1fy07h 发表于 2024-6-15 17:33:22

北京协和医院肿瘤内科:穿越抗癌重重迷雾,全力以赴为病人搏生机 | 致敬中国医师节·健康中国 你我同行㉕


    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><a style="color: black;"><span style="color: black;"><img src="https://mmbiz.qpic.cn/sz_mmbiz_png/BnPqMhCfRUvKH2mMBVfYiaosib5ato5ESn3ickTpLuZBFWicE9icQUVv7kccgXDqdic14dxsTl5B4NZy2Q4p3Qwkibv8A/640?wx_fmt=png&amp;tp=webp&amp;wxfrom=5&amp;wx_lazy=1&amp;wx_co=1" style="width: 50%; margin-bottom: 20px;"></span></a></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;"><span style="color: black;">医师报讯</span></strong><span style="color: black;">(融<span style="color: black;">媒介</span>记者 管颜青)在北京王府井大街以东,有一处屹立百年,充满中国古典建筑风格的院落。它是蜚声海内外的中国顶级医院——北京协和医院,其历史与中国现代医学发展史紧密相连,见证了现代医学在中国落地生根的恢宏画卷。</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">在回顾医院百年的历史长河中,有一张描绘1940年协和大内科查房的场面的漫画流传<span style="color: black;">迄今</span>,内科<span style="color: black;">大夫</span>几乎<span style="color: black;">所有</span>到场,还<span style="color: black;">包含</span>了皮肤科、放射科、神经精神科、儿科等科室的<span style="color: black;">大夫</span>参加。<span style="color: black;">她们</span>只为一个<span style="color: black;">病人</span>会诊,集思广益,百家争鸣,群策群力<span style="color: black;">处理</span>诊治中的疑难问题。时<span style="color: black;">迄今</span>日,<span style="color: black;">这般</span>壮观的内科大查房依然是协和内科的盛景。</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">精益求精的钻研学问是老协和人的命根子。在成立仅有20余年的肿瘤内科,这种“严谨、求精、勤奋、奉献”的百年精神依然延续。在陈书长教授、白春梅教授、巴一教授三代科室<span style="color: black;">专家</span>的传承接力下,<span style="color: black;">她们</span>扛起了领航肿瘤学科发展的重任。<span style="color: black;">她们</span>是国内率先提出“肿瘤规范化治疗”的理念、按指南规范肿瘤治疗的科室之一。<span style="color: black;">她们</span>穿越肿瘤治疗的重重迷雾,遵循“个体化治疗”“多学科综合协作”“<span style="color: black;">精细</span>抗癌”等先进的治疗模式,为全国的肿瘤疑难杂症<span style="color: black;">病人</span>寻找治疗的最优解。</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><img src="https://mmbiz.qpic.cn/sz_mmbiz_jpg/BnPqMhCfRUus12StjThibKVgUtXGDt2R9FaicQRicRnEJR0QApRxOR2RBXiaqYP0katmicHB3ibP0iava4aujPIaYgqUQ/640?wx_fmt=jpeg&amp;tp=webp&amp;wxfrom=5&amp;wx_lazy=1&amp;wx_co=1" style="width: 50%; margin-bottom: 20px;"></p><strong style="color: blue;">0</strong><strong style="color: blue;">1</strong><strong style="color: blue;">20余载初心如磐,<span style="color: black;">保护</span>健康全力以赴</strong>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">时钟拨回上个世纪90年代,此时肿瘤已<span style="color: black;">起始</span><span style="color: black;">作为</span>威胁人类生命和健康<span style="color: black;">要紧</span><span style="color: black;">疾患</span>之一。<span style="color: black;">伴同</span>着我国抗肿瘤治疗的<span style="color: black;">科研</span>逐步繁荣,全国各地纷纷<span style="color: black;">创立</span>了肿瘤内科的专业科室。在这一背景下,北京协和医院依托<span style="color: black;">持有</span>扎实深厚的内科治疗功底,率先于2001年11月在全国大型综合性医院中<span style="color: black;">创立</span>肿瘤化疗病房,在2002年8月以此为<span style="color: black;">基本</span><span style="color: black;">创立</span>了肿瘤内科。经过20余年的发展壮大,已<span style="color: black;">作为</span>国内领先的肿瘤规范化和创新性治疗中心。</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">做为</span><span style="color: black;">第1</span>批加入的<span style="color: black;">大夫</span>之一,</span><strong style="color: blue;"><span style="color: black;">肿瘤内科副<span style="color: black;">专家</span>赵林</span></strong><span style="color: black;">对科室发展深有感触。在她看来,<span style="color: black;">伴同</span>着肿瘤治疗模式的日新月异,科室紧跟肿瘤内科发展的时代步伐,积极学习开展新技术、新<span style="color: black;">方法</span>。从最初进入科室时<span style="color: black;">仅有</span>传统的化疗手段,到如今靶向、免疫、抗血管生成、疫苗、抗体偶联<span style="color: black;">药品</span>等治疗<span style="color: black;">方法</span>的层出不穷,多种治疗手段联合应用,肿瘤内科团队始终走在国内前沿,<span style="color: black;">帮忙</span><span style="color: black;">病人</span><span style="color: black;">得到</span>最新、最好、最适宜的治疗<span style="color: black;">方法</span>。</span></p><span style="color: black;">
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    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">“从刚建科的四五个人到<span style="color: black;">此刻</span>二十多人,如今的科室成员各有所长,覆盖的瘤种非常全面。”</span><strong style="color: blue;"><span style="color: black;">肿瘤内科<span style="color: black;">专家</span>医师王颖轶教授</span></strong><span style="color: black;">回忆说,科室成立初期<span style="color: black;">重点</span>覆盖当时较为<span style="color: black;">平常</span>的瘤种,<span style="color: black;">此刻</span>亚专科分的更细,瘤种<span style="color: black;">更加多</span>,<span style="color: black;">包含</span>乳腺癌、肺癌、消化系统肿瘤、泌尿生殖系统肿瘤、神经内分泌肿瘤等,以及罕见肿瘤、老年肿瘤、有合并症的肿瘤等<span style="color: black;">繁杂</span>疑难病例,<span style="color: black;">累积</span>了独到的经验,能达到“人<span style="color: black;">没</span>我有,人有我精”的状态。</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">王颖轶认为,与专科医院的肿瘤内科相比,科室<span style="color: black;">做为</span>全国大型综合性医院中的专科,在依托兄弟科室的强大综合实力下,更<span style="color: black;">拥有</span>治疗伴有合并症的肿瘤的<span style="color: black;">优良</span>。</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">十年前,曾有一名乳腺癌骨转移<span style="color: black;">病人</span><span style="color: black;">因为</span>骨骼病变压迫神经,<span style="color: black;">处在</span>截瘫状态。她多次寻医<span style="color: black;">没</span>果后,慕名来到北京协和医院。尽管<span style="color: black;">病人</span>在治疗前期<span style="color: black;">显现</span>了感染性休克,<span style="color: black;">导致</span>多脏器功能衰竭,命悬一线,但在肿瘤内科、骨科、重症医学科等多团队的协作下,<span style="color: black;">最后</span>将<span style="color: black;">病人</span>从死亡线上拉了回来,经治疗后肿瘤还缩小了2/3。要<span style="color: black;">晓得</span>,当时多脏器功能衰竭的死亡率高达95%。这是团队合力攻坚下的奇迹,诠释了协和人全力以赴勇攀医学高峰的使命与担当。</span></p><strong style="color: blue;">0</strong><strong style="color: blue;">2</strong><strong style="color: blue;">践行规范化诊疗理念,多学科协作寻找最优解</strong>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">尽管20<span style="color: black;">数年</span>来,科室的人员规模、治疗模式<span style="color: black;">出现</span>了变化,但始终不变的是“肿瘤规范化治疗”的理念。</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">“规范治疗是<span style="color: black;">咱们</span>科室的核心,<span style="color: black;">表现</span>了‘严谨’‘求精的协和精神。”赵林介绍,肿瘤内科有一本肿瘤治疗的工作手册,每年年底由科<span style="color: black;">专家</span>带领团队进行所有瘤种治疗<span style="color: black;">方法</span>的修订更新,纳入国内外权威的指南<span style="color: black;">举荐</span>和最新的临床<span style="color: black;">科研</span>,以此<span style="color: black;">指点</span>全科工作,从而保持治疗<span style="color: black;">方法</span>紧跟前沿。</span></p><span style="color: black;">
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    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">“规范化诊疗并非本本主义,<span style="color: black;">咱们</span>主张<span style="color: black;">按照</span><span style="color: black;">病人</span>的<span style="color: black;">实质</span><span style="color: black;">状况</span>进行探索创新。”王颖轶<span style="color: black;">暗示</span>,尽管科室有标准化的工作手册,但面对<span style="color: black;">繁杂</span>多样的<span style="color: black;">病人</span>群体时,科室<span style="color: black;">注意</span>“个体化治疗”“多学科综合协作”“<span style="color: black;">精细</span>抗癌”等治疗理念,为每位<span style="color: black;">病人</span>寻求个性化的治疗<span style="color: black;">方法</span>。尤其在巴一教授的带领下,科室更加<span style="color: black;">注意</span>多学科综合协作和<span style="color: black;">教育</span>查房,将规范化诊疗落实到每一个细节中。</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">做为</span>胰腺肿瘤、食管及胃部肿瘤、结直肠肿瘤多学科疑难会诊(MDT)小<span style="color: black;">构成</span>员,</span><strong style="color: blue;"><span style="color: black;">肿瘤内科<span style="color: black;">专家</span>助理王湘</span></strong><span style="color: black;">感受到越来越多的<span style="color: black;">病人</span>正从MDT中获益。</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">曾有一名结直肠癌<span style="color: black;">病人</span>伴有肺结核症状,但<span style="color: black;">没</span>法判断到底是结直肠癌<span style="color: black;">引起</span>的肺转移,还是本身就有肺结核<span style="color: black;">基本</span>病后<span style="color: black;">显现</span>的结直肠癌。<span style="color: black;">认识</span><span style="color: black;">病人</span>的<span style="color: black;">疾患</span><span style="color: black;">发展</span>对理清治疗<span style="color: black;">方法</span>的主次<span style="color: black;">次序</span>影响很大。为此,结直肠肿瘤MDT专家团队反复多次讨论了该病例,<span style="color: black;">包含</span>肿瘤内科、外科、<span style="color: black;">呼气</span>科、放射科、影像科、放疗科等学科。<span style="color: black;">最后</span>,MDT团队<span style="color: black;">经过</span>抽丝剥茧的分析,判断患者是结直肠癌肺转移合并肺结核。经过抗结核治疗、化疗、手术等一系列治疗后,<span style="color: black;">病人</span>已带瘤<span style="color: black;">存活</span>了8年,如今生活质量依然很好。</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">在北京协和医院,<span style="color: black;">这般</span>的MDT专业组共有40多个,肿瘤内科参与其中20多个专业组的讨论。<span style="color: black;">她们</span>从<span style="color: black;">病人</span>和家庭的<span style="color: black;">必须</span>出发,以<span style="color: black;">病人</span>为中心,<span style="color: black;">经过</span>医患<span style="color: black;">一起</span>决策,群策群力,为全国疑难重症的肿瘤<span style="color: black;">病人</span>排忧解难。</span></p><strong style="color: blue;">0</strong><strong style="color: blue;">3</strong><strong style="color: blue;">学习交流风雨<span style="color: black;">没</span>阻,<span style="color: black;">研究</span>以<span style="color: black;">病人</span>为出发点</strong>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">倘若</span>你全天跟随肿瘤内科医务人员的脚步,你会被科室浓厚的学术氛围深深感染。每周一举行新病例和疑难病例全科讨论会,周二和周五与前来学习的住院医、<span style="color: black;">科研</span>生、博士生、进修生交流沟通,周三经典文献和业务学习,周四<span style="color: black;">研究</span>交流分享。科室每年还举办国家级继续教育学习班和神经内分泌肿瘤学习班,并派成员参加ASCO、ESMO、JSMO等美欧日国际肿瘤学术会议,<span style="color: black;">即时</span>把握国际肿瘤治疗<span style="color: black;">行业</span>最新<span style="color: black;">发展</span>。</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">“这种<span style="color: black;">定时</span>的学习交流<span style="color: black;">咱们</span><span style="color: black;">已然</span><span style="color: black;">保持</span>了20<span style="color: black;">数年</span>了,<span style="color: black;">能够</span>说建科<span style="color: black;">败兴</span>风雨<span style="color: black;">没</span>阻。”王湘说,“肿瘤学科知识更新的速度非常快,学<span style="color: black;">没</span>止境。<span style="color: black;">因此呢</span>,<span style="color: black;">大众</span>都愿意主动交流学习。<span style="color: black;">咱们</span>常常针对一个病例,从病因、机制、病理,临床<span style="color: black;">科研</span>、治疗<span style="color: black;">重视</span>事项进行系统深入的分析,有时还会有唇枪舌战的激烈讨论,氛围非常好。”</span></p><span style="color: black;">
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    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">赵林<span style="color: black;">亦</span>深有同感:“<span style="color: black;">做为</span>一位有责任心的肿瘤科<span style="color: black;">大夫</span>,<span style="color: black;">必要</span>保持时刻学习的状态,以适应国内外肿瘤治疗飞跃式的发展变化。与此<span style="color: black;">同期</span>,科室注重<span style="color: black;">研究</span>和临床转化。在巴一<span style="color: black;">专家</span>到来后,<span style="color: black;">研究</span>更关注改善临床的<span style="color: black;">实质</span>问题。”</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">例如</span>,医学界<span style="color: black;">针对</span>免疫治疗的<span style="color: black;">认识</span>仅为冰山一角,<span style="color: black;">怎样</span><span style="color: black;">经过</span>肿瘤微环境或生物标记物预测免疫治疗疗效和安全性,仍<span style="color: black;">必须</span><span style="color: black;">更加多</span>的探索。再<span style="color: black;">例如</span>,肿瘤耐药性是限制<span style="color: black;">各样</span>治疗<span style="color: black;">方法</span>疗效的一大<span style="color: black;">困难</span>。寻找肿瘤的耐药机制,为<span style="color: black;">病人</span>带来用药<span style="color: black;">指点</span>,<span style="color: black;">亦</span>是科室关注的临床热点。</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">“<span style="color: black;">大夫</span>不仅要会看病,更要学会思考,<span style="color: black;">经过</span><span style="color: black;">研究</span>寻找临床问题的<span style="color: black;">处理</span><span style="color: black;">办法</span>。”赵林<span style="color: black;">暗示</span>,<span style="color: black;">日前</span>科室有1个肿瘤<span style="color: black;">基本</span><span style="color: black;">科研</span>实验室,与中国医学科学院国家分子生物学重点实验室合作开展细胞生物学、分子生物学及肿瘤免疫学等<span style="color: black;">基本</span><span style="color: black;">科研</span>。<span style="color: black;">同期</span>,科室<span style="color: black;">亦</span>是“国家级肿瘤<span style="color: black;">药品</span>临床<span style="color: black;">实验</span>基地”,年均开展20余项I~IV期肿瘤<span style="color: black;">药品</span>临床<span style="color: black;">实验</span>。<span style="color: black;">能够</span>说,从<span style="color: black;">基本</span><span style="color: black;">研究</span>到临床<span style="color: black;">实验</span>,只要是<span style="color: black;">病人</span>所需,都是肿瘤内科关注的重心,为<span style="color: black;">病人</span>寻找治疗新<span style="color: black;">方法</span>、新策略。</span></p><strong style="color: blue;">0</strong><strong style="color: blue;">4</strong><strong style="color: blue;">与<span style="color: black;">病人</span>守望前行,用温暖消除病痛</strong>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">随着我国肿瘤诊疗能力的<span style="color: black;">提高</span>,肿瘤正<span style="color: black;">作为</span>一种慢性病,<span style="color: black;">非常多</span>的中晚期<span style="color: black;">病人</span><span style="color: black;">能够</span>“带瘤<span style="color: black;">存活</span>”。然而,<span style="color: black;">非常多</span><span style="color: black;">病人</span>对肿瘤依然存在误区,有时还会<span style="color: black;">由于</span>过于恐惧而<span style="color: black;">茫然</span>应对。</p>

    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">“在肿瘤治疗快速发展的今天,依然有<span style="color: black;">非常多</span><span style="color: black;">病人</span>认为化疗的不良反应非常多,<span style="color: black;">必定</span>会掉头发、恶心、呕吐。<span style="color: black;">乃至</span>有<span style="color: black;">病人</span>说‘化疗化疗,一化就了’。<span style="color: black;">实质</span>上,这些都是人们对传统化疗的认知。如今,肿瘤治疗以靶向治疗和免疫治疗为中心,辅以化疗,避免了<span style="color: black;">非常多</span>不良反应。”在王颖轶看来,<span style="color: black;">大夫</span>与<span style="color: black;">病人</span>是并肩作战的战友,<span style="color: black;">大夫</span>有责任为<span style="color: black;">病人</span>科普<span style="color: black;">疾患</span>的<span style="color: black;">出现</span>发展和治疗<span style="color: black;">方法</span>,传递正确的防癌抗癌理念,消除<span style="color: black;">病人</span>误区。</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">为此,他和其他团队成员常用浅显易懂的语言,为<span style="color: black;">病人</span>和家属解释<span style="color: black;">繁杂</span>的治疗<span style="color: black;">方法</span>:“化疗就像一颗原子弹,它是<span style="color: black;">没</span>差异的攻击;靶向治疗就像定向导弹,定位<span style="color: black;">精细</span>;免疫治疗则是去除肿瘤细胞的伪装,让免疫细胞尽快识别杀伤肿瘤细胞……”</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">在积极的沟通下,<span style="color: black;">病人</span>与<span style="color: black;">大夫</span><span style="color: black;">创立</span>了信任,树立了积极治疗的<span style="color: black;">自信心</span>。但另一方面,肿瘤<span style="color: black;">病人</span><span style="color: black;">亦</span>面临<span style="color: black;">各样</span>身体上的痛苦和<span style="color: black;">很强</span>的心理<span style="color: black;">包袱</span>,<span style="color: black;">必须</span>医护人员一路搀扶,相伴前行。</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">为了缓解<span style="color: black;">病人</span><span style="color: black;">因为</span>肿瘤本身或治疗<span style="color: black;">导致</span>的<span style="color: black;">病痛</span>、恶心、呕吐、厌食等一系列症状,肿瘤内科围绕<span style="color: black;">病人</span><span style="color: black;">存活</span>质量,率先<span style="color: black;">创立</span>了<span style="color: black;">没</span>痛病房、<span style="color: black;">没</span>呕病房,为<span style="color: black;">病人</span><span style="color: black;">供给</span><span style="color: black;">病痛</span>、呕吐等分级处理,最大程度<span style="color: black;">帮忙</span>让<span style="color: black;">病人</span>远离肿瘤治疗中的痛苦。</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">“<span style="color: black;">咱们</span><span style="color: black;">期盼</span><span style="color: black;">经过</span>一系列工作,让肿瘤<span style="color: black;">病人</span>感受到治疗路上并不孤单。”王湘介绍,北京协和医院的挂号常常“一号难求”,为了方便肿瘤<span style="color: black;">病人</span>接受其他科室的<span style="color: black;">帮忙</span>,科室<span style="color: black;">供给</span>一站式转诊服务,避免<span style="color: black;">病人</span>病情延误。近年来,北京协和医院肿瘤内科还开设了医护联合门诊、专病门诊,与缓和医学中心<span style="color: black;">安定</span>疗护门诊、<span style="color: black;">麻木</span>科<span style="color: black;">病痛</span>门诊紧密联系,多<span style="color: black;">方向</span>服务<span style="color: black;">病人</span>,让<span style="color: black;">她们</span>在治疗中更安心、更舒心。</span></p><span style="color: black;"><strong style="color: blue;">记者手记</strong></span>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">在采访的尾声,三位专家不约而同地谈及肿瘤“防”大于“治”。尽管全国各地开展了<span style="color: black;">各样</span>内容丰富、形式多样的肿瘤防治宣传活动,但<span style="color: black;">怎样</span>让科学防癌抗癌的理念深入人心,依然道阻且长。为此,科室自成立之初就开展了<span style="color: black;">各样</span>科普宣教,如今正采用多种线上+线下相结合的形式科普防癌抗癌新知,呼吁群众做好肿瘤的三级预防。</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">消除肿瘤防治的盲区,点燃<span style="color: black;">病人</span>前行的灯塔。在这条充满荆棘的防癌抗癌的征途上,北京协和医院肿瘤内科的<span style="color: black;">大夫</span>们白衣为甲,勇抗病魔。<span style="color: black;">她们</span>的每一次身影,都让人感到心安。<span style="color: black;">由于</span><span style="color: black;">她们</span>是医者,与<span style="color: black;">病人</span>守望前行,<span style="color: black;">始终</span>都在。</span></p>
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                              </div><img src="data:image/png;base64,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" style="width: 50%; margin-bottom: 20px;">
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    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><img src="data:image/svg+xml,%3C%3Fxml version=1.0 encoding=UTF-8%3F%3E%3Csvg width=1px height=1px viewBox=0 0 1 1 version=1.1 xmlns=http://www.w3.org/2000/svg xmlns:xlink=http://www.w3.org/1999/xlink%3E%3Ctitle%3E%3C/title%3E%3Cg stroke=none stroke-width=1 fill=none fill-rule=evenodd fill-opacity=0%3E%3Cg transform=translate(-249.000000, -126.000000) fill=%23FFFFFF%3E%3Crect x=249 y=126 width=1 height=1%3E%3C/rect%3E%3C/g%3E%3C/g%3E%3C/svg%3E" style="width: 50%; margin-bottom: 20px;">&nbsp;<img src="data:image/svg+xml,%3C%3Fxml version=1.0 encoding=UTF-8%3F%3E%3Csvg width=1px height=1px viewBox=0 0 1 1 version=1.1 xmlns=http://www.w3.org/2000/svg xmlns:xlink=http://www.w3.org/1999/xlink%3E%3Ctitle%3E%3C/title%3E%3Cg stroke=none stroke-width=1 fill=none fill-rule=evenodd fill-opacity=0%3E%3Cg transform=translate(-249.000000, -126.000000) fill=%23FFFFFF%3E%3Crect x=249 y=126 width=1 height=1%3E%3C/rect%3E%3C/g%3E%3C/g%3E%3C/svg%3E" style="width: 50%; margin-bottom: 20px;">&nbsp;<img src="data:image/svg+xml,%3C%3Fxml version=1.0 encoding=UTF-8%3F%3E%3Csvg width=1px height=1px viewBox=0 0 1 1 version=1.1 xmlns=http://www.w3.org/2000/svg xmlns:xlink=http://www.w3.org/1999/xlink%3E%3Ctitle%3E%3C/title%3E%3Cg stroke=none stroke-width=1 fill=none fill-rule=evenodd fill-opacity=0%3E%3Cg transform=translate(-249.000000, -126.000000) fill=%23FFFFFF%3E%3Crect x=249 y=126 width=1 height=1%3E%3C/rect%3E%3C/g%3E%3C/g%3E%3C/svg%3E" style="width: 50%; margin-bottom: 20px;">&nbsp;<img src="data:image/svg+xml,%3C%3Fxml version=1.0 encoding=UTF-8%3F%3E%3Csvg width=1px height=1px viewBox=0 0 1 1 version=1.1 xmlns=http://www.w3.org/2000/svg xmlns:xlink=http://www.w3.org/1999/xlink%3E%3Ctitle%3E%3C/title%3E%3Cg stroke=none stroke-width=1 fill=none fill-rule=evenodd fill-opacity=0%3E%3Cg transform=translate(-249.000000, -126.000000) fill=%23FFFFFF%3E%3Crect x=249 y=126 width=1 height=1%3E%3C/rect%3E%3C/g%3E%3C/g%3E%3C/svg%3E" style="width: 50%; margin-bottom: 20px;">&nbsp;<img src="data:image/svg+xml,%3C%3Fxml version=1.0 encoding=UTF-8%3F%3E%3Csvg width=1px height=1px viewBox=0 0 1 1 version=1.1 xmlns=http://www.w3.org/2000/svg xmlns:xlink=http://www.w3.org/1999/xlink%3E%3Ctitle%3E%3C/title%3E%3Cg stroke=none stroke-width=1 fill=none fill-rule=evenodd fill-opacity=0%3E%3Cg transform=translate(-249.000000, -126.000000) fill=%23FFFFFF%3E%3Crect x=249 y=126 width=1 height=1%3E%3C/rect%3E%3C/g%3E%3C/g%3E%3C/svg%3E" style="width: 50%; margin-bottom: 20px;">&nbsp;<img src="data:image/svg+xml,%3C%3Fxml version=1.0 encoding=UTF-8%3F%3E%3Csvg width=1px height=1px viewBox=0 0 1 1 version=1.1 xmlns=http://www.w3.org/2000/svg xmlns:xlink=http://www.w3.org/1999/xlink%3E%3Ctitle%3E%3C/title%3E%3Cg stroke=none stroke-width=1 fill=none fill-rule=evenodd fill-opacity=0%3E%3Cg transform=translate(-249.000000, -126.000000) fill=%23FFFFFF%3E%3Crect x=249 y=126 width=1 height=1%3E%3C/rect%3E%3C/g%3E%3C/g%3E%3C/svg%3E" style="width: 50%; margin-bottom: 20px;">&nbsp;<img src="data:image/svg+xml,%3C%3Fxml version=1.0 encoding=UTF-8%3F%3E%3Csvg width=1px height=1px viewBox=0 0 1 1 version=1.1 xmlns=http://www.w3.org/2000/svg xmlns:xlink=http://www.w3.org/1999/xlink%3E%3Ctitle%3E%3C/title%3E%3Cg stroke=none stroke-width=1 fill=none fill-rule=evenodd fill-opacity=0%3E%3Cg transform=translate(-249.000000, -126.000000) fill=%23FFFFFF%3E%3Crect x=249 y=126 width=1 height=1%3E%3C/rect%3E%3C/g%3E%3C/g%3E%3C/svg%3E" style="width: 50%; margin-bottom: 20px;">&nbsp;<img src="data:image/svg+xml,%3C%3Fxml version=1.0 encoding=UTF-8%3F%3E%3Csvg width=1px height=1px viewBox=0 0 1 1 version=1.1 xmlns=http://www.w3.org/2000/svg xmlns:xlink=http://www.w3.org/1999/xlink%3E%3Ctitle%3E%3C/title%3E%3Cg stroke=none stroke-width=1 fill=none fill-rule=evenodd fill-opacity=0%3E%3Cg transform=translate(-249.000000, -126.000000) fill=%23FFFFFF%3E%3Crect x=249 y=126 width=1 height=1%3E%3C/rect%3E%3C/g%3E%3C/g%3E%3C/svg%3E" style="width: 50%; margin-bottom: 20px;"></p>
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nqkk58 发表于 2024-10-20 21:00:28

你的见解真是独到,让我受益良多。

j8typz 发表于 3 天前

你的话语如春风拂面,让我感到无比温暖。
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