Papel de la colangioyeyunostomía periférica intrahepática al segmento III (Soupault-Couinaud) para la ictericia maligna en la era de los stents endoscópicos y percutáneos
Role of segment III peripheral intrahepatic cholangio-jejunostomy (Soupault-Couinaud) for malignant jaundice in the era of endoscopic and percutaneous stents
César Ramírez-Plaza1
, Julio Santoyo, Miguel A. Suárez, José A. Pérez-Daga, José L. Fernández-Aguilar, Manuel Jiménez, Iván González-Poveda, Antonio González-Sánchez, José A. Bondía, Agustín de la Fuente
Autor para correspondencia
cprptot@hotmail.com
Correspondencia: Dr. César Ramírez Plaza. Servicio de Cirugía General y Aparato Digestivo. Hospital Regional Universitario Carlos Haya. Avda. de Carlos Haya, s/n. 29010 Málaga.
Correspondencia: Dr. César Ramírez Plaza. Servicio de Cirugía General y Aparato Digestivo. Hospital Regional Universitario Carlos Haya. Avda. de Carlos Haya, s/n. 29010 Málaga.
Sección de Cirugía HBP y Trasplante Hepático. Servicio de Cirugía General y Aparato Digestivo (Jefe del Servicio: Prof. Agustín de la Fuente Perucho). Hospital Regional Universitario Carlos Haya. Málaga.
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"apellidos" => "Bondía" ] 9 => array:2 [ "nombre" => "Agustín" "apellidos" => "de la Fuente" ] ] "afiliaciones" => array:1 [ 0 => array:1 [ "entidad" => "Sección de Cirugía HBP y Trasplante Hepático. Servicio de Cirugía General y Aparato Digestivo (Jefe del Servicio: Prof. Agustín de la Fuente Perucho). Hospital Regional Universitario Carlos Haya. Málaga." ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "1" "correspondencia" => "Correspondencia: Dr. César Ramírez Plaza. Servicio de Cirugía General y Aparato Digestivo. Hospital Regional Universitario Carlos Haya. Avda. de Carlos Haya, s/n. 29010 Málaga." ] ] ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Role of segment III peripheral intrahepatic cholangio-jejunostomy (Soupault-Couinaud) for malignant jaundice in the era of endoscopic and percutaneous stents" ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaAceptado" => "2002-03-31" "PalabrasClave" => array:2 [ "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec197924" "palabras" => array:3 [ 0 => "Ictericia maligna" 1 => "Tratamiento quirúrgico paliativo" 2 => "Técnica de Soupault-Couinaud" ] ] ] "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Key words" "identificador" => "xpalclavsec197923" "palabras" => array:3 [ 0 => "Malignant jaundice" 1 => "Palliative surgical treatment" 2 => "Soupault-Couinaud´s technique" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span class="elsevierStyleSectionTitle">Objetivo</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Presentar los resultados de nuestra experiencia con la técnica de Soupault-Couinaud (colangioyeyunostomía intrahepática periférica al segmento III) como terapeútica paliativa en pacientes seleccionados con lesiones malignas no resecables de la confluencia hepática. Se revisan asimismo las distintas opciones de tratamiento para este tipo de pacientes.</p> <span class="elsevierStyleSectionTitle">Pacientes y método</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Estudiamos de forma retrospectiva las historias clínicas de 7 pacientes intervenidos mediante este procedimiento en la Unidad de Cirugía HBP de nuestro Servicio de Cirugía Digestiva entre los años 1993 y 2000. Se han recogido los datos clínicos y analíticos preoperatorios, así como la información de la patología causante del bloqueo hiliar, y se comparan con la evolución clínica y los datos analíticos postoperatorios y de seguimiento, para poder así demostrar la utilidad o no de la técnica.</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">De los 7 pacientes, tres eran varones y 4 mujeres, con una edad media de 66 años. La ictericia estuvo presente en el 100% de los casos, y el 85,7% de los pacientes refirieron en el momento del ingreso prurito, síndrome tóxico y dolor abdominal superior. Las patologías causantes del bloqueo hiliar fueron cáncer de vesícula biliar (4 casos), colangiocarcinoma (dos casos) y metástasis ganglionares de ampuloma (un caso). En todos los casos la decisión de realizar una colangioyeyunostomía intrahepática periférica al segmento III fue tomada en el mismo acto operatorio. Los valores medios de bilirrubina total preoperatorios fueron de 13,4 mg/dl (rango de 3,7 a 23,5 mg/dl). El 85,7% de los pacientes experimentaron mejoría postoperatoria importante del síndrome ictérico, con descenso de la colemia previa al alta hasta una media de 5,3 mg/dl (rango de 0,82 a 16,51 mg/dl). La mortalidad fue nula, y la morbilidad del 57,1%, con una supervivencia media de 6 meses.</p> <span class="elsevierStyleSectionTitle">Conclusión</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">A pesar del limitado número de pacientes de esta serie, pensamos que la colangioyeyunostomía intrahepática periférica al segmento III (técnica de Soupault-Couinaud) aún representa una buena opción terapéutica paliativa para pacientes seleccionados con lesiones malignas no resecables de la confluencia hepática. En unidades HBP especializadas presenta una aceptable morbilidad y una minima (nula en nuestra experiencia) mortalidad, proporcionando a estos enfermos una paliación clínica y analítica prolongada, con la consiguiente repercusión en una mejor calidad de vida.</p>" ] "en" => array:1 [ "resumen" => "<span class="elsevierStyleSectionTitle">Aim</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">To present the results of our experience with Soupault-Couinaud’s technique (segment III peripheral intrahepatic cholangio-jejunostomy) as a palliative treatment in selected patients with non-resectable malignancies invading the confluence of the hepatic ducts. Different options for the treatment of these group of patients are also reviewed.</p> <span class="elsevierStyleSectionTitle">Patients and methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">From 1993 to 2000, 7 patients were operated on with this procedure in the HBP Surgery Department of our Digestive Surgery Service and their case-historys have been reviewed. Preoperative clinical and analytical data and information about the etiology of the malignant disease have been collected, being compared with the postoperative clinical and analytical surveillance results to confirm this technique being useful or not.</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">There were 3 men and 4 women, being the median age of our patients 66. Jaundice was present in 100%, and 85.7% referred pruritus, toxic syndrome and upper abdominal pain at admission. The malignancies responsible of the hilum blockade have been: gallbladder cancer (4 cases), cholangiocarcinoma (2 cases) and nodal metastases of an ampullary tumor (1 case). In all the cases, the decission of performing a segment III peripheral intrahepatic cholangio-jejunostomy was taken in the same moment of surgery. Median values of preoperative total bilirrubine (BT) levels were 13.4 mg/dl (range 3.7-12.5 mg/dl), and 85.7% of the patients experienced postoperative improvement of jaundice, with decreasing TB levels to a median of 5.3 mg/dl (range 0.82-16.51 mg/dl). Mortality in our grupe was 0% and morbidity rates were 57.1%, with a median survival of 6 months.</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">In spite of a low number of patients in our series, we think that segment III peripheral intrahepatic cholangio-jejunostomy (Soupault-Couinaud´s technique) is a good palliative option to treat selected patients with malignant non-resectable lesions at the hepatic hilum. When performed in specialized HPB Surgery Units, this technique has an acceptable morbidity and very low mortality (zero in our experience), offering to these patients a long-standing clinical and analytical palliation, all of these resulting in an improvement of quality of life.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "Bibliografía" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:29 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Surgical approaches to cholangicarcinoma at confluence of the hepatic ducts" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "L.H. Blumgart" 1 => "N.S. Hadjis" 2 => "I.S. Benjamin" 3 => "R. 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| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Octubre | 18 | 4 | 22 |
| 2024 Septiembre | 28 | 7 | 35 |
| 2024 Agosto | 30 | 11 | 41 |
| 2024 Julio | 20 | 16 | 36 |
| 2024 Junio | 12 | 20 | 32 |
| 2024 Mayo | 20 | 5 | 25 |
| 2024 Abril | 22 | 23 | 45 |
| 2024 Marzo | 44 | 24 | 68 |
| 2024 Febrero | 34 | 8 | 42 |
| 2024 Enero | 31 | 16 | 47 |
| 2023 Diciembre | 21 | 38 | 59 |
| 2023 Noviembre | 19 | 52 | 71 |
| 2023 Octubre | 31 | 28 | 59 |
| 2023 Septiembre | 14 | 13 | 27 |
| 2023 Agosto | 10 | 20 | 30 |
| 2023 Julio | 22 | 26 | 48 |
| 2023 Junio | 26 | 16 | 42 |
| 2023 Mayo | 15 | 11 | 26 |
| 2023 Abril | 12 | 5 | 17 |
| 2023 Marzo | 3 | 17 | 20 |
| 2023 Febrero | 18 | 15 | 33 |
| 2023 Enero | 4 | 7 | 11 |
| 2022 Diciembre | 15 | 21 | 36 |
| 2022 Noviembre | 36 | 33 | 69 |
| 2022 Octubre | 22 | 22 | 44 |
| 2022 Septiembre | 21 | 19 | 40 |
| 2022 Agosto | 42 | 32 | 74 |
| 2022 Julio | 21 | 14 | 35 |
| 2022 Junio | 18 | 7 | 25 |
| 2022 Mayo | 16 | 15 | 31 |
| 2022 Abril | 27 | 32 | 59 |
| 2022 Marzo | 36 | 15 | 51 |
| 2022 Febrero | 20 | 7 | 27 |
| 2022 Enero | 11 | 8 | 19 |
| 2021 Diciembre | 6 | 15 | 21 |
| 2021 Noviembre | 23 | 12 | 35 |
| 2021 Octubre | 16 | 9 | 25 |
| 2021 Septiembre | 18 | 13 | 31 |
| 2021 Agosto | 26 | 9 | 35 |
| 2021 Julio | 13 | 10 | 23 |
| 2021 Junio | 11 | 9 | 20 |
| 2021 Mayo | 21 | 12 | 33 |
| 2021 Abril | 34 | 26 | 60 |
| 2021 Marzo | 29 | 8 | 37 |
| 2021 Febrero | 28 | 10 | 38 |
| 2021 Enero | 10 | 12 | 22 |
| 2020 Diciembre | 19 | 15 | 34 |
| 2020 Noviembre | 23 | 25 | 48 |
| 2020 Octubre | 31 | 10 | 41 |
| 2020 Septiembre | 35 | 21 | 56 |
| 2020 Agosto | 37 | 17 | 54 |
| 2020 Julio | 24 | 11 | 35 |
| 2020 Junio | 25 | 13 | 38 |
| 2020 Mayo | 29 | 13 | 42 |
| 2020 Abril | 19 | 12 | 31 |
| 2020 Marzo | 50 | 25 | 75 |
| 2020 Febrero | 14 | 14 | 28 |
| 2020 Enero | 37 | 25 | 62 |
| 2019 Diciembre | 34 | 46 | 80 |
| 2019 Noviembre | 20 | 17 | 37 |
| 2019 Octubre | 28 | 24 | 52 |
| 2019 Septiembre | 20 | 24 | 44 |
| 2019 Agosto | 8 | 31 | 39 |
| 2019 Julio | 17 | 35 | 52 |
| 2019 Junio | 54 | 48 | 102 |
| 2019 Mayo | 173 | 165 | 338 |
| 2019 Abril | 70 | 70 | 140 |
| 2019 Marzo | 11 | 16 | 27 |
| 2019 Febrero | 12 | 20 | 32 |
| 2019 Enero | 15 | 11 | 26 |
| 2018 Diciembre | 8 | 13 | 21 |
| 2018 Noviembre | 9 | 17 | 26 |
| 2018 Octubre | 17 | 4 | 21 |
| 2018 Septiembre | 24 | 12 | 36 |
| 2018 Agosto | 8 | 14 | 22 |
| 2018 Julio | 1 | 7 | 8 |
| 2018 Junio | 5 | 10 | 15 |
| 2018 Mayo | 6 | 11 | 17 |
| 2018 Abril | 2 | 13 | 15 |
| 2018 Marzo | 5 | 3 | 8 |
| 2018 Febrero | 5 | 6 | 11 |
| 2018 Enero | 2 | 7 | 9 |
| 2017 Diciembre | 6 | 4 | 10 |
| 2017 Noviembre | 19 | 7 | 26 |
| 2017 Octubre | 13 | 5 | 18 |
| 2017 Septiembre | 7 | 12 | 19 |
| 2017 Agosto | 6 | 8 | 14 |
| 2017 Julio | 6 | 18 | 24 |
| 2017 Junio | 13 | 19 | 32 |
| 2017 Mayo | 10 | 13 | 23 |
| 2017 Abril | 5 | 7 | 12 |
| 2017 Marzo | 13 | 16 | 29 |
| 2017 Febrero | 10 | 13 | 23 |
| 2017 Enero | 10 | 4 | 14 |
| 2016 Diciembre | 18 | 9 | 27 |
| 2016 Noviembre | 42 | 4 | 46 |
| 2016 Octubre | 64 | 7 | 71 |
| 2016 Septiembre | 19 | 3 | 22 |
| 2016 Agosto | 9 | 1 | 10 |
| 2016 Julio | 20 | 1 | 21 |
| 2016 Junio | 28 | 17 | 45 |
| 2016 Mayo | 38 | 25 | 63 |
| 2016 Abril | 24 | 12 | 36 |
| 2016 Marzo | 30 | 16 | 46 |
| 2016 Febrero | 28 | 18 | 46 |
| 2016 Enero | 29 | 25 | 54 |
| 2015 Diciembre | 19 | 14 | 33 |
| 2015 Noviembre | 37 | 17 | 54 |
| 2015 Octubre | 54 | 19 | 73 |
| 2015 Septiembre | 38 | 11 | 49 |
| 2015 Agosto | 36 | 8 | 44 |
| 2015 Julio | 50 | 5 | 55 |
| 2015 Junio | 32 | 10 | 42 |
| 2015 Mayo | 46 | 5 | 51 |
| 2015 Abril | 36 | 4 | 40 |
| 2015 Marzo | 42 | 8 | 50 |
| 2015 Febrero | 48 | 4 | 52 |
| 2015 Enero | 45 | 3 | 48 |
| 2014 Diciembre | 34 | 1 | 35 |
| 2014 Noviembre | 27 | 4 | 31 |
| 2014 Octubre | 33 | 5 | 38 |
| 2014 Septiembre | 38 | 5 | 43 |
| 2014 Agosto | 47 | 2 | 49 |
| 2014 Julio | 41 | 4 | 45 |
| 2014 Junio | 30 | 1 | 31 |
| 2014 Mayo | 30 | 1 | 31 |
| 2014 Abril | 16 | 5 | 21 |
| 2014 Marzo | 17 | 0 | 17 |
| 2014 Febrero | 16 | 2 | 18 |
| 2014 Enero | 19 | 1 | 20 |
| 2013 Diciembre | 20 | 5 | 25 |
| 2013 Noviembre | 22 | 3 | 25 |
| 2013 Octubre | 28 | 4 | 32 |
| 2013 Septiembre | 16 | 2 | 18 |
| 2013 Agosto | 37 | 4 | 41 |
| 2013 Julio | 9 | 0 | 9 |
| 2002 Junio | 2546 | 0 | 2546 |
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