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 1 - January 2019 ISSN 2640-5245
Index: Wound Management & Prevention 2019;65(1):6.
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After months of planning and designing … after weeks of sending notifications to entities such as the National Library of Medicine (fondly known as PubMed) and our royalties company … and after updating our files on our manuscript management system, transferring more than 15 years’ worth of articles and accompanying data from the old website to the new, and acquiring new ISSNs, we are finally ready to be known as Wound Management & Prevention (formerlyOstomy Wound Management) and introduce you to our redesigned print issue and website (www.woundmanageprevent.com).
Renaming and redesigning our journal was not unlike buying a fixer-upper, something my real-estate-loving husband has made me all too familiar with. You assess the property (aka, journal) and decide whether it warrants the improvements that will make it habitable and comfortable (ie, reader-relevant) for the tenants (or in this case, the readers) you want to attract. You decide the project is a go. We knew the journal needed an overhaul to better reflect the shifting focus in wound care, particularly with regard to pressure injury, fromtreating to preventing wounds. This thought is underscored by Jeremy Bowden, Senior Vice President/Publisher. “As the field continues to evolve, we thought it was the appropriate time to change our journal to be more in line with articles we publish that are trending toward managing and preventing wounds,” he said.
You formulate a plan with contractors (in the journal’s case, our company’s design, production, IT, and marketing teams), timing everything out to facilitate a smooth transition. You approve the designs, hang the new cover on your office wall, and save it to your phone.
Then the electrician tells you he can’t access the wall on which you planned to install an additional outlet. Or with the journal, the content gets snarky about shifting from the old website to the new one, not to mention the challenge of incorporating several reader-friendly enhancements not previously available.
But then you savor the property’s fresh, new look. I hold this inaugural issue in my hands with the same reverence, knowing the improvements will make our articles easier to access and to read, both in print and online, our new “address” evidence of our determination to perpetuate our mission to inform wound, ostomy, and continence care clinicians well into a bright future.
Our “bones” (as my husband calls the basic structure of his buildings) remain the same and strong. Clinical Editor Lia van Rijswijk, DNP, MSN, CWCN, ensures our readers, “We continue to stand on the shoulders of giants to improve the lives of those who entrust us with their care,” publishing articles that address all of the clinical, demographic, and psychosocial issues that have bearing on wound care, as evidenced in this issue. Ostomies are permanent or temporary wounds (read the article by Kelleher et al1 on a new barrier seal designed for ileostomates) with all their attendant potential implications. Incontinence wreaks havoc on skin (check out the article by Leblebicioglu et al2 on developing and testing a new fecal incontinence containment device). Be sure to explore Gagnier and Pieper’s3 consideration of the role of end-stage renal disease, hemodialysis, and depression on the risk of developing wounds that become chronic and weigh the benefits of 3-dimensional wound measurement in the article by Darwin et al.4
This first issue of Wound Management & Prevention will introduce you to an ongoing column5 on caring for neonatal and pediatric wounds (“Children With Wounds: Asking the Right Questions”). At our Editorial Board members’ astute request, we also are initiating Back to Basics,6 a column to refresh or impart knowledge on the most fundamental of wound care devices (ie, dressings) and to underscore the important information available from Why Wound Care?(www.whywoundcare.com).
Nothing worthwhile is easy, and so it has been with this precious real estate I present to you. Every investment we make in its future is an investment in your future. Wound care et al may not be the most glamorous, “sexy” niche in health care, but the need to know how to prevent and heal wounds pervades every aspect of medicine. People who know how to do both are becoming more and more valuable in every setting, from acute care to home care, from neonates to the elderly. Thank you for being part of our evolution. Let us know what you think!
FROM THE EDITOR
Investing in Some Very Important Real Estate
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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