病例解析:胃黏膜下隆起性病变?胃间质瘤?

2019-07-23 王伯军 王伯军大夫谈消化

胃镜显示胃体上段前壁见一隆起,约0.8cm,表面光滑色泽同周边,用活检钳触之硬。超声胃镜显示胃体隆起,起源于胃壁固有肌层,0.7×0.5cm,边界清楚,低密度,回声均匀。超声胃镜诊断:胃体隆起,起源于固有肌层的低回声占位性病变,性质待查。

病例

镜显示体上段前壁见一隆起,约0.8cm,表面光滑色泽同周边,用活检钳触之硬。超声胃镜显示胃体隆起,起源于胃壁固有肌层,0.7×0.5cm,边界清楚,低密度,回声均匀。超声胃镜诊断:胃体隆起,起源于固有肌层的低回声占位性病变,性质待查。

情况是否严重?后续是否可自行消失?是否需半年复查一次胃镜?

回复

结合病史资料,提示为胃黏膜下隆起性病变。

胃黏膜下隆起性病变是一种形态改变,泛指起源于胃黏膜层以下组织的病变(胃壁分为四层:黏膜层、黏膜下层、固有肌层、浆膜层)。

胃镜检查只能见到胃黏膜表面的情况。胃黏膜下隆起性病变,在胃镜下只能见到胃壁局部隆起,表面黏膜大多完整、光滑。超声内镜是观察黏膜下的病变,明确病变起源于那一层,黏膜下病变的形态、生长方式,以判断其大致性质。

其实,胃黏膜下隆起性病变包括一组病变,分为:囊性病变、实质性病变。

囊性病变包括:囊肿、血管畸形等等,在超声内镜显示黏膜下液性暗区,多属良性病变,一般不需要处理。

实质性病变,超声内镜显示黏膜下实质性占位性病变,大多数是间质瘤,占85%~90%,少数为平滑肌瘤、脂肪瘤、异位胰腺等等。

脂肪瘤、异位胰腺是良性的,不会恶变,一般不要处理。

平滑肌瘤也是良性病变,少数长大后可以发生恶变,而且平滑肌瘤与平滑肌肉瘤(这是恶性的)在胃镜、超声胃镜下单从形态上难以区别,需要通过病理检查才能确定,但一般2cm以下都是良性的。

超声胃镜提示来源于胃壁固有肌层的实质性肿物,大多数是胃间质瘤。确诊只有待病理检查结果,一般需要做免疫组化,有时甚至需要基因测定才能确诊。

目前公认:间质瘤是潜在恶性的病变,其良恶性常常与病变大小密切相关。直径2cm以下的间质瘤,称为小间质瘤。

2cm以上的大的间质瘤,少见,有恶性可能,有的恶性程度较高,可转移复发。

2cm以下的小间质瘤,在临床上比较多见,尤其1cm以下的更是常见。其极大多数是良性的,仅仅表现为非常缓慢地生长,不会引起任何不适,也不会危及患者的生命健康;往往呈自限性生长,就是长大到一定程度以后就不会再生长,甚至会萎缩变小。

但极少数小的间质瘤随着慢慢长大会出现恶性肿瘤的特征,这就是所谓的“潜在恶性”。如果超声胃镜检查发现瘤体有以下“不良因素”:边缘不规则、溃疡、强回声、回声不均匀,提示其生长较为活跃,有可能转变为恶性程度比较高的间质瘤,这就需要及时处理。

对于没有“不良因素”的2cm以下的小间质瘤,常规推荐超声胃镜随访,6~12个月一次。如果随访期间肿块快速增长,需要手术切除。但长期超声胃镜随访,一则增加患者的心理负担,二则增加经济费用,毕竟大多数小间质瘤生长极其缓慢,不会变恶性的,因此,临床上常规建议:

1~2cm向消化道腔内生长的胃间质瘤在内镜下摘除,以达到诊断和治疗的目的,免去患者长期复查和担心。

<1cm的,可以胃镜复查,一年一次。如果有长大可能,需超声胃镜检查,以观察有无“不良因素”;逐渐长大到1.0cm以上,行胃镜下治疗;如果复查2~3次没有长大,可以延长时间2~3年复查一次即可。

患者已经做过超声胃镜,病变起源于胃壁固有肌层,0.7cm×0.5cm,边界清楚,低密度,回声均匀。因此很可能是胃间质瘤,属于微小胃间质瘤,超声内镜下没有“不良因素”,基本上可以肯定是良性的,生长很缓慢,服药没用,有自然消失的可能,但可能性较小。

目前不需要处理,可以胃镜随访观察,一年一次胃镜检查可以了。如果长大到1.0cm以上,建议进行胃镜下治疗,可在胃镜下进行切除,再行病理检查。如果复查2~3次没有长大,可以延长时间2~3年复查一次。其生长缓慢,但也并非无突然增长的可能。

患者也可能为胃平滑肌瘤,但可能性很小,但就算是平滑肌瘤,目前检查结果提示亦为良性,可继续按照以上意见处理。

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 (6)
#插入话题
  1. [GetPortalCommentsPageByObjectIdResponse(id=1931846, encodeId=2c1b19318466c, content=<a href='/topic/show?id=250183421dc' target=_blank style='color:#2F92EE;'>#胃黏膜#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=83421, encryptionId=250183421dc, topicName=胃黏膜)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=743d308, createdName=baoya, createdTime=Sun Jul 28 04:14:00 CST 2019, time=2019-07-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1672930, encodeId=d8a616e293037, content=<a href='/topic/show?id=b79b910345c' target=_blank style='color:#2F92EE;'>#解析#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=22, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=91034, encryptionId=b79b910345c, topicName=解析)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f42d26916490, createdName=hongbochen, createdTime=Fri Feb 28 23:14:00 CST 2020, time=2020-02-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1635104, encodeId=0f7c16351049e, content=<a href='/topic/show?id=dda8834222c' target=_blank style='color:#2F92EE;'>#胃黏膜下#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=83422, encryptionId=dda8834222c, topicName=胃黏膜下)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a12645, createdName=智慧医人, createdTime=Tue May 05 17:14:00 CST 2020, time=2020-05-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1426019, encodeId=101e142601958, content=<a href='/topic/show?id=02fe9e30227' target=_blank style='color:#2F92EE;'>#间质瘤#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=97302, encryptionId=02fe9e30227, topicName=间质瘤)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=7ede4029724, createdName=zhty5338, createdTime=Thu Jul 25 07:14:00 CST 2019, time=2019-07-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1520038, encodeId=11701520038f5, content=<a href='/topic/show?id=6ab11032506f' target=_blank style='color:#2F92EE;'>#黏膜#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=103250, encryptionId=6ab11032506f, topicName=黏膜)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=057f11309297, createdName=snowpeakxu, createdTime=Thu Jul 25 07:14:00 CST 2019, time=2019-07-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1615366, encodeId=9e0b16153662b, content=<a href='/topic/show?id=d6128339573' target=_blank style='color:#2F92EE;'>#胃间质瘤#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=83395, encryptionId=d6128339573, topicName=胃间质瘤)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=d54019619450, createdName=ms920641618706883, createdTime=Thu Jul 25 07:14:00 CST 2019, time=2019-07-25, status=1, ipAttribution=)]
    2019-07-28 baoya
  2. [GetPortalCommentsPageByObjectIdResponse(id=1931846, encodeId=2c1b19318466c, content=<a href='/topic/show?id=250183421dc' target=_blank style='color:#2F92EE;'>#胃黏膜#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=83421, encryptionId=250183421dc, topicName=胃黏膜)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=743d308, createdName=baoya, createdTime=Sun Jul 28 04:14:00 CST 2019, time=2019-07-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1672930, encodeId=d8a616e293037, content=<a href='/topic/show?id=b79b910345c' target=_blank style='color:#2F92EE;'>#解析#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=22, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=91034, encryptionId=b79b910345c, topicName=解析)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f42d26916490, createdName=hongbochen, createdTime=Fri Feb 28 23:14:00 CST 2020, time=2020-02-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1635104, encodeId=0f7c16351049e, content=<a href='/topic/show?id=dda8834222c' target=_blank style='color:#2F92EE;'>#胃黏膜下#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=83422, encryptionId=dda8834222c, topicName=胃黏膜下)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a12645, createdName=智慧医人, createdTime=Tue May 05 17:14:00 CST 2020, time=2020-05-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1426019, encodeId=101e142601958, content=<a href='/topic/show?id=02fe9e30227' target=_blank style='color:#2F92EE;'>#间质瘤#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=97302, encryptionId=02fe9e30227, topicName=间质瘤)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=7ede4029724, createdName=zhty5338, createdTime=Thu Jul 25 07:14:00 CST 2019, time=2019-07-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1520038, encodeId=11701520038f5, content=<a href='/topic/show?id=6ab11032506f' target=_blank style='color:#2F92EE;'>#黏膜#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=103250, encryptionId=6ab11032506f, topicName=黏膜)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=057f11309297, createdName=snowpeakxu, createdTime=Thu Jul 25 07:14:00 CST 2019, time=2019-07-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1615366, encodeId=9e0b16153662b, content=<a href='/topic/show?id=d6128339573' target=_blank style='color:#2F92EE;'>#胃间质瘤#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=83395, encryptionId=d6128339573, topicName=胃间质瘤)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=d54019619450, createdName=ms920641618706883, createdTime=Thu Jul 25 07:14:00 CST 2019, time=2019-07-25, status=1, ipAttribution=)]
    2020-02-28 hongbochen
  3. [GetPortalCommentsPageByObjectIdResponse(id=1931846, encodeId=2c1b19318466c, content=<a href='/topic/show?id=250183421dc' target=_blank style='color:#2F92EE;'>#胃黏膜#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=83421, encryptionId=250183421dc, topicName=胃黏膜)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=743d308, createdName=baoya, createdTime=Sun Jul 28 04:14:00 CST 2019, time=2019-07-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1672930, encodeId=d8a616e293037, content=<a href='/topic/show?id=b79b910345c' target=_blank style='color:#2F92EE;'>#解析#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=22, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=91034, encryptionId=b79b910345c, topicName=解析)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f42d26916490, createdName=hongbochen, createdTime=Fri Feb 28 23:14:00 CST 2020, time=2020-02-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1635104, encodeId=0f7c16351049e, content=<a href='/topic/show?id=dda8834222c' target=_blank style='color:#2F92EE;'>#胃黏膜下#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=83422, encryptionId=dda8834222c, topicName=胃黏膜下)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a12645, createdName=智慧医人, createdTime=Tue May 05 17:14:00 CST 2020, time=2020-05-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1426019, encodeId=101e142601958, content=<a href='/topic/show?id=02fe9e30227' target=_blank style='color:#2F92EE;'>#间质瘤#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=97302, encryptionId=02fe9e30227, topicName=间质瘤)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=7ede4029724, createdName=zhty5338, createdTime=Thu Jul 25 07:14:00 CST 2019, time=2019-07-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1520038, encodeId=11701520038f5, content=<a href='/topic/show?id=6ab11032506f' target=_blank style='color:#2F92EE;'>#黏膜#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=103250, encryptionId=6ab11032506f, topicName=黏膜)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=057f11309297, createdName=snowpeakxu, createdTime=Thu Jul 25 07:14:00 CST 2019, time=2019-07-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1615366, encodeId=9e0b16153662b, content=<a href='/topic/show?id=d6128339573' target=_blank style='color:#2F92EE;'>#胃间质瘤#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=83395, encryptionId=d6128339573, topicName=胃间质瘤)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=d54019619450, createdName=ms920641618706883, createdTime=Thu Jul 25 07:14:00 CST 2019, time=2019-07-25, status=1, ipAttribution=)]
  4. [GetPortalCommentsPageByObjectIdResponse(id=1931846, encodeId=2c1b19318466c, content=<a href='/topic/show?id=250183421dc' target=_blank style='color:#2F92EE;'>#胃黏膜#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=83421, encryptionId=250183421dc, topicName=胃黏膜)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=743d308, createdName=baoya, createdTime=Sun Jul 28 04:14:00 CST 2019, time=2019-07-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1672930, encodeId=d8a616e293037, content=<a href='/topic/show?id=b79b910345c' target=_blank style='color:#2F92EE;'>#解析#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=22, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=91034, encryptionId=b79b910345c, topicName=解析)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f42d26916490, createdName=hongbochen, createdTime=Fri Feb 28 23:14:00 CST 2020, time=2020-02-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1635104, encodeId=0f7c16351049e, content=<a href='/topic/show?id=dda8834222c' target=_blank style='color:#2F92EE;'>#胃黏膜下#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=83422, encryptionId=dda8834222c, topicName=胃黏膜下)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a12645, createdName=智慧医人, createdTime=Tue May 05 17:14:00 CST 2020, time=2020-05-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1426019, encodeId=101e142601958, content=<a href='/topic/show?id=02fe9e30227' target=_blank style='color:#2F92EE;'>#间质瘤#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=97302, encryptionId=02fe9e30227, topicName=间质瘤)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=7ede4029724, createdName=zhty5338, createdTime=Thu Jul 25 07:14:00 CST 2019, time=2019-07-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1520038, encodeId=11701520038f5, content=<a href='/topic/show?id=6ab11032506f' target=_blank style='color:#2F92EE;'>#黏膜#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=103250, encryptionId=6ab11032506f, topicName=黏膜)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=057f11309297, createdName=snowpeakxu, createdTime=Thu Jul 25 07:14:00 CST 2019, time=2019-07-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1615366, encodeId=9e0b16153662b, content=<a href='/topic/show?id=d6128339573' target=_blank style='color:#2F92EE;'>#胃间质瘤#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=83395, encryptionId=d6128339573, topicName=胃间质瘤)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=d54019619450, createdName=ms920641618706883, createdTime=Thu Jul 25 07:14:00 CST 2019, time=2019-07-25, status=1, ipAttribution=)]
  5. [GetPortalCommentsPageByObjectIdResponse(id=1931846, encodeId=2c1b19318466c, content=<a href='/topic/show?id=250183421dc' target=_blank style='color:#2F92EE;'>#胃黏膜#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=83421, encryptionId=250183421dc, topicName=胃黏膜)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=743d308, createdName=baoya, createdTime=Sun Jul 28 04:14:00 CST 2019, time=2019-07-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1672930, encodeId=d8a616e293037, content=<a href='/topic/show?id=b79b910345c' target=_blank style='color:#2F92EE;'>#解析#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=22, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=91034, encryptionId=b79b910345c, topicName=解析)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f42d26916490, createdName=hongbochen, createdTime=Fri Feb 28 23:14:00 CST 2020, time=2020-02-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1635104, encodeId=0f7c16351049e, content=<a href='/topic/show?id=dda8834222c' target=_blank style='color:#2F92EE;'>#胃黏膜下#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=83422, encryptionId=dda8834222c, topicName=胃黏膜下)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a12645, createdName=智慧医人, createdTime=Tue May 05 17:14:00 CST 2020, time=2020-05-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1426019, encodeId=101e142601958, content=<a href='/topic/show?id=02fe9e30227' target=_blank style='color:#2F92EE;'>#间质瘤#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=97302, encryptionId=02fe9e30227, topicName=间质瘤)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=7ede4029724, createdName=zhty5338, createdTime=Thu Jul 25 07:14:00 CST 2019, time=2019-07-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1520038, encodeId=11701520038f5, content=<a href='/topic/show?id=6ab11032506f' target=_blank style='color:#2F92EE;'>#黏膜#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=103250, encryptionId=6ab11032506f, topicName=黏膜)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=057f11309297, createdName=snowpeakxu, createdTime=Thu Jul 25 07:14:00 CST 2019, time=2019-07-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1615366, encodeId=9e0b16153662b, content=<a href='/topic/show?id=d6128339573' target=_blank style='color:#2F92EE;'>#胃间质瘤#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=83395, encryptionId=d6128339573, topicName=胃间质瘤)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=d54019619450, createdName=ms920641618706883, createdTime=Thu Jul 25 07:14:00 CST 2019, time=2019-07-25, status=1, ipAttribution=)]
    2019-07-25 snowpeakxu
  6. [GetPortalCommentsPageByObjectIdResponse(id=1931846, encodeId=2c1b19318466c, content=<a href='/topic/show?id=250183421dc' target=_blank style='color:#2F92EE;'>#胃黏膜#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=83421, encryptionId=250183421dc, topicName=胃黏膜)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=743d308, createdName=baoya, createdTime=Sun Jul 28 04:14:00 CST 2019, time=2019-07-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1672930, encodeId=d8a616e293037, content=<a href='/topic/show?id=b79b910345c' target=_blank style='color:#2F92EE;'>#解析#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=22, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=91034, encryptionId=b79b910345c, topicName=解析)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f42d26916490, createdName=hongbochen, createdTime=Fri Feb 28 23:14:00 CST 2020, time=2020-02-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1635104, encodeId=0f7c16351049e, content=<a href='/topic/show?id=dda8834222c' target=_blank style='color:#2F92EE;'>#胃黏膜下#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=83422, encryptionId=dda8834222c, topicName=胃黏膜下)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a12645, createdName=智慧医人, createdTime=Tue May 05 17:14:00 CST 2020, time=2020-05-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1426019, encodeId=101e142601958, content=<a href='/topic/show?id=02fe9e30227' target=_blank style='color:#2F92EE;'>#间质瘤#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=97302, encryptionId=02fe9e30227, topicName=间质瘤)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=7ede4029724, createdName=zhty5338, createdTime=Thu Jul 25 07:14:00 CST 2019, time=2019-07-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1520038, encodeId=11701520038f5, content=<a href='/topic/show?id=6ab11032506f' target=_blank style='color:#2F92EE;'>#黏膜#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=103250, encryptionId=6ab11032506f, topicName=黏膜)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=057f11309297, createdName=snowpeakxu, createdTime=Thu Jul 25 07:14:00 CST 2019, time=2019-07-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1615366, encodeId=9e0b16153662b, content=<a href='/topic/show?id=d6128339573' target=_blank style='color:#2F92EE;'>#胃间质瘤#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=83395, encryptionId=d6128339573, topicName=胃间质瘤)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=d54019619450, createdName=ms920641618706883, createdTime=Thu Jul 25 07:14:00 CST 2019, time=2019-07-25, status=1, ipAttribution=)]