Luo Y, Zhong M
Department of Gastrointestinal Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200127, China.
Zhonghua Wei Chang Wai Ke Za Zhi. 2020 Feb 22;23(3):E003. doi: 10.3760/cma.j.cn441530-20200217-00057.
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.
新型冠状病毒肺炎（NCP）目前正在中国肆虐。已证实NCP可在人与人之间传播并导致医院感染，这严重威胁着外科医护人员和住院患者。虽然结直肠手术并非抗击疫情的一线学科，但在这种特殊情况下，如何在最大程度保护患者及其家属、医护人员健康以及病房和医院安全的前提下，提供最高质量的医疗服务以确保既往临床工作有序开展，成为一项艰巨任务。参考《新型冠状病毒肺炎诊疗方案（试行第四版、第五版）》，并结合我院实际情况以及《上海仁济医院新型冠状病毒文件汇总》，我们总结了在NCP疫情防控形势下如何开展结直肠手术的临床实践，同时针对结直肠肿瘤急诊患者的诊治流程，分享了结直肠肿瘤的诊断、拟行手术的结直肠癌患者的管理、病房防护、围手术期管理等方面的经验。更重要的是，我们详细介绍了疑似或确诊新型冠状病毒肺炎的结直肠手术患者的手术管理和围手术期管理，包括医护人员、手术室及手术器械的防控措施。要点如下：（1）多学科团队（MDT）必须贯穿结直肠癌的诊治过程。成员不仅包括常规科室，还应包括呼吸科和感染科。（2）结肠镜检查可能导致NCP在患者和医生之间交叉感染。因此，应优先检查急诊病例和危及生命的患者（出血、梗阻、胃肠道异物等）。对于疑似或确诊NCP的急诊患者（肠梗阻），外科医生必须进行急诊手术，不建议通过结肠镜放置肠道减压管。（3）疑似或确诊NCP的结直肠癌患者应安置在配备独立医疗设备的隔离病房，且必须使用负压手术室（-5 Pa以下）。围手术期患者的所有一次性医疗物品、体液及粪便必须按照医疗废物标准统一处理。（4）诊治NCP结直肠癌患者的手术医护人员必须进行三级防护。术后，医护人员必须接受医学观察并隔离14天。我们希望我们的“仁济经验”能对同行有所帮助。
