大湾区慢性创面医护康标准化体系建设联盟,《中国科技论文》体表外科卷编辑委员会,黄广涛1,吴 军1,郇京宁1,2
(1.深圳大学第一附属医院(深圳市第二人民医院)烧伤整形科,广东深圳518000;2.上海交通大学医学院附属瑞金医院烧伤整形与创面修复科,上海200011)
摘要:负压封闭引流技术(negative pressure wound therapy, NPWT)自2017年国内首部烧伤外科应用专家共识发布以来,其技术类型与临床应用范围均取得了显著拓展。特别是在促进各类急慢性创面愈合及预防外科手术部位感染方面,已累积了大量高质量循证证据。为整合国内外最新研究成果与临床实践经验,规范操作标准,提升治疗水平,国内创面修复相关多学科领域的专家共同撰写了本更新版共识。本共识汇聚了国内多位在创面相关的多学科领域的专家,结合国内外最新研究成果,遵循严谨的循证医学原则,采用系统综述方法,聚焦于NPWT的技术分类、适应症、参数优化及并发症处理等核心议题。工作小组系统检索了PubMed、Web of Science、IEEE Xplore及中国知网等数据库中2015—2025年相关文献,共获得791篇。经去重、筛选,并根据纳入标准(临床研究、随机对照试验、meta分析及相关共识等)最终纳入210篇文献进行证据综合与评价。本共识旨在为创面修复相关学科的临床医生提供基于最新证据、统一且可操作的治疗方案与技术规范。共识内容充分结合了我国临床实践的现状与需求,以期推动NPWT在国内的合理、规范及高效应用,最终惠及广大患者。
关键词:负压封闭引流技术;手术部位感染;创面修复;手术切口并发症
Yesica Y. Quiroz 1 , Enver Moncada 2 , Erika Llorens 3 , Ivan Schwartzmann 4 , Jorge Caffarati 5 , Anna Bujons *
Summary
Introduction
Paratesticular sarcoma is an aggressive malignant tumor of mesenchymal origin. The rhabdo-myosarcoma is the most common among children. Rhabdomyosarcoma treatment consists of surgery, chemotherapy and radiotherapy. Prognosic depends on local recurrence and distant metastasis.
Material and methods
We present the case of a 16-year-old male, who in April 2016 underwent right radical orchiectomy surgery by testicular mass rapidly evolving, with pathological results indicating a paratesticular rhabdomyosarcoma. The extension study showed a precaval adenopathy suggestive of lymph node metastasis, therefore it was a high-grade rhabdomyosarcoma. There was an appropriate response after chemotherapy (Protocol EpSSG RMS2005) and we decided to perform a robotic.
Results
We performed a transperitoneal approach with 8 mm trocar and 12 mm optica trocar. We accessed the retroperitoneal space through a latero-colic incision. Then we performed a craniocaudal lymph node dissection until the aortic bifurcation. The surgical time was 240 min with a blood loss of 200 ml. There were no complications. The patient was discharged on the fourth day after surgery. Pathology showed metastasis of rhabdomyosarcoma without capsular rupture. After two months, we placed the left testicle into inguinal canal prior to radiotherapy.
Conclusions
Robotic lymph node metastasis lymphadenectomy from paratesticular sarcomas is a feasible treatment with the advantage of minimally invasive surgery and acceptable morbidity.
Authors
Barbara Zeiger
Issue: Volume 64 - Issue 7 - July 2018 ISSN 1943-2720
Index: Ostomy Wound Manage. 2018;64(7):6-7.
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May the love for my art actuate me at all times. — Maimonides, medieval physician and philosopher
Recent issues of Ostomy Wound Management reflect the Editors’ dedication to the science governing guidelines and protocols for wound, ostomy, and continence care. Although acutely aware of the myriad of factors that must be weighed and considered, the clinicians and their proxies that decide what to put before you each month tend to lean heavily on what has been supported by research. We are mindful of regulatory and litigious issues that impact care, but for us, evidence-based information is the cream that rises to the top and underscores the care provided.
That being said, we also are perched to celebrate innovative, outside-the-box products and approaches. Some are promising but yet to be thoroughly tested and/or implemented. Others demonstrate the art involved in solving unusual problems to improve quality of life and/or encourage healing. Like Maimonides, OWM is actuated by companies and clinicians who are inspired and driven to seek ways 1) to overcome the medical/clinical obstacles that challenge us, 2) discover artful solutions to clinical problems, or 3) (not uncommonly) find that unexpected observations stimulate research or become the foundation for an entirely new way of thinking. Hence, welcome to this year’s Innovations issue.
Sometimes the art emanates from the ability to repurpose a concept, exemplified in a recent article that appeared in Science Translational Medicine1 regarding a glue, applied like a gel, that can close a wound in, literally, a minute. The glue, called MeTro (short for methacryloyl-substituted tropoelastin) is a hybrid elastic protein that can be applied to an external or internal wound. Ultraviolet light is shined to initiate the healing process. Additional newly developed products include nanofiber dressings that use proteins that naturally occur in plants and animals that can foster healing and tissue regrowth and a new dressing that resembles butterfly fasteners that are tightened and then gently released once the edges of the wound have come together. The product concepts may not be new (our Clinical Editor says she and colleagues once made similar fasteners from scratch on a hydrocolloid protective skin barrier foundation), but the developers imaginatively played with their design concepts to create a new vision.
Sometimes the “art” is viewed through an event. The conference Wound Care: From Innovations to Clinical Trials (this year headed by OWM Editorial Board member Amit Gefen, PhD), presented in June 2018 in Edinburgh, Scotland, continues to proliferate wound diagnostic and management breakthroughs, including (not surprisingly, give its recent decriminalization for recreational use) marijuana for topical use in wound healing in Canada and an examination of the pathophysiological mechanisms common to dementia and pressure ulcers, 2 medical issues not usually examined side-by-side. Several new names were noted among presenters, boding well for the progress of this health care niche.
This issue of OWM includes innovators in their own right. Recognizing the lack of research regarding the factors that influence adaptation to an ostomy among patients in China, Wang et al2 used an ostomy product manufacturer’s database to explore why some people adjust better than others to having an enterostomy. A significant finding was that medical staff played an important role in helping the patient accept his/her new reality, a fact that suggests clinicians must employ their own creative means to connect with and support ostomates. Schwartz et al3 used a finite element modeling study to expand on previous research regarding the prophylactic use of anisotropic multilayer dressings. The dressing had been found to offer protection against pressure injury; the current study sought to discover how the dressing held up when exposed to varying amounts of moisture encountered in real-life scenarios. Wu et al4 present a case demonstration involving 3-dimensional printing used to create a splint for noninvasive use in wound care. The cost was approximately the same as a traditional splint, but it spared the patient from undergoing the painful process of manually measuring and fitting an immobilizer. We also share an article that appeared in the January 2018 issue of Today’s Wound Clinic on the innovatiove use of apps in wound clinic practice. And of course, we present the annual column, Innovations That Work! that allows manufacturers and providers to keep readers informed of the latest and greatest products and services that can be used to provide the latest and greatest care for your patients.
OWM, too, is innovating. We have updated our Instructions for Authors (incorporating the suggestions from our Editorial Board members discussed at our annual editorial board meeting) to clarify the different categories of manuscripts we accept and all the components thereof. We hope these amended instructions provide the details all authors need to sculpt OWM-worthy manuscripts and that they encourage fledgling authors to follow the guidelines and join the ranks of the published few. In addition, in January 2019 we will reveal our revamped print journal and website designs, refurbished to become even more reader-friendly and enhance our search capacity to help clinicians and researchers find and use our articles.
OWM also will be undergoing a name change to something that better reflects our evolving role in the wound, ostomy, continence arena (this absolutely involves art in the most familiar sense!). We will cover and remain true to the same scope of practice; the new name indicates a direction. Originally, we were Ostomy Management (1981). We then became Ostomy Wound Management (1985). In 2019, we will be……
In a great deal of his medically related writing, Maimonides referred to the art of care, recognizing that healing involves as much art as science. An artist’s perception and personal creative instincts influence how he/she uses the tools at hand or comes up with new means to express his vision, just as a clinician uses ingenuity and what is available to solve health issues and optimize care. We count our readers among clinicians seeking to keep the art in the science and the science in their art. We hope that with our innovations we continue to serve you well.
The opinions and statements expressed herein are specific to the respective authors and not necessarily those of OWM or HMP. This article was not subject to the Ostomy Wound Management peer-review process.
伤口世界平台生态圈,以“关爱人间所有伤口患者”为愿景,连接、整合和拓展线上和线下的管理慢性伤口的资源,倡导远程、就近和居家管理慢性伤口,解决伤口专家的碎片化时间的价值创造、诊疗经验的裂变复制、和患者的就近、居家和低成本管理慢性伤口的问题。
2019广东省医疗行业协会伤口管理分会年会
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