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Estenosis ureterales de las anastomosis urétero-ileales
J.M. Martínez sagarra, C. Conde redondo1, J. Amón sesmero, J. Estébanez zarranz, A. Rodríguez toves, D. Alonso fernández
Servicio de Urología. Hospital Universitario “Río Hortega”. Valladolid
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        "resumen" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Con la plastia de sustituci&#243;n pretendemos una cirug&#237;a oncol&#243;gica y a la vez mantener la imagen corporal y preservar la funci&#243;n renal&#46; La anastomosis enteroureteral es un punto muy importante de esta cirug&#237;a&#44; ya que los principales responsables de la p&#233;rdida de dicha funci&#243;n renal son la estenosis&#44; la infecci&#243;n y el reflujo&#46;</p><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Hemos realizado 206 sustituciones vesicales ortot&#243;picas &#40;noviembre 1981 - noviembre 1998&#41;&#46; Se realiz&#243; anastomosis ur&#233;teroileal directa tipo Wallace&#46; Como mecanismo antirreflujo se emple&#243; un sistema valvular mediante intususcepci&#243;n&#46; Analizamos los casos de obstrucci&#243;n&#44; la frecuencia de estenosis de la uni&#243;n ur&#233;teroileal y las estenosis valvulares ocurridos en nuestra serie como parte de las complicaciones&#44; cuyo periodo de seguimiento fue de 54 meses &#40;6-183&#41;&#46;</p><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Se han hallado 6 estenosis de la uni&#243;n ur&#233;terointestinal y 2 de la v&#225;lvula de intususcepci&#243;n&#46; De las estenosis ur&#233;teroileales &#40;3&#44;8&#37;&#41;&#44; 2 han sido precoces asociadas a f&#237;stula&#44; tratadas una por cirug&#237;a abierta y otra por la colocaci&#243;n de un doble J por v&#237;a anter&#243;grada percut&#225;nea&#46; De las cuatro restantes&#44; que han sido tard&#237;as&#44; s&#243;lo una se pudo solucionar mediante cat&#233;ter doble J&#44; el resto tuvieron que ser reintervenidas&#46; Las estenosis del sistema valvular &#40;1&#44;2&#37;&#41; se solucionaron mediante cirug&#237;a abierta&#46;</p><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Desde nuestra experiencia&#44; pensamos que el implante ur&#233;teroileal directo con espatulaci&#243;n del ur&#233;ter&#44; es una t&#233;cnica segura con poco riesgo de estenosis de la uni&#243;n ur&#233;teroileal&#46; Confiamos el sistema antirreflujo a la intususcepci&#243;n&#46;</p>"
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        "resumen" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Replacement plasty allows to perform oncology surgery while maintaining body image and preserving renal function&#46; Enteroureteral anastomosis is a significant element in this procedure where the main responsible for the loss of renal function are stenosis&#44; infection and reflux&#46;1</p><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Our group has performed 206 orthotopical vesical replacements &#40;November 1981 - November 1998&#41;&#44; using a direct Wallace-type uretero-ileal anastomosis&#46; An intussusception valve system was used as antireflux mechanism&#46; The number of obstructions&#44; rate of stenosis at the uretero-ileal junction and incidence of valve stenosis were all analyzed as part of the complications occurred over a follow-up period of 54 months &#40;6-183&#41;&#46;</p><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Findings included 6 stenosis at the uretero-intestinal junction and 2 at the intussusception valve&#46; Two &#40;3&#46;8&#37;&#41; of the uretero-ileal stenosis were earlier and associated to fistula&#59; one was treated with open surgery and one had a double J placed through antegrade percutaneous access&#46; Of the remaining late four&#44; only one was treated with a double J catheter while the other three had to be re-operated&#46; Stenoses of the valvular system &#40;1&#46;2&#37;&#41; were solved with open surgery&#46;</p><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">From our experience&#44; we believe that direct uretero-ileal implantation with scraping of the ureter is a safe technique with little risk for stenosis at the uretero-ileal junction&#46; Intussusception was used a antireflux system in all cases&#46;</p>"
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Información del artículo
ISSN: 02104806
Idioma original: Español
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