【家庭护理】严防足部皮肤破损！糖尿病患者护脚指南

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Custom Mod Mega1

主任医师、教授、博导，南方医科大学第三附属医院（广东省骨科医院）院长

中德骨科伤口管理学校校长

广东省骨科研究院运动医学研究所所长

广东省内运动医学专业唯一的博士研究生导师

美国哈弗大学医学院骨科访问学者

专业特长处于省内领先、国内或国际先进水平以上

2018年获得“国之名医卓越建树”荣誉称号

2017年被评为全国卫生计生系统先进工作者、广东省医学领军人才

中国医师协会运动医师分会副会长

STCOT中国部运动医学分会副主任委员

广东省医学会关节外科分会主任委员

广东省医学会运动医学会分会名誉主任委员

独立承担过国家“863”课题，主持过10余项省、部级科研项目

多份专业杂志编委
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最新文献

Robotic-assisted laparoscopic repair of a congenital rectourethral fistula with duplicated urethra 2026-09-11 00:00

Rohan G. Bhalla ^a , Belinda Li ^{b,d, *}, Mark C. Adams^b , Wallace W. Neblett^c , John C. Thomas ^b

Summary

Objective

To describe our experience with robot-assisted laparoscopic transperitoneal repair of a congenital rectourethral fistula in a pediatric patient with a urethral duplication.

Methods

The patient is a 2-year-old male with a past medical history of Tetralogy of Fallot presenting with a febrile urinary tract infection (UTI). He was diagnosed with urethral duplication and a rectourethral fistula by voiding cystourethrogram (VCUG). The parents were counseled on various options and agreed to proceed with a robotic repair.

Results

Robotic-assisted transperitoneal rectourethral fistula repair was performed. The procedure time was 229 min with an estimated blood loss (EBL) of 15 mL. His postoperative course was unremarkable. At his 2- week follow-up, the urethral catheter was removed and the patient was voiding normally and having normal bowel movements.

Conclusion

Congenital rectourethral fistula with urethral duplication is a rare anomaly with only a few reports in the literature. Pediatric robotic-assisted trans-peritoneal rectourethral fistula repair is a technically feasible approach in infants with minimal morbidity that allows for excellent visualization and avoids open repair.

Complete diphallia: How to proceed? 2026-09-10 00:00

Antonio Macedo Jr ^a,b , Se´rgio Leite Ottoni ^b , Paula Cartaxo Barros Camilato ^b , Hugo Santiago Crespo Ganchozo ^b , Gilmar Garrone^b , Ricardo de Mattos Marcondes ^b , Marcela Leal da Cruz ^{b, *}

Summary

Introduction

Diphallia is a rare anomaly. It has a range of appearances from a small accessory penile to complete duplication.

Methods

We present a 2 year-old boy with complete penile duplication. The left penile was the largest. NMR (Nuclear Magnetic Resonance) suggested one corporal body for each penile and VCUG (Voiding Cystourethrogram) showed a normal urethra in the right penile and stricture at glandular and mid penile urethra of the left penis. A Y confluence to bulbar urethra was observed confirming only one prostate and bladder.

Results

The cystoscopy through the right penile identified the urethral confluence in the bulbar area. We performed a meatotomy in the left penile to insert the cystoscope and confirmed the blind ending urethra. We decided to remove this penile. The penile was degloved entirely and clamped and took out the corpora at the base.

Discussion

Diphallia can have three presentations: only glans duplication, bifid diphallia and complete diphallia (two corpora cavernosa and a corpus spongiosum for each penile). In our case, each penile presented only one corpora cavernosa and the decision taken was based on urethral patency.

Conclusion

The treatment should always be planned individually whereas associated anomalies with the goal of attaining satisfactory functional and cosmetic.
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【家庭护理】严防足部皮肤破损！糖尿病患者护脚指南

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06 9月 2019

Author : 伤口世界

中诺医疗文章转载公众号上海第九人民医院作者谢挺

糖尿病患者大约有1.5%会发生足部溃疡，足部溃疡经久不愈，继发感染，发生坏疽。糖尿病足的截肢率很高，有报道称截肢率可高达85%，给患者造成极大痛苦，而通过积极的预防措施，可以降低40%~80%的截肢发生率。

　　在糖尿病足的预防和综合治疗中，足部护理占有特别突出的地位，通过家庭中实施的足部护理，可有效地防止或延缓糖尿病足的发生发展。足部护理的主要内容包括以下方面：

　　注意局部皮肤变化，观察皮肤的色、温度及感觉。如皮肤干燥无汗、弹性差、毛发脱落、皮温下降、皮色变暗、足背动脉搏动减弱或消失，提示动脉供血不足；如皮肤感觉缺失提示有神经营养障碍。

　　注意足部的保护，鞋袜要合适，最好选用软底布鞋及棉线袜，穿着以舒适不挤脚为宜，以保证足部血液循环的供应。由于糖尿病患者末梢神经感觉障碍，对冷热等物理刺激反应迟钝，因此冬天注意足部保暖，避免冻伤，用热水袋取暖时，热水袋内水温不超过60℃，热水袋外面用毛巾套包裹，不可直接触及皮肤，以防烫伤。

　　注意足部卫生，每晚用40~42℃的温水浸泡双脚15~30分钟，洗后用柔软吸水性强的毛巾擦干。消除过厚角质层防止干裂，可涂上植物油按摩，以保持皮肤柔软。

　　按摩足部以改善微循环。足部按摩每日早、中、晚各一次，每次10分钟，动作轻柔，应从趾尖开始向上按摩，有利于循环流畅。

　　修剪趾甲不应太靠近皮肤以免损伤甲沟皮肤导致感染，应沿着足趾甲平行修剪，不要剪向趾甲边角的深部。有胼胝的患者不要自行处理，应请专业人员帮助处理，避免不适当地应用鸡眼膏或脚癣浸泡液，以免造成足部感染。

　　减轻病变部位的负重。为了减轻病变局部的压迫，患者应注意卧床休息，不可长时间站立，行走时使用拐杖。患肢水肿者，把患肢抬高18~30°以利于静脉回流，减轻水肿。

　　日常多进行腿部运动，每日适当步行，做到定时、定量、量力而行、持之以恒。对较轻的患者可在护士的指导下，手扶椅子做单腿站立或甩腿运动，不能行走的患者在床上取坐姿位做提足运动，每日1~2次，每次至少20下。

　　糖尿病患者足部皮肤常易发生水疱，皮肤水疱易诱发感染和坏疽，一旦出现要积极处理。保持水疱清洁，避免受压，微循环改善后可自行吸收；对严重的水疱，可在无菌操作下抽出渗液。医生建议，出现了类似水疱等糖尿病皮肤早期皮肤损害，应当前往医院，在专业医护人员的指导下进行处理。

文章作者创面修复科谢挺副主任医师

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Robotic-assisted laparoscopic repair of a congenital rectourethral fistula with duplicated urethra 2026-09-11 00:00

Rohan G. Bhalla ^a , Belinda Li ^{b,d, *}, Mark C. Adams^b , Wallace W. Neblett^c , John C. Thomas ^b

Summary

Objective

To describe our experience with robot-assisted laparoscopic transperitoneal repair of a congenital rectourethral fistula in a pediatric patient with a urethral duplication.

Methods

The patient is a 2-year-old male with a past medical history of Tetralogy of Fallot presenting with a febrile urinary tract infection (UTI). He was diagnosed with urethral duplication and a rectourethral fistula by voiding cystourethrogram (VCUG). The parents were counseled on various options and agreed to proceed with a robotic repair.

Results

Robotic-assisted transperitoneal rectourethral fistula repair was performed. The procedure time was 229 min with an estimated blood loss (EBL) of 15 mL. His postoperative course was unremarkable. At his 2- week follow-up, the urethral catheter was removed and the patient was voiding normally and having normal bowel movements.

Conclusion

Congenital rectourethral fistula with urethral duplication is a rare anomaly with only a few reports in the literature. Pediatric robotic-assisted trans-peritoneal rectourethral fistula repair is a technically feasible approach in infants with minimal morbidity that allows for excellent visualization and avoids open repair.
Complete diphallia: How to proceed? 2026-09-10 00:00

Antonio Macedo Jr ^a,b , Se´rgio Leite Ottoni ^b , Paula Cartaxo Barros Camilato ^b , Hugo Santiago Crespo Ganchozo ^b , Gilmar Garrone^b , Ricardo de Mattos Marcondes ^b , Marcela Leal da Cruz ^{b, *}

Summary

Introduction

Diphallia is a rare anomaly. It has a range of appearances from a small accessory penile to complete duplication.

Methods

We present a 2 year-old boy with complete penile duplication. The left penile was the largest. NMR (Nuclear Magnetic Resonance) suggested one corporal body for each penile and VCUG (Voiding Cystourethrogram) showed a normal urethra in the right penile and stricture at glandular and mid penile urethra of the left penis. A Y confluence to bulbar urethra was observed confirming only one prostate and bladder.

Results

The cystoscopy through the right penile identified the urethral confluence in the bulbar area. We performed a meatotomy in the left penile to insert the cystoscope and confirmed the blind ending urethra. We decided to remove this penile. The penile was degloved entirely and clamped and took out the corpora at the base.

Discussion

Diphallia can have three presentations: only glans duplication, bifid diphallia and complete diphallia (two corpora cavernosa and a corpus spongiosum for each penile). In our case, each penile presented only one corpora cavernosa and the decision taken was based on urethral patency.

Conclusion

The treatment should always be planned individually whereas associated anomalies with the goal of attaining satisfactory functional and cosmetic.
Can portable ultrasound bladder scanner be applied to young children less than three years old? 2026-09-09 00:00

Minh-Tung Do ^a , Louis Kim ^b , Young Jae Im ^a,b , Kwanjin Park^{a,b, *}

Summary

Introduction The bladder scanner (BS), a portable ultrasound device specialized in bladder volume measurement, has been developed and applied to clinical assessment of postvoid residual urine, which is a requisite in evaluating patients with voiding dysfunction.

However, experiences in the application of the BS to the pediatric population remain limited despite commonly encountered reluctance to catheterization. This prospective observational study aimed to evaluate the correlation and accuracy of the newly developed pediatric module of the BS (BioCon-900) in measuring bladder volume in children 0e6 years.

Materials and methods

This study included 29 patients scheduled to undergo preventive untethering for their spinal dysraphism. When they undergo cystometry for the confirmation of normal neurologic function, bladder volume was measured by BS when recorded volume infusion reached each quartile of the age-adjusted estimated bladder capacity (EBC). The difference (bias) between measured and infused volume was expressed as a percentage of EBC (%EBC). The correlation coefficient and the Bland_Altman plot were obtained to determine the discriminating power and accuracy, respectively. The acceptable limit was set as 30%EBC.

Results

A strong correlation between the measured and infused volume (r = 0.95, P < 0.001) was found for the entire age range. This excellent correlation remained comparable between children less than three years and the older ones. Bladder volume tended to be overestimated, and the mean bias was 33 ± 22.3%EBC, and it became higher with increasing quartiles. The accuracy was acceptable in all ranges of measurement in the older group and first and second quartiles in the younger one.

Discussion

We have first evaluated the potential use of BS in 0_3 years old children and compared the results with 4_6- year-old children in whom the accuracy of BS has been demonstrated. The strong point of our study was the inclusion of data spanning all quartiles of bladder volume. The use of infused volume as reference enabled us to assess the accuracy in a more precise way than the use of ultrasound. Despite the good discriminating power, the accuracy was not acceptable in higher quartiles in the younger group. If the trend of overestimation especially higher volume, could be understood prior to measurement, it would be helpful to assume the real val.

Conclusions

The children’s module in BS showed excellent discriminating power and generally acceptable accuracy in more than four-year-old children. This may lose accuracy in higher quartiles among less than three years old children.

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2019广东省医疗行业协会伤口管理分会年会

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2019年6月15日中国广州
主办单位：广东省医疗行业协会伤口管理分会

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Custom Mod Mega1

主任医师、教授、博导，南方医科大学第三附属医院（广东省骨科医院）院长