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 65 - Issue 6 - June 2019 ISSN 2640-5245
Login or Register to download PDF
Buzz words, catch phrases, idioms, and kitschy terms proliferate every aspect of our professional and personal lives. According to the newest additions to Merriam-Webster, we can unplug (figuratively, having nothing to do with an electrical cord) and show friends receipts (proof of an action in texts and photos, not from Walmart) to avoid compromising our cybersafety. Although the dictionary documents these terms, rendering them legitimate (maybe for Scrabble purposes?) and lending credence to their presumed longevity, they often morph or fall out of use, giving way to phrases with that are more buzzy (ie, what folks can’t stop talking about).
Our use (which sometimes becomes misuse) of language must consider multiple meanings and what is acceptable at the time. These days, you would be hard-pressed to find a woman who is comfortable being referred to as a broad or a chick or a straight person who enjoys being happy and gay. When you get the 4-1-1, you are not dialing “information” on your phone (I am definitely dating myself), but rather, asking for more details, at the very least to get someone’s digits.
This language phenomenon certainly occurs in health care. In 1997 when I entered the world of medical writing and editing, my initial assignment was to interview self-described health care activist Dr. Regina Herzlinger, whose books detailed consumer- versus market-driven health care, the phraseology of the time. That was my first taste of the concept of prevailing professional lingo. That same year, the study by Argenta and Morykwas brought vacuum-assisted wound closure full-steam into the medical lexicon. Because the vac became so associated with one company, the terminology for the treatment evolved to negative pressure wound therapy, perhaps due to requests from the competition or probably because the manual of the American Medical Association requires the use of generic terms to describe product mentions in the literature.
We have witnessed the evolution from multidisciplinary to interdisciplinary care to explain care provided across different health care specialty silos, another catch phrase. (As a sidebar, I used to like silos until I saw Witness.) We have abbreviated; right along with shortening the President and the First Lady of the United States to POTUS and FLOTUS, we have seen long terms such as Clostridium difficile shortened to C diff, and organisms such as methicillin-resistant Staphylococcus aureus popularized as an acronym (ie, mer-sa [MRSA]).
On the buzzier side, we have novel terms such as liquid biopsy (testing blood and body fluids) and biomimicry (studying systems and substances in nature to better understand human problems). And then there is the microbiome phenomenon. Microbiome needs to be distinguished from microbiota (the collection of microbes that live in and on our bodies); the microbiome is the gene set within the microbes. The terminology is not new (it was first used by American molecular biologist Joshua Lederberg in 2001), but it recently has been heard more frequently, woven into recent research and even soap commercials.
Bed sores/pressure sores/decubitus ulcers/pressure ulcers/pressure injuries seem destined to remain on the evolutionary trajectory, in part with an eye to what is being discovered about their development and in part with an eye to our litigious society. Debates about medical/legal ramifications aside, I am fascinated by the pressure revolution — that fact that this one health issue has had so many labels through the years is testament to our ongoing determination to comprehend the biological mechanics, provide solutions (or better, prevent these suckers), and get the terminology correct because in health care it is crucial that we speak the same language. If clinicians do not speak the same language, patients pay the price. Clinical Editor Lia van Rijswijk, DNP, RN, CWCN, has observed this with regard to wound assessment; terms such as reducing dead space and assessing bioburden in the wound have not been validated, and wound dressings such as moist gauze have been described as moist wound care even though there is zero evidence of moisture retention. Terms that evolve without having been properly validated result in ambiguity, inter- and intraprofessional communication problems, and potentially less-than-optimal care.
In every creation and metamorphosis of our professional and everyday speak, we must incorporate the new but remain aware of the old, original terms, underscoring the fact that language is dynamic and fluid, particularly in the scientific/medical world where investigation, exploration, and learning are ongoing. As such, part of the role of research is to validate the terms we use to assess/describe conditions and treatments.
Words also must be taken in context. A hog can be an animal, a person who takes too much of something, or a large, imposing 2-wheeled vehicle. I hope you are coming up with your own examples of words that cross many fields and have multiple meanings (please share them on our social media sites!).
As readers, writers, researchers, and clinicians (ie, people with many roles), we must stay current with the lingo, pay homage to word origins, and express ourselves as accurately as possible. Wound Management & Prevention welcomes all submissions of manuscripts that critically evaluate/assess wound care terminology. Catch you on the flip side.
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
扫一扫了解详情:
任何关于疾病的建议都不能替代执业医师的面对面诊断。所有门诊时间仅供参考,最终以医院当日公布为准。
网友、医生言论仅代表其个人观点,不代表本站同意其说法,请谨慎参阅,本站不承担由此引起的法律责任。