• <tr id="yyy80"></tr>
  • <sup id="yyy80"></sup>
  • <tfoot id="yyy80"><noscript id="yyy80"></noscript></tfoot>
  • 99热精品在线国产_美女午夜性视频免费_国产精品国产高清国产av_av欧美777_自拍偷自拍亚洲精品老妇_亚洲熟女精品中文字幕_www日本黄色视频网_国产精品野战在线观看 ?

    Technical note on complete excision of choledochal cysts

    2013-05-24 15:47:27

    Hong Kong, China

    Technical note on complete excision of choledochal cysts

    Tan To Cheung and Sheung Tat Fan

    Hong Kong, China

    BACKGROUND:Choledochal cysts are congenital cystic dilatations of the extrahepatic or intrahepatic portion of the biliary tree. Complete excision of choledochal cysts is currently regarded as the gold standard treatment, while less extensive procedures including cystoduodenostomy have become obsolete due to the potential for malignant change in the remnant cyst. For type-1 choledochal cysts, which sometimes extend to the main pancreatic duct closely, some surgeons may adopt a less aggressive approach in order to avoid damage to the main pancreatic duct as such damage can lead to serious consequences. However, incomplete excision of choledochal cysts may also cause problems.

    METHOD:Here we report on a reoperation treating incomplete excision of a choledochal cyst with focus on the technical aspect.

    RESULTS:In the reoperation, meticulous dissection of the liver hilum which had been previously operated on was performed. The hepaticojejunostomy was left intact. With the assistance of intraoperative cholangiography, the residual pancreatic portion of the choledochal cyst was completely excised. The pancreatic opening and the lower end of the common bile duct were reconstructed. Whipple operation was avoided.

    CONCLUSION:Careful planning with the aid of precise imaging before and during the operation largely enhanced the accuracy of the excision of the choledochal cyst.

    (Hepatobiliary Pancreat Dis Int 2013;12:218-221)

    choledochal cyst; re-excision; incomplete excision

    Introduction

    Choledochal cysts are a congenital condition commonly found in the young population. The incidence is around 1 in 5000 with a high frequency in Asia.[1,2]The diagnosis is usually made in the fi rst few years of life but many cases are detected in early adulthood. Choledochal cysts are classif i ed according to Todani modif i cation of the Alonso-Lej classif i cation.[3]Type-1 choledochal cysts are the most common presentation, which account for 67.9% of all cases.[4]Apart from Caroli disease (type-5 choledochal cysts) which may require liver transplantation, choledochal cysts are best treated with complete excision, followed by hepaticojejunostomy when technically feasible. It is well recognized that patients with choledochal cysts have a higher risk of cholangiocarcinoma, and cystojejunostomy (or cystoduodenostomy), which was once a popular operation, has become an inferior treatment option in the modern era.[5]Excision of choledochal cysts can be a technically challenging operation, particularly when the lesion is intrahepatic or involves the distal end of the common bile duct. Intrahepatic choledochal cysts may require a partial or an anatomical hepatectomy for complete removal.[6]Lesions involving the pancreas are even more challenging, as injury to the main pancreatic duct may lead to serious complications. Surgeons who do not handle this condition frequently may try to avoid dissection towards the pancreatic duct, but incomplete excision may lead to problematic symptoms posing the risk of malignancy and cause dense adhesion that hinders subsequent operation.

    Case report

    The patient was a 27-year-old female who presented with epigastric pain. She had no jaundice but her serum alkaline phosphatase level was 540 μmol/L. Magnetic resonance imaging of the liver revealed a type-1 choledochal cyst 3×3.5×7 cm in size involving theproximal bile duct (Fig. 1A) and the pancreatic portion of the distal common bile duct (Fig. 1B). Magnetic resonance cholangiogram showed a tapering of the distal common bile duct making virtually a two-chamber conf i guration of the choledochal cyst (Fig. 1C). Open excision of the choledochal cyst and hepaticojejunostomy were performed in another hospital. She had uneventful recovery and was discharged a week after the operation.

    She developed recurrent episodes of epigastric pain, fever, chills and rigors two months after the operation. She was referred to our hospital for further management. Computed tomography showed a 3×3.5×3 cm residual component of choledochal cyst at the distal common bile duct with fi lling defects compatible with stones (Fig. 2A). Reconstruction computed tomography showed that the lesion was mainly inside the head of the pancreas (Fig. 2B). Complete excision of the residual choledochal cyst was indicated due to the symptoms and potential of malignancy.

    Fig. 1.A: Magnetic resonance imaging showing the proximal part of the choledochal cyst (arrow);B: Magnetic resonance imaging showing the distal part of the choledochal cyst inside the head of the pancreas (arrow);C: Magnetic resonance cholangiopancreatography showing a narrowing at the middle of the choledochal cyst (arrow).

    A right subcostal incision was made along the original wound. Adhesions resulting from the previous operation were taken down. The afferent and efferent limbs of hepaticojejunostomy were identif i ed just anterior to the liver hilum. The porta hepatis was dissected until the stump of the distal common bile duct was identif i ed. The distal component of the choledochal cyst was dissected out from the head of the pancreas until the insertion of the main pancreatic duct was seen. A catheter was inserted into the cyst for operative cholangiography (Fig. 3). Fifteen mL of contrast was instilled into the choledochal cyst and the lower margin of the lesion was shown. Free fl ow of contrast into the duodenum was observed (Fig. 4A). The distal margin of the lesion was marked by Liga clips (Fig. 4B) in order to def i ne the exact site of bile duct resection. The choledochal cyst was removed by cutting at the lowest end of the common bile duct where the main pancreatic duct opening was also exposed (Fig. 5). The common bile duct stump was closed with 5/0 Prolene suture in one single layer and no pancreatic stent was placed across it.

    Fig. 2.A: Contrast computed tomography scan showing a residual choledochal cyst in the head of the pancreas with stones inside (arrow);B: Reconstruction computed tomography scan showing the intrapancreatic portion of the choledochal cyst (arrow).

    Fig. 3.The choledochal cyst was identif i ed and the intrapancreatic portion was dissected out. A catheter was placed inside the choledochal cyst for cholangiography.

    Fig. 4.A: Intraoperative cholangiogram showing the full conf i guration of the choledochal cyst and contrast fl owing freely into the duodenum via the distal portion of the common bile duct;B: Two large metal clips were applied to the lower transection line of the choledochal cyst (arrow).

    The patient was kept nil by mouth with total parenteral nutrition support for one week. Somatostatin infusion was administered at 250 mcg per hour in the initial postoperative period to minimize pancreatic secretion.

    Histological examination showed cystic dilatation of the common bile duct compatible with choledochal cyst. There was no evidence of malignancy. The patient made an uneventful recovery and did not complain of any recurrent symptoms after the second operation.

    Fig. 5.The lower end of the choledochal cyst was cut open, exposing the pancreatic duct opening (arrow).

    Discussion

    Patients with choledochal cysts can present with jaundice, deranged liver function and cholangitis, which usually lead to early diagnosis in their childhood or even neonatal period.[7]However, the classical triad of presentations is rare and patients may not notice the presence of the disease until their adulthood.

    Type-1 choledochal cysts can now be excised with the laparoscopic approach although it is technically demanding.[8,9]The open approach to choledochal cyst excision remains widely practiced although it also requires a lot of expertise. The short-term complication rate for choledochal cyst excision is around 5%. The risk of recurrent cholangitis, pancreatitis, hepaticojejunostomy stricture and intrahepatic stone formation is around 16%.[4,10]The risk of malignancy after complete excision of a choledochal cyst is minimal,[4,11]while the remnant of an incompletely excised choledochal cyst still poses a threat of cancer formation.[12]In the case reported herein, it appeared that the incomplete excision of a type-1 choledochal cyst caused recurrent pancreatitis. However, there was the possibility that a co-existing type-3 choledochal cyst that had been left behind from the fi rst operation presented itself as an intrapancreatic lesion.

    In achieving complete excision, preoperative imaging and planning are crucial. Endoscopic retrograde cholangiopancreatography used to be the gold standard for examination of the biliary system, but with the development of modern technology, magnetic resonance cholangiopancreatography can actually provide images of very high quality without posing the risk of complications from instrumentation. In the present case, magnetic resonance cholangiopancreatography nicely demonstrated the presence of narrowing at the middle common bile duct which separated a single lesion into two components. If this was known beforehand, perhaps the lesion could have been completely excised in the fi rst operation.

    To achieve complete excision of the lesion in areoperation setting is a more complicated issue. Since the intrapancreatic portion of the lesion was 3 cm, Whipple operation was a backup option during the operation. Meticulous dissection of the liver hilum without destruction of hepaticojejunostomy was possible. The identif i cation of the main portal vein served as an important landmark for searching the truncated common hepatic duct located anteriorly. With the identif i cation of the proximal end of the lesion, operative cholangiography could be performed. It provided the precise anatomy of the operative fi eld, so a clear margin could be achieved. We did not put in a pancreatic stent across the distal common bile duct stump because there was adequate margin for repair. Alternatively, a 4-Fr pancreatic stent could be deployed to reduce the risk of pancreatic fi stula and then be retrieved by endoscopy afterwards. There is a disadvantage of routine placement of pancreatic stent as the stent may sometimes occlude the pancreatic duct, leading to pancreatitis in the early postoperative period. Although the role of somatostatin analogue in pancreatic fi stula formation is controversial, it has been shown that it can effectively decrease the fi stula output and seems to aid fi stula healing.[13-15]

    For huge and chronic choledochal cysts, complete excision is not always possible, and pericystic inf l ammation may lead to adhesion of underlying vascular structures including the portal vein. When diff i cult dissection is anticipated, partial excision of the cyst with mucosectomy of the remaining portion can be employed. The outer wall of the remnant cyst can be left adherent to the portal vascular structure without causing symptoms.[16]

    Choledochal cyst excision can be a very challenging operation due to the vital structures in the surroundings. Careful planning before operation and the use of operative cholangiography can assure complete excision of the lesions.

    Contributors:CTT and FST drafted and revised the manuscript. FST approved the manuscript.

    Funding:None.

    Ethical approval:Not needed.

    Competing interest:No benef i ts in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.

    1 Kasai M, Asakura Y, Taira Y. Surgical treatment of choledochal cyst. Ann Surg 1970;172:844-851.

    2 Howell CG, Templeton JM, Weiner S, Glassman M, Betts JM, Witzleben CL. Antenatal diagnosis and early surgery for choledochal cyst. J Pediatr Surg 1983;18:387-393.

    3 Todani T, Watanabe Y, Narusue M, Tabuchi K, Okajima K. Congenital bile duct cysts: Classif i cation, operative procedures, and review of thirty-seven cases including cancer arising from choledochal cyst. Am J Surg 1977;134:263-269.

    4 She WH, Chung HY, Lan LC, Wong KK, Saing H, Tam PK. Management of choledochal cyst: 30 years of experience and results in a single center. J Pediatr Surg 2009;44:2307-2311.

    5 Yoshikawa K, Yoshida K, Shirai Y, Sato N, Kashima Y, Coutinho DS, et al. A case of carcinoma arising in the intrapancreatic terminal choledochus 12 years after primary excision of a giant choledochal cyst. Am J Gastroenterol 1986; 81:378-384.

    6 Todani T, Narusue M, Watanabe Y, Tabuchi K, Okajima K. Management of congenital choledochal cyst with intrahepatic involvement. Ann Surg 1978;187:272-280.

    7 Todani T, Urushihara N, Morotomi Y, Watanabe Y, Uemura S, Noda T, et al. Characteristics of choledochal cysts in neonates and early infants. Eur J Pediatr Surg 1995;5:143-145.

    8 Liem NT, Dung le A, Son TN. Laparoscopic complete cyst excision and hepaticoduodenostomy for choledochal cyst: early results in 74 cases. J Laparoendosc Adv Surg Tech A 2009;19:S87-90.

    9 Tan HL, Shankar KR, Ford WD. Laparoscopic resection of type I choledochal cyst. Surg Endosc 2003;17:1495.

    10 Koshinaga T, Hoshino M, Inoue M, Gotoh H, Sugito K, Ikeda T, et al. Pancreatitis complicated with dilated choledochal remnant after congenital choledochal cyst excision. Pediatr Surg Int 2005;21:936-938.

    11 Li MJ, Feng JX, Jin QF. Early complications after excision with hepaticoenterostomy for infants and children with choledochal cysts. Hepatobiliary Pancreat Dis Int 2002;1:281-284.

    12 Fujisaki S, Akiyama T, Miyake H, Amano S, Tomita R, Fukuzawa M, et al. A case of carcinoma associated with the remained intrapancreatic biliary tract 17 years after the primary excision of a choledochal cyst. Hepatogastroenterology 1999;46:1655-1659.

    13 Gans SL, van Westreenen HL, Kiewiet JJ, Rauws EA, Gouma DJ, Boermeester MA. Systematic review and meta-analysis of somatostatin analogues for the treatment of pancreatic fi stula. Br J Surg 2012;99:754-760.

    14 Gurusamy KS, Koti R, Fusai G, Davidson BR. Somatostatin analogues for pancreatic surgery. Cochrane Database Syst Rev 2010;CD008370.

    15 Gayral F, Campion JP, Regimbeau JM, Blumberg J, Maisonobe P, Topart P, et al. Randomized, placebocontrolled, double-blind study of the eff i cacy of lanreotide 30 mg PR in the treatment of pancreatic and enterocutaneous fi stulae. Ann Surg 2009;250:872-877.

    16 Hay SA. Laparoscopic mucosectomy for large choledochal cyst. J Laparoendosc Adv Surg Tech A 2008;18:783-784.

    Received June 28, 2012

    Accepted after revision August 29, 2012

    Announcements for this section should be submitted in the correct format at least 3 months before the required date of publication. This list is provided as a service to readers; inclusion does not imply endorsement by the HBPD INT.

    Section editor

    Shui-Ying Lei

    Email: hbpdje@gmail.com

    April, 2013

    3rd ELPAT congress on ethical, legal and psychosocial aspects of transplantation

    April 20-23, 2013; World Trade Center, Rotterdam, The Netherlands

    The main theme of this congress is "Global issue, local solutions" and the focus is on the bridging the divide between international commitments, global outreach and the realization of their potential to improve the lives of patients across the world. The conference is open to all professionals involved in transplant medicine, including, but is not limited to, (bio-)ethicists, philosophers, clinicians, lawyers, anthropologists, psychologists and policy-makers in the fi eld of organ donation and transplantation. For more information, please contact: ELPAT, Frederike Ambagtsheer (Coordinator), or Marian van Noord (Secretary), Erasmus MC - Room D-415, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands. Tel: 31-10-7033002 or 31-6-42668336; Fax: 31-10-4366372; Email: secretariat@elpat.org; Website: www.elpat.org.

    May

    American transplant congress 2013 May 18-22, 2013; Seattle, WA, USA

    The 2013 American transplant congress is the 13th joint annual meeting of the American Society of Transplant Surgeons and the American Society of Transplantation. The American transplant congress will take place on May 18-22, 2013 in Seattle, Washington. The American Transplant Congress is designed for physicians, surgeons, scientists, nurses, organ procurement personnel, and pharmacists who are interested in the clinical and research aspects of solid organ and tissue transplantation. The program is developed to encourage the exchange of new scientif i c and clinical information and support an interchange of opinions regarding care and management issues, as well as socioeconomic, ethical, and regulatory issues relevant to organ and tissue transplantation. American transplant congress, 15000 Commerce Parkway, Suite C, Mt. Laurel, NJ 08054, USA. Tel: 856-439-0880; Fax: 856-439-1972; Website: www.atcmeeting.org.

    June

    ILTS 19th annual international congress June 12-15, 2013; Sydney, Australia

    The 19th annual international congress of ILTS is the leading educational congress for scientists, surgeons, anesthesiologists, physicians, nurses, and organ procurement personnel in the fi eld of liver transplantation from around the world. The congress is designed to allow the liver transplantation specialist to interact and network with individuals from various parts of the globe and to compare and understand the differences in procedures and therapy in the treatment of liver transplantation. Topics include any aspect of liver transplantation including: anesthesia/critical care medicine, extended criteria donors/disease transmission, fulminant liver failure, hepatitis C, immunosuppression, living donor, malignancies, outcomes, patient selection/ organ allocation, pediatrics, radiology, recurrent disease/ pathology, surgical techniques/complications. For more information, please visit: http://2013.ilts.org.

    The 1st world congress on controversies in gastroenterology (CIGI)

    June 13-15, 2013; Berlin, Germany

    The 1st world congress on controversies in gastroenterology (CIGI) will take place in Berlin, Germany on June 13-15, 2013. The intention of the CIGI congress is to function as an exclusive forum for international experts to debate the most important issues in the fi eld of gastroenterology. This thought-provoking academic dialogue will bring to light the most current clinical and technological questions. CIGI aims to provide a forum for discussion, for insights, for recommendations and for reliable solutions. English is the off i cial language of the congress. For more information, please contact: Headquarters & Administration, 53 Rothschild Boulevard, PO Box 68, Tel Aviv, 61000, Israel. Tel: 972-3-5666166; Fax: 972-3-5666177; Email: Info@comtecmed.com. Or Comtec China, Suite 405, Universal Center Building, 175 Xiangyang Road South, Shanghai 200031, China. Tel: 86-21-54660460; Fax: 86-21-54660450; Email: china@ comtecmed.com. Website: http://www.comtecmed.com.

    July

    22nd annual AACR aspen workshop: molecular biology in clinical oncology

    July 21-28, 2013; Westin Snowmass, Snowmass Village, Colorado

    The goal of this workshop is to provide a substantive overview of the emerging role that molecular biology plays in the clinical world. Exciting new research on the molecular mechanisms that control cell growth and differentiation has resulted in rapid expansion of our understanding of the fundamental nature of cancer cells and has suggested valuable new approaches to cancer prevention, diagnosis and treatment. The purpose of this workshop is to accelerate this process by increasing the clinical oncologist's awareness and working knowledge of molecular biology concepts and techniques. For further information, please contact Amy Baran, PhD, Program Administrator, at (215) 446-7192 or amy.baran@aacr.org. Website: http://www.aacr.org/home/scientists/meetings--workshops/educational-workshops--special-courses/ molecular-biology-in-clinical-oncology.aspx.

    September

    Third international conference on frontiers in basic cancer research

    September 18-22, 2013; Gaylord National Hotel and Convention Center, National Harbor, MD

    Conference chairperson is Prof. Scott W. Lowe from Memorial Sloan-Kettering Cancer Institute, New York, NY, USA. Basic cancer research has been inspired by the study of genes and the processes altered in human cancers by utilizing model systems ranging from yeast to mammals and patient-derived tissue. The third conference in this series will continue in the tradition of providing a stellar broad-based venue for presenting the best in basic cancer research. It is our hope that the meeting will provide a forum for discussion and interaction that will stimulate cross-disciplinary transfer of information, and thereby motivate and strengthen collaborative efforts. The conference will also provide early-career investigators with unique opportunities to interact with the leaders in the fi eld with mentoring roundtables during breakfast and lunch, the opportunity to present short talks in the plenary sessions, and three poster sessions and receptions for scientif i c interaction and networking. The deadline for submission of abstract is July 9, 2013. Website: http://www.aacr.org/home/ scientists/meetings--workshops/frontiers-in-basiccancer-research-.aspx

    14th world congress of the International Pancreas and Islet Transplant Association

    September 24-27, 2013; Monterey, California, USA

    The 14th world congress of the International Pancreas and Islet Transplant Association (IPITA 2013) is to be held in Monterey, California on September 24-27, 2013. The timing of this congress is optimal for the next wave of young scientists, as the meeting symposia will revolve around the multiple evolving options for beta cell replacement. The congress will be held in the spectacular setting of Monterey, strategically located on the Pacif i c Ocean, providing a perfect environment for the exchange of scientif i c ideas. The program will include the following topics: Clinical islet and pancreas transplantation (1, Advances in clinical islet transplantation - is this therapy ready to move beyond "experimental" trials? 2, Technological advances in islet isolation, immunoisolation barriers, beta cell imaging, and organ preservation; 3, Calcineurin-free and other novel immunosuppression regimens following pancreas or islet transplantation; 4, Pancreatectomy and autoislet transplantation for chronic pancreatitis; 5 Pancreas transplantation for indications beyond type 1 diabetes: trauma, pancreatitis, and type 2 diabetes; 6 Strategies to reduce Islet graft attrition); Immunology of islet and pancreas transplantation (1, advances in immunomonitoring the alloimmune and autoimmine response following beta cell replacement; 2, T-regulatory lymphocytes and mixed chimerism as strategies for transplantation tolerance and control of autoimmunity); Alternative source of islets (1, New sources for beta cells -functional maturation of stem cells, animal models, and preclinical issues; 2, Xenotransplantation with porcine islets - status of clinical trials and barriers to widespread application); and Further topics (1, Current state of the technology for insulin delivery and the closed loop; 2, Technological advances in the development of the bioartif i cial pancreas; 3, New advances in islet encapsulation). The deadline for submission of abstract is April 26, 2013. For more information, please contact: Secretariat: c/o: The Transplantation Society, Conference Services, 1255 University Street, Suite 605 Montreal, QC, H3B 3V9, Canada. Tel: 1-514-874-1717; Fax: 1-514-874-1716; Email: info@ipita2013.org; http:// www.ipita2013.org/.

    10.1016/S1499-3872(13)60036-3)

    AuthorAff i liations:Department of Surgery (Cheung TT and Fan ST) and State Key Laboratory for Liver Research (Fan ST), The University of Hong Kong, Hong Kong, China

    Sheung Tat Fan, MD, Department of Surgery, The University of Hong Kong, 102 Pokfulam Road, Hong Kong, China (Tel: 852-22554703; Fax: 852-29865262; Email: stfan@hku.hk)

    ? 2013, Hepatobiliary Pancreat Dis Int. All rights reserved.

    doi: 10.1016/S1499-3872(13)60035-1

    精品电影一区二区在线| 人人妻,人人澡人人爽秒播| 国产麻豆成人av免费视频| 两个人视频免费观看高清| 成人亚洲精品一区在线观看| 亚洲成人国产一区在线观看| 一边摸一边做爽爽视频免费| 又黄又粗又硬又大视频| 天堂影院成人在线观看| 欧美一级毛片孕妇| 精品一区二区三区四区五区乱码| or卡值多少钱| 18禁国产床啪视频网站| 日韩成人在线观看一区二区三区| 久久精品91蜜桃| 精品福利观看| 亚洲国产日韩欧美精品在线观看 | 午夜福利一区二区在线看| 女同久久另类99精品国产91| 老司机深夜福利视频在线观看| 亚洲在线自拍视频| 精品日产1卡2卡| 老司机午夜福利在线观看视频| 99久久国产精品久久久| a在线观看视频网站| 69av精品久久久久久| 精品免费久久久久久久清纯| 成在线人永久免费视频| 女生性感内裤真人,穿戴方法视频| 巨乳人妻的诱惑在线观看| 男人舔女人的私密视频| 99久久久亚洲精品蜜臀av| 美女国产高潮福利片在线看| 搞女人的毛片| 国产精品亚洲美女久久久| 亚洲一区二区三区不卡视频| 中文在线观看免费www的网站 | 性色av乱码一区二区三区2| 免费高清在线观看日韩| 国产av不卡久久| 国产亚洲欧美在线一区二区| 99热只有精品国产| 日韩精品免费视频一区二区三区| 亚洲国产毛片av蜜桃av| www.自偷自拍.com| 国产精品久久久久久亚洲av鲁大| 午夜福利高清视频| 国产一级毛片七仙女欲春2 | 91av网站免费观看| 美女高潮到喷水免费观看| 欧美激情 高清一区二区三区| 欧美午夜高清在线| av中文乱码字幕在线| 女同久久另类99精品国产91| 国产亚洲精品一区二区www| 免费一级毛片在线播放高清视频| 天堂影院成人在线观看| 热re99久久国产66热| 精品国产乱子伦一区二区三区| 久久 成人 亚洲| 国内精品久久久久精免费| 国产精品久久电影中文字幕| 在线看三级毛片| 久久这里只有精品19| 可以在线观看的亚洲视频| 亚洲一卡2卡3卡4卡5卡精品中文| 嫁个100分男人电影在线观看| 久久精品成人免费网站| 欧美激情高清一区二区三区| 免费看美女性在线毛片视频| 88av欧美| 岛国视频午夜一区免费看| 99re在线观看精品视频| 夜夜看夜夜爽夜夜摸| 婷婷精品国产亚洲av| 色婷婷久久久亚洲欧美| 成年版毛片免费区| 精品福利观看| 欧美三级亚洲精品| 伊人久久大香线蕉亚洲五| 久久欧美精品欧美久久欧美| 欧美在线黄色| 亚洲激情在线av| 在线天堂中文资源库| 亚洲熟妇熟女久久| 亚洲av电影在线进入| 亚洲av电影在线进入| 亚洲精品中文字幕一二三四区| 久久久久久久精品吃奶| 满18在线观看网站| 免费观看人在逋| 一边摸一边抽搐一进一小说| 好男人在线观看高清免费视频 | 成人永久免费在线观看视频| 亚洲av中文字字幕乱码综合 | 国产欧美日韩一区二区三| 国产91精品成人一区二区三区| АⅤ资源中文在线天堂| 久久久久久国产a免费观看| 亚洲欧美一区二区三区黑人| 午夜福利在线观看吧| 香蕉国产在线看| 制服诱惑二区| 成人手机av| 午夜精品久久久久久毛片777| 日韩一卡2卡3卡4卡2021年| 欧美色欧美亚洲另类二区| 好男人在线观看高清免费视频 | 99热这里只有精品一区 | 女人爽到高潮嗷嗷叫在线视频| 国产免费男女视频| 少妇熟女aⅴ在线视频| 又紧又爽又黄一区二区| 黄色成人免费大全| 亚洲国产欧美日韩在线播放| 亚洲全国av大片| 韩国精品一区二区三区| 女人高潮潮喷娇喘18禁视频| 一级a爱片免费观看的视频| 老熟妇仑乱视频hdxx| 亚洲精品一区av在线观看| 亚洲片人在线观看| 国产成年人精品一区二区| 免费高清在线观看日韩| 亚洲国产欧美一区二区综合| a在线观看视频网站| 人人妻人人澡人人看| 日本撒尿小便嘘嘘汇集6| 免费看日本二区| 精品久久久久久成人av| 50天的宝宝边吃奶边哭怎么回事| 久久精品国产综合久久久| 激情在线观看视频在线高清| 亚洲国产高清在线一区二区三 | 中文字幕人妻丝袜一区二区| 亚洲熟妇熟女久久| 亚洲欧美一区二区三区黑人| 国产精华一区二区三区| 国产精品亚洲av一区麻豆| 校园春色视频在线观看| 国产1区2区3区精品| 国产精品乱码一区二三区的特点| 成年版毛片免费区| 亚洲国产高清在线一区二区三 | 亚洲av成人不卡在线观看播放网| 最好的美女福利视频网| 黄色女人牲交| 国产精品,欧美在线| 久久久国产精品麻豆| a在线观看视频网站| 国产日本99.免费观看| 丰满人妻熟妇乱又伦精品不卡| 久久国产亚洲av麻豆专区| 亚洲国产精品合色在线| 欧美一区二区精品小视频在线| 国产精品香港三级国产av潘金莲| 好男人电影高清在线观看| 91成人精品电影| 久久中文看片网| 久久中文字幕人妻熟女| 日韩av在线大香蕉| tocl精华| 国产v大片淫在线免费观看| 两个人看的免费小视频| 91九色精品人成在线观看| 两性午夜刺激爽爽歪歪视频在线观看 | 男女下面进入的视频免费午夜 | 桃红色精品国产亚洲av| 免费在线观看黄色视频的| 首页视频小说图片口味搜索| 国产高清videossex| 99久久99久久久精品蜜桃| 久久久久久免费高清国产稀缺| 国产精品久久久av美女十八| av有码第一页| 久久久久国内视频| 狂野欧美激情性xxxx| 人妻丰满熟妇av一区二区三区| 成人永久免费在线观看视频| 自线自在国产av| 十八禁网站免费在线| 国产成人精品久久二区二区91| 麻豆国产av国片精品| 中文字幕最新亚洲高清| 在线十欧美十亚洲十日本专区| 天天躁狠狠躁夜夜躁狠狠躁| 99在线人妻在线中文字幕| 丝袜人妻中文字幕| 中出人妻视频一区二区| xxxwww97欧美| 麻豆一二三区av精品| 亚洲 欧美 日韩 在线 免费| 女人高潮潮喷娇喘18禁视频| 国产一区二区激情短视频| 麻豆国产av国片精品| 国产精品 欧美亚洲| 亚洲自偷自拍图片 自拍| 99久久久亚洲精品蜜臀av| 亚洲男人天堂网一区| 一夜夜www| 亚洲欧美激情综合另类| 久久人妻av系列| 国产精品一区二区精品视频观看| 男女午夜视频在线观看| 欧美黄色片欧美黄色片| 搡老妇女老女人老熟妇| xxxwww97欧美| 日日摸夜夜添夜夜添小说| 精品不卡国产一区二区三区| 精品一区二区三区视频在线观看免费| 国产精品久久久av美女十八| 亚洲精品久久成人aⅴ小说| 91av网站免费观看| 非洲黑人性xxxx精品又粗又长| 久久人妻av系列| 少妇 在线观看| 国产不卡一卡二| 丝袜美腿诱惑在线| 日本一区二区免费在线视频| 精品久久久久久久久久免费视频| www日本在线高清视频| 波多野结衣高清无吗| www.999成人在线观看| 国产亚洲精品久久久久5区| 三级毛片av免费| 国产99久久九九免费精品| 女同久久另类99精品国产91| av欧美777| 日韩视频一区二区在线观看| 青草久久国产| 丰满人妻熟妇乱又伦精品不卡| 久久久久国产精品人妻aⅴ院| av中文乱码字幕在线| videosex国产| 91国产中文字幕| 正在播放国产对白刺激| 欧美精品亚洲一区二区| 国产一区在线观看成人免费| 精品国产乱码久久久久久男人| 无人区码免费观看不卡| 欧美最黄视频在线播放免费| 精品国产亚洲在线| av欧美777| 亚洲一码二码三码区别大吗| 99久久精品国产亚洲精品| 人人妻人人看人人澡| 老熟妇仑乱视频hdxx| 99在线人妻在线中文字幕| 欧美成狂野欧美在线观看| 日本在线视频免费播放| 成人国产综合亚洲| 美女免费视频网站| 国产黄色小视频在线观看| 欧美中文日本在线观看视频| 人人妻人人看人人澡| 亚洲专区中文字幕在线| 久久久久久久久久黄片| cao死你这个sao货| 色综合欧美亚洲国产小说| 欧美激情久久久久久爽电影| 午夜福利18| 女性生殖器流出的白浆| 久久这里只有精品19| 日本一本二区三区精品| 亚洲成人免费电影在线观看| 黄色女人牲交| 久久精品成人免费网站| 丰满人妻熟妇乱又伦精品不卡| 欧美激情久久久久久爽电影| 天天躁夜夜躁狠狠躁躁| 亚洲av日韩精品久久久久久密| 亚洲一卡2卡3卡4卡5卡精品中文| 日本一本二区三区精品| 欧美日韩黄片免| 久久人妻福利社区极品人妻图片| tocl精华| 欧美最黄视频在线播放免费| 亚洲全国av大片| 精品久久久久久久毛片微露脸| 美女 人体艺术 gogo| 国产亚洲精品综合一区在线观看 | 成年版毛片免费区| 欧美在线黄色| av在线天堂中文字幕| 欧美色欧美亚洲另类二区| 亚洲国产日韩欧美精品在线观看 | 亚洲美女黄片视频| 成人午夜高清在线视频 | 亚洲精品在线观看二区| 女生性感内裤真人,穿戴方法视频| 麻豆av在线久日| 久久伊人香网站| 亚洲中文字幕日韩| 日韩精品免费视频一区二区三区| 日韩av在线大香蕉| svipshipincom国产片| 国产精品1区2区在线观看.| 黄色女人牲交| 国产av又大| 丁香六月欧美| 精品人妻1区二区| av在线天堂中文字幕| 色综合欧美亚洲国产小说| 国产精品国产高清国产av| 久久狼人影院| 麻豆av在线久日| 久久国产精品人妻蜜桃| 日韩中文字幕欧美一区二区| 男女做爰动态图高潮gif福利片| 亚洲精华国产精华精| 精品久久久久久久久久久久久 | 久久久久久久久久黄片| 十八禁人妻一区二区| 亚洲欧美日韩高清在线视频| 亚洲成人久久性| 久久久久久国产a免费观看| 成年免费大片在线观看| 亚洲最大成人中文| 久热这里只有精品99| 老鸭窝网址在线观看| √禁漫天堂资源中文www| 欧美成人午夜精品| 久久天堂一区二区三区四区| 国产欧美日韩一区二区精品| 国产亚洲精品综合一区在线观看 | 亚洲真实伦在线观看| 69av精品久久久久久| 欧美中文综合在线视频| 午夜两性在线视频| 99精品欧美一区二区三区四区| 国产极品粉嫩免费观看在线| 国产亚洲精品一区二区www| 12—13女人毛片做爰片一| 丝袜美腿诱惑在线| 亚洲国产精品久久男人天堂| 麻豆成人av在线观看| 国产精品一区二区三区四区久久 | 久久国产亚洲av麻豆专区| 欧美av亚洲av综合av国产av| 欧美zozozo另类| 九色国产91popny在线| 999久久久精品免费观看国产| 一区二区日韩欧美中文字幕| 欧美成人一区二区免费高清观看 | 久久久水蜜桃国产精品网| 真人一进一出gif抽搐免费| 午夜日韩欧美国产| 国产爱豆传媒在线观看 | 日日干狠狠操夜夜爽| 精品久久久久久久久久久久久 | 一进一出好大好爽视频| 一本一本综合久久| 午夜日韩欧美国产| 国产真人三级小视频在线观看| 久久亚洲真实| 欧美成人免费av一区二区三区| 99久久国产精品久久久| 中文字幕高清在线视频| 日韩一卡2卡3卡4卡2021年| 精品国产乱子伦一区二区三区| 日韩三级视频一区二区三区| 午夜福利视频1000在线观看| 国产1区2区3区精品| 搡老岳熟女国产| a级毛片在线看网站| 我的亚洲天堂| av天堂在线播放| 中亚洲国语对白在线视频| 脱女人内裤的视频| 人人妻人人澡欧美一区二区| 欧美成人性av电影在线观看| 国产又黄又爽又无遮挡在线| 国内少妇人妻偷人精品xxx网站 | 国产精品亚洲美女久久久| 欧美日本亚洲视频在线播放| 人成视频在线观看免费观看| 黄色a级毛片大全视频| 欧美又色又爽又黄视频| 久久精品国产亚洲av高清一级| 最近最新中文字幕大全电影3 | 国产91精品成人一区二区三区| 国产极品粉嫩免费观看在线| 两性午夜刺激爽爽歪歪视频在线观看 | 男男h啪啪无遮挡| 亚洲真实伦在线观看| 久久亚洲真实| 9191精品国产免费久久| 日韩成人在线观看一区二区三区| 1024视频免费在线观看| 国产欧美日韩一区二区精品| 搡老熟女国产l中国老女人| 国产精品久久久人人做人人爽| 最近在线观看免费完整版| 亚洲自偷自拍图片 自拍| 国产成年人精品一区二区| e午夜精品久久久久久久| 熟妇人妻久久中文字幕3abv| 免费在线观看完整版高清| 97超级碰碰碰精品色视频在线观看| 精品福利观看| 啦啦啦 在线观看视频| 在线av久久热| 久久国产精品影院| 色综合站精品国产| www国产在线视频色| 精品一区二区三区视频在线观看免费| 露出奶头的视频| 国产亚洲欧美精品永久| 亚洲三区欧美一区| 国产黄a三级三级三级人| 免费在线观看亚洲国产| 免费无遮挡裸体视频| 国产三级黄色录像| 日本撒尿小便嘘嘘汇集6| 一二三四在线观看免费中文在| 亚洲激情在线av| 午夜福利在线观看吧| 中文字幕av电影在线播放| 日韩精品青青久久久久久| 久久精品91无色码中文字幕| 久久国产亚洲av麻豆专区| 日韩精品免费视频一区二区三区| 麻豆国产av国片精品| 亚洲专区字幕在线| 男女床上黄色一级片免费看| 两人在一起打扑克的视频| 久热爱精品视频在线9| 亚洲av日韩精品久久久久久密| 久久久久国产一级毛片高清牌| 曰老女人黄片| 变态另类丝袜制服| 女人被狂操c到高潮| 久久精品91蜜桃| 黑丝袜美女国产一区| 中文字幕最新亚洲高清| 大型黄色视频在线免费观看| 久久精品aⅴ一区二区三区四区| 黄色视频不卡| 欧美丝袜亚洲另类 | 亚洲熟女毛片儿| 淫秽高清视频在线观看| 国产精品久久电影中文字幕| 欧美+亚洲+日韩+国产| 中国美女看黄片| 成人永久免费在线观看视频| 久久久久久久久久黄片| 老司机福利观看| 一区二区三区高清视频在线| 满18在线观看网站| 午夜免费鲁丝| 国产又色又爽无遮挡免费看| 1024手机看黄色片| 女性被躁到高潮视频| 宅男免费午夜| 精品日产1卡2卡| 此物有八面人人有两片| www.www免费av| 亚洲天堂国产精品一区在线| 日韩欧美 国产精品| 最近最新中文字幕大全免费视频| 午夜久久久久精精品| 国产精品久久久av美女十八| 成人手机av| 精品福利观看| 黄色视频,在线免费观看| 最新美女视频免费是黄的| 18禁黄网站禁片免费观看直播| 桃红色精品国产亚洲av| 国产免费男女视频| 国产精品日韩av在线免费观看| 久久伊人香网站| 男女午夜视频在线观看| 亚洲色图 男人天堂 中文字幕| 婷婷精品国产亚洲av| 国产亚洲精品久久久久5区| 免费观看精品视频网站| av中文乱码字幕在线| 青草久久国产| 国产精品乱码一区二三区的特点| 亚洲熟妇中文字幕五十中出| 欧洲精品卡2卡3卡4卡5卡区| 久久久国产欧美日韩av| 亚洲成人久久爱视频| 亚洲专区国产一区二区| 一夜夜www| 热re99久久国产66热| 中文字幕人妻丝袜一区二区| 亚洲男人的天堂狠狠| 亚洲精品一区av在线观看| 午夜精品久久久久久毛片777| 中文亚洲av片在线观看爽| cao死你这个sao货| 黑人欧美特级aaaaaa片| 亚洲精品久久成人aⅴ小说| 桃色一区二区三区在线观看| 悠悠久久av| 制服诱惑二区| 中文亚洲av片在线观看爽| 色播亚洲综合网| 亚洲自偷自拍图片 自拍| 精品久久久久久久毛片微露脸| 人妻丰满熟妇av一区二区三区| 黄色女人牲交| 成熟少妇高潮喷水视频| av中文乱码字幕在线| 无人区码免费观看不卡| 亚洲成人免费电影在线观看| 啪啪无遮挡十八禁网站| 国产伦在线观看视频一区| 嫩草影院精品99| 成人一区二区视频在线观看| 欧美黄色片欧美黄色片| 欧美中文综合在线视频| 日韩 欧美 亚洲 中文字幕| 国产精品美女特级片免费视频播放器 | 一级a爱片免费观看的视频| 非洲黑人性xxxx精品又粗又长| 麻豆久久精品国产亚洲av| 两性夫妻黄色片| 身体一侧抽搐| 亚洲成av人片免费观看| 激情在线观看视频在线高清| 少妇裸体淫交视频免费看高清 | 亚洲av成人不卡在线观看播放网| 久久久国产成人免费| 精品一区二区三区视频在线观看免费| 午夜福利在线观看吧| 国产精品98久久久久久宅男小说| 日韩av在线大香蕉| 激情在线观看视频在线高清| 国产成人精品久久二区二区91| 亚洲一区中文字幕在线| 最近最新中文字幕大全免费视频| 欧美绝顶高潮抽搐喷水| 久久中文字幕人妻熟女| 男男h啪啪无遮挡| 露出奶头的视频| 热re99久久国产66热| av有码第一页| 久久国产亚洲av麻豆专区| 亚洲无线在线观看| 久久 成人 亚洲| 国产一区二区在线av高清观看| 精品国产乱子伦一区二区三区| 久久久久久久久久黄片| 天堂影院成人在线观看| 他把我摸到了高潮在线观看| 国产久久久一区二区三区| 男人舔女人下体高潮全视频| 99久久综合精品五月天人人| www日本黄色视频网| 狂野欧美激情性xxxx| 国产在线观看jvid| 久久草成人影院| 搡老岳熟女国产| 99久久综合精品五月天人人| 啦啦啦免费观看视频1| 人妻久久中文字幕网| 巨乳人妻的诱惑在线观看| 亚洲欧美精品综合久久99| 中文字幕人成人乱码亚洲影| 中出人妻视频一区二区| 99re在线观看精品视频| 亚洲精品国产一区二区精华液| 一a级毛片在线观看| 午夜福利成人在线免费观看| 人人妻人人澡欧美一区二区| 国产单亲对白刺激| 精华霜和精华液先用哪个| 欧美成人免费av一区二区三区| av欧美777| 国产av一区在线观看免费| 久久精品国产清高在天天线| 成人18禁高潮啪啪吃奶动态图| 亚洲av美国av| 99精品在免费线老司机午夜| 成人免费观看视频高清| 欧美日本视频| 香蕉丝袜av| 岛国在线观看网站| 久久亚洲真实| 久久香蕉精品热| 青草久久国产| 欧美亚洲日本最大视频资源| 麻豆成人午夜福利视频| 男人舔女人的私密视频| 中文字幕精品亚洲无线码一区 | 国产一区二区三区在线臀色熟女| 无限看片的www在线观看| a级毛片在线看网站| 国产99白浆流出| 无人区码免费观看不卡| 18禁黄网站禁片免费观看直播| 嫩草影视91久久| 中文字幕人妻熟女乱码| 天天躁狠狠躁夜夜躁狠狠躁| 最新美女视频免费是黄的| 亚洲性夜色夜夜综合| 午夜日韩欧美国产| 欧美激情高清一区二区三区| 欧美成人午夜精品| 别揉我奶头~嗯~啊~动态视频| 亚洲自拍偷在线| 国产人伦9x9x在线观看| av有码第一页| 99国产精品一区二区三区| 桃红色精品国产亚洲av| 天天躁夜夜躁狠狠躁躁| 亚洲成国产人片在线观看| 午夜福利一区二区在线看| 午夜成年电影在线免费观看| 麻豆久久精品国产亚洲av| 欧美黄色淫秽网站| 亚洲第一青青草原| av电影中文网址|