同步报告病例4（第六回）：没有最烂，只有更烂一个危重足患者保脚经历

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15 10月 2019

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Author : 伤口世界

原创：十六点五中山二院糖尿病足中心

一周不懈地换药

获得了慢慢的成果

耐心是糖尿病足治疗最重要的一心。

患者全身情况有了改善

各种炎症指标都有明确的改善

基本没有发热

白细胞恢复正常

分类仍然较高

但患者腹胀比较明显

血浆白蛋白上升缓慢

尿量有所增加

关键的是抗生素终于慢慢降了级

患者腹泻的情况有改善

这与护士们细心的局部换药有密切的关系

终于为全身抗生素的使用赢得了喘息的机会

从局部看

我们的判断

右足已经达到了可以装负压的程度

意味着患者右足基本达到了保足的水平

至少一个足能够保住了

而惨淡的左足也有所好转

尤其是足背部可以看到明显的肉芽生长

而令人担心的左足内侧也有生长的迹象

没有发现明确的新窦道和脓腔

我们准备继续对左足进行换药

看看下周中是否能够也装负压

总之

患者应该已经度过最艰难的时刻

迎来了保住双足的曙光！

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伤口世界

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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

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Conclusions

Robotic lymph node metastasis lymphadenectomy from paratesticular sarcomas is a feasible treatment with the advantage of minimally invasive surgery and acceptable morbidity.

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主任医师、教授、博导，南方医科大学第三附属医院（广东省骨科医院）院长