Del Missier A, La Torre F, Toma E
Registered Nurse, Clinical Specialist in Ostomy Care, Latina.
Professor in General Surgery, Director U.O.C. Trauma and Emergency Surgery "Sapienza Università di Roma" - Rome.
Clin Ter. 2019 Mar-Apr;170(2):e86-e92. doi: 10.7417/CT.2019.2115.
Peristomal granulomatosis is a chronic inflammatory disease of uncertain aetiology, and a high recurrence rate. It frequently occurs in patients with enterostomy and urostomy. The most frequent type affects the mucocutaneous junction, causing bleeding and painful nodular lesions, which complicate management of the ostomy pouching system. Currently, only invasive treatments are available, consisting in cauterisation or surgical removal of the granuloma. Our objective was to evaluate efficacy of a topic mixture oil, composed by a 1:1 of extracts of Neem and Red Hypericum; amongst its many therapeutical properties, it is proven to inhibit the over-granulation process.
Two clinical cases presenting typical peristomal granulomatosis were selected. On first access after recruitment, the patients underwent an accurate nursing anamnesis, a global assessment was carried out according to the Toven Method and an assessment of peristomal sore skin according to SACS 2.0. Granulomatosis wounds were treated with the oil mixture, applied on a hydrofiber pad, secured over the wound site by means of a transparent film. This allowed the release of active ingredients while ensuring the pouching system secure adhesion. The chosen protocol consisted in 2 dressing changes per week, while monitoring the granulomatosis wound evolution by means of a TOR Form validated data form and documenting progress by taking photographs.
Initially a regression of the inflammatory process was observed, with significant decrease of bleeding and pain. Gradually, the proliferating lesions reduced in size (both width and extent), and eventually healed completely. The product was very well tolerated, even when in contact with the stoma mucous membrane. No recurrence signs were observed either at the follow up visit 15 days from end of treatment, and in clinical case N.2 equally none were present two months after treatment.
Compared to conventional methods which are invasive, not resolving, and not tolerated by patients, the product was demonstrated to be an innovative therapeutical solution, easy to apply, with no side effects and well-liked by patients. The excellent results obtained require further confirmation and validation through new studies on a statistically significant number of cases.
造口周围肉芽肿病是一种病因不明的慢性炎症性疾病，复发率高。它常发生于肠造口术和尿路造口术患者。最常见的类型影响黏膜皮肤交界处，导致出血和疼痛性结节性病变，这使造口袋系统的管理变得复杂。目前，仅有侵入性治疗方法，包括烧灼或手术切除肉芽肿。我们的目的是评估一种由印楝和金丝桃提取物按1:1比例组成的外用混合油的疗效；在其众多治疗特性中，已证实它可抑制过度肉芽形成过程。
选取两例呈现典型造口周围肉芽肿病的临床病例。入选后首次就诊时，患者接受了详细的护理问诊，根据托文方法进行了全面评估，并根据SACS 2.0对造口周围皮肤溃疡进行了评估。用混合油治疗肉芽肿伤口，将其涂抹在水凝胶垫上，通过透明薄膜固定在伤口部位。这既能释放活性成分，又能确保造口袋系统牢固粘贴。所选方案为每周更换两次敷料，同时通过经TOR表格验证的数据表监测肉芽肿伤口的演变情况，并拍照记录进展。
最初观察到炎症过程消退，出血和疼痛明显减轻。逐渐地，增生性病变的大小（宽度和范围）减小，最终完全愈合。该产品耐受性良好，即使与造口黏膜接触时也是如此。在治疗结束后15天的随访中未观察到复发迹象，临床病例2在治疗两个月后同样未出现复发迹象。
与具有侵入性、无效且患者不耐受的传统方法相比，该产品被证明是一种创新的治疗方案，易于应用，无副作用且受患者欢迎。所取得的优异结果需要通过对大量病例进行统计学意义上的新研究来进一步证实和验证。
