Ascitis quilosa después de nefrectomía radical laparoscópica. Tratamiento conservador sin paracentesis
Chylous ascites following radical nephrectomy. Conservative Management whithout paracentese
Luis A. Fariña1
, María Concepción Martínez
Autor para correspondencia
luisfarina@yahoo.com
Correspondencia autor: Dr. Luis A. Fariña Pérez Servicio de Urologia. Hospital Povisa Salamanca, 5, 36211 Vigo, Pontevedra Tel.: 986 413 144
Correspondencia autor: Dr. Luis A. Fariña Pérez Servicio de Urologia. Hospital Povisa Salamanca, 5, 36211 Vigo, Pontevedra Tel.: 986 413 144
1 Servicios de Urología y Radiología. Hospital Povisa. Vigo, Pontevedra, España
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Tratamiento conservador sin paracentesis" "tieneTextoCompleto" => 0 "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "703" "paginaFinal" => "705" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Luis A. Fariña, María Concepción Martínez" "autores" => array:2 [ 0 => array:4 [ "nombre" => "Luis A." "apellidos" => "Fariña" "email" => array:1 [ 0 => "luisfarina@yahoo.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">1</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "María" "apellidos" => "Concepción Martínez" ] ] "afiliaciones" => array:1 [ 0 => array:3 [ "entidad" => "Servicios de Urología y Radiología. Hospital Povisa. Vigo, Pontevedra, España" "etiqueta" => "<span class="elsevierStyleSup">1</span>" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "1" "correspondencia" => "Correspondencia autor: Dr. Luis A. Fariña Pérez Servicio de Urologia. Hospital Povisa Salamanca, 5, 36211 Vigo, Pontevedra Tel.: 986 413 144" ] ] ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Chylous ascites following radical nephrectomy. Conservative Management whithout paracentese" ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2007-10-01" "fechaAceptado" => "2007-11-01" "PalabrasClave" => array:1 [ "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec89013" "palabras" => array:3 [ 0 => "Ascitis quilosa" 1 => "Laparoscopia" 2 => "Cáncer renal" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span class="elsevierStyleSectionTitle">Introducción</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">La ascitis quilosa es una complicación rara después de diferentes intervenciones abdominales y retroperitoneales. Aunque suele desaparecer con medidas conservadoras, puede ser necesaria una reintervención para sellar los vasos linfáticos que permanecen abiertos en el lecho operatorio.</p> <span class="elsevierStyleSectionTitle">Caso clínico</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Una mujer de 60 años fue intervenida de nefrectomia radical laparoscópica izquierda de un tumor de 9,5 x 7,5 cm, estadio pT2 pN0. En la intervención se hizo una disección cuidadosa del hilio, se ligaron o coagularon algunos gruesos vasos linfáticos peritumorales y se clipó el uréter distal. Unos dias después del alta, consulta por aumento del perimetro abdominal y en los estudios de imagen se encuentra ascitis quilosa difusa. Fue tratada de manera conservadora, sin realizar paracentesis diagnóstica o evacuadora, con dieta baja en sal y lípidos, y espironolactona, con curación completa en el plazo de un mes.</p> <span class="elsevierStyleSectionTitle">Comentario</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Un tratamiento conservador con diuréticos, dieta baja en lípidos y eventualmente con paracentesis debe ser la primera opción de tratamiento de las ascitis quilosa después de nefrectomia. En los últimos años se han descrito técnicas laparoscópicas para resolver una ascitis quilosa de forma poco invasiva, aunque no exenta de dificultad, tratándose de una re-intervención.</p>" ] "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span class="elsevierStyleSectionTitle">Introduction</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Chylous ascites is a rare complication after a number of abdominal and retroperitoneal surgeries. Althought conservative treatment may be curative, a reoperation to sell out the open megalymphatics in the operative field may be needed.</p> <span class="elsevierStyleSectionTitle">Patient and method</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">A 60 year-old woman was treated with a laparoscopic radical nephrectomy for a 9.5x7.5 cm, pT2 pN0 tumor. A carefull dissection of the renal hilium was performed, distal ureter was clipped and several gross peritumoral lymphatic vessels were clipped or coagulated, with no inmediate complications. Several days after being discharged home, she complained of increased abdominal perimeter and on image studies a difuse chylous ascitis was found. She was treated in a conservative way, with no diagnostic or palliative paracentesis, low salt and lipids diet, and espironolactone, with complete cure in a month. After six months of follow-up, no simptoms nor CT- signs of ascites or tumor recurred.</p> <span class="elsevierStyleSectionTitle">Comment</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">A conservative treatment, with diuretics, low lipids and salt diet, and eventually repeated paracentesis should be the first options for chylous ascites after nephrectomy. In the last years, several laparoscopic techniques had been described to treat chylous ascites in a low invasive way, but the intrinsic difficulties of such a re-operation much be considered.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "Referencias" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:14 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1." 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| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 0 | 2 | 2 |
| 2024 Octubre | 0 | 2 | 2 |
| 2024 Septiembre | 0 | 5 | 5 |
| 2024 Agosto | 0 | 1 | 1 |
| 2024 Julio | 0 | 5 | 5 |
| 2024 Junio | 0 | 4 | 4 |
| 2024 Mayo | 0 | 2 | 2 |
| 2024 Abril | 0 | 15 | 15 |
| 2024 Marzo | 0 | 40 | 40 |
| 2024 Febrero | 0 | 13 | 13 |
| 2024 Enero | 0 | 8 | 8 |
| 2023 Diciembre | 0 | 8 | 8 |
| 2023 Noviembre | 0 | 48 | 48 |
| 2023 Octubre | 0 | 28 | 28 |
| 2023 Septiembre | 0 | 18 | 18 |
| 2023 Agosto | 0 | 18 | 18 |
| 2023 Julio | 0 | 83 | 83 |
| 2023 Junio | 0 | 1 | 1 |
| 2023 Abril | 0 | 10 | 10 |
| 2023 Marzo | 1 | 10 | 11 |
| 2023 Febrero | 0 | 9 | 9 |
| 2023 Enero | 0 | 5 | 5 |
| 2022 Diciembre | 0 | 10 | 10 |
| 2022 Noviembre | 0 | 14 | 14 |
| 2022 Octubre | 0 | 5 | 5 |
| 2022 Septiembre | 0 | 35 | 35 |
| 2022 Agosto | 0 | 20 | 20 |
| 2022 Julio | 0 | 1 | 1 |
| 2022 Junio | 0 | 7 | 7 |
| 2022 Mayo | 0 | 9 | 9 |
| 2022 Abril | 0 | 12 | 12 |
| 2022 Marzo | 0 | 9 | 9 |
| 2022 Febrero | 0 | 6 | 6 |
| 2022 Enero | 0 | 3 | 3 |
| 2021 Diciembre | 0 | 5 | 5 |
| 2021 Noviembre | 0 | 10 | 10 |
| 2021 Octubre | 0 | 2 | 2 |
| 2021 Septiembre | 0 | 2 | 2 |
| 2021 Agosto | 0 | 3 | 3 |
| 2021 Julio | 0 | 3 | 3 |
| 2021 Junio | 0 | 0 | 0 |
| 2021 Mayo | 0 | 4 | 4 |
| 2021 Abril | 0 | 1 | 1 |
| 2021 Marzo | 0 | 1 | 1 |
| 2021 Febrero | 0 | 7 | 7 |
| 2021 Enero | 0 | 4 | 4 |
| 2020 Diciembre | 0 | 3 | 3 |
| 2020 Noviembre | 0 | 2 | 2 |
| 2020 Octubre | 0 | 1 | 1 |
| 2020 Septiembre | 0 | 8 | 8 |
| 2020 Agosto | 0 | 5 | 5 |
| 2020 Julio | 0 | 3 | 3 |
| 2020 Junio | 0 | 1 | 1 |
| 2020 Mayo | 0 | 14 | 14 |
| 2020 Abril | 0 | 6 | 6 |
| 2020 Marzo | 0 | 7 | 7 |
| 2020 Febrero | 0 | 5 | 5 |
| 2020 Enero | 0 | 11 | 11 |
| 2019 Diciembre | 0 | 17 | 17 |
| 2019 Noviembre | 0 | 6 | 6 |
| 2019 Octubre | 0 | 14 | 14 |
| 2019 Septiembre | 0 | 11 | 11 |
| 2019 Agosto | 0 | 11 | 11 |
| 2019 Julio | 0 | 12 | 12 |
| 2019 Junio | 0 | 18 | 18 |
| 2019 Mayo | 0 | 60 | 60 |
| 2019 Abril | 0 | 38 | 38 |
| 2019 Marzo | 0 | 9 | 9 |
| 2019 Febrero | 0 | 15 | 15 |
| 2019 Enero | 0 | 3 | 3 |
| 2018 Diciembre | 0 | 10 | 10 |
| 2018 Noviembre | 0 | 22 | 22 |
| 2018 Octubre | 0 | 23 | 23 |
| 2018 Septiembre | 0 | 1 | 1 |
| 2018 Agosto | 0 | 1 | 1 |
| 2018 Julio | 0 | 5 | 5 |
| 2018 Junio | 0 | 1 | 1 |
| 2018 Marzo | 0 | 3 | 3 |
| 2018 Febrero | 2 | 4 | 6 |
| 2018 Enero | 2 | 5 | 7 |
| 2017 Diciembre | 4 | 7 | 11 |
| 2017 Noviembre | 6 | 8 | 14 |
| 2017 Octubre | 10 | 6 | 16 |
| 2017 Septiembre | 9 | 9 | 18 |
| 2017 Agosto | 8 | 7 | 15 |
| 2017 Julio | 7 | 6 | 13 |
| 2017 Junio | 3 | 22 | 25 |
| 2017 Mayo | 14 | 11 | 25 |
| 2017 Abril | 9 | 3 | 12 |
| 2017 Marzo | 14 | 73 | 87 |
| 2017 Febrero | 5 | 14 | 19 |
| 2017 Enero | 2 | 6 | 8 |
| 2016 Diciembre | 11 | 21 | 32 |
| 2016 Noviembre | 30 | 24 | 54 |
| 2016 Octubre | 31 | 19 | 50 |
| 2016 Septiembre | 17 | 19 | 36 |
| 2016 Agosto | 9 | 11 | 20 |
| 2016 Julio | 16 | 1 | 17 |
| 2016 Junio | 26 | 29 | 55 |
| 2016 Mayo | 14 | 35 | 49 |
| 2016 Abril | 14 | 32 | 46 |
| 2016 Marzo | 22 | 23 | 45 |
| 2016 Febrero | 13 | 27 | 40 |
| 2016 Enero | 19 | 38 | 57 |
| 2015 Diciembre | 14 | 26 | 40 |
| 2015 Noviembre | 10 | 18 | 28 |
| 2015 Octubre | 19 | 23 | 42 |
| 2015 Septiembre | 9 | 9 | 18 |
| 2015 Agosto | 8 | 7 | 15 |
| 2015 Julio | 12 | 10 | 22 |
| 2015 Junio | 5 | 6 | 11 |
| 2015 Mayo | 10 | 10 | 20 |
| 2015 Abril | 5 | 19 | 24 |
| 2015 Marzo | 11 | 25 | 36 |
| 2015 Febrero | 3 | 11 | 14 |
| 2015 Enero | 10 | 6 | 16 |
| 2014 Diciembre | 5 | 9 | 14 |
| 2014 Noviembre | 8 | 4 | 12 |
| 2014 Octubre | 11 | 10 | 21 |
| 2014 Septiembre | 10 | 2 | 12 |
| 2014 Agosto | 10 | 4 | 14 |
| 2014 Julio | 10 | 8 | 18 |
| 2014 Junio | 3 | 4 | 7 |
| 2014 Mayo | 1 | 2 | 3 |
| 2014 Abril | 1 | 2 | 3 |
| 2014 Marzo | 1 | 3 | 4 |
| 2014 Febrero | 6 | 8 | 14 |
| 2014 Enero | 3 | 1 | 4 |
| 2013 Diciembre | 7 | 3 | 10 |
| 2013 Noviembre | 13 | 6 | 19 |
| 2013 Octubre | 3 | 9 | 12 |
| 2013 Septiembre | 8 | 18 | 26 |
| 2013 Agosto | 5 | 42 | 47 |
| 2013 Julio | 4 | 2 | 6 |
| 2009 Mayo | 360 | 0 | 360 |
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