[超低位直肠癌诊疗篇] 术前分期3a期以上患者勉强做保肛手术 复发转移率非常高

从理论上还是经验上术前分期3a-3c期超低位直肠癌患者,做保肛手术风险巨大,得不偿失。

原创文章,版权所有,侵权必究。

居于《超低位直肠癌诊疗篇之(一)保肛决策依据》理论上讨论的综合因素,和我六年来做3000人肠癌群群主解答时,看过的上千病例和数百跟踪诊疗过程和结果的经验。术前核磁分期t3-4n1-2b的超低位3a、3b、3c期直肠癌患者,勉强做保肛手术的患者,或医生给保肛意愿强烈的患者做医学实验性保肛手术的患者,术后复发转移率都非常高。这种分期和位置的直肠癌要求医生做保肛手术,其实就是给医生一个不可能完成的任务,患者不科学的靠意志保肛最后大概率的结果是肠癌周边医生为了保肛而无法切除干净很多的怀疑病灶,和理论上有机会被侵犯的人体组织和淋巴结。而这些术前术后做放疗降期或术后放疗补救的措施,也在放疗医生小心翼翼的不要误伤周边其它的功能器官而导致放疗不足,最后导致术后1-2年内复发转移的患者比比皆是。就是幸运不会复发转移的患者,低于5公分的超低位直肠癌,医生在肿瘤下缘按指南下切2公分,艺高人胆大的医生下切1公分,也会切除掉一节内括约肌,或者放疗时伤害到非常敏感的探测功能器官内括约肌的探测功能,而导致术后屎屁部分,控制不了的肛门,冒着复发转移风险保下来一个功能不完整的肛门而后患无穷。

幸运不复发转移的超低位直肠癌患者术后肛门功能完好率很低,术后不堪大便无法控制重新回医院做造口手术的患者不在少数

理论上超低位直肠癌低于距离肛门5公分,如4.5公分医生牺牲掉1公分的安全距离,冒险下缘切1公分,就已经要切除只有2公分的内括约肌0.5公分,等于切掉四分之一内括约肌了,而假如只有4公分,医生下切1公分,就要切掉一半的内括约肌了。虽然我没有找到研究报告论述理论上内括约肌切除一半之后,还能不能保持内括约肌的探测和跟外括约肌配合的肛门控制功能。但是,在实际的病例跟踪上,低于距离肛门4.5公分的超低位直肠癌患者,几乎专业医院的医生都不会帮患者做保肛手术,从几个地级市医院不专业的医院,给低于4.5公分以下的患者做保肛手术,也明显切除了部分或者全部的内括约肌的跟踪病例看来,术后肛门都无法控制,术后整天要穿着成人纸尿裤过日子,还一直担心会不会复发转移。做群主解答跟踪6年的病例,基本没有看过距离肛门4.5公分或者更低的超低位直肠癌患者做保肛手术之后,1-2年之后恢复肛门控制功能而且还不复发转移的病例,而复发转移的病例最多,术后不复发因肛门功能长久恢复不了,肛门无法控制想拉就拉,可以感觉到肛门不受控制的自我反复间歇性的自动收缩,苦不堪言还在苦苦等待的次之,而术后因不堪大便无法控制之苦回医院重新做永久造口的人也不在少数。

经验丰富的创群管理员也受不了保肛利益的诱惑,做了不坚定的决策,五年之后一切努力付之东流之时,我回复一个肛管癌患者,不科学、靠意志保肛的群友解答内容照登。

你在入群必读群文件里看过我写的肛门的结构了吗?内括约肌上端就在4公分左右,而切除肿瘤下缘按照规范是2公分,4公分肠癌切除掉2公分,就把整个内括约肌给切除了,这样肛门的整体功能就破坏了,保肛还有意义吗?艺高人胆大的医生下缘切1公分,都要5公分以上超低位直肠癌患者才能够保住术后肛门的功能,而距离肛门4公分的位置是靠近盆腔的位置,那里直肠肠外就是包裹直肠的脂肪和盆腔壁,肿瘤出肠就侵犯盆腔,肿瘤不出肠癌细胞也可以通过淋巴管出肠侵犯周边的淋巴系统、脂肪和盆腔,而那个地方是非常的狭窄,特别是身体肥胖的患者,医生很难很难切除干净那个位置肠段周边的脂肪的,盆腔壁除了薄薄的一层皮之外就是骨头,那个地方被侵犯了,医生根本就不够距离切除病灶,因为盆腔就无肉可切。

所以,侵犯盆腔就是晚期,这个地方切除肛门就能够清理掉所有的怀疑病灶,反正5公分以下的低位直肠癌都需要放疗内括约肌就要受到第一次伤害,手术再切除掉作为肛门探测功能的内括约肌,肛门功能术后可以正常控制的概率很低很低,理论上控制不了而因为切不干净的风险却很大很大。所以,5公分以下保肛的复发转移率特别高!保下来的肛门还控制不了!保肛意志太过强烈的人,有些医生会满足患者的要求勉为其难的做保肛手术,但是复发转移的风险患者承担;根据群里无数次经验总结,低位保肛都是用命去堵的,而效果往往不尽人意,赌赢者寥寥!我只能讲解清楚之后提请群友慎重做保肛决策。

患者保肛意志强烈,医生也同意保肛,我再说不能够保肛,就显得皇上不急太监急了!这种付出生命教训的案例群里六年来比比皆是,就连很理智的创群管理员也犯了这个一失足成千古恨的严重错误,最后她老公上个月走了,她5年来的辛苦付出都得不到应有的回报。她是肠癌群里一个少有的好家属,她老公什么都不管,什么都不懂,见医生讨论病情、跟医生制定治疗计划、在群里、找文献学习肠癌的诊疗知识、护理调理知识;护理、调理她老公,可谓费尽心机、尽心尽力。每次造口放大便和换底盘全部都是她做的,经常见她半夜不睡守着给她老公放临时造口袋大便!可惜啊!第一步选择错误了,一步错步步错,最后她五年来的不懈努力都付之东流了!

本人针对肠癌患者急需学会遵循的《根据确诊肠癌报告内容的专业医院诊疗选择篇》《正确树立科学治疗癌症观念篇》、《放化疗期间的止吐止泻篇》、《化疗期癌症患者食疗四大原则之滋补食疗篇》《吻合口炎、肛门炎症护理篇》《体质型大便多次调理篇》《术后康复期复查应变篇》《低位保肛篇》等系列文章已经在知乎上发表,并制作成视频。本人独创的化疗期间的6种大便紊乱行之有效的调理方法,被数千人实践模仿有效的方法也被广泛的模仿和遵循。

日后将陆续发表《术后补血补气篇》《医生诊疗理念解读篇》《医生治疗方法解读篇》《复查复发转移应变篇》《医生复发转移诊疗篇》《舒缓治疗、滋补食疗篇》《与癌共存的舒缓治疗理念改变篇》,《晚晚期治疗、护理篇》《中西医结合调理篇》《临时与永久造口篇》等100多篇围绕患者确诊之后5年内全周期患者和家属所需要的,肠癌知识的系列科普文章与视频,都会在今年以内在知乎陆续发表,100多篇文章全部发表完毕之后,我将针对一些肠癌的个性问题以每周一篇文章或回答问题的方式发表系列肠癌科普文章。

本人所有的文章都为原创,只作为患者或家属免费下载学习、转发分享使用,患者和家属看完觉得文章和视频对你有确确实实帮助的话,请记得点关注,赞同,喜欢、收藏,下载、评论转发。

延伸阅读

回到首頁 Back to Homepage

分享此资料:

[超低位直肠癌诊疗篇] 术前分期3a期以上患者勉强做保肛手术 复发转移率非常高》有4,393个想法

  1. שירותי ליווי בחיפה

    This is the right blog for everyone who wishes to understand this topic. You realize so much its almost tough to argue with you (not that I really would want toÖHaHa). You certainly put a brand new spin on a topic that has been discussed for years. Great stuff, just great!

    回复
  2. Zakglymn

    [url=https://viagraatab.quest/]sildenafil 20 mg daily[/url] [url=https://buycialis.digital/]cialis order online india[/url] [url=https://vpxl.digital/]vpxl pills cheap[/url]

    回复
  3. Richardlumma

    [url=http://buymodafinil.guru/]where to buy provigil[/url] [url=http://buyfinasteride.works/]finasterid[/url] [url=http://cialisqtabs.quest/]buy cialis generic india[/url] [url=http://xenical.digital/]buy xenical 120[/url] [url=http://buyrobaxin.shop/]robaxin 500mg[/url] [url=http://buystrattera.works/]cost of strattera in australia[/url] [url=http://drugstore.email/]overseas pharmacy no prescription[/url]

    回复
  4. Williamgot

    [url=https://cialisatab.quest/]cheapest tadalafil no prescription[/url] [url=https://buylisinopril.guru/]lisinopril pills 2.5 mg[/url] [url=https://xenical.digital/]orlistat 60 mg online india[/url] [url=https://viagrattabs.monster/]can i buy sildenafil in canada[/url] [url=https://gabapentintab.online/]neurontin tablets 300mg[/url] [url=https://cialisptabs.monster/]generic cialis paypal[/url] [url=https://anafranil.boutique/]anafranil 10 mg[/url] [url=https://cialisjtabs.monster/]canadian pharmacy generic cialis[/url]

    回复
  5. Ashglymn

    [url=https://cafergot.store/]cafergot over the counter[/url] [url=https://lipitortab.com/]lipitor 20mg canada price[/url] [url=https://cialisutabs.quest/]cheap brand name cialis[/url] [url=https://medbuyp.com/]nexium 40 mg prescription[/url] [url=https://clomid.golf/]clomid 40 mg[/url] [url=https://triamterene.live/]triamterene-hctz 75-50 mg tab[/url] [url=https://cipro.email/]how much is ciprofloxacin 500mg[/url] [url=https://hydroxychloroquinepp.com/]plaquenil otc[/url]

    回复
  6. JamesNEf

    [url=http://cialisvtab.quest/]tadalafil brand name[/url] [url=http://albenza.golf/]albenza otc[/url] [url=http://paroxetine.boutique/]generic paxil price[/url] [url=http://cymbalta.sale/]cymbalta prescription cost[/url] [url=http://propranololtabs.online/]propranolol 10 mg pill[/url] [url=http://nexium.works/]nexium.com[/url] [url=http://buybenicar.works/]benicar 10[/url] [url=http://buyneurontin.boutique/]buy neurontin 300 mg[/url]

    回复
  7. Maryglymn

    [url=https://benicar.guru/]benicar 40 5 mg[/url] [url=https://glucophage.digital/]how to get metformin uk[/url] [url=https://viagrabtabs.quest/]where to get female viagra in india[/url] [url=https://vpxl.digital/]vpxl[/url]

    回复
  8. JamesNEf

    [url=http://xenical.digital/]orlistat 120 mg online india[/url] [url=http://buylisinopril.guru/]2 lisinopril[/url] [url=http://kamagra.guru/]where can i buy kamagra in australia[/url]

    回复
  9. Joeglymn

    [url=https://levofloxacin.fun/]antibiotic levaquin[/url] [url=https://flomax.fun/]best price for flomax[/url] [url=https://trental.cfd/]buy trental uk[/url] [url=https://hydroxychloroquine.sbs/]plaquenil 200mg tablets[/url] [url=https://trimox.fun/]amoxicillin 500mg online[/url] [url=https://viagradtabs.quest/]viagra cost[/url] [url=https://cephalexin.works/]keflex sale[/url] [url=https://strattera.life/]strattera brand name[/url]

    回复
  10. Darrylpeday

    [url=https://vermox.site/]vermox 100mg tablets[/url] [url=https://hydroxychloroquine.stream/]hydroxychloroquine 700[/url] [url=https://strattera.fun/]how to buy strattera[/url] [url=https://albendazole.xyz/]albendazole buy india[/url] [url=https://aurogra.life/]aurogra[/url]

    回复
  11. Ashglymn

    [url=https://cialisdtabs.quest/]buy cialis black online[/url] [url=https://medrol.store/]medrol 500 mg[/url] [url=https://baclofen.store/]baclofen 20 mg online[/url] [url=https://buyalbuterol.quest/]online pharmacy ventolin[/url]

    回复
  12. Joeglymn

    [url=https://motilium.site/]motilium generic[/url] [url=https://augmentin.xyz/]augmentin 100 mg tablet[/url] [url=https://retina.run/]buy tretinoin cream india[/url] [url=https://strattera.life/]strattera 25 mg capsule[/url] [url=https://fluconazole.xyz/]fluconazole without script[/url] [url=https://amoxil.site/]where can you buy amoxicillin over the counter[/url] [url=https://viagradtabs.quest/]soft viagra[/url] [url=https://aurogra.xyz/]aurogra 100 prices[/url]

    回复
  13. Samglymn

    [url=http://flomax.fun/]flomax over the counter drug[/url] [url=http://effexor.fun/]effexor 37.5 mg capsule[/url] [url=http://drugstore.fun/]canadadrugpharmacy[/url] [url=http://viagradtabs.quest/]generic sildenafil 20 mg cost[/url] [url=http://advair.site/]advair generic[/url] [url=http://hydrochlorothiazide.site/]buy hydrochlorothiazide uk[/url] [url=http://tizanidine.fun/]tizanidine brand name india[/url] [url=http://femaleviagra.cfd/]viagra mail order[/url]

    回复
  14. Samglymn

    [url=http://prazosin.xyz/]prazosin 1mg tablets[/url] [url=http://amoxil.site/]amoxicillin pill[/url] [url=http://hydrochlorothiazide.site/]medication zestoretic[/url] [url=http://strattera.life/]strattera 100mg cost[/url] [url=http://tadalafil.moscow/]cialis south africa[/url] [url=http://azithromycin.sbs/]buy azithromycin online uk[/url] [url=http://effexor.fun/]effexor 20 mg[/url] [url=http://estrace.xyz/]estrace coupon cream[/url]

    回复
  15. Richardlumma

    [url=http://cialisvtab.monster/]generic tadalafil from uk[/url] [url=http://strattera.fun/]generic strattera cost[/url] [url=http://malegra.site/]malegra canada[/url] [url=http://tizanidine.site/]tizanidine cost prescription[/url] [url=http://prednisolone.run/]cost of prednisolone[/url]

    回复
  16. Josephhok

    [url=http://viagrautab.monster/]viagra pill price in mexico[/url] [url=http://valtrex.click/]valtrex 1g tablets cost[/url] [url=http://atarax.fun/]atarax 25 mg 1mg[/url] [url=http://advair.fun/]advair online[/url] [url=http://prednisolone.run/]buy predislone tablets[/url] [url=http://elimite.cfd/]can you buy elimite cream over the counter[/url]

    回复
  17. Maryglymn

    [url=https://azithromycin.sbs/]azithromycin 200mg[/url] [url=https://chloroquine.boutique/]chloroquine us[/url] [url=https://tretinoin.fun/]where can i buy tretinoin online[/url] [url=https://motilium.site/]motilium cvs[/url] [url=https://hydroxychloroquine.media/]hydroxychloroquine brand name[/url] [url=https://tizanidine.fun/]medication tizanidine 4 mg[/url]

    回复
  18. Darrylpeday

    [url=https://lopressor.site/]lopressor xl[/url] [url=https://buspar.site/]buspar online[/url] [url=https://antabuse.fun/]disulfiram tablets online[/url] [url=https://vardenafil.men/]levitra prescription online[/url] [url=https://tetracycline.fun/]tetracycline buy[/url] [url=https://prednisolone.run/]prednisolone tablets 25mg[/url]

    回复
  19. Ricmooks

    [url=https://tizanidine.site/]tizanidine 4 mg brand name[/url] [url=https://baclofen.business/]baclofen 25 mg[/url] [url=https://viagrautab.monster/]viagra sales[/url] [url=https://atarax.fun/]atarax 25 mg tablets[/url] [url=https://ampicillin.sbs/]over the counter ampicillin pills[/url] [url=https://sumycin.site/]tetracycline capsules price[/url]

    回复
  20. Williamgot

    [url=https://elimite.cfd/]elimite cream ebay[/url] [url=https://tetracycline.fun/]buy tetracycline canada[/url] [url=https://dexamethasone.cfd/]dexamethasone 4 mg tablet price[/url] [url=https://sumycin.xyz/]tetracycline price in canada[/url] [url=https://prednisolone.boutique/]prednisolone tablet cost[/url] [url=https://vermox.site/]vermox price canada[/url]

    回复
  21. JamesNEf

    [url=http://plavix.site/]clopidogrel 300 mg[/url] [url=http://malegra.site/]malegra 200 mg[/url] [url=http://provigil.xyz/]can i buy provigil online[/url] [url=http://baclofen.fun/]baclofen pill[/url] [url=http://anafranil.xyz/]clomipramine anafranil[/url]

    回复
  22. Zakglymn

    [url=https://metformin.fun/]metformin hcl[/url] [url=https://augmentin.xyz/]augmentin 875 mg generic[/url] [url=https://viagradtabs.quest/]cheapest generic viagra prices online[/url]

    回复
  23. Richardlumma

    [url=http://sildenafil.site/]viagra discount prices[/url] [url=http://cephalexin.icu/]cephalexin 500 mg cap[/url] [url=http://glucophage.site/]metformin over the counter without a prescription[/url] [url=http://finasteride.site/]propecia 1mg tablets[/url] [url=http://hydroxychloroquine.ink/]hydroxychloroquine sulfate tablet[/url] [url=http://prednisone.network/]deltasone otc[/url]

    回复
  24. JamesNEf

    [url=https://hydroxyzine.fun/]atarax 20 mg[/url] [url=https://seroquel.site/]seroquel blood pressure[/url] [url=https://augmentin.business/]buy amoxicillin from canada[/url] [url=https://prozac.media/]brand name prozac online[/url]

    回复
  25. Josephhok

    [url=http://prozac.media/]prozac without prescription[/url] [url=http://allopurinol.xyz/]allopurinol canadian pharmacy[/url] [url=http://trazodone.icu/]how much is trazodone 50 mg[/url] [url=http://albenza.business/]where to buy albenza[/url] [url=http://suhagra.fun/]suhagra price[/url] [url=http://trental.xyz/]medication trental[/url] [url=http://vardenafil.network/]can i buy levitra over the counter[/url]

    回复
  26. JamesNEf

    [url=https://hydroxychloroquine.makeup/]plaquenil 250[/url] [url=https://levothyroxine.xyz/]synthroid 0.088 mg[/url] [url=https://estrace.fun/]estrace generic cost[/url] [url=https://allopurinol.icu/]price of allopurinol 300 mg[/url] [url=https://prednisone.network/]buy prednisone no prescription pharmacy[/url]

    回复
  27. Richardlumma

    [url=http://fildena.fun/]fildena in india[/url] [url=http://zanaflex.site/]zanaflex for sale[/url] [url=http://budesonide.run/]budesonide 500 mcg[/url] [url=http://onlinepharmacy.download/]online pharmacy australia[/url] [url=http://prednisolone.fun/]generic prednisolone[/url] [url=http://albenza.business/]albendazole online purchase[/url] [url=http://levothyroxine.xyz/]synthroid 1.25 mcg[/url] [url=http://retinoa.xyz/]retino 0.025 gel[/url]

    回复
  28. Richardlumma

    [url=http://dapoxetine.fun/]dapoxetine online pharmacy india[/url] [url=http://azithromycin.media/]medicine zithromax[/url] [url=http://tamoxifen.fun/]buy generic tamoxifen[/url] [url=http://suhagra.fun/]buy suhagra 100[/url] [url=http://yasmin.monster/]order yasmin online usa[/url] [url=http://finasteride.site/]propecia online no prescription[/url] [url=http://albenza.business/]albendazole online canada[/url]

    回复
  29. Samglymn

    [url=https://viagravtabs.monster/]sildenafil tablets online in india[/url] [url=https://viagraotabs.quest/]viagra 100 price[/url] [url=https://nexium.cfd/]nexium 40 mg capsules[/url] [url=https://silagra.site/]silagra 50 mg tablet[/url] [url=https://fluoxetine.life/]fluoxetine brand name uk[/url] [url=https://onlinepharmacy.run/]pharmacy order online[/url] [url=https://zestoretic.fun/]zestoretic cost[/url]

    回复
  30. JamesNEf

    [url=https://glucophage.site/]cost of 750 mg metformin[/url] [url=https://kamagra.fun/]buy kamagra oral jelly[/url] [url=https://antabuse.site/]antabuse prescription uk[/url] [url=https://glucophage.icu/]glucophage lowest price[/url] [url=https://trazodone.icu/]trazodone 50 mg tablet[/url] [url=https://azithromycin.media/]azithromycin 1g for sale[/url] [url=https://trazodone.fun/]trazodone online prescription[/url]

    回复
  31. Maryglymn

    [url=https://atomoxetine.sbs/]strattera cap 10mg[/url] [url=https://ampicillin.site/]ampicillin 750 mg[/url] [url=https://methocarbamol.site/]buy robaxin canada[/url]

    回复
  32. Josephhok

    [url=http://diflucan.xyz/]diflucan 150mg tab[/url] [url=http://allopurinol.icu/]buy allopurinol 100mg online uk[/url] [url=http://seroquel.site/]seroquel 100mg generic[/url]

    回复
  33. JamesNEf

    [url=https://fildena.fun/]fildena 100mg[/url] [url=https://onlinepharmacy.win/]onlinecanadianpharmacy 24[/url] [url=https://hydroxychloroquine.makeup/]hydroxychloroquine 4 mg[/url] [url=https://albenza.business/]albendazole generic usa[/url] [url=https://trazodone.fun/]trazodone brand[/url] [url=https://hydrochlorothiazide.cfd/]cost of hydrochlorothiazide[/url]

    回复
  34. Zakglymn

    [url=http://fluoxetine.life/]prozac discount[/url] [url=http://valtrex.fun/]generic valtrex for sale[/url] [url=http://propecia.capetown/]cheap propecia online canada[/url] [url=http://sildalis.click/]sildalis canada[/url]

    回复
  35. Ricmooks

    [url=https://dapoxetine.fun/]avana 522[/url] [url=https://allopurinol.xyz/]allopurinol tabs[/url] [url=https://trental.xyz/]drug trental[/url] [url=https://allopurinol.icu/]allopurinol pill[/url]

    回复
  36. Alanglymn

    [url=https://modafinil.durban/]modafinil purchase canada[/url] [url=https://lisinopril.site/]lisinopril 5 mg buy online[/url] [url=https://lasix.wtf/]lasix online purchase[/url] [url=https://dexamethasone.site/]dexamethasone 6 tablet[/url] [url=https://modafinil.run/]buy modafinil tablets online[/url] [url=https://orlistat.life/]xenical generic[/url] [url=https://dutasteride.fun/]avodart prescription online[/url] [url=https://diclofenac.fun/]voltaren price uk[/url]

    回复
  37. Ashglymn

    [url=https://valtrex.works/]how to get valtrex prescription online[/url] [url=https://tadacip.cfd/]canadian pharmacy 20 mg tadacip[/url] [url=https://strattera.shop/]straterra order[/url] [url=https://clomid.company/]clomid online pharmacy uk[/url] [url=https://trazodone.guru/]trazodone 50 mg without prescription[/url]

    回复
  38. Darrylpeday

    [url=http://lopressor.xyz/]lopressor hct[/url] [url=http://propecia.autos/]buy genuine propecia[/url] [url=http://propecia.lol/]finasteride uk price[/url] [url=http://celebrex.life/]celebrex 200[/url]

    回复
  39. Ricmooks

    [url=https://cytotec.best/]misoprostol pills price[/url] [url=https://provigil.cfd/]how much is modafinil[/url] [url=https://modafinil.hair/]buy modafinil online europe[/url] [url=https://wellbutrin.site/]wellbutrin 65mg[/url]

    回复
  40. Darrylpeday

    [url=http://mebendazole.fun/]vermox over the counter[/url] [url=http://zoloft.sbs/]zoloft 250 mg daily[/url] [url=http://buspar.life/]buy buspar online cheap[/url] [url=http://tadacip.works/]where to buy tadacip[/url] [url=http://synthroid.business/]synthroid 50[/url] [url=http://prozac.moscow/]fluoxetine 40mg prices[/url]

    回复
  41. Josephhok

    [url=https://cialishtabs.monster/]generic cialis 80mg[/url] [url=https://augmentin.fun/]buy amoxicillin 500mg capsules uk[/url] [url=https://erectafil.cfd/]erectafil 40[/url] [url=https://propecia.autos/]price of propecia[/url] [url=https://synthroid.business/]synthroid 30 mg[/url] [url=https://finpecia.life/]finasteride 5g[/url]

    回复
  42. JamesNEf

    [url=http://doxycycline.sbs/]doxycycline cost[/url] [url=http://celebrex.life/]cost of celebrex[/url] [url=http://budesonide.sbs/]budesonide discount[/url] [url=http://viagraltab.monster/]viagra online singapore[/url] [url=http://prednisone.moscow/]prednisone 20mg tab cost[/url]

    回复
  43. Darrylpeday

    [url=http://finpecia.life/]propecia 1mg[/url] [url=http://retinoa.fun/]retino[/url] [url=http://vardenafil.ink/]10mg levitra[/url] [url=http://prozac.moscow/]buy cheap fluoxetine online[/url] [url=http://propranolol.fun/]buy inderal online uk[/url] [url=http://budesonide.sbs/]budesonide brand name[/url] [url=http://onlinepharmacy.moscow/]rate canadian pharmacies[/url]

    回复
  44. JamesNEf

    [url=http://baclofen.site/]baclofen 60 mg[/url] [url=http://vardenafil.download/]vardenafil[/url] [url=http://finasteride.fun/]cost of propecia in australia[/url] [url=http://synthroid.business/]synthroid 112 cost[/url] [url=http://budesonide.sbs/]budesonide discount[/url]

    回复
  45. Williamgot

    [url=https://budesonide.sbs/]buy budesonide[/url] [url=https://clomid.moscow/]where can i buy clomid pills[/url] [url=https://sildenafil.moscow/]buy female viagra online india[/url] [url=https://retinoa.fun/]retino gel[/url] [url=https://prednisone.moscow/]prednisone cream rx[/url] [url=https://valtrex.run/]valtrex generic price[/url] [url=https://vardenafil.ink/]buy cheap levitra[/url]

    回复
  46. Williamgot

    [url=https://methocarbamol.xyz/]robaxin otc usa[/url] [url=https://anafranil.fun/]anafranil price in south africa[/url] [url=https://flomax.life/]flomax cream[/url] [url=https://propecia.autos/]propecia 1mg tablets[/url] [url=https://viagraltab.monster/]viagra from india for sale[/url]

    回复
  47. Alanglymn

    [url=http://nexium.fun/]buy nexium cheap[/url] [url=http://triamterene.xyz/]triamterene/hctz 37.5-25 mg[/url] [url=http://silagra.life/]silagra tablets online[/url] [url=http://erythromycin.fun/]erythromycin 333 mg tab[/url] [url=http://zoloft.hair/]zoloft rx discount[/url] [url=http://femaleviagra.xyz/]viagra 50 mg buy online[/url] [url=http://plavix.fun/]plavix 75 mg price uk[/url]

    回复
  48. Ashglymn

    [url=https://finasteride.solutions/]propecia over the counter canada[/url] [url=https://cephalexin.digital/]cephalexin 500 mg cap[/url] [url=https://augmentin.email/]augmentin 250 5 mg[/url]

    回复
  49. Eyeglymn

    [url=https://strattera.icu/]strattera 40 mg coupon[/url] [url=https://triamterene.xyz/]triamterene 75[/url] [url=https://erythromycin.fun/]erythromycin pill[/url]

    回复
  50. Zakglymn

    [url=https://bactrim.xyz/]buying bactrim antibiotic online[/url] [url=https://budesonide.xyz/]budesonide tablets[/url] [url=https://viagrattab.quest/]sildenafil citrate uk[/url] [url=https://lyrica.run/]lyrica pills price[/url] [url=https://strattera.icu/]strattera for sale[/url] [url=https://zoloft.durban/]order zoloft online no prescription[/url]

    回复
  51. Samglymn

    [url=http://atarax.click/]atarax generic[/url] [url=http://gabapentin.xyz/]purchase neurontin canada[/url] [url=http://tenormin.fun/]atenolol cream[/url] [url=http://zithromax.site/]zithromax pak[/url] [url=http://clomid.network/]how to buy clomid[/url] [url=http://onlinedrugstore.fun/]onlinepharmaciescanada[/url] [url=http://anafranil.site/]anafranil 20 mg capsule[/url] [url=http://bupropion.site/]wellbutrin price canada[/url]

    回复
  52. Williamgot

    [url=https://metformin.moscow/]buying metformin canada[/url] [url=https://disulfiram.fun/]buy disulfiram without prescription[/url] [url=https://bupropion.cfd/]wellbutrin 150 mg cost[/url] [url=https://cialisktabs.quest/]best cialis[/url] [url=https://mebendazole.xyz/]vermox generic[/url] [url=https://cialisetabs.monster/]buy cialis daily[/url]

    回复
  53. Darrylpeday

    [url=http://tizanidine.xyz/]tizanidine canada[/url] [url=http://celebrex.sbs/]buy celebrex usa[/url] [url=http://cialismtabs.monster/]buy generic cialis canada[/url] [url=http://femaleviagra.monster/]canadian pharmacy generic viagra[/url] [url=http://metformin.moscow/]metformin price singapore[/url] [url=http://disulfiram.site/]disulfiram price in usa[/url] [url=http://vardenafil.life/]levitra prices[/url]

    回复
  54. Josephhok

    [url=http://disulfiram.site/]antabuse medication australia[/url] [url=http://paxil.site/]paroxetine coupon[/url] [url=http://valtrex.site/]valtrex medication online[/url] [url=http://neurontin.click/]neurontin 300 mg pill[/url]

    回复
  55. Richardlumma

    [url=https://duloxetine.xyz/]generic cymbalta canada[/url] [url=https://cialismtabs.monster/]tadalafil 50mg[/url] [url=https://avodart.site/]avodart generic[/url] [url=https://doxycycline.party/]doxycycline 100mg capsules uk[/url] [url=https://biaxin.fun/]biaxin brand name[/url]

    回复
  56. Joeglymn

    [url=https://bactrim.icu/]400mg bactrim[/url] [url=https://lasix.fun/]lasix price[/url] [url=https://zofran.fun/]where can i buy zofran online[/url] [url=https://accutane.site/]generic accutane online pharmacy[/url]

    回复
  57. JamesNEf

    [url=https://cialisetabs.monster/]how much is tadalafil[/url] [url=https://femaleviagra.monster/]best viagra for women[/url] [url=https://trazodone.media/]how much is trazodone 50 mg[/url] [url=https://diflucan.fun/]diflucan best price[/url]

    回复
  58. Samglymn

    [url=http://prozac.capetown/]how to get prozac[/url] [url=http://motilium.fun/]motilium 20 mg[/url] [url=http://anafranil.site/]anafranil for depression[/url] [url=http://ampicillin.life/]ampicillin tablet 500mg[/url] [url=http://dexamethasone.fun/]dexamethasone 8 mg tablets[/url] [url=http://bupropion.site/]generic wellbutrin price[/url] [url=http://vardenafil.live/]generic levitra coupon[/url] [url=http://amoxil.fun/]augmentin 625 mg[/url]

    回复
  59. Richardlumma

    [url=https://allopurinol.site/]allopurinol no prescription[/url] [url=https://chloroquine.fun/]buy chloroquine online canada[/url] [url=https://permethrin.xyz/]generic elimite[/url] [url=https://hydroxychloroquine.mom/]where to buy cheap plaquenil[/url]

    回复
  60. Ricmooks

    [url=http://disulfiram.fun/]disulfiram brand in india[/url] [url=http://metformin.moscow/]metformin without prescription[/url] [url=http://sildenafil.ink/]viagra 100 buy online[/url] [url=http://lexapro.sbs/]lexapro for sale online[/url] [url=http://benicar.site/]brand benicar[/url] [url=http://duloxetine.cfd/]buy cymbalta online[/url] [url=http://celebrex.sbs/]celebrex medicine price[/url]

    回复
  61. Ashglymn

    [url=https://antabuse.fun/]buy antabuse online without a prescription[/url] [url=https://celexa.online/]celexa 40 mg[/url] [url=https://plavix.works/]clopidogrel 150 mg daily[/url] [url=https://tadacip.boutique/]buy tadacip online uk[/url] [url=https://synthroidtabs.online/]synthroid 0.137 mg[/url] [url=https://clonidine.cfd/]clonidine iv[/url]

    回复
  62. Darrylpeday

    [url=http://glucophage.life/]glucophage brand[/url] [url=http://mebendazole.cfd/]vermox online[/url] [url=http://robaxin.site/]robaxin eq[/url] [url=http://mebendazole.xyz/]where can i buy vermox medication online[/url] [url=http://trazodone.media/]buy trazodone online uk[/url]

    回复
  63. Zakglymn

    [url=https://escitalopram.cfd/]lexapro 1.25 mg[/url] [url=https://doxycycline.fun/]doxycycline tetracycline[/url] [url=https://erectafil.fun/]erectafil 40 mg[/url] [url=https://hydroxychloroquine.tech/]hydroxychloroquine generic name[/url] [url=https://silagra.xyz/]silagra tablet[/url]

    回复
  64. Joeglymn

    [url=https://bactrim.icu/]buying bactrim antibiotic online[/url] [url=https://bupropion.site/]wellbutrin 100mg[/url] [url=https://cialisrtab.monster/]discount cialis no prescription[/url] [url=https://dexamethasone.fun/]dexamethasone cream[/url]

    回复
  65. Samglymn

    [url=http://cheapviagramedicationprescription.monster/]buying viagra without prescription[/url] [url=http://bestcialispillswithoutrx.quest/]buy generic tadalafil online[/url] [url=http://viagratabletprescription.monster/]genuine viagra canada[/url] [url=http://acyclovir.icu/]zovirax 400 mg price[/url] [url=http://vardenafil.durban/]levitra pills uk[/url] [url=http://cheapviagra50prescription.quest/]buy sildenafil no prescription[/url] [url=http://levitra.monster/]levitra 20g[/url] [url=http://pharmacyonline.click/]good online mexican pharmacy[/url]

    回复
  66. Joeglymn

    [url=https://orderviagratabwithoutprescription.quest/]no prescription generic sildenafil online[/url] [url=https://levitra.monster/]cost of vardenafil[/url] [url=https://vardenafil.durban/]levitra capsules[/url] [url=https://viagrapriceonline.monster/]how to get viagra tablets[/url] [url=https://acyclovirtab.online/]acyclovir cream price[/url] [url=https://lisinopril.ink/]buy lisinopril 20 mg[/url]

    回复
  67. Williamgot

    [url=https://atarax.sbs/]atarax pills[/url] [url=https://propecia.media/]propecia uk cheap[/url] [url=https://clonidine.company/]clonidine 50 mg[/url] [url=https://cheapcialispillwithnoprescription.quest/]cialis online in india[/url] [url=https://orderviagratabsnoprescription.quest/]viagra pills online[/url] [url=https://propranolol.business/]medicine inderal 40[/url] [url=https://orderviagrapillswithnoprescription.monster/]can you order generic viagra online[/url] [url=https://genericcialismedicationforsale.monster/]cialis where to buy[/url]

    回复
  68. Joeglymn

    [url=https://canadianpharmacy.company/]overseas online pharmacy[/url] [url=https://cialis40mgwithnorx.quest/]2.5 mg cialis daily[/url] [url=https://acyclovirtab.online/]pharmacy prices for acyclovir[/url] [url=https://accutane.beauty/]roche accutane[/url] [url=https://trazodone.download/]trazodone price[/url] [url=https://seroquel.email/]seroquel 100 mg tablet[/url]

    回复
  69. Darrylpeday

    [url=https://orderviagra100mgwithnorx.monster/]sildenafil 100mg from india[/url] [url=https://buyingbestviagratabs.quest/]viagra online in india[/url] [url=https://cheapcialistabletprescription.monster/]buy cialis in usa[/url] [url=https://orderviagratabsnoprescription.quest/]can i buy viagra[/url] [url=https://atarax.sbs/]atarax uk prescription[/url] [url=https://lasix.business/]lasix medication over the counter[/url] [url=https://propecia.media/]propecia canada[/url] [url=https://augmentin.company/]buy amoxicillin 500mg uk online[/url]

    回复
  70. Ricmooks

    [url=http://viagratabletsnoprescription.monster/]buy genuine viagra online uk[/url] [url=http://buyviagratabnoprescription.quest/]buy viagra tablet india online[/url] [url=http://buyviagra200mgonline.quest/]where to buy generic sildenafil[/url] [url=http://buyinggenericviagra100mg.quest/]cheap viagra from india[/url]

    回复
  71. Zakglymn

    [url=https://prednisone.download/]buy prednisone no prescription[/url] [url=https://buyviagra100mgwithoutprescription.monster/]generic viagra cost canada[/url] [url=https://pharmacyonline.click/]www pharmacyonline[/url] [url=https://modafinila.online/]provigil india price[/url] [url=https://bestviagradrugwithnorx.monster/]viagra 100mg buy online[/url] [url=https://cialis40mgwithnorx.quest/]buy tadalafil pills[/url]

    回复