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AJOG：经阴道全子宫切除术中同时切除输卵管的利与弊

2017-06-15 qinqiyun MedSci原创

经阴道全子宫切除术输卵管切除术卵巢癌决策分析
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在经腹腔镜全子宫切除术和开腹全子宫切除术中，切除双侧输卵管是常规操作，但在经阴道全子宫切除术中不会常规切除输卵管，经阴道全子宫切除术中究竟该不该常规切除输卵管呢？

背景：在经腹腔镜全子宫切除术和开腹全子宫切除术中，切除双侧输卵管是常规操作，但在经阴道全子宫切除术中不会常规切除输卵管，因为普遍认为会增加死亡率、手术难度或者缺乏足够的手术训练。

目的：探究在经阴道全子宫切除术中，同时行双侧输卵管切除术，带来的并发症以及长期花费。

设计：研究者们用TreeAgePro设计了决策分析模型。手术并发症的主要评估指标有卵巢癌发生率和死亡率。模型并发症包括输血、转为腹腔镜或开腹手术，以及30天内需要干预的脓肿或血肿、肠梗阻、二次入院和二次手术。此外，研究者还将术后时间窗所发生的附件区良性手术纳入分析。费用从已发表的文献和医疗报销数据中收集。并发症发生率来自已发表的文献和2008年-2013年记录在国家手术质量提高规划数据库的13397例经阴道全子宫切除术。

结果：单纯经阴道全子宫切除术，术后每225人中1人诊断卵巢癌，每450人中1人死于卵巢癌，而行经阴道全子宫及双侧输卵管切除术，则无此发病率及死亡率。总体而言，行输卵管切除术并不比不切除输卵管的费用高（$7，350.62 vs $8，113.45）。敏感度分析表明驱动费用增加的是保留输卵管的女性中术后附件区良性手术风险的增加。经阴道全子宫切除同时切除输卵管会比单纯切除全子宫有更高的并发症（7.95% vs 7.68%）。主要并发症包括30天内的输血、肠梗阻、二次入院和二次手术。简而言之，常规行输卵管切除术每预防1例卵巢癌额外增加0.61次并发症，每预防1例死亡增加1.21次并发症。

结论：鉴于切除输卵管的优势和经济效益，输卵管切除术应该成为经阴道全子宫切除术中的常规操作。虽然并发症有小幅度的增加，但相应的预防癌症的效果还是很值得肯定的。

原始出处：
Lauren A.Cadish,Jonathan P.Shepherd,Emma L.Badber,et al.Risks and benefits of opportunistic salpingectomy during vaginal hysterectomy :A decision analysis.AJOG.14 June 2017.http://dx.doi.org/10.1016/j.ajog.2017.06.

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    2017-10-23 12498aa2m72(暂无昵称)

    #子宫切除#

    0

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    2017-10-10 liao1619

    #输卵管#

    0

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    2018-02-05 doctorzheng

    #切除术#

    0

  4. [GetPortalCommentsPageByObjectIdResponse(id=1709255, encodeId=6e8d1e0925593, content=<a href='/topic/show?id=5b354516591' target=_blank style='color:#2F92EE;'>#子宫切除#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=45165, encryptionId=5b354516591, topicName=子宫切除)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=982231632710, createdName=12498aa2m72(暂无昵称), createdTime=Mon Oct 23 06:56:00 CST 2017, time=2017-10-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1924610, encodeId=b677192461048, content=<a href='/topic/show?id=ecbc93e6143' target=_blank style='color:#2F92EE;'>#输卵管#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=93761, encryptionId=ecbc93e6143, topicName=输卵管)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e03212, createdName=liao1619, createdTime=Tue Oct 10 22:56:00 CST 2017, time=2017-10-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1876893, encodeId=b1ac18e6893a8, content=<a href='/topic/show?id=67c5319121e' target=_blank style='color:#2F92EE;'>#切除术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=31912, encryptionId=67c5319121e, topicName=切除术)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=9d8a96, createdName=doctorzheng, createdTime=Mon Feb 05 02:56:00 CST 2018, time=2018-02-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1805600, encodeId=c90418056009d, content=<a href='/topic/show?id=64c4e848838' target=_blank style='color:#2F92EE;'>#经阴道全子宫切除术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=78488, encryptionId=64c4e848838, topicName=经阴道全子宫切除术)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4736501, createdName=xiaoyang_ambs, createdTime=Thu Nov 09 11:56:00 CST 2017, time=2017-11-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1748135, encodeId=61661e481353e, content=<a href='/topic/show?id=1f0529416f2' target=_blank style='color:#2F92EE;'>#全子宫切除术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=29416, encryptionId=1f0529416f2, topicName=全子宫切除术)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=zhaojie88, createdTime=Fri Jun 16 01:56:00 CST 2017, time=2017-06-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1344453, encodeId=55f413444530a, content=<a href='/topic/show?id=3ea645166c7' target=_blank style='color:#2F92EE;'>#子宫切除术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=65, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=45166, encryptionId=3ea645166c7, topicName=子宫切除术)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=05202500204, createdName=minhuang75_72521584, createdTime=Sat Jun 17 07:56:00 CST 2017, time=2017-06-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=211236, encodeId=d427211236f7, content=受益匪浅，谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=71, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM4o2XVpJ6449yqDsjibydI5HnJ8MibGxNn4HZiaZib0bdfibbwoz3KQrIyN9AGxq36ZlZRNicYlPfOOWMtwgsajY6mGNFiaPclFdowjD0/0, createdBy=97bd1338592, createdName=清风拂面, createdTime=Thu Jun 15 21:42:44 CST 2017, time=2017-06-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=211216, encodeId=5d43211216fc, content=学习了，涨知识, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220115/46bcf39c32de4aa6b45c5f9d66c8ee77/6cb4a20c55bb4b7691122f47747bfca2.jpg, createdBy=9dad1662329, createdName=1ddf0692m34(暂无匿称), createdTime=Thu Jun 15 20:33:53 CST 2017, time=2017-06-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=211194, encodeId=35ae211194fb, content=学习了，受益匪浅。, beContent=null, objectType=article, channel=null, level=null, likeNumber=70, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/ajNVdqHZLLDicHg2ldsSNmib46PmdzpO7CQEmPjuULp1v45zPWwMYhrnXgvl3OtmUCZSQfgITWn96X9moL94nUGA/0, createdBy=28072041016, createdName=131****1460, createdTime=Thu Jun 15 19:01:04 CST 2017, time=2017-06-15, status=1, ipAttribution=)]
    2017-11-09 xiaoyang_ambs

    #经阴道全子宫切除术#

    0

  5. [GetPortalCommentsPageByObjectIdResponse(id=1709255, encodeId=6e8d1e0925593, content=<a href='/topic/show?id=5b354516591' target=_blank style='color:#2F92EE;'>#子宫切除#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=45165, encryptionId=5b354516591, topicName=子宫切除)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=982231632710, createdName=12498aa2m72(暂无昵称), createdTime=Mon Oct 23 06:56:00 CST 2017, time=2017-10-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1924610, encodeId=b677192461048, content=<a href='/topic/show?id=ecbc93e6143' target=_blank style='color:#2F92EE;'>#输卵管#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=93761, encryptionId=ecbc93e6143, topicName=输卵管)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e03212, createdName=liao1619, createdTime=Tue Oct 10 22:56:00 CST 2017, time=2017-10-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1876893, encodeId=b1ac18e6893a8, content=<a href='/topic/show?id=67c5319121e' target=_blank style='color:#2F92EE;'>#切除术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=31912, encryptionId=67c5319121e, topicName=切除术)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=9d8a96, createdName=doctorzheng, createdTime=Mon Feb 05 02:56:00 CST 2018, time=2018-02-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1805600, encodeId=c90418056009d, content=<a href='/topic/show?id=64c4e848838' target=_blank style='color:#2F92EE;'>#经阴道全子宫切除术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=78488, encryptionId=64c4e848838, topicName=经阴道全子宫切除术)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4736501, createdName=xiaoyang_ambs, createdTime=Thu Nov 09 11:56:00 CST 2017, time=2017-11-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1748135, encodeId=61661e481353e, content=<a href='/topic/show?id=1f0529416f2' target=_blank style='color:#2F92EE;'>#全子宫切除术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=29416, encryptionId=1f0529416f2, topicName=全子宫切除术)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=zhaojie88, createdTime=Fri Jun 16 01:56:00 CST 2017, time=2017-06-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1344453, encodeId=55f413444530a, content=<a href='/topic/show?id=3ea645166c7' target=_blank style='color:#2F92EE;'>#子宫切除术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=65, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=45166, encryptionId=3ea645166c7, topicName=子宫切除术)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=05202500204, createdName=minhuang75_72521584, createdTime=Sat Jun 17 07:56:00 CST 2017, time=2017-06-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=211236, encodeId=d427211236f7, content=受益匪浅，谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=71, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM4o2XVpJ6449yqDsjibydI5HnJ8MibGxNn4HZiaZib0bdfibbwoz3KQrIyN9AGxq36ZlZRNicYlPfOOWMtwgsajY6mGNFiaPclFdowjD0/0, createdBy=97bd1338592, createdName=清风拂面, createdTime=Thu Jun 15 21:42:44 CST 2017, time=2017-06-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=211216, encodeId=5d43211216fc, content=学习了，涨知识, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220115/46bcf39c32de4aa6b45c5f9d66c8ee77/6cb4a20c55bb4b7691122f47747bfca2.jpg, createdBy=9dad1662329, createdName=1ddf0692m34(暂无匿称), createdTime=Thu Jun 15 20:33:53 CST 2017, time=2017-06-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=211194, encodeId=35ae211194fb, content=学习了，受益匪浅。, beContent=null, objectType=article, channel=null, level=null, likeNumber=70, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/ajNVdqHZLLDicHg2ldsSNmib46PmdzpO7CQEmPjuULp1v45zPWwMYhrnXgvl3OtmUCZSQfgITWn96X9moL94nUGA/0, createdBy=28072041016, createdName=131****1460, createdTime=Thu Jun 15 19:01:04 CST 2017, time=2017-06-15, status=1, ipAttribution=)]
    2017-06-16 zhaojie88

    #全子宫切除术#

    0

  6. [GetPortalCommentsPageByObjectIdResponse(id=1709255, encodeId=6e8d1e0925593, content=<a href='/topic/show?id=5b354516591' target=_blank style='color:#2F92EE;'>#子宫切除#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=45165, encryptionId=5b354516591, topicName=子宫切除)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=982231632710, createdName=12498aa2m72(暂无昵称), createdTime=Mon Oct 23 06:56:00 CST 2017, time=2017-10-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1924610, encodeId=b677192461048, content=<a href='/topic/show?id=ecbc93e6143' target=_blank style='color:#2F92EE;'>#输卵管#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=93761, encryptionId=ecbc93e6143, topicName=输卵管)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e03212, createdName=liao1619, createdTime=Tue Oct 10 22:56:00 CST 2017, time=2017-10-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1876893, encodeId=b1ac18e6893a8, content=<a href='/topic/show?id=67c5319121e' target=_blank style='color:#2F92EE;'>#切除术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=31912, encryptionId=67c5319121e, topicName=切除术)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=9d8a96, createdName=doctorzheng, createdTime=Mon Feb 05 02:56:00 CST 2018, time=2018-02-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1805600, encodeId=c90418056009d, content=<a href='/topic/show?id=64c4e848838' target=_blank style='color:#2F92EE;'>#经阴道全子宫切除术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=78488, encryptionId=64c4e848838, topicName=经阴道全子宫切除术)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4736501, createdName=xiaoyang_ambs, createdTime=Thu Nov 09 11:56:00 CST 2017, time=2017-11-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1748135, encodeId=61661e481353e, content=<a href='/topic/show?id=1f0529416f2' target=_blank style='color:#2F92EE;'>#全子宫切除术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=29416, encryptionId=1f0529416f2, topicName=全子宫切除术)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=zhaojie88, createdTime=Fri Jun 16 01:56:00 CST 2017, time=2017-06-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1344453, encodeId=55f413444530a, content=<a href='/topic/show?id=3ea645166c7' target=_blank style='color:#2F92EE;'>#子宫切除术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=65, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=45166, encryptionId=3ea645166c7, topicName=子宫切除术)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=05202500204, createdName=minhuang75_72521584, createdTime=Sat Jun 17 07:56:00 CST 2017, time=2017-06-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=211236, encodeId=d427211236f7, content=受益匪浅，谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=71, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM4o2XVpJ6449yqDsjibydI5HnJ8MibGxNn4HZiaZib0bdfibbwoz3KQrIyN9AGxq36ZlZRNicYlPfOOWMtwgsajY6mGNFiaPclFdowjD0/0, createdBy=97bd1338592, createdName=清风拂面, createdTime=Thu Jun 15 21:42:44 CST 2017, time=2017-06-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=211216, encodeId=5d43211216fc, content=学习了，涨知识, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220115/46bcf39c32de4aa6b45c5f9d66c8ee77/6cb4a20c55bb4b7691122f47747bfca2.jpg, createdBy=9dad1662329, createdName=1ddf0692m34(暂无匿称), createdTime=Thu Jun 15 20:33:53 CST 2017, time=2017-06-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=211194, encodeId=35ae211194fb, content=学习了，受益匪浅。, beContent=null, objectType=article, channel=null, level=null, likeNumber=70, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/ajNVdqHZLLDicHg2ldsSNmib46PmdzpO7CQEmPjuULp1v45zPWwMYhrnXgvl3OtmUCZSQfgITWn96X9moL94nUGA/0, createdBy=28072041016, createdName=131****1460, createdTime=Thu Jun 15 19:01:04 CST 2017, time=2017-06-15, status=1, ipAttribution=)]
    2017-06-17 minhuang75_72521584

    #子宫切除术#

    0

  7. [GetPortalCommentsPageByObjectIdResponse(id=1709255, encodeId=6e8d1e0925593, content=<a href='/topic/show?id=5b354516591' target=_blank style='color:#2F92EE;'>#子宫切除#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=45165, encryptionId=5b354516591, topicName=子宫切除)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=982231632710, createdName=12498aa2m72(暂无昵称), createdTime=Mon Oct 23 06:56:00 CST 2017, time=2017-10-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1924610, encodeId=b677192461048, content=<a href='/topic/show?id=ecbc93e6143' target=_blank style='color:#2F92EE;'>#输卵管#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=93761, encryptionId=ecbc93e6143, topicName=输卵管)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e03212, createdName=liao1619, createdTime=Tue Oct 10 22:56:00 CST 2017, time=2017-10-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1876893, encodeId=b1ac18e6893a8, content=<a href='/topic/show?id=67c5319121e' target=_blank style='color:#2F92EE;'>#切除术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=31912, encryptionId=67c5319121e, topicName=切除术)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=9d8a96, createdName=doctorzheng, createdTime=Mon Feb 05 02:56:00 CST 2018, time=2018-02-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1805600, encodeId=c90418056009d, content=<a href='/topic/show?id=64c4e848838' target=_blank style='color:#2F92EE;'>#经阴道全子宫切除术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=78488, encryptionId=64c4e848838, topicName=经阴道全子宫切除术)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4736501, createdName=xiaoyang_ambs, createdTime=Thu Nov 09 11:56:00 CST 2017, time=2017-11-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1748135, encodeId=61661e481353e, content=<a href='/topic/show?id=1f0529416f2' target=_blank style='color:#2F92EE;'>#全子宫切除术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=29416, encryptionId=1f0529416f2, topicName=全子宫切除术)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=zhaojie88, createdTime=Fri Jun 16 01:56:00 CST 2017, time=2017-06-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1344453, encodeId=55f413444530a, content=<a href='/topic/show?id=3ea645166c7' target=_blank style='color:#2F92EE;'>#子宫切除术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=65, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=45166, encryptionId=3ea645166c7, topicName=子宫切除术)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=05202500204, createdName=minhuang75_72521584, createdTime=Sat Jun 17 07:56:00 CST 2017, time=2017-06-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=211236, encodeId=d427211236f7, content=受益匪浅，谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=71, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM4o2XVpJ6449yqDsjibydI5HnJ8MibGxNn4HZiaZib0bdfibbwoz3KQrIyN9AGxq36ZlZRNicYlPfOOWMtwgsajY6mGNFiaPclFdowjD0/0, createdBy=97bd1338592, createdName=清风拂面, createdTime=Thu Jun 15 21:42:44 CST 2017, time=2017-06-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=211216, encodeId=5d43211216fc, content=学习了，涨知识, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220115/46bcf39c32de4aa6b45c5f9d66c8ee77/6cb4a20c55bb4b7691122f47747bfca2.jpg, createdBy=9dad1662329, createdName=1ddf0692m34(暂无匿称), createdTime=Thu Jun 15 20:33:53 CST 2017, time=2017-06-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=211194, encodeId=35ae211194fb, content=学习了，受益匪浅。, beContent=null, objectType=article, channel=null, level=null, likeNumber=70, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/ajNVdqHZLLDicHg2ldsSNmib46PmdzpO7CQEmPjuULp1v45zPWwMYhrnXgvl3OtmUCZSQfgITWn96X9moL94nUGA/0, createdBy=28072041016, createdName=131****1460, createdTime=Thu Jun 15 19:01:04 CST 2017, time=2017-06-15, status=1, ipAttribution=)]
    2017-06-15 清风拂面

    受益匪浅，谢谢分享

    0

  8. [GetPortalCommentsPageByObjectIdResponse(id=1709255, encodeId=6e8d1e0925593, content=<a href='/topic/show?id=5b354516591' target=_blank style='color:#2F92EE;'>#子宫切除#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=45165, encryptionId=5b354516591, topicName=子宫切除)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=982231632710, createdName=12498aa2m72(暂无昵称), createdTime=Mon Oct 23 06:56:00 CST 2017, time=2017-10-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1924610, encodeId=b677192461048, content=<a href='/topic/show?id=ecbc93e6143' target=_blank style='color:#2F92EE;'>#输卵管#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=93761, encryptionId=ecbc93e6143, topicName=输卵管)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e03212, createdName=liao1619, createdTime=Tue Oct 10 22:56:00 CST 2017, time=2017-10-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1876893, encodeId=b1ac18e6893a8, content=<a href='/topic/show?id=67c5319121e' target=_blank style='color:#2F92EE;'>#切除术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=31912, encryptionId=67c5319121e, topicName=切除术)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=9d8a96, createdName=doctorzheng, createdTime=Mon Feb 05 02:56:00 CST 2018, time=2018-02-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1805600, encodeId=c90418056009d, content=<a href='/topic/show?id=64c4e848838' target=_blank style='color:#2F92EE;'>#经阴道全子宫切除术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=78488, encryptionId=64c4e848838, topicName=经阴道全子宫切除术)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4736501, createdName=xiaoyang_ambs, createdTime=Thu Nov 09 11:56:00 CST 2017, time=2017-11-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1748135, encodeId=61661e481353e, content=<a href='/topic/show?id=1f0529416f2' target=_blank style='color:#2F92EE;'>#全子宫切除术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=29416, encryptionId=1f0529416f2, topicName=全子宫切除术)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=zhaojie88, createdTime=Fri Jun 16 01:56:00 CST 2017, time=2017-06-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1344453, encodeId=55f413444530a, content=<a href='/topic/show?id=3ea645166c7' target=_blank style='color:#2F92EE;'>#子宫切除术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=65, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=45166, encryptionId=3ea645166c7, topicName=子宫切除术)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=05202500204, createdName=minhuang75_72521584, createdTime=Sat Jun 17 07:56:00 CST 2017, time=2017-06-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=211236, encodeId=d427211236f7, content=受益匪浅，谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=71, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM4o2XVpJ6449yqDsjibydI5HnJ8MibGxNn4HZiaZib0bdfibbwoz3KQrIyN9AGxq36ZlZRNicYlPfOOWMtwgsajY6mGNFiaPclFdowjD0/0, createdBy=97bd1338592, createdName=清风拂面, createdTime=Thu Jun 15 21:42:44 CST 2017, time=2017-06-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=211216, encodeId=5d43211216fc, content=学习了，涨知识, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220115/46bcf39c32de4aa6b45c5f9d66c8ee77/6cb4a20c55bb4b7691122f47747bfca2.jpg, createdBy=9dad1662329, createdName=1ddf0692m34(暂无匿称), createdTime=Thu Jun 15 20:33:53 CST 2017, time=2017-06-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=211194, encodeId=35ae211194fb, content=学习了，受益匪浅。, beContent=null, objectType=article, channel=null, level=null, likeNumber=70, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/ajNVdqHZLLDicHg2ldsSNmib46PmdzpO7CQEmPjuULp1v45zPWwMYhrnXgvl3OtmUCZSQfgITWn96X9moL94nUGA/0, createdBy=28072041016, createdName=131****1460, createdTime=Thu Jun 15 19:01:04 CST 2017, time=2017-06-15, status=1, ipAttribution=)]
    2017-06-15 1ddf0692m34(暂无匿称)

    学习了，涨知识

    0

  9. [GetPortalCommentsPageByObjectIdResponse(id=1709255, encodeId=6e8d1e0925593, content=<a href='/topic/show?id=5b354516591' target=_blank style='color:#2F92EE;'>#子宫切除#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=45165, encryptionId=5b354516591, topicName=子宫切除)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=982231632710, createdName=12498aa2m72(暂无昵称), createdTime=Mon Oct 23 06:56:00 CST 2017, time=2017-10-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1924610, encodeId=b677192461048, content=<a href='/topic/show?id=ecbc93e6143' target=_blank style='color:#2F92EE;'>#输卵管#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=93761, encryptionId=ecbc93e6143, topicName=输卵管)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e03212, createdName=liao1619, createdTime=Tue Oct 10 22:56:00 CST 2017, time=2017-10-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1876893, encodeId=b1ac18e6893a8, content=<a href='/topic/show?id=67c5319121e' target=_blank style='color:#2F92EE;'>#切除术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=31912, encryptionId=67c5319121e, topicName=切除术)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=9d8a96, createdName=doctorzheng, createdTime=Mon Feb 05 02:56:00 CST 2018, time=2018-02-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1805600, encodeId=c90418056009d, content=<a href='/topic/show?id=64c4e848838' target=_blank style='color:#2F92EE;'>#经阴道全子宫切除术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=78488, encryptionId=64c4e848838, topicName=经阴道全子宫切除术)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4736501, createdName=xiaoyang_ambs, createdTime=Thu Nov 09 11:56:00 CST 2017, time=2017-11-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1748135, encodeId=61661e481353e, content=<a href='/topic/show?id=1f0529416f2' target=_blank style='color:#2F92EE;'>#全子宫切除术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=29416, encryptionId=1f0529416f2, topicName=全子宫切除术)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=zhaojie88, createdTime=Fri Jun 16 01:56:00 CST 2017, time=2017-06-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1344453, encodeId=55f413444530a, content=<a href='/topic/show?id=3ea645166c7' target=_blank style='color:#2F92EE;'>#子宫切除术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=65, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=45166, encryptionId=3ea645166c7, topicName=子宫切除术)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=05202500204, createdName=minhuang75_72521584, createdTime=Sat Jun 17 07:56:00 CST 2017, time=2017-06-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=211236, encodeId=d427211236f7, content=受益匪浅，谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=71, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM4o2XVpJ6449yqDsjibydI5HnJ8MibGxNn4HZiaZib0bdfibbwoz3KQrIyN9AGxq36ZlZRNicYlPfOOWMtwgsajY6mGNFiaPclFdowjD0/0, createdBy=97bd1338592, createdName=清风拂面, createdTime=Thu Jun 15 21:42:44 CST 2017, time=2017-06-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=211216, encodeId=5d43211216fc, content=学习了，涨知识, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220115/46bcf39c32de4aa6b45c5f9d66c8ee77/6cb4a20c55bb4b7691122f47747bfca2.jpg, createdBy=9dad1662329, createdName=1ddf0692m34(暂无匿称), createdTime=Thu Jun 15 20:33:53 CST 2017, time=2017-06-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=211194, encodeId=35ae211194fb, content=学习了，受益匪浅。, beContent=null, objectType=article, channel=null, level=null, likeNumber=70, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/ajNVdqHZLLDicHg2ldsSNmib46PmdzpO7CQEmPjuULp1v45zPWwMYhrnXgvl3OtmUCZSQfgITWn96X9moL94nUGA/0, createdBy=28072041016, createdName=131****1460, createdTime=Thu Jun 15 19:01:04 CST 2017, time=2017-06-15, status=1, ipAttribution=)]
    2017-06-15 131****1460

    学习了，受益匪浅。

    0