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专访|陆信武:颈动脉狭窄需防中风,微创新技术拆除主动脉瘤

2017-06-04 肖蓓 澎湃新闻

主动脉夹层、主动脉瘤,是致死率非常高的疾病,犹如一颗“不定时炸弹”,随时威胁患者生命。近三十年,随着血管外科的兴起,微创介入手术逐渐取代传统的开胸大手术,通过在血管内放置支架来拆除这个随时会破裂的“炸弹”。上海交大医学院附属第九人民医院血管外科主任陆信武教授,就是专注于此类疾病的“拆弹专家”。他带领九院血管外科,在累及弓上分支的主动脉腔内修复术中,创造 “激光原位开窗技术”,取得了初步成果。他

主动脉夹层、主动脉瘤,是致死率非常高的疾病,犹如一颗“不定时炸弹”,随时威胁患者生命。近三十年,随着血管外科的兴起,微创介入手术逐渐取代传统的开胸大手术,通过在血管内放置支架来拆除这个随时会破裂的“炸弹”。

上海交大医学院附属第九人民医院血管外科主任陆信武教授,就是专注于此类疾病的“拆弹专家”。他带领九院血管外科,在累及弓上分支的主动脉腔内修复术中,创造 “激光原位开窗技术”,取得了初步成果。

他说,“传统的开胸大手术由心胸外科进行,必须在心脏停跳体外循环的条件下进行,创伤大,住院时间长,术后要进入ICU,死亡率高达35%。而采用微创介入手术两三个小时就能完成,创伤小、恢复快,一周后就可以出院。”

创造“激光原位开窗技术”

正常的人体动脉血管由三层结构组成——内膜、中膜和外膜,三层结构紧密贴合,共同承载血流的通过。动脉夹层是指由于内膜局部撕裂,受到强有力的血液冲击,内膜逐步剥离、扩展,在动脉内形成真、假两腔。从而导致一系列包括撕裂样疼痛的表现。

陆信武解释说,主动脉是身体的主干血管,承受直接来自心脏跳动的压力,血流量巨大,出现内膜层撕裂,如果不进行恰当和及时的治疗,破裂的机会非常大,死亡率也非常高。以往的文献报告,1周内的死亡率高达50%,一个月内的死亡率在60%~70%之间。慢性期因假腔的扩大和压力的增加,形成夹层动脉瘤,真腔血管的血流量降低,则会导致主动脉所供血区域的脏器缺血。

主动脉弓上动脉疾病包括急性A型和B型主动脉夹层和动脉瘤,这些都是血管外科手术的难题。这些疾病的发病率和死亡率常常与临床表现出的并发症(如内脏、肾和肢体缺血或血管破裂)相关。其中,A型夹层的死亡率很高。

陆信武说,对于急性动脉夹层的患者,首先应该进行相应的保守治疗,控制血压、控制疼痛。在患者情况适当稳定后,根据夹层的类型选择手术及介入治疗。常见类型的主动脉夹层,以微创腔内治疗为主。九院在B型主动脉夹层的微创介入手术水平达到国内前列,近两年又探索在A型主动脉夹层进行“原位激光开窗技术”。

由于主动脉复杂的解剖结构和分支的变异性,在胸主动脉腔内修复术中,主动脉主要分支的重建是非常复杂的。基于经验,在累及弓上分支的主动脉腔内修复术(TEVAR)中,原位激光开窗技术对于弓上分支的血运重建有着极大的助益。原位开窗术是很多技术的结合:用针或者导丝的尖端穿刺,射频探测,或者应用激光开窗。导管从远端肱动脉穿刺进入,植入覆膜支架,运用激光在覆膜支架的膜上打孔开窗,重建弓上三支动脉的血运。这一创新技术经过体外研究、动物实验以及临床研究,已经取得了初步成果,现已完成了一百多例临床病例,相关论文发表在《美国心脏外科协会杂志》。

他总结道,“这技术用一个快速简单的改变,稳定又安全地扩大了TEVAR技术的适用范围,术后恢复好,没有围手术期中风,心肌梗塞、 短暂性脑缺血发作、脑梗死或其他神经系统并发症发生,没有内漏。手术动脉术后及长期随访皆显影良好。”

曾有一个31岁的外地男子,突发主动脉夹层,胸痛三天,因为害怕开胸手术,由外地转院来到九院。“患者大学毕业,是家庭的顶梁柱,还有两个孩子,无论如何要全力抢救!”接到患者后,陆信武立即安排急诊手术,当天做了激光原位开窗弓上三分支重建手术,一周后原来的A型夹层完全封闭,顺利出院,6个月后随访,升主动脉成熟良好,现在一年了恢复得很好。

颈动脉狭窄需防中风

颈动脉狭窄是导致大脑供血不足引起脑中风的重要原因,颈动脉狭窄的人可有头晕目眩,一侧眼暂时性发黑,胳膊腿发麻无力,说话不清等不适,但80%的病人没有任何症状。正因为症状不明显,很多人对于颈动脉狭窄的重视不足。

陆信武说,颈动脉狭窄的病人,会出现头晕、眼黑、摔倒等短暂性脑缺血症状,或者“小中风”等,但是过后就觉得没事了,认为不需要手术治疗。其实,这一疾病是中风的重要原因。由于颈动脉血管内的斑块形成了动脉狭窄,在血流速度快的时候,斑块破裂出血形成血栓,小血栓随着血流冲到脑动脉中就易造成缺血性脑中风。50岁以上、高血压、高血脂、糖尿病、冠心病、吸烟、肥胖为此病的易患因素。这些高危人群应该定期做颈动脉彩超和脑血管造影,检测是否存在血管狭窄或阻塞。

其实,大部分颈动脉狭窄的病人是可以通过治疗预防中风的,主要措施有药物、颈动脉内膜剥脱手术和血管内支架成形术。当颈动脉狭窄在50%~70%的,通过药物治疗可以明显降低中风概率,药物包括他丁类药物来稳定斑块以及抗血小板药物等。

颈动脉狭窄大于70%以上的,需要进行手术干预。颈动脉内膜切除术是将动脉内膜切开并剥离增厚的内膜而使血管再通的手术,首要目的是预防卒中的发生。颈动脉支架成形术创伤小,病人在清醒状态下,从大腿根部穿刺,用球囊扩张狭窄部位,再将支架放置在血管内,保持管腔持久通畅。此治疗方法操作简单,成功率超过95%。联合使用脑保护装置可降低血栓脱落、脑栓塞并发症的危险性。

随着生活方式的改变,动脉粥样硬化出现年轻化趋势。陆信武说,动脉分三层,上下肢动脉是高阻力的,血流速度慢,当出现50%的狭窄时会引起病变;内脏动脉是中阻力,当出现60%的狭窄时会出现症状;颈动脉是低阻力的,血流速度快,当出现70%的狭窄时,才会出现症状。

如何预防动脉狭窄?陆信武说,一句话就是“管住嘴,迈开腿”,首先要改变饮食结构,减少高脂肪、高蛋白、牛奶、咖啡的摄入量,其次改变久坐、开车的生活习惯,多运动。对于45岁以上的高血压、高血脂、高血糖的高危人群,可以通过定期做B超、CT检查发现是否存在动脉狭窄。

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[GetPortalCommentsPageByObjectIdResponse(id=1843461, encodeId=95df1843461ce, content=<a href='/topic/show?id=dab8100523bb' target=_blank style='color:#2F92EE;'>#颈动脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=68, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=100523, encryptionId=dab8100523bb, topicName=颈动脉)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=416347, createdName=mhzhuang@stu.e, createdTime=Mon Jan 22 02:44:00 CST 2018, time=2018-01-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1903762, encodeId=14b71903e62f4, content=<a href='/topic/show?id=be285836438' target=_blank style='color:#2F92EE;'>#新技术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=56, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=58364, encryptionId=be285836438, topicName=新技术)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d39f177, createdName=lixiao3326, createdTime=Wed Aug 16 18:44:00 CST 2017, time=2017-08-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1703251, encodeId=893a1e0325135, content=<a href='/topic/show?id=dba720e31b7' target=_blank style='color:#2F92EE;'>#专访#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=53, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=20731, encryptionId=dba720e31b7, topicName=专访)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=070a30497323, createdName=flyingeagle87, createdTime=Sun Sep 24 08:44:00 CST 2017, time=2017-09-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2076156, encodeId=09ec20e61560f, content=<a href='/topic/show?id=e3279e985cf' target=_blank style='color:#2F92EE;'>#陆信武#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=86, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=97985, encryptionId=e3279e985cf, topicName=陆信武)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ba58436, createdName=马龙, createdTime=Tue Jul 04 05:44:00 CST 2017, time=2017-07-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1285356, encodeId=698b128535698, content=<a href='/topic/show?id=77903209422' target=_blank style='color:#2F92EE;'>#创新#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=32094, encryptionId=77903209422, topicName=创新)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=512a199, createdName=lilianxiang, createdTime=Tue Jun 06 13:44:00 CST 2017, time=2017-06-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1316991, encodeId=c506131699144, content=<a href='/topic/show?id=df8950505a2' target=_blank style='color:#2F92EE;'>#微创#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=50505, encryptionId=df8950505a2, topicName=微创)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=644e456, createdName=vera_1203, createdTime=Tue Jun 06 13:44:00 CST 2017, time=2017-06-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1415144, encodeId=71871415144ed, content=<a href='/topic/show?id=04812314540' target=_blank style='color:#2F92EE;'>#主动脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=60, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=23145, encryptionId=04812314540, topicName=主动脉)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=77603112682, createdName=circumcision, createdTime=Tue Jun 06 13:44:00 CST 2017, time=2017-06-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1429020, encodeId=2ecb14290204f, content=<a href='/topic/show?id=ee192321560' target=_blank style='color:#2F92EE;'>#主动脉瘤#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=46, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=23215, encryptionId=ee192321560, topicName=主动脉瘤)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=95e34160730, createdName=fengting4, createdTime=Tue Jun 06 13:44:00 CST 2017, time=2017-06-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1496872, encodeId=bec214968e2b7, content=<a href='/topic/show?id=217b33259df' target=_blank style='color:#2F92EE;'>#动脉狭窄#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=33259, encryptionId=217b33259df, topicName=动脉狭窄)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=b4ae9287436, createdName=piaojinhua, createdTime=Tue Jun 06 13:44:00 CST 2017, time=2017-06-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=206822, encodeId=af032068220e, content=非常好的文章,学习了,很受益, beContent=null, objectType=article, channel=null, level=null, likeNumber=83, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7LIiaRZTzJ3SEfiauCzTMPW7YvPPYLNJBXG9oh6Al1icq2VQQkIHWxqXehcicTS62YKJVBhxeth3wggw/0, createdBy=7ce01621306, createdName=天涯183, createdTime=Mon Jun 05 11:10:44 CST 2017, time=2017-06-05, status=1, ipAttribution=)]
  4. [GetPortalCommentsPageByObjectIdResponse(id=1843461, encodeId=95df1843461ce, content=<a href='/topic/show?id=dab8100523bb' target=_blank style='color:#2F92EE;'>#颈动脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=68, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=100523, encryptionId=dab8100523bb, topicName=颈动脉)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=416347, createdName=mhzhuang@stu.e, createdTime=Mon Jan 22 02:44:00 CST 2018, time=2018-01-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1903762, encodeId=14b71903e62f4, content=<a href='/topic/show?id=be285836438' target=_blank style='color:#2F92EE;'>#新技术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=56, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=58364, encryptionId=be285836438, topicName=新技术)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d39f177, createdName=lixiao3326, createdTime=Wed Aug 16 18:44:00 CST 2017, time=2017-08-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1703251, encodeId=893a1e0325135, content=<a href='/topic/show?id=dba720e31b7' target=_blank style='color:#2F92EE;'>#专访#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=53, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=20731, encryptionId=dba720e31b7, topicName=专访)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=070a30497323, createdName=flyingeagle87, createdTime=Sun Sep 24 08:44:00 CST 2017, time=2017-09-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2076156, encodeId=09ec20e61560f, content=<a href='/topic/show?id=e3279e985cf' target=_blank style='color:#2F92EE;'>#陆信武#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=86, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=97985, encryptionId=e3279e985cf, topicName=陆信武)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ba58436, createdName=马龙, createdTime=Tue Jul 04 05:44:00 CST 2017, time=2017-07-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1285356, encodeId=698b128535698, content=<a href='/topic/show?id=77903209422' target=_blank style='color:#2F92EE;'>#创新#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=32094, encryptionId=77903209422, topicName=创新)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=512a199, createdName=lilianxiang, createdTime=Tue Jun 06 13:44:00 CST 2017, time=2017-06-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1316991, encodeId=c506131699144, content=<a href='/topic/show?id=df8950505a2' target=_blank style='color:#2F92EE;'>#微创#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=50505, encryptionId=df8950505a2, topicName=微创)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=644e456, createdName=vera_1203, createdTime=Tue Jun 06 13:44:00 CST 2017, time=2017-06-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1415144, encodeId=71871415144ed, content=<a href='/topic/show?id=04812314540' target=_blank style='color:#2F92EE;'>#主动脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=60, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=23145, encryptionId=04812314540, topicName=主动脉)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=77603112682, createdName=circumcision, createdTime=Tue Jun 06 13:44:00 CST 2017, time=2017-06-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1429020, encodeId=2ecb14290204f, content=<a href='/topic/show?id=ee192321560' target=_blank style='color:#2F92EE;'>#主动脉瘤#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=46, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=23215, encryptionId=ee192321560, topicName=主动脉瘤)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=95e34160730, createdName=fengting4, createdTime=Tue Jun 06 13:44:00 CST 2017, time=2017-06-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1496872, encodeId=bec214968e2b7, content=<a href='/topic/show?id=217b33259df' target=_blank style='color:#2F92EE;'>#动脉狭窄#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=33259, encryptionId=217b33259df, topicName=动脉狭窄)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=b4ae9287436, createdName=piaojinhua, createdTime=Tue Jun 06 13:44:00 CST 2017, time=2017-06-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=206822, encodeId=af032068220e, content=非常好的文章,学习了,很受益, beContent=null, objectType=article, channel=null, level=null, likeNumber=83, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7LIiaRZTzJ3SEfiauCzTMPW7YvPPYLNJBXG9oh6Al1icq2VQQkIHWxqXehcicTS62YKJVBhxeth3wggw/0, createdBy=7ce01621306, createdName=天涯183, createdTime=Mon Jun 05 11:10:44 CST 2017, time=2017-06-05, status=1, ipAttribution=)]
    2017-07-04 马龙
  5. [GetPortalCommentsPageByObjectIdResponse(id=1843461, encodeId=95df1843461ce, content=<a href='/topic/show?id=dab8100523bb' target=_blank style='color:#2F92EE;'>#颈动脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=68, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=100523, encryptionId=dab8100523bb, topicName=颈动脉)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=416347, createdName=mhzhuang@stu.e, createdTime=Mon Jan 22 02:44:00 CST 2018, time=2018-01-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1903762, encodeId=14b71903e62f4, content=<a href='/topic/show?id=be285836438' target=_blank style='color:#2F92EE;'>#新技术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=56, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=58364, encryptionId=be285836438, topicName=新技术)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d39f177, 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href='/topic/show?id=ee192321560' target=_blank style='color:#2F92EE;'>#主动脉瘤#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=46, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=23215, encryptionId=ee192321560, topicName=主动脉瘤)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=95e34160730, createdName=fengting4, createdTime=Tue Jun 06 13:44:00 CST 2017, time=2017-06-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1496872, encodeId=bec214968e2b7, content=<a href='/topic/show?id=217b33259df' target=_blank style='color:#2F92EE;'>#动脉狭窄#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=33259, encryptionId=217b33259df, topicName=动脉狭窄)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=b4ae9287436, createdName=piaojinhua, createdTime=Tue Jun 06 13:44:00 CST 2017, time=2017-06-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=206822, encodeId=af032068220e, content=非常好的文章,学习了,很受益, beContent=null, objectType=article, channel=null, level=null, likeNumber=83, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7LIiaRZTzJ3SEfiauCzTMPW7YvPPYLNJBXG9oh6Al1icq2VQQkIHWxqXehcicTS62YKJVBhxeth3wggw/0, createdBy=7ce01621306, createdName=天涯183, createdTime=Mon Jun 05 11:10:44 CST 2017, time=2017-06-05, status=1, ipAttribution=)]
  6. 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encryptionId=e3279e985cf, topicName=陆信武)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ba58436, createdName=马龙, createdTime=Tue Jul 04 05:44:00 CST 2017, time=2017-07-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1285356, encodeId=698b128535698, content=<a href='/topic/show?id=77903209422' target=_blank style='color:#2F92EE;'>#创新#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=32094, encryptionId=77903209422, topicName=创新)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=512a199, createdName=lilianxiang, createdTime=Tue Jun 06 13:44:00 CST 2017, time=2017-06-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1316991, encodeId=c506131699144, content=<a href='/topic/show?id=df8950505a2' target=_blank style='color:#2F92EE;'>#微创#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=50505, encryptionId=df8950505a2, topicName=微创)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=644e456, createdName=vera_1203, createdTime=Tue Jun 06 13:44:00 CST 2017, time=2017-06-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1415144, encodeId=71871415144ed, content=<a href='/topic/show?id=04812314540' target=_blank style='color:#2F92EE;'>#主动脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=60, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=23145, encryptionId=04812314540, topicName=主动脉)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=77603112682, createdName=circumcision, createdTime=Tue Jun 06 13:44:00 CST 2017, time=2017-06-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1429020, encodeId=2ecb14290204f, content=<a href='/topic/show?id=ee192321560' target=_blank style='color:#2F92EE;'>#主动脉瘤#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=46, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=23215, encryptionId=ee192321560, topicName=主动脉瘤)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=95e34160730, createdName=fengting4, createdTime=Tue Jun 06 13:44:00 CST 2017, time=2017-06-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1496872, encodeId=bec214968e2b7, content=<a href='/topic/show?id=217b33259df' target=_blank style='color:#2F92EE;'>#动脉狭窄#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=33259, encryptionId=217b33259df, topicName=动脉狭窄)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=b4ae9287436, createdName=piaojinhua, createdTime=Tue Jun 06 13:44:00 CST 2017, time=2017-06-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=206822, encodeId=af032068220e, content=非常好的文章,学习了,很受益, beContent=null, objectType=article, channel=null, level=null, likeNumber=83, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7LIiaRZTzJ3SEfiauCzTMPW7YvPPYLNJBXG9oh6Al1icq2VQQkIHWxqXehcicTS62YKJVBhxeth3wggw/0, createdBy=7ce01621306, createdName=天涯183, createdTime=Mon Jun 05 11:10:44 CST 2017, time=2017-06-05, status=1, ipAttribution=)]
    2017-06-06 vera_1203
  7. [GetPortalCommentsPageByObjectIdResponse(id=1843461, encodeId=95df1843461ce, content=<a href='/topic/show?id=dab8100523bb' target=_blank style='color:#2F92EE;'>#颈动脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=68, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=100523, encryptionId=dab8100523bb, topicName=颈动脉)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=416347, createdName=mhzhuang@stu.e, createdTime=Mon Jan 22 02:44:00 CST 2018, time=2018-01-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1903762, encodeId=14b71903e62f4, content=<a href='/topic/show?id=be285836438' target=_blank style='color:#2F92EE;'>#新技术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=56, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=58364, encryptionId=be285836438, topicName=新技术)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d39f177, 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time=2017-06-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=206822, encodeId=af032068220e, content=非常好的文章,学习了,很受益, beContent=null, objectType=article, channel=null, level=null, likeNumber=83, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7LIiaRZTzJ3SEfiauCzTMPW7YvPPYLNJBXG9oh6Al1icq2VQQkIHWxqXehcicTS62YKJVBhxeth3wggw/0, createdBy=7ce01621306, createdName=天涯183, createdTime=Mon Jun 05 11:10:44 CST 2017, time=2017-06-05, status=1, ipAttribution=)]
  8. 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level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=50505, encryptionId=df8950505a2, topicName=微创)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=644e456, createdName=vera_1203, createdTime=Tue Jun 06 13:44:00 CST 2017, time=2017-06-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1415144, encodeId=71871415144ed, content=<a href='/topic/show?id=04812314540' target=_blank style='color:#2F92EE;'>#主动脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=60, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=23145, encryptionId=04812314540, topicName=主动脉)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=77603112682, createdName=circumcision, createdTime=Tue Jun 06 13:44:00 CST 2017, time=2017-06-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1429020, encodeId=2ecb14290204f, content=<a 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time=2017-06-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=206822, encodeId=af032068220e, content=非常好的文章,学习了,很受益, beContent=null, objectType=article, channel=null, level=null, likeNumber=83, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7LIiaRZTzJ3SEfiauCzTMPW7YvPPYLNJBXG9oh6Al1icq2VQQkIHWxqXehcicTS62YKJVBhxeth3wggw/0, createdBy=7ce01621306, createdName=天涯183, createdTime=Mon Jun 05 11:10:44 CST 2017, time=2017-06-05, status=1, ipAttribution=)]
  9. [GetPortalCommentsPageByObjectIdResponse(id=1843461, encodeId=95df1843461ce, content=<a href='/topic/show?id=dab8100523bb' target=_blank style='color:#2F92EE;'>#颈动脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=68, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=100523, encryptionId=dab8100523bb, topicName=颈动脉)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=416347, createdName=mhzhuang@stu.e, createdTime=Mon Jan 22 02:44:00 CST 2018, time=2018-01-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1903762, encodeId=14b71903e62f4, content=<a href='/topic/show?id=be285836438' target=_blank style='color:#2F92EE;'>#新技术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=56, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=58364, encryptionId=be285836438, topicName=新技术)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d39f177, 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time=2017-06-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=206822, encodeId=af032068220e, content=非常好的文章,学习了,很受益, beContent=null, objectType=article, channel=null, level=null, likeNumber=83, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7LIiaRZTzJ3SEfiauCzTMPW7YvPPYLNJBXG9oh6Al1icq2VQQkIHWxqXehcicTS62YKJVBhxeth3wggw/0, createdBy=7ce01621306, createdName=天涯183, createdTime=Mon Jun 05 11:10:44 CST 2017, time=2017-06-05, status=1, ipAttribution=)]
  10. 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time=2017-06-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=206822, encodeId=af032068220e, content=非常好的文章,学习了,很受益, beContent=null, objectType=article, channel=null, level=null, likeNumber=83, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7LIiaRZTzJ3SEfiauCzTMPW7YvPPYLNJBXG9oh6Al1icq2VQQkIHWxqXehcicTS62YKJVBhxeth3wggw/0, createdBy=7ce01621306, createdName=天涯183, createdTime=Mon Jun 05 11:10:44 CST 2017, time=2017-06-05, status=1, ipAttribution=)]
    2017-06-05 天涯183

    非常好的文章,学习了,很受益

    0

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