Sustitución de uréter con apéndice cecal en un paciente con estenosis ureteral: primer caso reportado en México y revisión de la literatura

J.A. Rodríguez-Robles, L. Almazan-Treviño, J.I. Monjaras-Guerra, V.I. Victoria-Mejía, A.C. Martínez-Baez, M.P. Ávila-Boza, M.A. Reyes-Gutierrez
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引用次数: 1

Abstract

Over a span of 20 years, urologic, gynecologic, and general surgery operations were responsible for 42%, 34%, and 24% of injuries, respectively. In 1912, Melnikoff described the first substitution of a ureter with the vermiform appendix as treatment for ureteral stricture.

Objective

Our aim was to present herein a case of ureter substitution with the cecal appendix to promote the feasibility of the procedure and to describe the first experience at a tertiary care hospital in Mexico.

Material and methods

A 35-year-old woman was diagnosed with right distal ureteral stricture secondary to injury after a total abdominal hysterectomy and right nephrostomy placement.

Results

Given that the course of the stricture was approximately 10 cm, transposition of the appendix was decided upon. The cecal end of the appendix was previously isolated and splinted with a double-J ureteral stent and then anastomosed to the ureter with the end-to-end method and the distal end was reimplanted into the bladder with the Politano-Leadbetter technique. At 11 months after the procedure, the patient presented with adequate progression, was asymptomatic, and the control imaging studies showed satisfactory passage of urine from the kidney to the bladder, with no pyelocaliceal dilation or stricture.

Conclusions

There are various advantages to using the appendix as a substitute material, among which are good contractibility, availability to be moved with a blood supply, the fact that it does not absorb urine, the possibility to create a submucosal tunnel to prevent reflux, and a caliber similar to that of the ureteral lumen.

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输尿管狭窄患者输尿管盲肠阑尾置换:墨西哥首次报道的病例及文献综述
在20年的时间里,泌尿外科、妇科和普通外科手术分别造成42%、34%和24%的伤害。1912年,Melnikoff首次用蚓状阑尾代替输尿管治疗输尿管狭窄。目的我们的目的是在此提出一例输尿管替换盲肠阑尾的病例,以促进该手术的可行性,并描述在墨西哥三级医院的第一次经验。材料与方法一名35岁女性,经腹式全子宫切除术及右侧肾造口术后诊断为继发于损伤的右侧输尿管远端狭窄。结果考虑到狭窄的过程约为10cm,决定阑尾移位。先将阑尾的盲肠端分离,用双j型输尿管支架夹板固定,然后端到端与输尿管吻合,远端采用Politano-Leadbetter技术植入膀胱。在手术后11个月,患者表现出适当的进展,无症状,对照影像学检查显示尿液从肾脏到膀胱的通道良好,无肾盂扩张或狭窄。结论使用阑尾作为替代材料具有诸多优点,其中包括良好的收缩性、可随血液供应移动、不吸收尿液、可建立粘膜下隧道以防止反流、直径与输尿管管腔相似。
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来源期刊
Revista mexicana de urologia
Revista mexicana de urologia Medicine-Urology
CiteScore
0.20
自引率
0.00%
发文量
49
期刊介绍: Revista Mexicana de Urología (RMU) [Mexican Journal of Urology] (ISSN: 0185-4542 / ISSN electronic: 2007-4085) is bimonthly publication that disseminates research by academicians and professionals of the international medical community interested in urological subjects, in the format of original articles, clinical cases, review articles brief communications and letters to the editor. Owing to its nature, it is publication with international scope that disseminates contributions in Spanish and English that are rigorously reviewed by peers under the double blind modality. Neither journalistic documents nor those that lack rigorous medical or scientific support are suitable for publication.
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