根治性膀胱全切原位膀胱术远期临床分析（附32例报告）
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摘要
目的:探讨回肠或结肠原位新膀胱术的远期临床疗效。方法:膀胱肿瘤患者32例,其中男性28例,女性4例;年龄20～77岁,平均59岁。均采用膀胱全切术后,应用末段回肠或乙状结肠做新膀胱行正位膀胱重建术。结果:32例患者中获得随访29例,失访3例(9.4%),随访时间3～36个月,平均17.9个月。患者一般于术后三个月恢复可控性排尿,白天可控排尿23例(92%),12例出现夜间尿失禁(48%);20例患者术后6个月行尿动力学检查新膀胱容量(378±57)ml,最大尿流率(14.9±1.3)ml/s,残余尿量(26±8)ml;输尿管返流2例,输尿管狭窄2例,无尿道狭窄,无尿道肿瘤复发;术后3个月及6个月复查血常规,血电解质均在正常范围内,无高氯性酸中毒,肾功能正常。1例在围手术期因肠吻合口漏至感染性休克,多器官功能衰竭而死亡;随访期间1例因术后一年化疗时出现颅内感染死亡;1例因术后两年时肿瘤盆腔多发转移死亡,余均无瘤存活。结论:回肠或结肠代膀胱术具有新膀胱容量大、内压低,正位排尿、可控性好、并发症少等特点,明显地提高患者的术后生活质量,患者易于接受,是一种比较理想的手术方式。
Objective: To evaluate the orthotopic ileocolon continent urinary reservoir after radical cyctectomy for managing bladder cancer. Methods: 32 patients with bladder cancer (28 males and 4females; age range from 20 to 70 years), all managed by the orthotopic ileocolon continent urinary reservoir after radical cyctectomy were reviewed and evaluated. Results: Of the 32 patients, 29 were followed up for 6 to 36 months (mean, months). No serious operation related complications occurred. The daytime urinary continence rate was 92%; Urodynamics was carried out at 6 months after operation, It was showed that the average capacity of the urinary reservoir. the peak flow rate and postvoid residual were 386ml, 12.5ml/s and 26ml respectively. Ureteral reflux occurred only in 2 cases and ureteral stricture occueeed in 2 cases, but no evidences of urethral stricture and no hyperchloremic acidosis have been observed. Conclusions: Orthotopic ileocolon continent urinary reservoir might be considerd as an ideal from of urinary diversion, characterized by low pressure, large capacity, orthotopic and continent urination.
Objective: To evaluate the orthotopic ileocolon continent urinary reservoir after radical cyctectomy for managing bladder cancer. Methods: 32 patients with bladder cancer (28 males and 4females; age range from 20 to 70 years), all managed by the orthotopic ileocolon continent urinary reservoir after radical cyctectomy were reviewed and evaluated. Results: Of the 32 patients, 29 were followed up for 6 to 36 months (mean, months). No serious operation related complications occurred. The daytime urinary continence rate was 92%; Urodynamics was carried out at 6 months after operation, It was showed that the average capacity of the urinary reservoir. the peak flow rate and postvoid residual were 386ml, 12.5ml/s and 26ml respectively. Ureteral reflux occurred only in 2 cases and ureteral stricture occueeed in 2 cases, but no evidences of urethral stricture and no hyperchloremic acidosis have been observed. Conclusions: Orthotopic ileocolon continent urinary reservoir might be considerd as an ideal from of urinary diversion, characterized by low pressure, large capacity, orthotopic and continent urination.
引文
[1]顾方六,刘玉立. 50年泌尿男生殖系统肿瘤发病和构成情况的变迁[J].华泌尿外科杂志, 2002, 23:88-90.
[2] Parkin MD, Bray F, Ferly J, et al. Global Cancer Statistics, 2002. CA Cancer J Clin, 2005, 55:74-108.
[3]瘧颂庭,臧美孚,夏熐.尿路上皮肿瘤概论[M].见:吴阶平,吴阶平泌尿外科学,济南:山东科学技术出版社, 204,919-942.
[4] Sylvester RJ, Oosterlinck W, van der Meijiden AP. A sigle immediate postoperative instillation of chemotherapy decreases the risk of recurrence in patients with stage Ta T1 bladder cancer:a meta-analysis of published results of randomized clinical trials[J]. Urol, 2004, 171(6 Pt1):2186-2190.
[5] Oosterlinck W, Kurth KH, Schroder F, et al. A prospective European Organization for Research and Treatment of cancer Genitournary Group randomized trial comparing transurethral resection followed by a single intravesical instillation of epirubicin or water in single stage Ta, T1 papillary carcinoma of the bladder. [J]. Urol, 1993, 149:749-752.
[6] Kaasinen E, Rintala E, Hellstrom P, et al. Factors explaning recurrence in patients undergoing chemoimmunotherapy regimens for frequently recurring superficial bladder carcinoma[J]. Eur Urol, 2002, 42:167-174.
[7] Stein JP, Quek ML, Skinner DG, Lymphadenectomy for invasive bladder cancer:historical perspective and contemporary rationle[J]. BJU Int, 2006, 97:227-231.
[8] Stein JP, Lieskovsky G, Cote R, et al. Redical cystectomy in the treatment of invasive bladder cancer:long-term results in 1054 patients[J]. Clin Oncol, 2001, 19:666-675.
[9] Kuczyk M, Turkeri L, Hammerer P, et al. Is there a role of for bladder preserving strategies in the treatment of muscle-invasive bladder cancer? [J]. Eur Urol, 2003, 44:57-64.
[10]Bricker EM. Bladder substitution after pelvic evisceration Surg[J]. Clin North Am, 1950, 30:1511-1521.
[11]Hautmann RE. Urinary diversion:ileal conduit to neobladder. [J]. Urol, 2003, 169:834-842.
[12]叶敏. Studer回肠代膀胱术的技术改进和临床应用[J].中华泌尿外科杂志, 2003,24:686-690.
[13]郭艳丽,闫慧明,宋善俊?组织因子在结肠癌表达的临床意义[J].中国现代医学杂志, 2005, 15:2250-2252, 2256.
[14]Bassi P. Outcome of radical cystectomy for invasive bladder[J]. cancer. Curr Opin Urol, 2000, 10:459-463.
[15]Dutta SC, Chang SC, Coffey CS, et al. Health related quality of life assessment after radical cystectomy:comparison of ileal conduit with continent orthotopic neobladder. [J]. Urol, 2002, 168, 164-167.
[16]Hautmann RE, De Petriconi R, Gottfried HW, et al. The ileal neobladder:complications and functional results in 363 patients after 11years of follwup[J]. Urol, 1999, 161, 422-427.
[17]Steven K, Poulsen AL. The orthotopic Kock ileal neobladder:functional results, urodynamic features, complications and survival in 166 men. [J]. Urol, 2000, 164:288-295.
[18]王晓雄?进一步重视尿流改道和膀胱重建术的临床研究[J].中华泌尿外科杂志, 2002, 23:453-455.
[19]叶敏,陈建华,张良,等?可控性回结肠膀胱术的技术改进及临床应用[J].中华泌尿外科杂志, 1997, 18:395-397.
[20]Da Pozzo LF, Renzo COLOMBE, Paolo PoMBA, et al. Detubularized sigmoid colon for bladder replacement after redical cystectomy. [J]. Urol, 1994, 152:1409-1412.
[21]Jung P, Mersdorf A, Wolfe T, et al. The continent sigmoid urinary reservoir:an experimental study in pigs. Br [J]. Urol, 1996, 78:524-529.
[22]Fujisawa M, Gotoh A, Nakamura I, et al. Long-term assessment of serum vitamin B12 concentrations in patients with various types of orthotopic intestional neobladder. [J]. Urology, 2000, 56:236-240.
[23]Senzi A, Draxl H, Posch B, et al. The risk of urethral tumors in female bladder cancer:can the urethral be used for orthotopic reconstruction of the lower urinary tract? [J]. Urol, 1995, 151:950-952.
[24]Freeman JA, Tanter HA, Esrig D, et al. Urethral recurrence in patients with orthotopic ileal neobladder. [J]. Urol, 1996, 156:1615-1619.
[25]Hardeman SW, Soloway MS. Urethral recurrence following redical cystectomy. [J]. Urol, 1990, 144:666-669.
[26]Ghoneim MA, Shaaban A, Mahuan M, et al. Further experience with the Urethral Kock pouch. [J]. Urol, 1992, 147:361-365.
[27]柿峻秀宏,小柳知彦?小儿泌尿外科最前线(Overview).见:姮添忠生,监修[M].泌尿外科诊断,治疗最前线?出版第一刷.东京:株式会社寺田国际事务所, 2000:205-215.
[28]侯成玉,周荣祥,孟凡学,等.改良Maryland回肠代膀胱术[J].中华泌尿外科杂志, 1999, 20:93-94.
[29]Hautmann RE, The ileal neobladder to the female urethra. [J]. Urol Clin North AM, 1997, 24:827-835.
[30]黄国华,葛根,潘正跃,等.回肠新膀胱术60例报告[J].中华泌尿外科杂志, 1999, 20:740-742.
[31]徐鸿毅,邱学德,石永福,等.回肠新膀胱术的临床疗效观察[J].中华泌尿外科杂志, 1998, 19:685-688.
[32]Cella DF, Tulsky DS, Gray G, et al. The functional assessment of cancer therapy(FACT)scale:development and validation of the general measure. [J]. Clin Onco, 1993, 11:570-579.
[33]Aaronson NK, Ahmedzai S, Bergman B, et al. The European Organization for Research and Treatment of Cancer QLQ-C30:a quality of life instrument for use in international clinical trials in oncology. [J]. Natl Cancer Inst, 1993, 85:365-376.
[34]Ware J. SF-36 Health Survey:Manual and Interpretation [M]. Guide. Boston:The Health Institute, 1993.
[35]Dutta SC, Chang SS, Coffy CS, et al. Health related quality of life assessment after radical cystectomy:comparison of ileal conduit with continent orthotopic neobladder. [J]. Urol, 2002, 168:164-167.
[36]Hara I, Miyake H, Hara S, et al. Health related quality of life assessment after radical cystectomy for bladder cancer:a comparison of ileal and orthotopic bladder replacement. [J]. BJU Int, 2002, 89:10-13.
[37]Tatsuaki Y, Hiroyuki A, Shinji U, et al. Health related quality of life after orthotopic neobladder construction and its comparion with normative values in the Japanese population. [J]. Urol, 2005, 174:1944-1947.
[1]吴阶平.泌尿外科学.济南;山东科学技术出版社, 2004, 889-917.
[2] Mulders P, Figlin R, Kernion J, et al. Renal cell carcinoma recent progress and future direction. [J]. Cancer Res, 1997, 57(22):5189 - 5195.
[3]梁辉,李晓飞.晚期肾癌的免疫治疗. [J].国外医学泌尿系统分册, 2003, 23, 4:349-351.
[4] Karumanchi S, Ananth M. Renal cancer molecular mechanisms and newer therapeutic options. [J]. Current Opinion in Nephrology and Hypertension, 2002, 11, 1:37-42 .
[5]朱伟,付杰新,李建安,等.α-干扰素在肾癌根治术后的应用[J].临床泌尿外科杂志, 2001, 16, 6:261-262.
[6]石明,韩平,曹贵华,等.肾癌术后应用α-干扰素的疗效分析[J].西部医学杂志, 2006, 21, 2:288-289.
[7]包尔敦,凌桂明,祝捷,等.α-干扰素和白介素-2在肾癌治疗中的作用[J].临床泌尿外科杂志, 1998, 5, 13:206-207.
[8] Pittman K, Selby P. The management of renal cell carcinoma. [J]. Crit Rev Oncol /Hematol, 1994;16:181–200.
[9] Vogelzang N, Stadler W. Kidney cancer. [J]. Lancet, 1998;352:1691- 1696.
[10] Dickman P, Hakulinen T, Luostarinen T, et al. Survival of cancer patients in Finland 1955–1994. [J]. Acta Oncol, 1999;12:101–103.
[11] Fossa S, Gunderson R, Moe B, et al. Recombinant interferonalpha combined with prednisone in metastatic renal cell carcinoma. [J]. Cancer, 1990;65:2451–2454.
[12] Minna K, Tarja T, Pellinlemi, et al. Feasibility of Prolonged Use of Interferon-a in Metastatic Kidney Carcinoma. [J]. Cancer, 2001;92;4:761-767.
[13] Facendola G, Locatelli M, Pizzocaro G, et al. Subcutaneous administration of interleukin-2 and interferonα-2b in advanced renal cell carcinoma. a confirmatory study. Br J [J]. Cancer, 1995;72:1531–1535.
[14] Gleave M, Elhilali M, Fradet Y, et al. Interferon gamma-1b compared with placebo in metastatic renal-cell carcinoma. N Engl[J]. Med, 1998;338:1265–1271.
[15] Fossa S, Martinelli G, Otto U, et al. Recombinant interferon alfa-2a with orwithout vinblastine in metastatic renal cell carcinoma results of a European multi -center phase III study. Ann Oncol, 19 92;3:301–305.
[16] Pyrhonen S, Salminen E, Ruutu M, et al. Prospective randomized trial of interferonα-2a plus vinblastine versus vinblastine alone in pati entswith advancedrenal cell cancer. [J]. Clin Oncol, 1999;17:2859–2867.
[17] Jekunen A, Pyrhonen S. A combination of vinblastine and doxorubicin with interferon-α. Am[J]. Clin Oncol, 1996;19:384-385.
[18] Haarstad H, Jacobsen A, Schjolseth S, et al. Interferon-a, 5-FU and prednisone in metastatic renal cell carcinoma:a phase II study. [J]. Ann Oncol, 1994;5:245–248.
[19] Ravaud A, Audhuy B, Gomez F, et al. Subcutaneous interleukin-2, interferonα-2a, and continuous infusion ofluorouracil in metastaticrenal cell carcinoma:a multicenter phase II trial. [J]. Clin Oncol, 1998;16:2728–2732.
[20]早川正道.干扰素治疗进展期肾癌. [M]日本医学介绍, 2003, 24, 5:200-201.
[21]李新德,卢湧湧,成晟,等.根治性肾切除术联合应用α-干扰素治疗肾癌. [J].天津医学杂志, 2007, 35, 2:154-155.
[22]白启柴.肾癌根治性切除术后联合应用α-干扰素的疗效观察. [M]全科医学临床与教育, 2007, 5, 4:291-292.
[2] Parkin MD, Bray F, Ferly J, et al. Global Cancer Statistics, 2002. CA Cancer J Clin, 2005, 55:74-108.
[3]瘧颂庭,臧美孚,夏熐.尿路上皮肿瘤概论[M].见:吴阶平,吴阶平泌尿外科学,济南:山东科学技术出版社, 204,919-942.
[4] Sylvester RJ, Oosterlinck W, van der Meijiden AP. A sigle immediate postoperative instillation of chemotherapy decreases the risk of recurrence in patients with stage Ta T1 bladder cancer:a meta-analysis of published results of randomized clinical trials[J]. Urol, 2004, 171(6 Pt1):2186-2190.
[5] Oosterlinck W, Kurth KH, Schroder F, et al. A prospective European Organization for Research and Treatment of cancer Genitournary Group randomized trial comparing transurethral resection followed by a single intravesical instillation of epirubicin or water in single stage Ta, T1 papillary carcinoma of the bladder. [J]. Urol, 1993, 149:749-752.
[6] Kaasinen E, Rintala E, Hellstrom P, et al. Factors explaning recurrence in patients undergoing chemoimmunotherapy regimens for frequently recurring superficial bladder carcinoma[J]. Eur Urol, 2002, 42:167-174.
[7] Stein JP, Quek ML, Skinner DG, Lymphadenectomy for invasive bladder cancer:historical perspective and contemporary rationle[J]. BJU Int, 2006, 97:227-231.
[8] Stein JP, Lieskovsky G, Cote R, et al. Redical cystectomy in the treatment of invasive bladder cancer:long-term results in 1054 patients[J]. Clin Oncol, 2001, 19:666-675.
[9] Kuczyk M, Turkeri L, Hammerer P, et al. Is there a role of for bladder preserving strategies in the treatment of muscle-invasive bladder cancer? [J]. Eur Urol, 2003, 44:57-64.
[10]Bricker EM. Bladder substitution after pelvic evisceration Surg[J]. Clin North Am, 1950, 30:1511-1521.
[11]Hautmann RE. Urinary diversion:ileal conduit to neobladder. [J]. Urol, 2003, 169:834-842.
[12]叶敏. Studer回肠代膀胱术的技术改进和临床应用[J].中华泌尿外科杂志, 2003,24:686-690.
[13]郭艳丽,闫慧明,宋善俊?组织因子在结肠癌表达的临床意义[J].中国现代医学杂志, 2005, 15:2250-2252, 2256.
[14]Bassi P. Outcome of radical cystectomy for invasive bladder[J]. cancer. Curr Opin Urol, 2000, 10:459-463.
[15]Dutta SC, Chang SC, Coffey CS, et al. Health related quality of life assessment after radical cystectomy:comparison of ileal conduit with continent orthotopic neobladder. [J]. Urol, 2002, 168, 164-167.
[16]Hautmann RE, De Petriconi R, Gottfried HW, et al. The ileal neobladder:complications and functional results in 363 patients after 11years of follwup[J]. Urol, 1999, 161, 422-427.
[17]Steven K, Poulsen AL. The orthotopic Kock ileal neobladder:functional results, urodynamic features, complications and survival in 166 men. [J]. Urol, 2000, 164:288-295.
[18]王晓雄?进一步重视尿流改道和膀胱重建术的临床研究[J].中华泌尿外科杂志, 2002, 23:453-455.
[19]叶敏,陈建华,张良,等?可控性回结肠膀胱术的技术改进及临床应用[J].中华泌尿外科杂志, 1997, 18:395-397.
[20]Da Pozzo LF, Renzo COLOMBE, Paolo PoMBA, et al. Detubularized sigmoid colon for bladder replacement after redical cystectomy. [J]. Urol, 1994, 152:1409-1412.
[21]Jung P, Mersdorf A, Wolfe T, et al. The continent sigmoid urinary reservoir:an experimental study in pigs. Br [J]. Urol, 1996, 78:524-529.
[22]Fujisawa M, Gotoh A, Nakamura I, et al. Long-term assessment of serum vitamin B12 concentrations in patients with various types of orthotopic intestional neobladder. [J]. Urology, 2000, 56:236-240.
[23]Senzi A, Draxl H, Posch B, et al. The risk of urethral tumors in female bladder cancer:can the urethral be used for orthotopic reconstruction of the lower urinary tract? [J]. Urol, 1995, 151:950-952.
[24]Freeman JA, Tanter HA, Esrig D, et al. Urethral recurrence in patients with orthotopic ileal neobladder. [J]. Urol, 1996, 156:1615-1619.
[25]Hardeman SW, Soloway MS. Urethral recurrence following redical cystectomy. [J]. Urol, 1990, 144:666-669.
[26]Ghoneim MA, Shaaban A, Mahuan M, et al. Further experience with the Urethral Kock pouch. [J]. Urol, 1992, 147:361-365.
[27]柿峻秀宏,小柳知彦?小儿泌尿外科最前线(Overview).见:姮添忠生,监修[M].泌尿外科诊断,治疗最前线?出版第一刷.东京:株式会社寺田国际事务所, 2000:205-215.
[28]侯成玉,周荣祥,孟凡学,等.改良Maryland回肠代膀胱术[J].中华泌尿外科杂志, 1999, 20:93-94.
[29]Hautmann RE, The ileal neobladder to the female urethra. [J]. Urol Clin North AM, 1997, 24:827-835.
[30]黄国华,葛根,潘正跃,等.回肠新膀胱术60例报告[J].中华泌尿外科杂志, 1999, 20:740-742.
[31]徐鸿毅,邱学德,石永福,等.回肠新膀胱术的临床疗效观察[J].中华泌尿外科杂志, 1998, 19:685-688.
[32]Cella DF, Tulsky DS, Gray G, et al. The functional assessment of cancer therapy(FACT)scale:development and validation of the general measure. [J]. Clin Onco, 1993, 11:570-579.
[33]Aaronson NK, Ahmedzai S, Bergman B, et al. The European Organization for Research and Treatment of Cancer QLQ-C30:a quality of life instrument for use in international clinical trials in oncology. [J]. Natl Cancer Inst, 1993, 85:365-376.
[34]Ware J. SF-36 Health Survey:Manual and Interpretation [M]. Guide. Boston:The Health Institute, 1993.
[35]Dutta SC, Chang SS, Coffy CS, et al. Health related quality of life assessment after radical cystectomy:comparison of ileal conduit with continent orthotopic neobladder. [J]. Urol, 2002, 168:164-167.
[36]Hara I, Miyake H, Hara S, et al. Health related quality of life assessment after radical cystectomy for bladder cancer:a comparison of ileal and orthotopic bladder replacement. [J]. BJU Int, 2002, 89:10-13.
[37]Tatsuaki Y, Hiroyuki A, Shinji U, et al. Health related quality of life after orthotopic neobladder construction and its comparion with normative values in the Japanese population. [J]. Urol, 2005, 174:1944-1947.
[1]吴阶平.泌尿外科学.济南;山东科学技术出版社, 2004, 889-917.
[2] Mulders P, Figlin R, Kernion J, et al. Renal cell carcinoma recent progress and future direction. [J]. Cancer Res, 1997, 57(22):5189 - 5195.
[3]梁辉,李晓飞.晚期肾癌的免疫治疗. [J].国外医学泌尿系统分册, 2003, 23, 4:349-351.
[4] Karumanchi S, Ananth M. Renal cancer molecular mechanisms and newer therapeutic options. [J]. Current Opinion in Nephrology and Hypertension, 2002, 11, 1:37-42 .
[5]朱伟,付杰新,李建安,等.α-干扰素在肾癌根治术后的应用[J].临床泌尿外科杂志, 2001, 16, 6:261-262.
[6]石明,韩平,曹贵华,等.肾癌术后应用α-干扰素的疗效分析[J].西部医学杂志, 2006, 21, 2:288-289.
[7]包尔敦,凌桂明,祝捷,等.α-干扰素和白介素-2在肾癌治疗中的作用[J].临床泌尿外科杂志, 1998, 5, 13:206-207.
[8] Pittman K, Selby P. The management of renal cell carcinoma. [J]. Crit Rev Oncol /Hematol, 1994;16:181–200.
[9] Vogelzang N, Stadler W. Kidney cancer. [J]. Lancet, 1998;352:1691- 1696.
[10] Dickman P, Hakulinen T, Luostarinen T, et al. Survival of cancer patients in Finland 1955–1994. [J]. Acta Oncol, 1999;12:101–103.
[11] Fossa S, Gunderson R, Moe B, et al. Recombinant interferonalpha combined with prednisone in metastatic renal cell carcinoma. [J]. Cancer, 1990;65:2451–2454.
[12] Minna K, Tarja T, Pellinlemi, et al. Feasibility of Prolonged Use of Interferon-a in Metastatic Kidney Carcinoma. [J]. Cancer, 2001;92;4:761-767.
[13] Facendola G, Locatelli M, Pizzocaro G, et al. Subcutaneous administration of interleukin-2 and interferonα-2b in advanced renal cell carcinoma. a confirmatory study. Br J [J]. Cancer, 1995;72:1531–1535.
[14] Gleave M, Elhilali M, Fradet Y, et al. Interferon gamma-1b compared with placebo in metastatic renal-cell carcinoma. N Engl[J]. Med, 1998;338:1265–1271.
[15] Fossa S, Martinelli G, Otto U, et al. Recombinant interferon alfa-2a with orwithout vinblastine in metastatic renal cell carcinoma results of a European multi -center phase III study. Ann Oncol, 19 92;3:301–305.
[16] Pyrhonen S, Salminen E, Ruutu M, et al. Prospective randomized trial of interferonα-2a plus vinblastine versus vinblastine alone in pati entswith advancedrenal cell cancer. [J]. Clin Oncol, 1999;17:2859–2867.
[17] Jekunen A, Pyrhonen S. A combination of vinblastine and doxorubicin with interferon-α. Am[J]. Clin Oncol, 1996;19:384-385.
[18] Haarstad H, Jacobsen A, Schjolseth S, et al. Interferon-a, 5-FU and prednisone in metastatic renal cell carcinoma:a phase II study. [J]. Ann Oncol, 1994;5:245–248.
[19] Ravaud A, Audhuy B, Gomez F, et al. Subcutaneous interleukin-2, interferonα-2a, and continuous infusion ofluorouracil in metastaticrenal cell carcinoma:a multicenter phase II trial. [J]. Clin Oncol, 1998;16:2728–2732.
[20]早川正道.干扰素治疗进展期肾癌. [M]日本医学介绍, 2003, 24, 5:200-201.
[21]李新德,卢湧湧,成晟,等.根治性肾切除术联合应用α-干扰素治疗肾癌. [J].天津医学杂志, 2007, 35, 2:154-155.
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