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
Jeanine Gleba
Keywords
Ostomy
United Ostomy Associations of America
Issue: Volume 65 - Issue 4 - April 2019 ISSN 2640-5245
United Ostomy Associations of America (UOAA) is an organization for patients whose mission is to promote quality of life for people with ostomies and continent diversions through information, support, advocacy, and collaboration. We are grateful for this opportunity to contribute to Wound Management & Prevention with this new column and look forward to keeping the issues faced by ostomy patients at the forefront for the readers of this prominent clinical resource.
Approximately 100 000 new ostomy surgeries are performed annually. UOAA serves the estimated 725 000 to 1 million people in the United States who are currently living with an ostomy or continent diversion.
Ostomy patients are known to face hospital stays that may be too short to facilitate their learning about their new situation. Education in the acute care setting is concentrated and information is not always absorbed by the patient and caregivers. Therefore, postop education and support must continue to be available once a patient leaves the acute care setting. Through UOAA, ostomates can find support and education through one of our 300+ support groups in the United States.
UOAA receives hundreds of calls a year for persons trying to address a gamut of needs — from trying to find assistance with all aspects of ostomy care, to information on obtaining ostomy supplies, to how to handle insurance issues, or how to simply adapt to life with an ostomy. The emotional and adaptation issues are real and were brought to the forefront of the ostomy community with the recent tragic suicide death of 10-year-old Seven Bridges who once had an ostomy from a birth defect. Now more than ever, we need to educate the public and medical professionals of the emotional needs of persons living with an ostomy, many of whom feel alone and overwhelmed with their struggles. We all need to work together to remove the stigma associated with having an ostomy and wearing a pouch for bodily waste. We need to spread the message that “Ostomies save lives” and that support is available.
A visit to our website will show you it is more user-friendly with a new look and much valuable information with free educational resources for you to share with your ostomy and continent-diversion patients. It is also mobile-friendly. Here is a sample of what you can find:
New Ostomy Patient Guide (you can request copies of this)
Ostomy Nutrition Guide
Sexuality and Emotional Health Information
Skin Care Guide and Webinars
Ostomy Travel Tips and TSA Travel Card
Handy resources like our Know Your Ostomy Checklist
In 2017, our organization also started an Advocacy Committee that is grounded in the core values of our vision of a society where people with ostomies or continent diversions are universally accepted and supported socially, economically, medically, and psychologically and is guided by our Advocacy Agenda. We now have a national Advocacy Network that takes action on issues that affect the quality of life of all people living with an ostomy or continent diversion. This committee has created new self-advocacy toolkits that can benefit your patients as well such as:
Ostomy 101 infographic
Expect More — Take Control of Your Health Care
Swimming
Travel
However, we can’t do it alone. We rely heavily on clinicians to inform their patients that we are available to share our multitude of resources to help them on their ostomy journey and adapt to their “new normal”. Watch this important message from ostomate and patient advocate, Keagan Lynggard-Hysell, on what she hopes medical clinicians will do for their ostomy patients.
Here are some simple things you can do that would only take a couple of minutes, but could make a huge difference in the lives of your patients:
Tell your patients about UOAA and share our website address www.ostomy.org so they have ostomy support and educational resources at their fingertips
Give your patients the toll-free number to our information line (800-826-0826) if they do not have access to the internet and need to find a support group or educational information
Check out our nurse resources here
Spread the word about UOAA with your coworkers and employees in other departments, especially discharge planners and visiting nurses
Share the news that UOAA has a National Conference, a chance to meet other people just like them who gather for education, inspiring talks, social events, and a chance to connect with medical professionals and ostomy product manufacturers. Our 2019 conference is in Philadelphia August 6th-10th. Please contact 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。 to order a supply of postcards to share with your patients.
Post the Ostomy and Continent Diversion Patient Bill of Rights in your health care facility
Together we will make a positive impact!
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。