Baidu
map

「保胆手术」被踢出中国专家共识,胆囊良性疾病到底怎么治?

2021-09-30 MedSci原创 MedSci原创

「保胆手术」or「切除胆囊」?

胆囊切除术是公认的胆囊良性疾病的治愈手段, 国内外学术界对于手术适应证和手术时机已有明确共识。近年来,保胆手术治疗胆囊良性疾病颇受热议,一 些医生将保护胆囊的学术观点等同于保留胆囊的手术技术,这种误解可能导致病人出现差异性的预后。

近日,中国外科杂志发表了《胆囊良性疾病外科治疗的专家共识》(以下简称为共识)指出,不规范治疗不仅会导致胆囊癌的发病率上升,还会延误胆囊癌的诊断和治疗时机。同时,共识强调,在治疗胆囊良性疾病时,不能盲目扩大胆囊切除术的指征,并反对对胆囊良性疾病实施保胆手术,且不推荐使用药物溶石、排石和体外冲击波碎石等治疗方法。

保护胆囊保留胆囊一样吗?

胆囊是一个具有浓缩、储存、排泄胆汁并能调 节胆道压力的重要消化器官,部分患者在胆囊切除后可能出现腹痛、消化不良等症状,极少数病人还会出现严重的并发症。因此,把握手术适应证和手术时机、提高手术技术、防治并发症是治疗胆囊良性疾病的基本原则。

目前,科学界对结石性胆囊炎仍存在切胆保胆之争。针对此问题,共识指出胆囊切除术是胆囊良性疾病的唯一治愈性手段,反对实施保胆取石手术。正如胆道之父黄志强院士所说,保胆取石并不是盲目地去保留胆囊,不是把胆囊保留下来就是保胆,保护有功能的胆囊才是真正意义上的保胆,而不是保留一个病变的胆囊。

共识指出,由于胆囊结石是胆囊癌的危险因素,无论其有无症状,均有手术指征。对于暂不接受手术的无症状胆囊结石患者,应密切随访,如出现临床症状、胆囊结石相关并发症(急性胰腺炎、胆总管结石或胆管炎等)及有胆囊癌的危险因素时,应及时实施胆囊切除术。

胆囊切除手术最佳时机是什么时候?

科学地掌握手术适应证,把握手术时机、规范手术方式、加强围手术期管理、防治并发症、预防癌变是胆囊良性疾病外科治疗的基本原则。临床医师应科学掌握胆囊良性疾病的手术指征,符合下述手术指征中任一项的患者,应择期行胆囊切除术:

1)胆囊结石,无论是否有症状;

2)有相关并发症,如继发性胆总管结石、胆管炎、胆源性胰腺炎等;

3)具有胆囊癌危险因素,如胆囊萎缩、充满型结石、瓷化胆囊、胆囊壁增厚(≥3 mm)、胆囊肿瘤性息肉等;

4)合并先天性胰胆管汇合异常、原发性硬化性胆管炎、肥胖与糖尿病等;

5)胆囊畸形等;

共识推荐,胆囊结石患者无论有无症状,均推荐实施胆囊切除术。对于暂不接受手术治疗的无症状胆囊结石患者,应密切随访,如出现症状、胆囊结石相关并发症及胆囊癌危险因素时,应及时实施胆囊切除术。

胆囊炎的治疗方式如何选?

在胆囊炎的诊疗过程中,应依据临床症状、体征、实验室检查结果和影像学检查结果综合评估急性胆囊炎的严重程度,制订相应治疗决策并动态评估病情及疗效。

1)对于轻度急性胆囊炎患者,共识推荐:轻度急性胆囊炎首选急诊胆囊切除术。但如经综合评估发现手术风险较高,可考虑替代治疗方案。轻度急性胆囊炎应在起病1周内尽早实施胆囊切除术,首选LC72 h内为最佳手术时机。

(2)对于中度和重度急性胆囊炎患者,共识推荐:中、重度急性胆囊炎可早期或急诊实施胆囊切除术。对于不适合行急诊手术者,可先行PTGBD

(3)对于慢性胆囊炎患者如合并胆囊结石、胆囊壁增厚、胆囊萎缩、胆囊排空障碍等患者,共识推荐实施胆囊切除术。

(4)对于黄色肉芽肿性胆囊炎(XGC)患者,建议实施胆囊切除术,并在术中行快速病理学检查排除胆囊癌,术中病理学检查结果对制定手术决策至关重要。

(5)对于胆囊腺肌症患者,共识推荐适时实施胆囊切除术,术中应行病理学检查。不建议对胆囊腺肌症实施局部切除术。

(6)对于有症状的胆囊畸形和发育异常,如出现折叠、重复畸形和萎缩患者,推荐实施胆囊切除术。

综上,规范胆囊良性疾病的外科治疗十分必要,对于符合适应证的胆囊良性疾病,应及时给予相应治疗。 目前,胆囊切除仍是治愈胆囊良性疾病科的手段。当然,随着技术进步,其适应证和应用范围可以进一步扩大。

参考资料

1.仇毓东,徐 保胆理念正误 .中国实用外科杂志.20218

2.中华医学会外科学分会胆道外科学组, 中国医师协会外科医师分会胆道外科医师委员会. 胆囊良性疾病外科治疗的专家共识(2021)[J]. 中华外科杂志, 2021, 59(11):881-886.

版权声明:
本网站所有内容来源注明为“梅斯医学”或“MedSci原创”的文字、图片和音视频资料,版权均属于梅斯医学所有。非经授权,任何媒体、网站或个人不得转载,授权转载时须注明来源为“梅斯医学”。其它来源的文章系转载文章,或“梅斯号”自媒体发布的文章,仅系出于传递更多信息之目的,本站仅负责审核内容合规,其内容不代表本站立场,本站不负责内容的准确性和版权。如果存在侵权、或不希望被转载的媒体或个人可与我们联系,我们将立即进行删除处理。
在此留言
评论区 (7)
#插入话题
  1. [GetPortalCommentsPageByObjectIdResponse(id=1741673, encodeId=9cfa1e41673b2, content=<a href='/topic/show?id=c2c621665c4' target=_blank style='color:#2F92EE;'>#中国专家共识#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=124, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=21665, encryptionId=c2c621665c4, topicName=中国专家共识)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=218a34934063, createdName=12498f1em19(暂无昵称), createdTime=Sat Jul 02 19:20:46 CST 2022, time=2022-07-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1845871, encodeId=8b0718458e1f6, content=<a href='/topic/show?id=5d2f206482e' target=_blank style='color:#2F92EE;'>#专家共识#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=70, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=20648, encryptionId=5d2f206482e, topicName=专家共识)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=568152, createdName=snowpeakxu, createdTime=Sat Mar 12 06:20:46 CST 2022, time=2022-03-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1069281, encodeId=174e10692815e, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=83, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=98855705572, createdName=ms6000000865925601, createdTime=Thu Nov 11 14:27:29 CST 2021, time=2021-11-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1058481, encodeId=ac041058481d0, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=82, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=193e5625489, createdName=ms6000000177538915, createdTime=Thu Oct 07 23:01:50 CST 2021, time=2021-10-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1056728, encodeId=4f6d1056e2891, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=90, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=07b81340417, createdName=1286114196, createdTime=Fri Oct 01 10:49:36 CST 2021, time=2021-10-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1056620, encodeId=5d9310566207e, content=集合, beContent=null, objectType=article, channel=null, level=null, likeNumber=77, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=9bc35614860, createdName=ms4000000631092445, createdTime=Thu Sep 30 19:03:56 CST 2021, time=2021-09-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1056611, encodeId=6ce8105661143, content=好文章,值得一读。, beContent=null, objectType=article, channel=null, level=null, likeNumber=75, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTJlfgys76DEiaNtbYo2re3ibjrUPTRibEXRyFwAB4aAGiave842S0FQDf0wAoaH226NiaSoPPDzhndsf1g/132, createdBy=88b489038, createdName=yangchou, createdTime=Thu Sep 30 17:56:57 CST 2021, time=2021-09-30, status=1, ipAttribution=)]
  2. [GetPortalCommentsPageByObjectIdResponse(id=1741673, encodeId=9cfa1e41673b2, content=<a href='/topic/show?id=c2c621665c4' target=_blank style='color:#2F92EE;'>#中国专家共识#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=124, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=21665, encryptionId=c2c621665c4, topicName=中国专家共识)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=218a34934063, createdName=12498f1em19(暂无昵称), createdTime=Sat Jul 02 19:20:46 CST 2022, time=2022-07-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1845871, encodeId=8b0718458e1f6, content=<a href='/topic/show?id=5d2f206482e' target=_blank style='color:#2F92EE;'>#专家共识#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=70, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=20648, encryptionId=5d2f206482e, topicName=专家共识)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=568152, createdName=snowpeakxu, createdTime=Sat Mar 12 06:20:46 CST 2022, time=2022-03-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1069281, encodeId=174e10692815e, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=83, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=98855705572, createdName=ms6000000865925601, createdTime=Thu Nov 11 14:27:29 CST 2021, time=2021-11-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1058481, encodeId=ac041058481d0, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=82, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=193e5625489, createdName=ms6000000177538915, createdTime=Thu Oct 07 23:01:50 CST 2021, time=2021-10-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1056728, encodeId=4f6d1056e2891, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=90, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=07b81340417, createdName=1286114196, createdTime=Fri Oct 01 10:49:36 CST 2021, time=2021-10-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1056620, encodeId=5d9310566207e, content=集合, beContent=null, objectType=article, channel=null, level=null, likeNumber=77, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=9bc35614860, createdName=ms4000000631092445, createdTime=Thu Sep 30 19:03:56 CST 2021, time=2021-09-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1056611, encodeId=6ce8105661143, content=好文章,值得一读。, beContent=null, objectType=article, channel=null, level=null, likeNumber=75, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTJlfgys76DEiaNtbYo2re3ibjrUPTRibEXRyFwAB4aAGiave842S0FQDf0wAoaH226NiaSoPPDzhndsf1g/132, createdBy=88b489038, createdName=yangchou, createdTime=Thu Sep 30 17:56:57 CST 2021, time=2021-09-30, status=1, ipAttribution=)]
  3. [GetPortalCommentsPageByObjectIdResponse(id=1741673, encodeId=9cfa1e41673b2, content=<a href='/topic/show?id=c2c621665c4' target=_blank style='color:#2F92EE;'>#中国专家共识#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=124, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=21665, encryptionId=c2c621665c4, topicName=中国专家共识)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=218a34934063, createdName=12498f1em19(暂无昵称), createdTime=Sat Jul 02 19:20:46 CST 2022, time=2022-07-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1845871, encodeId=8b0718458e1f6, content=<a href='/topic/show?id=5d2f206482e' target=_blank style='color:#2F92EE;'>#专家共识#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=70, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=20648, encryptionId=5d2f206482e, topicName=专家共识)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=568152, createdName=snowpeakxu, createdTime=Sat Mar 12 06:20:46 CST 2022, time=2022-03-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1069281, encodeId=174e10692815e, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=83, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=98855705572, createdName=ms6000000865925601, createdTime=Thu Nov 11 14:27:29 CST 2021, time=2021-11-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1058481, encodeId=ac041058481d0, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=82, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=193e5625489, createdName=ms6000000177538915, createdTime=Thu Oct 07 23:01:50 CST 2021, time=2021-10-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1056728, encodeId=4f6d1056e2891, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=90, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=07b81340417, createdName=1286114196, createdTime=Fri Oct 01 10:49:36 CST 2021, time=2021-10-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1056620, encodeId=5d9310566207e, content=集合, beContent=null, objectType=article, channel=null, level=null, likeNumber=77, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=9bc35614860, createdName=ms4000000631092445, createdTime=Thu Sep 30 19:03:56 CST 2021, time=2021-09-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1056611, encodeId=6ce8105661143, content=好文章,值得一读。, beContent=null, objectType=article, channel=null, level=null, likeNumber=75, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTJlfgys76DEiaNtbYo2re3ibjrUPTRibEXRyFwAB4aAGiave842S0FQDf0wAoaH226NiaSoPPDzhndsf1g/132, createdBy=88b489038, createdName=yangchou, createdTime=Thu Sep 30 17:56:57 CST 2021, time=2021-09-30, status=1, ipAttribution=)]
    2021-11-11 ms6000000865925601

    学习了

    0

  4. [GetPortalCommentsPageByObjectIdResponse(id=1741673, encodeId=9cfa1e41673b2, content=<a href='/topic/show?id=c2c621665c4' target=_blank style='color:#2F92EE;'>#中国专家共识#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=124, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=21665, encryptionId=c2c621665c4, topicName=中国专家共识)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=218a34934063, createdName=12498f1em19(暂无昵称), createdTime=Sat Jul 02 19:20:46 CST 2022, time=2022-07-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1845871, encodeId=8b0718458e1f6, content=<a href='/topic/show?id=5d2f206482e' target=_blank style='color:#2F92EE;'>#专家共识#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=70, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=20648, encryptionId=5d2f206482e, topicName=专家共识)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=568152, createdName=snowpeakxu, createdTime=Sat Mar 12 06:20:46 CST 2022, time=2022-03-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1069281, encodeId=174e10692815e, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=83, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=98855705572, createdName=ms6000000865925601, createdTime=Thu Nov 11 14:27:29 CST 2021, time=2021-11-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1058481, encodeId=ac041058481d0, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=82, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=193e5625489, createdName=ms6000000177538915, createdTime=Thu Oct 07 23:01:50 CST 2021, time=2021-10-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1056728, encodeId=4f6d1056e2891, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=90, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=07b81340417, createdName=1286114196, createdTime=Fri Oct 01 10:49:36 CST 2021, time=2021-10-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1056620, encodeId=5d9310566207e, content=集合, beContent=null, objectType=article, channel=null, level=null, likeNumber=77, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=9bc35614860, createdName=ms4000000631092445, createdTime=Thu Sep 30 19:03:56 CST 2021, time=2021-09-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1056611, encodeId=6ce8105661143, content=好文章,值得一读。, beContent=null, objectType=article, channel=null, level=null, likeNumber=75, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTJlfgys76DEiaNtbYo2re3ibjrUPTRibEXRyFwAB4aAGiave842S0FQDf0wAoaH226NiaSoPPDzhndsf1g/132, createdBy=88b489038, createdName=yangchou, createdTime=Thu Sep 30 17:56:57 CST 2021, time=2021-09-30, status=1, ipAttribution=)]
    2021-10-07 ms6000000177538915

    学习

    0

  5. [GetPortalCommentsPageByObjectIdResponse(id=1741673, encodeId=9cfa1e41673b2, content=<a href='/topic/show?id=c2c621665c4' target=_blank style='color:#2F92EE;'>#中国专家共识#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=124, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=21665, encryptionId=c2c621665c4, topicName=中国专家共识)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=218a34934063, createdName=12498f1em19(暂无昵称), createdTime=Sat Jul 02 19:20:46 CST 2022, time=2022-07-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1845871, encodeId=8b0718458e1f6, content=<a href='/topic/show?id=5d2f206482e' target=_blank style='color:#2F92EE;'>#专家共识#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=70, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=20648, encryptionId=5d2f206482e, topicName=专家共识)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=568152, createdName=snowpeakxu, createdTime=Sat Mar 12 06:20:46 CST 2022, time=2022-03-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1069281, encodeId=174e10692815e, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=83, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=98855705572, createdName=ms6000000865925601, createdTime=Thu Nov 11 14:27:29 CST 2021, time=2021-11-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1058481, encodeId=ac041058481d0, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=82, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=193e5625489, createdName=ms6000000177538915, createdTime=Thu Oct 07 23:01:50 CST 2021, time=2021-10-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1056728, encodeId=4f6d1056e2891, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=90, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=07b81340417, createdName=1286114196, createdTime=Fri Oct 01 10:49:36 CST 2021, time=2021-10-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1056620, encodeId=5d9310566207e, content=集合, beContent=null, objectType=article, channel=null, level=null, likeNumber=77, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=9bc35614860, createdName=ms4000000631092445, createdTime=Thu Sep 30 19:03:56 CST 2021, time=2021-09-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1056611, encodeId=6ce8105661143, content=好文章,值得一读。, beContent=null, objectType=article, channel=null, level=null, likeNumber=75, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTJlfgys76DEiaNtbYo2re3ibjrUPTRibEXRyFwAB4aAGiave842S0FQDf0wAoaH226NiaSoPPDzhndsf1g/132, createdBy=88b489038, createdName=yangchou, createdTime=Thu Sep 30 17:56:57 CST 2021, time=2021-09-30, status=1, ipAttribution=)]
    2021-10-01 1286114196

    学习了

    0

  6. [GetPortalCommentsPageByObjectIdResponse(id=1741673, encodeId=9cfa1e41673b2, content=<a href='/topic/show?id=c2c621665c4' target=_blank style='color:#2F92EE;'>#中国专家共识#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=124, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=21665, encryptionId=c2c621665c4, topicName=中国专家共识)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=218a34934063, createdName=12498f1em19(暂无昵称), createdTime=Sat Jul 02 19:20:46 CST 2022, time=2022-07-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1845871, encodeId=8b0718458e1f6, content=<a href='/topic/show?id=5d2f206482e' target=_blank style='color:#2F92EE;'>#专家共识#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=70, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=20648, encryptionId=5d2f206482e, topicName=专家共识)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=568152, createdName=snowpeakxu, createdTime=Sat Mar 12 06:20:46 CST 2022, time=2022-03-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1069281, encodeId=174e10692815e, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=83, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=98855705572, createdName=ms6000000865925601, createdTime=Thu Nov 11 14:27:29 CST 2021, time=2021-11-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1058481, encodeId=ac041058481d0, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=82, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=193e5625489, createdName=ms6000000177538915, createdTime=Thu Oct 07 23:01:50 CST 2021, time=2021-10-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1056728, encodeId=4f6d1056e2891, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=90, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=07b81340417, createdName=1286114196, createdTime=Fri Oct 01 10:49:36 CST 2021, time=2021-10-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1056620, encodeId=5d9310566207e, content=集合, beContent=null, objectType=article, channel=null, level=null, likeNumber=77, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=9bc35614860, createdName=ms4000000631092445, createdTime=Thu Sep 30 19:03:56 CST 2021, time=2021-09-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1056611, encodeId=6ce8105661143, content=好文章,值得一读。, beContent=null, objectType=article, channel=null, level=null, likeNumber=75, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTJlfgys76DEiaNtbYo2re3ibjrUPTRibEXRyFwAB4aAGiave842S0FQDf0wAoaH226NiaSoPPDzhndsf1g/132, createdBy=88b489038, createdName=yangchou, createdTime=Thu Sep 30 17:56:57 CST 2021, time=2021-09-30, status=1, ipAttribution=)]
    2021-09-30 ms4000000631092445

    集合

    0

  7. [GetPortalCommentsPageByObjectIdResponse(id=1741673, encodeId=9cfa1e41673b2, content=<a href='/topic/show?id=c2c621665c4' target=_blank style='color:#2F92EE;'>#中国专家共识#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=124, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=21665, encryptionId=c2c621665c4, topicName=中国专家共识)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=218a34934063, createdName=12498f1em19(暂无昵称), createdTime=Sat Jul 02 19:20:46 CST 2022, time=2022-07-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1845871, encodeId=8b0718458e1f6, content=<a href='/topic/show?id=5d2f206482e' target=_blank style='color:#2F92EE;'>#专家共识#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=70, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=20648, encryptionId=5d2f206482e, topicName=专家共识)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=568152, createdName=snowpeakxu, createdTime=Sat Mar 12 06:20:46 CST 2022, time=2022-03-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1069281, encodeId=174e10692815e, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=83, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=98855705572, createdName=ms6000000865925601, createdTime=Thu Nov 11 14:27:29 CST 2021, time=2021-11-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1058481, encodeId=ac041058481d0, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=82, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=193e5625489, createdName=ms6000000177538915, createdTime=Thu Oct 07 23:01:50 CST 2021, time=2021-10-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1056728, encodeId=4f6d1056e2891, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=90, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=07b81340417, createdName=1286114196, createdTime=Fri Oct 01 10:49:36 CST 2021, time=2021-10-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1056620, encodeId=5d9310566207e, content=集合, beContent=null, objectType=article, channel=null, level=null, likeNumber=77, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=9bc35614860, createdName=ms4000000631092445, createdTime=Thu Sep 30 19:03:56 CST 2021, time=2021-09-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1056611, encodeId=6ce8105661143, content=好文章,值得一读。, beContent=null, objectType=article, channel=null, level=null, likeNumber=75, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTJlfgys76DEiaNtbYo2re3ibjrUPTRibEXRyFwAB4aAGiave842S0FQDf0wAoaH226NiaSoPPDzhndsf1g/132, createdBy=88b489038, createdName=yangchou, createdTime=Thu Sep 30 17:56:57 CST 2021, time=2021-09-30, status=1, ipAttribution=)]
    2021-09-30 yangchou

    好文章,值得一读。

    0

相关资讯

医院不给发热患儿诊治?泰安市卫健委回应:不属实

据山东省泰安市卫生健康委员会网站消息,2021年2月3日中午,在了解到相关媒体转载“孩子发烧39.8度,中午来到医院,到晚上十一点才打上针”的视频后,泰安市卫健委立即成立工作专

急性冠脉综合征ACS合并上消化道出血的诊治

抗栓治疗作为急性冠脉综合征(ACS)药物治疗的基石,对于ACS及其接受介入治疗的患者,双联抗血小板治疗能够显着降低早期和长期不良心血管事件的发生率。然而,与抗栓治疗相关的各种出血并发症也日渐增加。

临床心得:相同病史、相似症状,草率诊断要不得

临床医生常规以“一元论”模式收集患者的所有症状和体征,并据此做出疾病诊断。然而,有些医生常会受定式思维影响,若既往有相同的疾病史,当再次出现相似症状时,往往会不由自主地联想到前几次疾病的诊断。

让"蓝唇"再度红润:肺高血压诊治的重要进展及一些思考

"蓝唇"不是电影《阿凡达》中的故事人物,而是肺高血压患者的代名词,因这类患者常常由于缺氧导致嘴唇呈现蓝紫色。肺高血压是指各种原因导致的平均肺动脉压力(mPAP)≥25 mmHg(1 mmHg=0.133 kPa,海平面,静息状态,右心导管检查)。自1891年德国病理科医师Romberg报道首例肺高血压病例以来,经过一个多世纪的努力探索,我们对肺高血压发病机制的认识不断深入、诊疗策略不断优化、患者预

白春学:肺结节诊治中国共识解读:CACP 2019

2014年9月20日制定中国首个《肺结节诊治中国专家共识》发表在《中华结核和呼吸杂志》,2018年更新共识。

Eur Heart J:半数中风与心血管病有关,中风诊治需要心脏科医生!欧洲心脏杂志述评

近期,欧洲心脏杂志刊登述评称,心脏科医生要更好地了解中风。中风不仅是全球第二大死亡原因,也是导致成人残疾的主要原因。在中国,中风是居民死亡的第一大病因。

Baidu
map
Baidu
map
Baidu
map