RESUMEN
Gastric cancer is one of the common malignant tumors of the digestive system. The data from China Gastrointestinal Cancer Surgical Alliance suggests that there are great differences in the incidence of gastric cancer, the distribution of tumors in different stages and level of diagnosis and treatment in different regions of our country, and there are some differences in the data records of different medical centers. Therefore, it is very important to implement the standardized diagnosis and treatment and quality control of gastric cancer, to establish a standardized gastric cancer data-base, and to promote the standardization, homogenization and standardization of the diagnosis and treatment of gastric cancer in the country. As a result, the Expert Committee of Quality Control of Gastric Cancer of the National Cancer Quality Control Center drafts and formulates the Quality Control Index for Standardized Diagnosis and Treatment of Gastric Cancer in China (2022 Edition), in which the quality control index includes the aspects of imaging examination, pathological diagnosis, surgical treatment, drug therapy, radiotherapy and postoperative quality control of gastric cancer. The authors give a thorough elaboration on the lymph node dissection scope, standardization and quality control of postoperative lymph node detection and construction of database of gastric cancer.
RESUMEN
Novel coronavirus pneumonia (NCP) is currently raging in China. It has been proven that NCP can be transmitted from human to human and cause hospital infection, which seriously threatens surgical staffs and inpatients. Although colorectal surgery is not a front-line subject in the fight against the epidemic, but in this special situation, now it is a difficult task that with the premise of how to maximize the protection for patients and their families, health of medical staff, and the safety of wards and hospitals, we can provide the highest quality medical services to ensure the orderly development of previous clinical work. Referring to the "Diagnosis and Treatment Scheme for NCP (Trial Version 4 and 5)" and combining the actual practice situation in our hospital with the "Summary of New Coronavirus Files of Shanghai Renji Hospital", we summarize how to carry out the clinical practice of colorectal surgery under the situation of the prevention and control of the NCP epidemiology, meanwhile under such situation aiming the procedure of diagnose and treatment for emergency patients with colorectal tumor, we share the experiences of the diagnosis of colorectal tumor, the management of patients with colorectal cancer who are scheduled to be admitted for surgery, the protection of wards, the perioperative management. More importantly, we introduce in detail the operative management and perioperative management of colorectal surgery patients suspected or diagnosed with new coronary pneumonia, including prevention and control measures for medical staff, operating rooms and surgical instruments. The main points are as follows: (1) Multidisciplinary team (MDT) must be run through the diagnosis and treatment of colorectal cancer. The members include not only routine departments, but also respiratory department and infectious department. (2) Colonoscopy examination may cause cross infection of NCP to patients and doctors. Therefore, it is prior to examine the emergency cases and life-threatening patients (bleeding, obstruction, gastrointestinal foreign bodies, etc.). If the emergent patients (intestinal obstruction) with suspected or confirmed NCP, the surgeons must perform emergency surgery, and intestinal decompressive tube through colonoscopy is not recommended. (3) The colorectal cancer patients with suspected or confirmed NCP should be placed in the isolated room with separate medical devices, and the operative room with negative pressure (under-5 Pa) must be separated. All disposable medical items, body fluids and feces of the patients in perioperative periods must be unified disposed according to the medical waste standard. (4) The surgical medical workers who process colorectal cancer patients with NCP must be protected by three-level. After operation, the medical workers must receive medical observation and be isolated for 14 days. We hope our "Renji experience" will be beneficial to colleagues.
RESUMEN
Radiation-induced bowel injury is a common complication of radiation therapy for pelvic malignancy. Given the huge number of patients diagnosed with pelvic malignancy, the number of patients diagnosed with radiation-induced bowel injury increased year by year, which put a great burden on the clinical diagnosis and treatment of radiation-induced bowel injury. In particular, chronic radiation-induced bowel injury, which is manifested in the process of prolonged, repeated and progressive aggravation, seriously affects the physical and mental health of patients and makes clinical diagnosis and treatment difficult. However, due to insufficient attention and understanding from doctors and patients, standardized diagnosis and treatment of radiation-induced bowel injury still have a long way to go. Radiation-induced bowel injury is self-limited but irreversible. During diagnosis, we should pay attention to overall evaluation of the stage of disease based on clinical symptoms, endoscopic examination, imaging examination, pathology and nutritional risk. The treatment methods include health education, drug therapy, enema therapy, formalin local treatment, endoscopic treatment and surgical treatment, etc. The treatment decision-making should be based on clinical symptoms, endoscopic or imaging findings to alleviate the clinical symptoms of patients as the primary goal and to improve the long-term quality of life of patients as the ultimate goal.
RESUMEN
Objective@#To study the effects of a standardized diagnosis and treatment program for type 2 diabetes mellitus patients, in a community in Urumqi.@*Methods@#In March 2016, 1 000 patients with type 2 diabetes at the Urumqi Xinhua Road community health service center and affiliated communities were selected to participate in a questionnaire survey and in a promotion for a 12-month standardized treatment. T-test and χ2 test were used to compare the blood sugar, blood pressure, blood lipids, ratio of urine microalbumin and creatinine (urine A/C) and other metabolic indices in patients before and after the promotion.@*Results@#In a total of 112 finalists, after a 4-month follow-up, rates of regular exercise, diet control, taking medication on time and regular blood glucose monitoring all improved significantly from 35.7%, 40.2%, 13.7%, 29.5% to 56.3%, 68.8%, 56.3%, 45.5%, respectively (χ2=9.508, 8.643, 45.319, 6.171; P < 0.05). The rates of smoking and drinking were lower after the promotion (χ2=4.291, 4.56; P < 0.05). Body mass index (BMI), fasting blood glucose (FPG), glycated hemoglobin (HbA1c), systolic blood pressure, total cholesterol (TC), creatinine, and urine A/C decreased significantly, while there was no significant difference in the diastolic blood pressure. The percentage of participants with normal blood sugar, lipids and blood pressure, significantly improved from 38.4%, 37.5%, 23.6%, 8.9% to 63.4%, 66.4%, 43.7%, 23.2%, respectively. The rate of urine A/C positivity decreased from 40.2% to 26.8% (χ2=14.004, 18.309, 10.604, 8.473, 4.510, P < 0.05).@*Conclusion@#Standardized type 2 diabetes treatment programs can improve the blood levels of glucose and lipids, as well as lower blood pressure and the positive rate of urine A/C. It can help reduce the multiple risk factors and long-term complications by improving the self-management of diabetes.