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
Jeanne Dagna
Keywords
ostomy, travel, TSA
Issue: Volume 65-Issue 10-October 2019-ISSN 2640-5245
Index: Wound Management & Prevention 2019;65(10)
Article
Traveling is a wonderful adventure; traveling with an ostomy shouldn’t make that adventure any less fun or provoke anxiety. Persons with ostomies can enjoy seeing new places, all while carrying medications and ostomy supplies and adhering to the rules of safe air travel. As clinicians, it is very important to be up to date on the Transportation Security Administration (TSA) rules and regulations regarding what can be carried onboard and how items such as medical appliances and medications must be packaged for travel.
Anyone with an ostomy understandably might be afraid and hesitant to go through the security screening process required to fly. We’ve all read and heard horror stories about people whose pouches leaked or were inadvertently pulled off during the screening process and/or people who encountered less-than-friendly TSA screeners. Most people with an ostomy want to be just like everyone else in the security queue, so the idea that they have to openly identify their ostomy or pouch (in a congested environment) can be daunting. Imagining the worst can make the first time going through screening the hardest; an ostomate myself, I still get a bit anxious. Having been through the process enough times, I know, in the end, it will all be okay. Most importantly, travel and TSA security have come a long way!
Clinicians often are the key to providing their patients the information and support necessary in advance of the trip. Sharing the following tips with your patients can help them conform with travel security precautions and encourage them to go places and live their best lives.
What is the Goal of the TSA?
The TSA website describes its responsibility as maintaining security while ensuring the public is treated with respect and sensitivity. TSA staff go through extensive training related to supporting all passengers moving through the screening process, but this doesn’t always allay passengers’ fears. If patients have questions or desire support from the TSA, they can contact a Passenger Support Specialist at least 72 hours in advance of their travel date/time. These specialists can provide information specific to the ostomate’s condition/needs. For example, if someone isn’t able to stand in line for the screening process or fears being unable to leave the line to access a bathroom, they can contact the TSA, explain their condition and needs, and ask the TSA for assistance; you can assure the ostomate he/she is not the first person with an ostomy to ask for support or assistance. The Passenger Support Specialist TSA Cares Line for passengers requesting assistance with medical/disability before they travel is (855) 787-2227, or email: 该Email地址已收到反垃圾邮件插件保护。要显示它您需要在浏览器中启用JavaScript。.
Clinicians should speak to ostomates about the training provided TSA agents specific to persons with medical conditions. Be proactive in supporting your patients and educate yourself by contacting the TSA. Ask the the agency pertinent questions that would benefit your patients as they navigate travel with an ostomy.
Ways Clinicians Can Address Patient Air Travel Concerns
The rules of airline travel with an ostomy are predicated upon the TSA rules regarding Disabilities and Medical Conditions that include carrying medications and supplies onboard a plane. Having a medical condition does not exempt anyone from following the TSA rules; we just need to be more aware of how we can adhere to these rules while we remain comfortable and confident to enjoy new places and new cultures. Clinicians can provide resources for their patients so they can achieve this confidence when traveling with their ostomy. One suggestion is to download the United Ostomy Association of America’s
Travel Communication Card, which contains the TSA Notification Card to better communicate with TSA agents in the screening area about having an ostomy. The link to the travel card is www.ostomy.org/wp-content/uploads/2019/02/travelcard_20170711.pdf. Patients can show the agent this card along with their passport or photo ID and quietly let the agent know about the ostomy; if additional screening such as a gentle patdown or handswab is required, the agents will be aware of any ostomy precautions that should be taken. I have experienced these additional screening procedures — they are not as scary as they might seem. Encourage your patients to be open and honest with TSA agents. This is key to a considerate encounter between your patient and the TSA.
I have been screened in all manners possible. Each time, the TSA agent was caring and professional. When I was taken aside, I quietly informed them I have an ileostomy and pointed to where it was located on top of my clothing. The agent either 1) patted me down, while carefully checking my comfort and their hand location/pressure on the body as they went; or 2) swabbed my hands with a piece of thin tissue-like paper after I rubbed them gently on my clothing on top of my pouch area. This paper is run through a machine to ensure no evidence of any residue of dangerous/explosive materials is found. Although screening by a uniformed agent always is a bit anxiety-provoking, I felt empowered as I walked to my departure gate.
Share the TSA Pre-Check option with your patients. TSA precheck prequalifies and clears a person to get through the screening lines more efficiently and quickly. Applying for Pre-Check must be done weeks in advance of the patient’s plan to travel. To learn more about TSA Pre-Checks and the current fee, visit www.tsa.gov/precheck.
Remind your patients to consider asking for an aisle seat when booking a flight to ensure easier bathroom access. Additionally, having a traveler card helps if an ostomate needs to inform the flight attendant about his/her medical condition and that it may require access to the bathroom at times when it is recommended flyers remain in their seats.
Inform your patients that if, on the rare chance that they do run into a problem at an airport, they should contact the UOAA (800-826-0826). The UOAA has a TSA Liaison; if there is an incident, the UOAA can work with the TSA to ensure it doesn’t occur again. Sharing these experiences with the UOAA/TSA Liaisons will help educate all TSA agents.
Packing Tips for Ostomates
Remind your patients to bring more supplies than they might need for their time away. The general rule is to pack a minimum of twice the amount of supplies (wafers/pouches/wipes) anticipated. Remember, traveling often includes sitting more than usual (flying on a long flight), walking more than usual (touring), and eating/drinking different foods than are typically consumed. Changes in routine often render it necessary to change ostomy wafers and pouches more often than normal.
Have your patients assemble individual packages of pouch change supplies in case of a sudden leak while in the hotel room or while touring. I use a sandwich-sized bag, which doubles as a discreet way to dispose of the used pouch/wafer.
Always suggest that patients precut their wafers before travel so they will not need scissors. However, you can inform patients that ostomy scissors are allowed on planes per the updated TSA rules for medical supplies. A good travel hack is to carry a pair ofmustache scissors. They are curved just like larger ostomy scissors but much easier to pack and carry in a travel kit. Patients also may find it helpful to carry waterproof tape or wafer extenders to tape the edges of the wafer to facilitate swimming or tub bathing. Also, heat/humidity and/or moving around often can loosen the wafer edges. so taping provides a greater sense of security.
Consider recommending carrying rehydration powder mix, especially for persons with an ileostomy to add to a bottle or large glass of water. Remaining hydrated is important no matter where they are.
Tell patients to keep supplies with them and never pack them in their checked luggage, except for “extras” in case luggage is delayed or lost. I carry my packets in my carry-on along with my medication. I can always buy new clothing at my destination, wear what I have on, or borrow from friends, but my medication and ostomy supplies are items not easily purchased or something that I can be flexible about not having or easily replaced. Keeping supplies with me allows me to enjoy my trip without worries.
Follow TSA rules regarding medications, which include keeping meds in their pharmacy-labeled packages. I also recommend people pack all “in case” meds, such as any antidiarrheal, antinausea, seasickness, or pain meds one might need. These can be transported in a carry-on; I also include a letter from my doctor explaining that I have an ostomy and traveling with my supplies and associated medications. I have found that a zip cosmetic bag or even a material pencil case allows me to carry all of my meds and the letter. They are easy to access, and this type of holder is streamlined and easy to include in my carry-on.
Helping your patients follow and understand TSA rules and guiding them on how to do so will give your patients the confidence they need to see the world. If you are lucky, they might bring you back a souvenir for all your effort!
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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