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 C. Zeiger
Issue: Volume 65 - Issue 4 - April 2019 ISSN 2640-5245
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The Chinese-attributed, oxymoronic blessing/curse, May you live in interesting times, implies status quo-embracing, not-so-interesting times are better for your health than interesting times of disruption, turmoil, and change.
This year has been quite interesting.
Our journal was renamed Wound Management & Prevention to more accurately reflect the direction health care in general and wound care specifically is headed in terms of patient care.
We revamped our print and website designs to be more reader- and user-friendly.
The Wound Care division of HMP is launching the Post-Acute Care Symposium (PACS; visit pacsymposium.com) concurrent with the Symposium on Advanced Wound Care (SAWC Spring) this May in San Antonio, Texas. The new conference is designed to provide nurses specifically the tools they need to meet their day-to-day challenges; the curriculum focuses on the strategies necessary for implementing clinical practice guidelines, protocols, and care pathways for wound and incontinence interventions.
Also at the SAWC Spring, the Wound Care division is debuting the Wound Care Learning Network (WCLN; visit www.woundcarelearningnetwork.com), a new website that overarches the resources available from HMP, features up-to-the-minute industry news, and maximizes digital content to enhance the learning experience.
Last but far from least, the SAWC Spring itself has been rejuvenated and now includes 1) a new “Leading Edge” Track that features cutting-edge topics presented by attendee-favorite educators and highlights collaborations and partnerships to proliferate the mission to improve patient care, 2) more nurse practitioner continuing education credits, and 3) advanced wound care abstract categories that more fully capture practice reality and research conducted in today’s settings.
Let’s just say I am not big on change. This may be a direct result of having parents whose philosophy was basically, As bad as things are, change could be worse — the whole “the devil you know” approach to life. This also would explain why I met my husband in high school and we have been married 45 years. It also is a factor as to why we have lived in only 2 houses our entire married life. According to the United States Census Bureau,1 Americans on average move 11.7 times in their lifetimes, although lately they are changing domiciles at historically low rates. My lack of desire for change also, in part, may be why I have been with this journal through its many incarnations for almost 19 years when the average person changes jobs an average of 12 times during his or her career.2
That being said, despite my personal aversion to change, the changes imposed to improve the exchange of information on wound, ostomy, and continence care have had positive repercussions. Although they naturally have meant a bit of extra work, they are yielding the intended results. Ironically, removing the O from our name has far from slowed the submission of ostomy-related manuscripts and in fact has led to a partnership with the United Ostomy Association of America and a new online exclusive column, Up Front With Ostomies.3 Our manuscript submissions have increased year over year. Our social media numbers have soared (perhaps also due to the efforts of our new Web Editor, Jessica Wilbur); one article has close to 6000 impressions.
One recent change was not as positive. Many of you have been following my dad’s travails with and ultimate acceptance of incontinence,4 offering your insights and delight in his perseverance in extracting the joy from life. After a brain bleed, hospitalization, and a brief stay in rehab, on March 4 we lost him. I do not use the term lost capriciously. Three weeks before he died, he was celebrating my husband’s birthday, looking spry despite the walker and happy to spend time with his precious family (see photo). We lost his presence, his kindness, his humor, and his love in one fell swoop. When my editorials ran, he and I were grateful for the outpouring of support from our clinical family, and I would have been remiss in not sharing the news of his passing.
So, yes this has been quite the interesting year, and we are dealing with the aftermath of the changes. Most changes have come with benefits in enhanced clinician knowledge that will parlay into improved patient outcomes. Most changes will serve to further underscore the vision of HMP and its publications and programs. Some changes will make us grateful for the productive, purposeful longevity of our relationships — professional and personal. Truth be told, I am hoping next year is a little less “interesting.”
S ome things change, some stay the sameY ou add a track, amend a nameM aybe you submit a studyP ursue a path. Seek out a buddyO f all the good a conference bringsS o much depends on these 3 things:I nvest in all your mind can holdU nleash excitement and be boldM ingle, network, don't be mum San Antone: oh here we come!
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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