not requiring donor site surgery.Plastic surgeons are familiar with autologous ear cartilage and ADM,which are easy to obtain and treat.Both ear cartilage and ADM are expected to be the first-line choices in future studies.

Comparative Study of the Disinfection Effects of Three Types of Conjunctiva Sac Irrigations

Purpose:The antiseptic effectiveness of 5% anerdian Ⅲ, 0.016% gentamicin,and 0.5% tobramycin solutions in pre-surgical irrigation of conjunctival sac were compared. Methods:A total of 295 cataract patients (302 eyes) who had undergone phacoemulsification aspiration combined with intraocular lens insertion. (IOL).were recruited in this prospective study.Operative eyes were given 0.3% levofloxacin eye drops for 3 days and then were randomized into three treatment groups:anerdian. (A), gentamicin (B) and tobramycin (C).The patients received conjunctival sac irrigation using the respective solutions at 10 minutes preoperatively.Conjunctival sac sampling was performed before and after irrigation and the samples were used for subsequent bacterial culture and swab tests. The positive culture rate was used as the main outcome. Results:The positive rates of bacterial culture before conjunctival sac irrigationwere 17.31% (18 eyes) in group A, 13.86% (14 eyes) in group B and 17.3% (14 eyes) in group C.Post irrigation,the positive rates in the three groups decreased to 5.76% . (6 eyes),5.94% . (6 eyes) and 7.22% (7 eyes), respectively. The positive rates among the three groups did not differ significantly.However,the positive rate in group A only significantly differed before and after the irrigation (P<0.05). No toxic or allergic reactions were observed on the ocular surface of any patient after irrigation. Conclusion: The antiseptic effects of the three types of con junctival sac irrigations did not differ. (Eye Science 2013; 28: 20-23)

结膜囊冲洗预防术后细菌性眼内炎的研究进展

伴随着我国人口老龄化进程的不断加快,近年来白内障、青光眼等疾病的发病率呈逐年上升趋势,相应的术后细菌性眼内炎的发生率也随之增长。由于细菌性眼内炎的病原菌主要来自于结膜囊,使得术前行结膜囊冲洗成为预防术后细菌性眼内炎的必要环节。但临床上对于结膜囊冲洗液的类型、剂量尚无统一标准。本文通过对国内、外结膜囊冲洗液的类型、冲洗方法等方面的相关研究进行总结,发现目前临床应用的结膜囊冲洗液主要包括抗生素类冲洗液、碘类消毒液,均存在各自的优势与弊端。相较于单一的结膜囊冲洗液,多种结膜囊冲洗液联合应用抑菌效果更好,同时还具有较好的安全性。本研究可为临床医生预防术后眼内炎提供一定参考。

手术治疗眼球摘除术后结膜囊畸形的下睑外翻

目的:回顾分析治疗眼球摘除术后结膜囊畸形的下睑外翻这类手术的关键技术。方法:回顾性分析2015年3月-2017年12月在笔者医院接受手术治疗的眼球摘除术后结膜囊畸形的下睑外翻患者8例(8只眼),所有患者仅行针对结膜囊畸形的手术矫正,而未采取针对下睑外翻常用的下睑全层楔形切除、外侧睑板条锚定、皮瓣法等术式。结果:8例患者均单纯行二期义眼台植入+结膜囊成形术并穹窿部弧形压管获得了深在、稳定的结膜囊,佩戴义眼片后,下睑缘位置满意,无内外翻。在无需接受任何下睑外翻矫正措施的情况下获得了满意的下睑形态及功能。结论:眼球摘除术后结膜囊畸形的下睑外翻手术关键点在于矫正眼眶凹陷,恢复结膜囊正常形态,尤其是加深下穹窿。

0.01%次氯酸在白内障超声乳化术前应用的安全性和有效性

目的:评估0.01%次氯酸作为白内障超声乳化术前结膜囊消毒剂的效果和对眼表的影响。方法:随机对照临床试验。285例单眼拟行白内障超声乳化手术的患者随机分为次氯酸组和聚维酮碘组,在消毒前后取结膜囊拭子,使用血琼脂培养基和巧克力琼脂培养基分别进行细菌培养和菌落形成能力(CFUs)测试。所有患者在消毒后2 h,1 d和1 wk接受眼部症状评分、疼痛程度评分的评估,并行角膜荧光素染色、眼红指数、泪河高度和非接触式泪膜破裂时间(NIBUT)检查,记录术后眼内炎的发生率。结果:使用0.01%次氯酸进行结膜囊消毒可显著降低细菌培养阳性率和CFUs,与消毒前相比有差异(均P<0.01),次氯酸消毒能力与聚维酮碘相当(χ2=0.811,P=0.368)。次氯酸组患者眼部症状评分和疼痛程度评分显著低于聚维酮碘组(均P<0.01)。次氯酸组角膜荧光素染色评分、眼红指数均显著低于聚维酮碘组(均P<0.01)。两组患者均无眼内炎发生。结论:0.01%次氯酸作为结膜囊消毒剂安全有效,且患者的不适和对眼表的损伤较小。

Conjunctival flaps for the treatment of advanced ocular surface disease—looking back and beyond

Conjunctival flaps have previously proven to be effective in preserving the globe for individuals with severe ocular surface disease.Infectious keratitis,neurotrophic keratitis,nontraumatic corneal melts,descemetoceles,perforations,and corneal burns are all indications for this procedure.The flaps promote nutrition,metabolism,structure,and vascularity,as well as reduce pain,irritation,inflammation,and infection.Furthermore,patients avoid the emotional and psychological repercussions of enucleation or evisceration,while requiring fewer postoperative medications and office visits.Currently,fewer flaps are performed due to the emergence of additional therapeutic techniques,such as serum tears,bandage lenses,corneal grafting,Oxervate,amniotic membrane,and umbilical cord grafting.However,despite newer conservative medical methods,conjunctival flaps have been demonstrated to be useful and advantageous.Moreover,future technologies and approaches for globe preservation and sight restoration after prior conjunctival flaps are anticipated.Herein,we review the history,advantages,and disadvantages of various surgical techniques:Gundersen’s bipedicle flap,partial limbal advancement flap,selective pedunculated conjunctival flap with or without Tenon’s capsule,and Mekonnen’s modified inferior palpebral-bulbar conjunctival flap.The surgical pearls and recommendations offered by the innovators are also reviewed,including restrictions and potential complications.Procedures for visual rehabilitation in selective cases after conjunctival flap are reviewed as well.

新鲜羊膜移植在结膜囊成形术中的应用

目的 探讨新鲜人羊膜移植治疗结膜囊狭窄临床应用的可行性及疗效。 方法 2 0 0 1年 3月～ 2 0 0 3年 3月 ,用新鲜羊膜对 30例 ( 30只眼 )结膜囊狭窄患者行羊膜移植结膜囊成形术。术前在无菌条件下切取羊膜组织 ,将其上皮面向上平铺于手术粘贴纸上 ,剪成 5 cm× 8cm大小数块 ,放入含庆大霉素 ( 4× 10 6 U/ ml)生理盐水的密封湿房中 ,4℃冰箱保存 12小时。术中充分分离球结膜与筋膜组织达眶缘 ,游离并剪除结膜下粘连的瘢痕组织 ,修剪羊膜组织使其稍大于结膜缺损区约 10 mm,其上皮面向上置于结膜缺损区 ,用 7/ 0尼龙线将其连续缝合于结膜游离创缘上 ;同时行下穹窿加深成形术 ,部分患者行羟基磷灰石义眼座二期植入术和 /或外伤性上睑下垂矫正术。 结果 30例 ( 30只眼 )均于术后 10、14天拆除羊膜移植缝线及下穹窿加深成形术缝线 ,所有移植羊膜均成活 ,结膜囊下穹窿充分加深 ,配戴义眼效果满意。术后随访 3～ 18个月 ,未发现植片感染、挛缩 ,以及免疫排斥反应和羊膜溶解 ,手术获得成功。 结论 新鲜人羊膜移植部分结膜囊成形术是一种取材简便。

结膜囊成形术矫治无眼球性结膜囊狭窄

目的 评价几种结膜囊成形手术的疗效。方法 各种原因引起的结膜囊狭窄及闭锁87例分别用羊膜、皮肤、自体结膜岛状移植做结膜囊成形术行回顾性研究。结果 随访6-52月,无继发感染,75例治愈,能放置正常大小义眼片,外观满意,9例好转,能放置较小眼片,3例无效,重新手术。结论 对Ⅰ°、Ⅱ°结膜囊狭窄结膜缺损可用羊膜移植或自体结膜岛状移植,对Ⅲ°和结膜囊闭锁可用游离皮片移植,埋线法穹隆加深术能抵抗术后结膜囊收缩,眼座植入与结膜囊成形术可同期进行。

中国白内障人群术前结膜囊细菌培养结果的Meta分析

目的:系统研究中国白内障人群术前结膜囊细菌构成和药物敏感情况的变化,为白内障术前无菌化准备提供科学的理论依据。方法:计算机检索中文科技期刊数据库、万方数据库、中国知网学术文献网络出版总库及中文生物医学文献数据库。收集2004-01/2013-09发表的有关中国人群白内障结膜囊细菌培养的文献,并辅以手工检索、因特网搜索。并采用Meta分析对所纳入研究结果进行分析。结果:共纳入7篇文献,共11499眼,白内障患者术前结膜囊培养阳性率为26.03%(2993/11499),主要由G^+球菌(86.40%)、G^+杆菌(8.10%)、G^-杆菌(4.13%)以及G^-球菌(1.37%)构成。G^+球菌主要以表皮葡萄球菌(67.30%)、金黄色葡萄球菌(12.53%)和微球菌(6.98%)为主。大多菌株对妥布霉素、万古霉素、环丙沙星和庆大霉素敏感,对妥布霉素和环丙沙星耐药性有上升趋势。结论:白内障术前的结膜囊主要由表皮葡萄球菌构成,对青霉素和红霉素耐药,大多数菌株对妥布霉素、万古霉素、环丙沙星和庆大霉素敏感,对妥布霉素和环丙沙星耐药性有上升趋势。

不同浓度聚维酮碘二次冲洗法对白内障手术结膜囊消毒效果的评价

目的:评价不同浓度聚维酮碘二次冲洗法对白内障手术结膜囊消毒的效果。方法:选取我院眼科2016-08/2017-10接受白内障超声乳化联合人工晶状体植入术治疗的白内障患者600例600眼,术前、开睑后两次采用聚维酮碘冲洗法对结膜囊消毒,根据聚维酮碘二次冲洗所使用浓度不同将患者分为Ⅰ组320例、Ⅱ组280例,浓度分别为0.025%、0.05%。两组一次、二次冲洗后获取结膜囊拭子标本进行细菌鉴定,二次冲洗时评定患者的主观舒适度及球结膜充血、角膜上皮损伤情况,并统计术后眼内炎发生情况。结果:Ⅰ组、Ⅱ组聚维酮碘一次、二次冲洗后细菌培养阳性率比较均无差异(P>0.05)。Ⅰ组结膜囊二次冲洗时异物感、痒感、畏光、眼红等主观感觉发生率明显低于Ⅱ组(P<0.05)。Ⅰ组结膜囊二次冲洗后球结膜充血、角膜上皮损伤程度较Ⅱ组显著低(P<0.05)。Ⅰ组、Ⅱ组术后分别有2眼(0.6%)、1眼(0.4%)发生眼内炎(P>0.05)。结论:0.025%聚维酮碘已有高效的消毒作用,与0.05%聚维酮碘相比,其对于改善患者主观舒适度及减轻球结膜充血、角膜上皮损伤更有优势,更适用于白内障手术患者。

低浓度聚维酮碘降低结膜囊细菌量的有效性分析

目的:探讨1,5,25g/L三种不同浓度聚维酮碘清除结膜囊细菌的效果及其副作用。方法:采用随机对照性研究方法,选择2009-09/10在武汉爱尔眼科医院行白内障手术的患者205例205眼,用随机数字法分为3组。手术前1d,用3g/L氧氟沙星眼液滴患眼3次。术前约5～10min左右,表面麻醉后依照不同分组分别用1,5,25g/L三种不同浓度聚维酮碘冲洗结膜囊。在下列时间点采集患者结膜囊标本做细菌培养和药物敏感性试验:入院时未用任何药物之前的基准培养;使用1d的3g/L氧氟沙星滴眼液后,未冲洗结膜囊前;聚维酮碘冲洗结膜囊约5～10min后,手术刚开始时;手术结束时。各组间培养阳性率的比较,采用Pearson卡方检验。并注意观察使用聚维酮碘后眼部的不良反应。结果:未用药前,1g/L聚维酮碘组、5g/L聚维酮碘组及25g/L聚维酮碘组结膜囊细菌培养阳性率分别为63.0%,61.4%及59.6%;手术完成后,3组结膜囊培养阳性率分别为12.3%,11.4%及12.9%,各组在用药前与手术结束时的阳性率差别均有显著的统计学意义(χ2值分别为54.88,57.61,40.47,P值均为0)。但是无论是用药前,还是在手术结束时,三组间培养阳性率的差别均无统计学意义(未用药前χ2=0.15,P=0.92;手术结束时χ2=0.06,P=0.96)。62例使用25g/L聚维酮碘患者有4例患者出现结膜充血和轻度角膜水肿,占6%,无其他不良反应,其他2组没有发现明显不良反应,三组间差别有显著的统计学意义(χ2=9.4,P=0.009)。结论:术前使用1g/L低浓度聚维酮碘冲洗结膜囊可以有效清除眼表细菌,和使用25g/L高浓度聚维酮碘的效果相似,而且更为安全。

新疆哈萨克族白内障患者术前结膜囊细菌培养及药敏试验分析

目的：了解哈萨克族白内障患者结膜囊带菌和药敏情况。方法：收集538例哈萨克族白内障患者的结膜囊分泌物进行细菌培养、鉴定和药敏试验。结果：538份标本细菌培养阳性214例,阳性率39.8%。病原菌的种类以革兰氏阳性球菌为主（88.3%）,其中表皮葡萄球菌最常见（66.4%）,其次是微球菌（9.8%）。性别对哈萨克族白内障患者结膜囊带菌率无影响,而年龄、居住地对带菌率有影响（≥60岁人群结膜囊带菌率明显高于40~59岁人群,农牧区人群结膜囊带菌率明显高于城市人群）。分离出的革兰氏阳性球菌对青霉素、红霉素、四环素和氯霉素的敏感性较差,耐药率〉70%;而对万古霉素、替考拉宁、利福平、妥布霉互和阿米卡星较敏感,耐药率〈20%。结论：革兰氏阳性球菌是哈萨克族白内障患者结膜囊最常见的菌种,尤其是表皮葡萄球菌;结膜囊带菌情况与受检者的年龄和居住地域相关。临床上应严格掌握抗菌药物使用的适应证,以减少细菌耐药的发生。

108例干眼症之结膜囊细菌菌落

连续选取我院角膜病门诊１０８例（２１６只眼）确诊为干眼症患者、２１６例（４３２只眼）正常人分别结膜囊细菌培养，结果说明结膜囊作细菌培养阳性率于眼症患者明显高于正常人（Ｐ＜０．００１），且以致病力较强的绿脓杆菌及金黄色葡萄球菌最多。建议干眼症患者除了给予人工泪液外还应给予预防性抗生素治疗。

老年人内眼手术前结膜囊细菌培养的分析

目的 了解老年人内眼手术前的结膜囊细菌情况。方法 对老年患者 2 79例 (3 5 0眼 )术前进行结膜囊细菌培养 ,并对阳性者作药敏试验。结果 术前结膜囊细菌培养阳性率为 17 43 %。药敏试验结果 :敏感药物为氧氟沙星、先锋霉素、庆大霉素等。结论 老年人内眼手术前用敏感抗生素滴眼 ,并常规行结膜囊细菌培养及药敏试验是必要的。

正常眼和白内障手术前后结膜囊细菌菌谱及抗生素应用的对比研究

目的检查正常眼的结膜囊存在的细菌种类,并进行药敏分析,对目前临床常用的抗生素滴眼液药效进行对比。方法207例(207眼)正常眼及200例(200眼)白内障的结膜囊标本进行细菌培养,200例白内障分4组给予林可霉素,妥布霉素,氧氟沙星,左氧氟沙星滴眼后术前及手术后再次培养,并将所有培养为阳性的标本进行药敏分析。结果407眼的结膜囊细菌培养阳性率31.45%,其中70岁以上者阳性率最高为42.05%(37/88)。革兰氏阳性球菌阳性率达到80.47%,革兰氏阴性杆菌为16.40%。4种抗生素结膜囊细菌的清除率分别为70.59%、89.47%、94.74%、100.00%;所有白内障眼术前使用抗生素后细菌阳性率为4.00%,手术后1 d拆开眼垫后细菌培养阳性率为6.00%。结论正常眼的结膜囊可有多种细菌存在,高龄者检出率高。其中以表皮葡萄球菌多见,其次为洛菲不动杆菌和金黄葡萄球菌;目前常用的4种抗生素滴眼液的效果强弱不同,提示在临床进行白内障等内眼手术时应根据结膜囊细菌培养的情况选用敏感抗生素,术后也应进行局部抗生素滴眼液的应用。

内眼术前结膜囊冲洗液的临床研究

目的探讨一种既具有清洁结膜囊作用且刺激性小,又利于环境保护的内眼手术前结膜囊冲洗液。方法排除局部及全身炎症,需行内眼手术的患者150例150眼,随机分为A组(生理盐水)、B组(0.02%升汞+生理盐水)、C组(0.4%庆大霉素+生理盐水),每组50例50眼,冲洗前、后用眼拭子采集结膜囊标本送检做细菌培养。分别对三组病例在冲洗后15、30min结膜充血情况进行比较观察。结果三组病例术前结膜囊冲洗后细菌阳性率比较差异无统计学意义,冲洗后结膜充血情况A组的刺激性较小,B组的刺激性较大。结论应用生理盐水作为内眼术前结膜囊冲洗液,可减轻病人的痛苦,又能达到抑菌抗感染,避免造成环境污染;同时可为手术医师提供最清晰的手术视野。

白内障手术结膜囊及房水细菌培养的临床观察

目的 探讨白内障术中结膜囊、房水污染与眼内炎的关系。方法 对 74例 80眼白内障囊外摘除术中结膜囊及房水进行细菌培养。结果 16 0份细菌培养标本中 ,细菌培养阳性者 18株 ,平均培养阳性率为 11.3%。房水为 8株 ,检出率为 10 .0 % ;结膜囊为 10株 ,检出率为 12 .5 %。以表皮葡萄球菌为主 (11 18) ,其中 3眼结膜囊及房水检出同一菌株。检出阳性的 15眼无 1例发展成眼内炎。结论 白内障摘除术后前房有少量细菌 ,虽不致发生眼内炎 ,但不可掉以轻心。

异种(牛)脱细胞真皮在结膜囊成形术中的临床应用

目的探讨采用异种(牛)脱细胞真皮作为移植材料行结膜囊成形术的安全性及效果。方法 9例(9眼)眼内容摘出术后结膜囊狭窄患者,行义眼座植入联合结膜囊成形术,术中应用Medpor义眼座作为眼窝填充材料、异种(牛)脱细胞真皮作为结膜生长支架移植材料。义眼座植入后行结膜囊成形术,将异种脱细胞真皮修剪后移植于结膜缺损处,放入眼模,缝合睑缘,术后抗炎治疗3个月拆除睑缘缝线。随访观察6～18个月,平均8个月。结果 9例患者术后均无明显排斥反应,无义眼座暴露;植片色泽逐渐红润,无坏死、脱落及明显收缩,结膜上皮爬行并覆盖植片表面。术后3个月植片近似正常结膜外观,结膜囊成形好,配戴义眼片后患眼外观良好,不滑脱。9例患者中8例效果良好,1例一般。结论采用异种(牛)脱细胞真皮作为结膜囊成形移植材料,手术操作方便,异种脱细胞真皮组织相容性好,结膜囊成形效果满意。