Valoración de pieloplastia desmembrada con técnica de Anderson-Hynes con y sin catéter doble J en el tratamiento de la hidronefrosis por estenosis pieloureteral en niños, Hospital de Niños Dr. Roberto Gilbert Elizalde, 2006-2009
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2011
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Universidad de Guayaquil. Facultad de Ciencias Médicas. Escuela de Graduados
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La hidronefrosis secundaria a estenosis pieloureteral en pacientes pediátricos puede causar importante lesión al parénquima renal. Sin embargo en etapas tempranas el riñón del niño tiene un alto poder de recuperación, por lo que la solución del problema puede tornar la función del riñón a la normalidad. En el hospital “Dr. Roberto Gilbert Elizalde” se vienen realizando para la solución de este problema varios tipos de pieloplastias. La más empleada es con la técnica de Anderson Hynes con colocación de catéter doble J la que desde hace algunos años se utiliza en el mundo con reportes de exitosos resultados. Sin embargo en esta institución la técnica se la aplicaba sin colocación del catéter doble J. Con el objetivo de comparar estos dos procedimientos quirúrgicos en cuanto a ventajas para el tratamiento de la hidronefrosis por estenosis pieloureteral en niños se realizó un estudio observacional, correlacional, no experimental longitudinal retrospectivo al que se incorporó40 observaciones de intervenciones de pieloplastia desmembrada con técnica de Anderson Hynes con catéter doble J y 60 casos en los cuales no se colocó el catéter doble J. Para el análisis estadístico se emplearon la prueba z y la prueba de chi2 considerándose significativos valores de P < 0.05. Para el análisis de impacto se utilizarán elodds ratio (OR), número de pacientes necesarios a tratar (NNT), reducción del riesgo absoluto (RRA).El estudio reveló que el número de reintervenciones, complicaciones y la estancia hospitalaria fue estadísticamente menor (P < 0.05) en el grupo indicado con pieloplastia con colocación de catéter. Se observó una reducción significativa de la estancia hospitalaria con la primera técnica quirúrgica (P 0.02), también una reducción sostenida del riesgo absoluto de estancia prolongada (RRA: 45,0% IC 95%23,81-66,19) y de la razón de exceso (OR: 0,14; IC95% 0.05-0,412)
Hydronephrosis secondary to ureteropelvic junction obstruction in children can cause significant injury to the renal parenchyma. But early in the kidney of the child has a high resilience, so that the solution of the problem may make kidney function to normal. In the hospital, "Dr Roberto Gilbert Elizalde" being made to solve this problem several types of pyeloplasty. The most used is the Anderson Hynes technique with double-J catheter placement For several years is used in the world pyeloplasty with double J stent with reports of successful results. However, in the hospital this technique is applied without double-J stent insertion In order to know whether the use of dismembered pyeloplasty with double J catheter versus surgical benefits offered pyeloplasty without double J stent for the treatment of hydronephrosis and pyelo-ureteral stenosis in pediatric patients is an observational, correlational, not Retrospective longitudinal experimental which he joined 40 observations interventions dismembered pyeloplasty with Anderson Hynes technique with double J stent and 60 cases in which no catheter was placed double-J For statistical analysis, z test was used chi2 test considering significant values of P <0.05. For the impact analysis must use the odds ratio (OR), number of patients needed to treat (NNT), absolute risk reduction (ARR). The study revealed that neither the number of reoperations and the number of complications had statistically significant differences between techniques (P> 0.05), although in both cases there was a trend to be lower in pyeloplasty with a catheter. There was a significant reduction in hospital stay with the first surgical procedure (P 0.02), also a sustained reduction in absolute risk of prolonged stay (RRA: 45,0% IC 95% 23,81-66,19) and excess ratio (OR: 0,14; IC95% 0.05-0,412)
Hydronephrosis secondary to ureteropelvic junction obstruction in children can cause significant injury to the renal parenchyma. But early in the kidney of the child has a high resilience, so that the solution of the problem may make kidney function to normal. In the hospital, "Dr Roberto Gilbert Elizalde" being made to solve this problem several types of pyeloplasty. The most used is the Anderson Hynes technique with double-J catheter placement For several years is used in the world pyeloplasty with double J stent with reports of successful results. However, in the hospital this technique is applied without double-J stent insertion In order to know whether the use of dismembered pyeloplasty with double J catheter versus surgical benefits offered pyeloplasty without double J stent for the treatment of hydronephrosis and pyelo-ureteral stenosis in pediatric patients is an observational, correlational, not Retrospective longitudinal experimental which he joined 40 observations interventions dismembered pyeloplasty with Anderson Hynes technique with double J stent and 60 cases in which no catheter was placed double-J For statistical analysis, z test was used chi2 test considering significant values of P <0.05. For the impact analysis must use the odds ratio (OR), number of patients needed to treat (NNT), absolute risk reduction (ARR). The study revealed that neither the number of reoperations and the number of complications had statistically significant differences between techniques (P> 0.05), although in both cases there was a trend to be lower in pyeloplasty with a catheter. There was a significant reduction in hospital stay with the first surgical procedure (P 0.02), also a sustained reduction in absolute risk of prolonged stay (RRA: 45,0% IC 95% 23,81-66,19) and excess ratio (OR: 0,14; IC95% 0.05-0,412)
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Pieloplastia, Técnica de Anderson-Hynes, Hidronefrosis, Estenosis pieloureteral, Pediatría, Estudios retrospectivos, Hospital de Niños Dr. Roberto Gilbert Elizalde, Cantón Guayaquil, Ecuador