深思!规培生从三甲学了腹腔镜手术,回到基层没法做!只会腹腔镜不会开腹,是误入歧途?腹腔镜已成主流,卫生院不开展,到底能做啥?

2024-10-08 梅斯头条 MedSci原创 发表于上海

规培学了腹腔镜,却不会开腹

规培学了腹腔镜,却不会开腹

这是错误的学习思路?等于误入歧途?

近期,江西某三甲一名骨科副主任医师讲述了部分规培生所遇到的现实情况。

她说道:“昨天晚上我以前带的规培医生打电话给我,他在我们科也轮转了很久,因为是定向医学生,所以规培结束后他就不得不回乡镇卫生院工作了。对于手术操作,基本的腹腔镜下阑尾切除和胆囊切除术他都能够熟练掌握他说他回乡镇医院上班后,院长就让他开阑尾炎,进手术室时有点懵,因为乡镇医院没有腹腔镜,他从来没有做过开腹下行阑尾切除术,他规培期间所接触的都是腹腔镜手术,他只能如实地和院长说,他觉得非常尴尬。在乡镇卫生院完全没有用武之地了。”

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这是一种确实存在的现状,由于大医院普及了腹腔镜技术,只要涉及到腹部手术,第一时间都会优先考虑腹腔镜,那些在大医院实习、规培、进修的医生接触的自然也都是腹腔镜,像那些传统的开腹手术,很多医生压根就没机会见到。

对此,厦门一名消化外科的医生表示:“现在的年轻医生,会开腹的已经不多了!这是我近年来的观察体验,我对此也十分痛恨、无奈。那么,为什么年轻医生不会开腹了?因为现在哪还有什么开腹手术给你做呀,我们医院不算大,微创率都95%以上了,规培教学时根本没有那个环境让年轻医生去动手开腹,都是直接上腔镜。”

“但大家都知道,学腹腔镜必须要先熟练掌握传统手术,否则需要立即开腹时你不会,那就是重大事故,不配当医生。所以我想质疑一下如今的规培教学,就问咱们这些承担了教学任务的医院,开腹手术不应该是第一课吗?怎么能允许学生在不熟练开腹的情况下就去学习腹腔镜呢?只会腹腔镜,不会开腹,这是错误的学习思路,等于误入歧途!

对此,笔者也想感慨一下,现在,老一代外科医生手术做的好,但对腹腔镜掌握不熟练;参加过规培的外科医生,腹腔镜手术确实挺熟练,但不用腔镜时,让他开腹,就特别生疏,甚至还有点害怕,不敢上手。总感觉现在医院规培对手术这一块有点本末倒置了,新医生们是得要掌握腔镜手术,但前提是你要先学会做非腔镜传统开腹手术,不然你就不是完整的外科医生。

规培时我们学到了啥?

学不到开腹,腹腔镜也学不精

不得不说,外科手术已经是腹腔镜的天下了。

腹腔镜手术操作简便,多采用2-4孔操作法,其中一个开在人体的肚脐眼上,可避免在病人腹腔部位留下长条状的伤疤,患者恢复后,仅在腹腔部位留有1-3个0.5-1cm的线状疤痕,可以说是创面小,痛楚小的手术,因此也有人称之为“钥匙孔”手术。

腹腔镜手术作为一种新发展起来的微创方法,是手术发展的必然趋势,随着科技突飞猛进地发展,相关学科的融入为开展新技术、新方法奠定了基础。

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现如今,越来越多的医生已经能十分熟练地开展腹腔镜手术了,这使得过去的许多开放性手术现已被微创手术取而代之,大大增加了患者选择手术方式的机会。由于腹腔镜手术的开展减轻了病人开刀的痛楚,同时使病人的恢复期缩短,它近年来已经以一种惊人的速度普及开来了。

大小医院全都普及,这就导致我们即将踏上工作岗位的规培医生很难再见到传统的开腹手术,用他们的话讲就是“半天等不来一个开腹的”。

传统观点认为,所有想要学腹腔镜的医生,入门级条件就是必须先熟练掌握腹腔开腹手术。但是大量实证表明,这是一种落后的观点,因为许许多多的外科医生事先根本不会开腹手术,直接就上手腹腔镜,经过训练,也能在较短时间内熟练使用腹腔镜。

新观点代替了老旧的观点,于是越来越多的医生不把传统开腹手术当成一回事,也不认为开腹手术是腹腔镜的基础。所以,在规培教学时,一些学生学不到开腹,直接学腹腔镜的现象就层出不穷了。

山东一名规培生就表示:“带教老师让我们上手术台时,操作的全都是腹腔镜手术,我至今都没有亲眼见过活体腹部内的脏器排列,只在大一上《系统解剖学》时见过大体老师的。现在医生们轻易不开腹,我们能接触到的也都是腹腔镜,即使是腹腔镜,带教老师也不敢让我们上手,好不容易碰到一个开腹的,成绩好的学生都想进手术室观摩一下,但这样的机会不多。”

开腹手术难学到,直接学习腹腔镜,可就算是腹腔镜,学生们也学不到位。

一名带教老师就曾表示:“我前段时间带教了一名规培学员,这是他在本院规培的第三年,来到我们科室已经有好几个月了,但是手术上的并不多,主要工作在病房。有一次分台手术,他想要学习,一问,他上腹腔镜胆囊切除(LC)手术都不超过 10 台,这次却问我能不能主刀,说胆囊切除挺简单的。”

“我当时不知所措,作为带教老师理应给学生动手的机会,而且 LC 确实也是肝胆胰外科的入门手术,但老主任曾教导,在主刀 LC 之前,医生至少要扶 100 台 LC 的镜子,甚至更多,所以当时我拒绝了他。为了不影响他的手术积极性,也为了看看他三年规培的效果,我把腹腔镜下取标本和关腹让他来主刀。事实证明他对于取物袋的使用和脐下孔的关闭都不能独立完成。

“这三年他算是很勤奋、很主动的学生,但都如此糟糕,说实在的,要问我规培生三年能学到什么东西,还真学不到啥,腹腔镜动手次数最多,都是如此,开腹手术更是皮毛都不懂的。”

所以,规培学到了真东西吗?真的难以学到!还是得靠未来在工作中一边实践一边积累。

腹腔镜已成主流,

卫生院不开展,到底能做啥手术?

 

如上文所言,作为定向生,规培结束后必须要回乡镇卫生院,在三甲学了腹腔镜,但是卫生院却没有设备做不了,这令年轻的医生十分尴尬。

于是我们就很纳闷,像腹腔镜这样的手术,已经非常普及了,就这样的技术基层医院居然还没有开展,基层医院到底能做什么样的手术呀?是不是在整天摸鱼?如果一直这样躺平摆烂,这不能做,那没有条件,你让年轻医生还怎么留下来?

以洛阳市孟津区某镇卫生院为例,在该院简介中,医院能做的手术包括外伤清创缝合术、下肢静脉曲张、腹股沟疝、体表肿瘤 (脂肪瘤、纤维瘤、鸡眼等)、骨折石膏夹板固定术、泌尿外科一般手术、包皮环切术、 一般肛肠科手术、血栓性外痔、肛周脓肿、肛瘘等常见手术。简介中并未提到腹腔镜手术。

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俗话说打铁还需自身硬,基层医院在人才、设备、科室等方面太薄弱了,患者不愿意去终于找到了原因。

必须要说,现在国家致力于分级诊疗,给了基层医院很多政策,为什么不能借助国家投入的金钱,做好长远规划、健全诊疗科目呢?乡镇卫生院通过引进人才、改善设施、配置设备、对口支援等方式,完全可以达到一、二级医院的专科水平。

就单说腹腔镜手术这个问题,它是近年来开展的新技术,切口小,出血少,恢复快,手术当天可进食和下地活动,术后2~3日出院。在我们村(阜阳颍泉),有非常多上了岁数的农村大爷大奶无论大病小病都只在卫生院看病,其实他们非常需要这项技术,能从腹腔镜上获得很大益处,就因为乡镇卫生院开展的少,不去购买设备,导致这些老人根本没有选择的机会。

所以,咱们不能再让人说卫生院是吃白饭的了,卫生院也不能再摆烂躺平,既然农村老人有这个需求,卫生院就应该选派技术骨干,到上级医院进修深造。经过1~2年的正规腹腔镜专科培训,在上级医师的指导下,基层医生也可以尽快掌握腹腔镜的基本操作技术,这对于患者和卫生院来说,是双赢的事。

未来,如果乡镇卫生院也能普及腹腔镜,这对于老少爷们来说,是一件值得高兴的大喜事!

撰文 | 阿拉斯加宝
编辑 | 阿拉斯加宝

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    2024-10-14 yangchou 来自浙江省

    好文章,谢谢分享。

    0

  2. [GetPortalCommentsPageByObjectIdResponse(id=2230749, encodeId=9db62230e493c, content=好文章,谢谢分享。, beContent=null, objectType=article, channel=null, level=null, likeNumber=15, 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=Mon Oct 14 08:25:31 CST 2024, time=2024-10-14, status=1, ipAttribution=浙江省), GetPortalCommentsPageByObjectIdResponse(id=2230515, encodeId=e6e82230515ae, content=好文章,值得推荐。, beContent=null, objectType=article, channel=null, level=null, likeNumber=23, 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=Sat Oct 12 17:07:36 CST 2024, time=2024-10-12, status=1, ipAttribution=江苏省), GetPortalCommentsPageByObjectIdResponse(id=2230599, encodeId=14152230599ea, content=好文章,值得推荐。, beContent=null, objectType=article, channel=null, level=null, likeNumber=16, 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=Sun Oct 13 11:18:11 CST 2024, time=2024-10-13, status=1, ipAttribution=江苏省), GetPortalCommentsPageByObjectIdResponse(id=2230405, encodeId=e541223040523, content=好文章,值得一读。, beContent=null, objectType=article, channel=null, level=null, likeNumber=15, 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=Fri Oct 11 22:12:49 CST 2024, time=2024-10-11, status=1, ipAttribution=江苏省), GetPortalCommentsPageByObjectIdResponse(id=2230157, encodeId=69cf223015ee0, content=好文章,值得推荐。, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, 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 Oct 10 13:17:02 CST 2024, time=2024-10-10, status=1, ipAttribution=浙江省), GetPortalCommentsPageByObjectIdResponse(id=2230029, encodeId=ec0a2230029e6, content=好文章,值得一读。, beContent=null, objectType=article, channel=null, level=null, likeNumber=53, 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=Wed Oct 09 20:22:58 CST 2024, time=2024-10-09, status=1, ipAttribution=江苏省), GetPortalCommentsPageByObjectIdResponse(id=2229909, encodeId=80f0222990928, content=好文章,谢谢分享。, beContent=null, objectType=article, channel=null, level=null, likeNumber=58, 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=Wed Oct 09 08:44:24 CST 2024, time=2024-10-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2229824, encodeId=f39522298245e, content=1223, beContent=null, objectType=article, channel=null, level=null, likeNumber=48, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=12929487465, createdName=ms2000001614134640, createdTime=Tue Oct 08 15:41:22 CST 2024, time=2024-10-08, status=1, ipAttribution=湖南省)]
    2024-10-12 yangchou 来自江苏省

    好文章,值得推荐。

    0

  3. [GetPortalCommentsPageByObjectIdResponse(id=2230749, encodeId=9db62230e493c, content=好文章,谢谢分享。, beContent=null, objectType=article, channel=null, level=null, likeNumber=15, 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=Mon Oct 14 08:25:31 CST 2024, time=2024-10-14, status=1, ipAttribution=浙江省), GetPortalCommentsPageByObjectIdResponse(id=2230515, encodeId=e6e82230515ae, content=好文章,值得推荐。, beContent=null, objectType=article, channel=null, level=null, likeNumber=23, 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=Sat Oct 12 17:07:36 CST 2024, time=2024-10-12, status=1, ipAttribution=江苏省), GetPortalCommentsPageByObjectIdResponse(id=2230599, encodeId=14152230599ea, content=好文章,值得推荐。, beContent=null, objectType=article, channel=null, level=null, likeNumber=16, 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=Sun Oct 13 11:18:11 CST 2024, time=2024-10-13, status=1, ipAttribution=江苏省), GetPortalCommentsPageByObjectIdResponse(id=2230405, encodeId=e541223040523, content=好文章,值得一读。, beContent=null, objectType=article, channel=null, level=null, likeNumber=15, 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=Fri Oct 11 22:12:49 CST 2024, time=2024-10-11, status=1, ipAttribution=江苏省), GetPortalCommentsPageByObjectIdResponse(id=2230157, encodeId=69cf223015ee0, content=好文章,值得推荐。, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, 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 Oct 10 13:17:02 CST 2024, time=2024-10-10, status=1, ipAttribution=浙江省), GetPortalCommentsPageByObjectIdResponse(id=2230029, encodeId=ec0a2230029e6, content=好文章,值得一读。, beContent=null, objectType=article, channel=null, level=null, likeNumber=53, 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=Wed Oct 09 20:22:58 CST 2024, time=2024-10-09, status=1, ipAttribution=江苏省), GetPortalCommentsPageByObjectIdResponse(id=2229909, encodeId=80f0222990928, content=好文章,谢谢分享。, beContent=null, objectType=article, channel=null, level=null, likeNumber=58, 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=Wed Oct 09 08:44:24 CST 2024, time=2024-10-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2229824, encodeId=f39522298245e, content=1223, beContent=null, objectType=article, channel=null, level=null, likeNumber=48, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=12929487465, createdName=ms2000001614134640, createdTime=Tue Oct 08 15:41:22 CST 2024, time=2024-10-08, status=1, ipAttribution=湖南省)]
    2024-10-13 yangchou 来自江苏省

    好文章,值得推荐。

    0

  4. [GetPortalCommentsPageByObjectIdResponse(id=2230749, encodeId=9db62230e493c, content=好文章,谢谢分享。, beContent=null, objectType=article, channel=null, level=null, likeNumber=15, 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=Mon Oct 14 08:25:31 CST 2024, time=2024-10-14, status=1, ipAttribution=浙江省), GetPortalCommentsPageByObjectIdResponse(id=2230515, encodeId=e6e82230515ae, content=好文章,值得推荐。, beContent=null, objectType=article, channel=null, level=null, likeNumber=23, 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=Sat Oct 12 17:07:36 CST 2024, time=2024-10-12, status=1, ipAttribution=江苏省), GetPortalCommentsPageByObjectIdResponse(id=2230599, encodeId=14152230599ea, content=好文章,值得推荐。, beContent=null, objectType=article, channel=null, level=null, likeNumber=16, 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=Sun Oct 13 11:18:11 CST 2024, time=2024-10-13, status=1, ipAttribution=江苏省), GetPortalCommentsPageByObjectIdResponse(id=2230405, encodeId=e541223040523, content=好文章,值得一读。, beContent=null, objectType=article, channel=null, level=null, likeNumber=15, 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=Fri Oct 11 22:12:49 CST 2024, time=2024-10-11, status=1, ipAttribution=江苏省), GetPortalCommentsPageByObjectIdResponse(id=2230157, encodeId=69cf223015ee0, content=好文章,值得推荐。, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, 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 Oct 10 13:17:02 CST 2024, time=2024-10-10, status=1, ipAttribution=浙江省), GetPortalCommentsPageByObjectIdResponse(id=2230029, encodeId=ec0a2230029e6, content=好文章,值得一读。, beContent=null, objectType=article, channel=null, level=null, likeNumber=53, 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=Wed Oct 09 20:22:58 CST 2024, time=2024-10-09, status=1, ipAttribution=江苏省), GetPortalCommentsPageByObjectIdResponse(id=2229909, encodeId=80f0222990928, content=好文章,谢谢分享。, beContent=null, objectType=article, channel=null, level=null, likeNumber=58, 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=Wed Oct 09 08:44:24 CST 2024, time=2024-10-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2229824, encodeId=f39522298245e, content=1223, beContent=null, objectType=article, channel=null, level=null, likeNumber=48, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=12929487465, createdName=ms2000001614134640, createdTime=Tue Oct 08 15:41:22 CST 2024, time=2024-10-08, status=1, ipAttribution=湖南省)]
    2024-10-11 yangchou 来自江苏省

    好文章,值得一读。

    0

  5. [GetPortalCommentsPageByObjectIdResponse(id=2230749, encodeId=9db62230e493c, content=好文章,谢谢分享。, beContent=null, objectType=article, channel=null, level=null, likeNumber=15, 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=Mon Oct 14 08:25:31 CST 2024, time=2024-10-14, status=1, ipAttribution=浙江省), GetPortalCommentsPageByObjectIdResponse(id=2230515, encodeId=e6e82230515ae, content=好文章,值得推荐。, beContent=null, objectType=article, channel=null, level=null, likeNumber=23, 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=Sat Oct 12 17:07:36 CST 2024, time=2024-10-12, status=1, ipAttribution=江苏省), GetPortalCommentsPageByObjectIdResponse(id=2230599, encodeId=14152230599ea, content=好文章,值得推荐。, beContent=null, objectType=article, channel=null, level=null, likeNumber=16, 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=Sun Oct 13 11:18:11 CST 2024, time=2024-10-13, status=1, ipAttribution=江苏省), GetPortalCommentsPageByObjectIdResponse(id=2230405, encodeId=e541223040523, content=好文章,值得一读。, beContent=null, objectType=article, channel=null, level=null, likeNumber=15, 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=Fri Oct 11 22:12:49 CST 2024, time=2024-10-11, status=1, ipAttribution=江苏省), GetPortalCommentsPageByObjectIdResponse(id=2230157, encodeId=69cf223015ee0, content=好文章,值得推荐。, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, 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 Oct 10 13:17:02 CST 2024, time=2024-10-10, status=1, ipAttribution=浙江省), GetPortalCommentsPageByObjectIdResponse(id=2230029, encodeId=ec0a2230029e6, content=好文章,值得一读。, beContent=null, objectType=article, channel=null, level=null, likeNumber=53, 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=Wed Oct 09 20:22:58 CST 2024, time=2024-10-09, status=1, ipAttribution=江苏省), GetPortalCommentsPageByObjectIdResponse(id=2229909, encodeId=80f0222990928, content=好文章,谢谢分享。, beContent=null, objectType=article, channel=null, level=null, likeNumber=58, 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=Wed Oct 09 08:44:24 CST 2024, time=2024-10-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2229824, encodeId=f39522298245e, content=1223, beContent=null, objectType=article, channel=null, level=null, likeNumber=48, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=12929487465, createdName=ms2000001614134640, createdTime=Tue Oct 08 15:41:22 CST 2024, time=2024-10-08, status=1, ipAttribution=湖南省)]
    2024-10-10 yangchou 来自浙江省

    好文章,值得推荐。

    0

  6. [GetPortalCommentsPageByObjectIdResponse(id=2230749, encodeId=9db62230e493c, content=好文章,谢谢分享。, beContent=null, objectType=article, channel=null, level=null, likeNumber=15, 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=Mon Oct 14 08:25:31 CST 2024, time=2024-10-14, status=1, ipAttribution=浙江省), GetPortalCommentsPageByObjectIdResponse(id=2230515, encodeId=e6e82230515ae, content=好文章,值得推荐。, beContent=null, objectType=article, channel=null, level=null, likeNumber=23, 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=Sat Oct 12 17:07:36 CST 2024, time=2024-10-12, status=1, ipAttribution=江苏省), GetPortalCommentsPageByObjectIdResponse(id=2230599, encodeId=14152230599ea, content=好文章,值得推荐。, beContent=null, objectType=article, channel=null, level=null, likeNumber=16, 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=Sun Oct 13 11:18:11 CST 2024, time=2024-10-13, status=1, ipAttribution=江苏省), GetPortalCommentsPageByObjectIdResponse(id=2230405, encodeId=e541223040523, content=好文章,值得一读。, beContent=null, objectType=article, channel=null, level=null, likeNumber=15, 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=Fri Oct 11 22:12:49 CST 2024, time=2024-10-11, status=1, ipAttribution=江苏省), GetPortalCommentsPageByObjectIdResponse(id=2230157, encodeId=69cf223015ee0, content=好文章,值得推荐。, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, 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 Oct 10 13:17:02 CST 2024, time=2024-10-10, status=1, ipAttribution=浙江省), GetPortalCommentsPageByObjectIdResponse(id=2230029, encodeId=ec0a2230029e6, content=好文章,值得一读。, beContent=null, objectType=article, channel=null, level=null, likeNumber=53, 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=Wed Oct 09 20:22:58 CST 2024, time=2024-10-09, status=1, ipAttribution=江苏省), GetPortalCommentsPageByObjectIdResponse(id=2229909, encodeId=80f0222990928, content=好文章,谢谢分享。, beContent=null, objectType=article, channel=null, level=null, likeNumber=58, 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=Wed Oct 09 08:44:24 CST 2024, time=2024-10-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2229824, encodeId=f39522298245e, content=1223, beContent=null, objectType=article, channel=null, level=null, likeNumber=48, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=12929487465, createdName=ms2000001614134640, createdTime=Tue Oct 08 15:41:22 CST 2024, time=2024-10-08, status=1, ipAttribution=湖南省)]
    2024-10-09 yangchou 来自江苏省

    好文章,值得一读。

    0

  7. [GetPortalCommentsPageByObjectIdResponse(id=2230749, encodeId=9db62230e493c, content=好文章,谢谢分享。, beContent=null, objectType=article, channel=null, level=null, likeNumber=15, 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=Mon Oct 14 08:25:31 CST 2024, time=2024-10-14, status=1, ipAttribution=浙江省), GetPortalCommentsPageByObjectIdResponse(id=2230515, encodeId=e6e82230515ae, content=好文章,值得推荐。, beContent=null, objectType=article, channel=null, level=null, likeNumber=23, 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=Sat Oct 12 17:07:36 CST 2024, time=2024-10-12, status=1, ipAttribution=江苏省), GetPortalCommentsPageByObjectIdResponse(id=2230599, encodeId=14152230599ea, content=好文章,值得推荐。, beContent=null, objectType=article, channel=null, level=null, likeNumber=16, 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=Sun Oct 13 11:18:11 CST 2024, time=2024-10-13, status=1, ipAttribution=江苏省), GetPortalCommentsPageByObjectIdResponse(id=2230405, encodeId=e541223040523, content=好文章,值得一读。, beContent=null, objectType=article, channel=null, level=null, likeNumber=15, 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=Fri Oct 11 22:12:49 CST 2024, time=2024-10-11, status=1, ipAttribution=江苏省), GetPortalCommentsPageByObjectIdResponse(id=2230157, encodeId=69cf223015ee0, content=好文章,值得推荐。, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, 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 Oct 10 13:17:02 CST 2024, time=2024-10-10, status=1, ipAttribution=浙江省), GetPortalCommentsPageByObjectIdResponse(id=2230029, encodeId=ec0a2230029e6, content=好文章,值得一读。, beContent=null, objectType=article, channel=null, level=null, likeNumber=53, 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=Wed Oct 09 20:22:58 CST 2024, time=2024-10-09, status=1, ipAttribution=江苏省), GetPortalCommentsPageByObjectIdResponse(id=2229909, encodeId=80f0222990928, content=好文章,谢谢分享。, beContent=null, objectType=article, channel=null, level=null, likeNumber=58, 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=Wed Oct 09 08:44:24 CST 2024, time=2024-10-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2229824, encodeId=f39522298245e, content=1223, beContent=null, objectType=article, channel=null, level=null, likeNumber=48, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=12929487465, createdName=ms2000001614134640, createdTime=Tue Oct 08 15:41:22 CST 2024, time=2024-10-08, status=1, ipAttribution=湖南省)]
    2024-10-09 yangchou

    好文章,谢谢分享。

    0

  8. [GetPortalCommentsPageByObjectIdResponse(id=2230749, encodeId=9db62230e493c, content=好文章,谢谢分享。, beContent=null, objectType=article, channel=null, level=null, likeNumber=15, 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=Mon Oct 14 08:25:31 CST 2024, time=2024-10-14, status=1, ipAttribution=浙江省), GetPortalCommentsPageByObjectIdResponse(id=2230515, encodeId=e6e82230515ae, content=好文章,值得推荐。, beContent=null, objectType=article, channel=null, level=null, likeNumber=23, 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=Sat Oct 12 17:07:36 CST 2024, time=2024-10-12, status=1, ipAttribution=江苏省), GetPortalCommentsPageByObjectIdResponse(id=2230599, encodeId=14152230599ea, content=好文章,值得推荐。, beContent=null, objectType=article, channel=null, level=null, likeNumber=16, 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=Sun Oct 13 11:18:11 CST 2024, time=2024-10-13, status=1, ipAttribution=江苏省), GetPortalCommentsPageByObjectIdResponse(id=2230405, encodeId=e541223040523, content=好文章,值得一读。, beContent=null, objectType=article, channel=null, level=null, likeNumber=15, 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=Fri Oct 11 22:12:49 CST 2024, time=2024-10-11, status=1, ipAttribution=江苏省), GetPortalCommentsPageByObjectIdResponse(id=2230157, encodeId=69cf223015ee0, content=好文章,值得推荐。, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, 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 Oct 10 13:17:02 CST 2024, time=2024-10-10, status=1, ipAttribution=浙江省), GetPortalCommentsPageByObjectIdResponse(id=2230029, encodeId=ec0a2230029e6, content=好文章,值得一读。, beContent=null, objectType=article, channel=null, level=null, likeNumber=53, 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=Wed Oct 09 20:22:58 CST 2024, time=2024-10-09, status=1, ipAttribution=江苏省), GetPortalCommentsPageByObjectIdResponse(id=2229909, encodeId=80f0222990928, content=好文章,谢谢分享。, beContent=null, objectType=article, channel=null, level=null, likeNumber=58, 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=Wed Oct 09 08:44:24 CST 2024, time=2024-10-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2229824, encodeId=f39522298245e, content=1223, beContent=null, objectType=article, channel=null, level=null, likeNumber=48, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=12929487465, createdName=ms2000001614134640, createdTime=Tue Oct 08 15:41:22 CST 2024, time=2024-10-08, status=1, ipAttribution=湖南省)]
    2024-10-08 ms2000001614134640 来自湖南省

    1223

    0