子宫内膜射频消融术后自然妊娠并足月活产1例

2019-09-22 马庆亚 李晓冬 刘洁 生殖医学杂志

患者,女,34岁。因自然流产后10个月,阴道 不规则出血2个月于2013年8月27日入院。平素 月经欠规律,7/30~32 d,量多,曾因大出血、重度贫 血行诊刮术,病理提示子宫内膜息肉(具体不详)。 lo个月前于孕5个月自然流产,诉胎盘未排出,行 钳夹术。其后月经经期延长至10~15 d,周期无改 变,经量为原来2倍,LMP:2013一06—28,此次量少但 淋漓不尽,持续2个月。

患者,女,34岁。因自然流产后10个月,阴道 不规则出血2个月于2013年8月27日入院。平素 月经欠规律,7/30~32 d,量多,曾因大出血、重度贫 血行诊刮术,病理提示子宫内膜息肉(具体不详)。 lo个月前于孕5个月自然流产,诉胎盘未排出,行 钳夹术。其后月经经期延长至10~15 d,周期无改 变,经量为原来2倍,LMP:2013一06—28,此次量少但 淋漓不尽,持续2个月。1 d前阴道出血增多,伴心 慌、乏力等不适,就诊于当地医院,妇科超声检查显 示:子宫内膜厚度约1.7 cm,其内可见多个液性暗 区。为进一步治疗于我科收住院治疗。既往发现系 统性红斑狼疮4年,口服羟氯喹(o.2 g,2次/d)、泼 尼松(10 mg,1次/d);4年前于我院行“颅内静脉窦 血栓介入治疗术”,自诉已治愈。既往“乳腺纤维瘤 切除”术后。28岁结婚,G1POAl,2012年因男方 “重度少弱精子症”行ICSI—ET,三胎妊娠,两胎停 育,一胎于孕22周自然流产,合并妊娠期高血压。 初步诊断:(1)异常子宫出血(子宫内膜病变?)(2)系 统性红斑狼疮;(3)颅内静脉窦血栓。于2013年8 月29日行诊断性刮宫术,病理(编号13—6006)检查 显示:子宫内膜单纯性增生。经讨论后建议:(1)放 置左炔诺孕酮宫内节育系统(曼月乐);(2)后半周期 孕激素疗法;(3)子宫内膜消融术,考虑患者仍有生 育要求目前并不推荐。其要求口服药物治疗签字 出院。 1个月后患者因再次出现异常子宫出血伴腹痛 于2013年9月26日人院治疗,患者自上次出院后于月经第15~20天口服地屈孕酮10 mg,2次/d,血 止6 d,再次出现淋漓出血,近日增多,似月经量,有 血块,伴轻微腹痛及乏力。人院后给予抗炎、止血治 疗,其坚决要求行子宫内膜去除术,遂于2013年9 月30日行宫腔镜检查术+NovaSure子宫内膜射频 消融术。置镜探查:颈管未见异常,宫腔形态基本正 常,子宫内膜淡粉色,后壁及颈管见局限性突起,双 侧输卵管开口可见;官腔深11 cm,颈管约4 cm,骚 刮宫腔后行子宫内膜射频消融术,置人NovaSure (两次),设置宫腔深度6.5 cm,宽度4.5 cm,功率 161 W,时间110 s,术后再次置镜,宫底正中内膜淡 粉色,其余宫腔呈焦黄色。手术顺利,术后患者无阴 道出血、无腹痛等不适。 NovaSure子宫内膜射频消融术后3月,患者因 阴道出血7 h,多于月经量2 h于2014年1月5日 再次入院。查血常规示血红蛋白(HGB)130 g/L, 给予抗炎、止血治疗后出血减少,建议行宫腔镜检查 术,患者拒绝并出院。 2014年7月患者因停经4个月就诊于我科门 诊,行妇科超声提示宫内孕,据超声推算LMP: 2014一03—15。孕期免疫风湿科协助用药,给予继续 口服羟氯喹(o.2 g,2次/d)、泼尼松(10 mg,1次/d)、 维D钙咀嚼片(600 mg,1次/d)、阿司匹林肠溶片(12.5 m,1次/d)治疗,定期复查系统性红斑狼疮相 关抗体及炎症性指标无异常;孕期平稳,定期产检胎 儿无异常,并于2014年12月8日(孕38w w)臀位 剖宫产1男婴。 产后1年余,患者因阴道出血伴腹痛3 d于 2016年3月31日再次于我科住院治疗。患者诉产 后7个月月经来潮,7~8/28~30 d,规律半年,近两 个月出现经期延长,10~15/20~28 d。半个月前就 诊于石家庄市第四医院,妇科超声(2016年3月17 日)示:宫腔回声较多,欠均匀,厚约1.3 cm,HGB 100 g/L,未予治疗。3 d前再次出现异常子宫出血, 量多于月经量,有血块,伴腹痛,感头晕乏力就诊于 我院。于2016年4月1日行诊断性刮宫术,病理 (编号467660)检查示:少许破碎增殖期子宫内膜、 颈管内膜及鳞状上皮。于2016年4月8日放置左 炔诺孕酮宫内节育系统。2018年12月10日门诊 随访,患者诉放置曼月乐后一直为闭经状态。

讨论

异常子宫出血(abnormal uterine bleeding) 是女性的常见疾病,表现为月经的周期性、频率、经 期长度及经期的出血量中任何一项的异常,发病率 约20%口],为了明确诊治,2011年国际妇产科联盟 月经组将异常子宫出血限定于育龄期非妊娠女性的 非正常子宫出血,且将其病因分为PALM—COEIN 九类,包括器质性病变引起的异常子宫出血以及功 能失调性异常子宫出血[2]。异常子宫出血的治疗原 则是减少出血、纠正贫血、调整月经周期,治疗方案 包括性激素治疗、诊刮、放置左炔诺孕酮宫内节育系 统(曼月乐)、子宫内膜去除、卵巢去势、切除子 宫等‘3I。 在我们的病例中,考虑患者为系统性红斑狼疮 引起的异常子宫出血及贫血,诊刮后使用激素治疗, 后再次因大出血人院,由于病情反复加之患者既往 有大出血、重度贫血的病史,不仅对患者身体造成较 大创伤,心理上也造成极大的困扰。遂在患者坚决 要求下行子宫内膜射频消融术,但对于本例患者,曼 月乐仍是第一位的选择。 NovaSure子宫内膜射频消融术是一种微创、高 性价比治疗异常子宫出血的方法,以其安全高效、手 术治疗时间短、术中出血量少、微创、疼痛感较轻、术 后恢复迅速等优势赢得了临床医师的青睐,并且患 者对其满意度较高,尤其是对于合并严重内科疾病 的患者是一个理想的选择。NovaSure子宫内膜消 融术对异常子宫出血患者进行治疗可显著改善整体疗效,还可减少创伤、促进术后恢复,临床认为该疗 法安全可靠具有良好的应用价值。射频消融通过其 热效应,凝固、变性子宫内膜及浅肌层,以达到治疗 目的。因射频能量不同,子宫内膜受损程度不同, 90%的术后女性经血量恢复到正常水平甚至更低, 其中40%的女性术后可以出现闭经[4]。另外国人 有报道应用射频消融技术治疗158例围绝经期异常 子宫出血的患者,其治疗过程中无特殊不适,术后 76.58%的患者永久性闭经,20.26%的患者术后 2~3个月出现少量月经,治疗总有效率为96.84% 以上[5]。马宁等[63采用NovaSure技术对70例异常 子宫出血患者进行了治疗,其中包含严重内科合并 症者19例,11例肾脏合并症患者,3例肾移植术后 患者,8例肾功能不全患者,心血管合并症6例等; 术后随访半年有效率为97.1%,闭经率54.3%,无 效率2.9%,体现了NovaSure手术在治疗异常子宫 出血合并严重内科疾病患者方面的独特优势。 与NovaSure手术相关的轻微并发症可能包括 出血、感染、子宫穿孑L和器械故障[7],更严重的并发 症可能包括肠损伤、心脏骤停、尿路损伤、二氧化碳 栓塞、败血症和死亡[8],长期并发症包括宫腔积血或 消融后输卯管绝育综合征的风险[9]。子宫内膜消融 术后子宫内膜癌的发病率并无上升,大多数子宫内 膜消融术后诊断子宫内膜癌的患者都有异常子宫出 血和疼痛的临床表现,超过75%的消融术后子宫内 膜癌诊断时为I期,与无消融术史的女性一致。 子宫内膜消融术后仍然存在妊娠的可能,受孕 机率约为o.7%,这类妊娠一半以上由于自然流产 或个人选择终止妊娠而未能维持至分娩[1“。子宫 内膜消融术后的妊娠造成严重并发症的风险很大, 包括早产、胎盘粘连、子宫破裂、剖宫产和剖宫产子 宫切除以及围产期死亡等u2I。所以术前应充分告 知患者术后妊娠及相关严重并发症的可能,必须使 用可靠的避孕方法至渡过围绝经期口3I。有文献报 道NovaSure子宫内膜消融术后妊娠的患者年龄从 26~50岁不等,术后妊娠的中位时间为1.5年(3周~ 13年)[14。。临床上亦有术后宫颈妊娠、滋养细胞疾 病等的报道[13115]。临床医师对任何消融术后的育 龄女性应保持警惕,不论其消融术后月经模式如何 都有妊娠可能。对于术后妊娠的女性,应及时转介 经验丰富的专家进行胎盘粘连评估和后期分娩的管 理,以减少相关并发症的发生。本例为原发性不孕 患者,术后并未使用避孕措施,3个月后再次出现大量异常子宫出血,术后5个月自然妊娠,在免疫风湿 科及妇产科共同的保驾护航下剖宫产1足月男婴, 属于罕见的治疗失败的并发症,但仍然是十分高危 的,所以临床上应严格掌握适应证,减少并发症的发 生,并与患者充分沟通,加强术后指导,做好临床宣 教工作。

参考文献略。

原始出处:

马庆亚,李晓冬,刘洁,张媛等,子宫内膜射频消融术后自然妊娠并足月活产1例[J],生殖医学杂志,2019,28(7):824-826.

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  2. [GetPortalCommentsPageByObjectIdResponse(id=1813572, encodeId=c46218135e2d0, content=<a href='/topic/show?id=78d392998b8' target=_blank style='color:#2F92EE;'>#足月活产#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=92998, encryptionId=78d392998b8, topicName=足月活产)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=zhaojie88, createdTime=Wed Nov 06 00:06:00 CST 2019, time=2019-11-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1708551, encodeId=25371e085510f, content=<a href='/topic/show?id=4c2d3051535' target=_blank style='color:#2F92EE;'>#内膜#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=30515, encryptionId=4c2d3051535, topicName=内膜)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=730431558473, createdName=12498974m61暂无昵称, createdTime=Tue Jun 09 17:06:00 CST 2020, time=2020-06-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1991023, encodeId=2d12199102309, content=<a href='/topic/show?id=fd3286249a6' target=_blank style='color:#2F92EE;'>#自然妊娠#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=23, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=86249, encryptionId=fd3286249a6, topicName=自然妊娠)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=bfa6343, createdName=aliceclz, createdTime=Fri Nov 15 14:06:00 CST 2019, time=2019-11-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1694719, encodeId=8b961694e1915, content=<a href='/topic/show?id=471d4682409' target=_blank style='color:#2F92EE;'>#射频消融术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=46824, encryptionId=471d4682409, topicName=射频消融术)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=febc29728754, createdName=zhmscau, createdTime=Fri Feb 14 07:06:00 CST 2020, time=2020-02-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1279948, encodeId=c73912e994829, content=<a href='/topic/show?id=0b0546822fd' target=_blank style='color:#2F92EE;'>#射频消融#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=22, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=46822, encryptionId=0b0546822fd, topicName=射频消融)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=dc7a157, createdName=jinweidong, createdTime=Tue Sep 24 05:06:00 CST 2019, time=2019-09-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1421786, encodeId=689c1421e86ac, content=<a href='/topic/show?id=4bc865819d2' target=_blank style='color:#2F92EE;'>#消融#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=23, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=65819, encryptionId=4bc865819d2, topicName=消融)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=1a193676008, createdName=xiangyuzhou972, createdTime=Tue Sep 24 05:06:00 CST 2019, time=2019-09-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1560282, encodeId=5a2b1560282a7, content=<a href='/topic/show?id=a9fd65826da' target=_blank style='color:#2F92EE;'>#消融术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=65826, encryptionId=a9fd65826da, topicName=消融术)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=1c4415117207, createdName=dingxiaobo, createdTime=Tue Sep 24 05:06:00 CST 2019, time=2019-09-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1566291, encodeId=c4131566291da, content=<a href='/topic/show?id=a9fd65826da' target=_blank style='color:#2F92EE;'>#消融术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=22, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=65826, encryptionId=a9fd65826da, topicName=消融术)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=1c4415117207, createdName=dingxiaobo, createdTime=Tue Sep 24 05:06:00 CST 2019, time=2019-09-24, status=1, ipAttribution=)]
  3. [GetPortalCommentsPageByObjectIdResponse(id=1813572, encodeId=c46218135e2d0, content=<a href='/topic/show?id=78d392998b8' target=_blank style='color:#2F92EE;'>#足月活产#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=92998, encryptionId=78d392998b8, topicName=足月活产)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=zhaojie88, createdTime=Wed Nov 06 00:06:00 CST 2019, time=2019-11-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1708551, encodeId=25371e085510f, content=<a href='/topic/show?id=4c2d3051535' target=_blank style='color:#2F92EE;'>#内膜#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=30515, encryptionId=4c2d3051535, topicName=内膜)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=730431558473, createdName=12498974m61暂无昵称, createdTime=Tue Jun 09 17:06:00 CST 2020, time=2020-06-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1991023, encodeId=2d12199102309, content=<a href='/topic/show?id=fd3286249a6' target=_blank style='color:#2F92EE;'>#自然妊娠#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=23, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=86249, encryptionId=fd3286249a6, topicName=自然妊娠)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=bfa6343, createdName=aliceclz, createdTime=Fri Nov 15 14:06:00 CST 2019, time=2019-11-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1694719, encodeId=8b961694e1915, content=<a href='/topic/show?id=471d4682409' target=_blank style='color:#2F92EE;'>#射频消融术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=46824, encryptionId=471d4682409, topicName=射频消融术)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=febc29728754, createdName=zhmscau, createdTime=Fri Feb 14 07:06:00 CST 2020, time=2020-02-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1279948, encodeId=c73912e994829, content=<a href='/topic/show?id=0b0546822fd' target=_blank style='color:#2F92EE;'>#射频消融#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=22, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=46822, encryptionId=0b0546822fd, topicName=射频消融)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=dc7a157, createdName=jinweidong, createdTime=Tue Sep 24 05:06:00 CST 2019, time=2019-09-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1421786, encodeId=689c1421e86ac, content=<a href='/topic/show?id=4bc865819d2' target=_blank style='color:#2F92EE;'>#消融#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=23, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=65819, encryptionId=4bc865819d2, topicName=消融)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=1a193676008, createdName=xiangyuzhou972, createdTime=Tue Sep 24 05:06:00 CST 2019, time=2019-09-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1560282, encodeId=5a2b1560282a7, content=<a href='/topic/show?id=a9fd65826da' target=_blank style='color:#2F92EE;'>#消融术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=65826, encryptionId=a9fd65826da, topicName=消融术)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=1c4415117207, createdName=dingxiaobo, createdTime=Tue Sep 24 05:06:00 CST 2019, time=2019-09-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1566291, encodeId=c4131566291da, content=<a href='/topic/show?id=a9fd65826da' target=_blank style='color:#2F92EE;'>#消融术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=22, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=65826, encryptionId=a9fd65826da, topicName=消融术)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=1c4415117207, createdName=dingxiaobo, createdTime=Tue Sep 24 05:06:00 CST 2019, time=2019-09-24, status=1, ipAttribution=)]
  4. [GetPortalCommentsPageByObjectIdResponse(id=1813572, encodeId=c46218135e2d0, content=<a href='/topic/show?id=78d392998b8' target=_blank style='color:#2F92EE;'>#足月活产#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=92998, encryptionId=78d392998b8, topicName=足月活产)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=zhaojie88, createdTime=Wed Nov 06 00:06:00 CST 2019, time=2019-11-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1708551, encodeId=25371e085510f, content=<a href='/topic/show?id=4c2d3051535' target=_blank style='color:#2F92EE;'>#内膜#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=30515, encryptionId=4c2d3051535, topicName=内膜)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=730431558473, createdName=12498974m61暂无昵称, createdTime=Tue Jun 09 17:06:00 CST 2020, time=2020-06-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1991023, encodeId=2d12199102309, content=<a href='/topic/show?id=fd3286249a6' target=_blank style='color:#2F92EE;'>#自然妊娠#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=23, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=86249, encryptionId=fd3286249a6, topicName=自然妊娠)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=bfa6343, createdName=aliceclz, createdTime=Fri Nov 15 14:06:00 CST 2019, time=2019-11-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1694719, encodeId=8b961694e1915, content=<a href='/topic/show?id=471d4682409' target=_blank style='color:#2F92EE;'>#射频消融术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=46824, encryptionId=471d4682409, topicName=射频消融术)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=febc29728754, createdName=zhmscau, createdTime=Fri Feb 14 07:06:00 CST 2020, time=2020-02-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1279948, encodeId=c73912e994829, content=<a href='/topic/show?id=0b0546822fd' target=_blank style='color:#2F92EE;'>#射频消融#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=22, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=46822, encryptionId=0b0546822fd, topicName=射频消融)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=dc7a157, createdName=jinweidong, createdTime=Tue Sep 24 05:06:00 CST 2019, time=2019-09-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1421786, encodeId=689c1421e86ac, content=<a href='/topic/show?id=4bc865819d2' target=_blank style='color:#2F92EE;'>#消融#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=23, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=65819, encryptionId=4bc865819d2, topicName=消融)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=1a193676008, createdName=xiangyuzhou972, createdTime=Tue Sep 24 05:06:00 CST 2019, time=2019-09-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1560282, encodeId=5a2b1560282a7, content=<a href='/topic/show?id=a9fd65826da' target=_blank style='color:#2F92EE;'>#消融术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=65826, encryptionId=a9fd65826da, topicName=消融术)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=1c4415117207, createdName=dingxiaobo, createdTime=Tue Sep 24 05:06:00 CST 2019, time=2019-09-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1566291, encodeId=c4131566291da, content=<a href='/topic/show?id=a9fd65826da' target=_blank style='color:#2F92EE;'>#消融术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=22, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=65826, encryptionId=a9fd65826da, topicName=消融术)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=1c4415117207, createdName=dingxiaobo, createdTime=Tue Sep 24 05:06:00 CST 2019, time=2019-09-24, status=1, ipAttribution=)]
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