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Nueva técnica para la colocación de catéter doble J, a través de una incisión de uréter en laparoscopia experimental en un modelo inanimado

Nueva técnica para la colocación de catéter doble J, a través de una incisión de uréter en laparoscopia experimental en un modelo inanimado

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05/09/2013

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 _a Caz Qr`i ?==:52:*2.84=>#4;4
4=>
 K_WÃDQI@ @_NFNLKI
 
_ATQCAL
 Klwadagalwat8
Ik d`i`dkdnôl ga dkwîwar g`oia ’H– ãkik}kr`tdô}ndk at radqalwa, Ik wîdlndk cët d`cøl {qata qwninxk at ra}`tndn`lklg` ki }kdnalwa ~ d`i`dkri` ãkrawrôfrkgk, Ta }ratalwk qlk wîdlndk kiwarlkwnk tnl la#datngkg ga ra}`tndn`lkr ki }kdnalwa,
Ckwarnki ~ cîw`g`t8
Ta k}indk dkwîwar g`oia ’H– }`r nl#dntnôl cagnki al c`gai` qrawarki) al ql gnt}`tnwn` gnta#ûkg` {qa d`ltntwa al }nlxk ~ g`t dkoiat fqãkt, Ta d`i`dkal alg`wrknlar) akiqklg` wnac}` ~ kdningkg }krk ra}r`#gqdnr ik wîdlndk }`r dnld` qrôi`f`t,
_atqiwkg`t8
Ik cagnk ~ gatnkdnôl atwëlgkr ga w`g`ti`t gkw`t qa ga 46)2>2 ~ ?4);22 rat}adwnkcalwa, Wnac#}` cãlnc` ;,71 ~ cëznc` ;7,76 cnlqw`t, L` ta aldqal#wrkl gnaraldnkt alwra ikt cagnkt ga i`t dnld` qrôi`f`t}krwndn}klwat d`l gnaralwat lnaiat ga alwralkcnalw`al ik}kr`td`}nk,
Gntdqtnôl8
Wrkgndn`lkicalwa ik d`i`dkdnôl ga dkwîwarg`oia ’H–) al dnrqfãk ik}kr`tdô}ndk }`r nldntnôl qrawarki atql }r`dagncnalw` gnãdni, Ta }raara ai ra}`tndn`lkcnalw`gai }kdnalwa }krk d`i`dkdnôl rawrôfrkgk) kfrafklg` c`r#oningkg) nltqc`t ~ wnac}` {qnrørfnd`, Ik lqak wîdlndk}arcnwa ik d`i`dkdnôl ëdni) ~ al ql qwqr` anwkrë ai ra}`#tndn`lkcnalw` gai }kdnalwa al dnrqfãk ik}kr`tdô}ndk,
 
 KOTW_KDW
 Okdefr`qlg8
 G`qoia#H dkwjawar }ikdacalw nk ik}kr`td`}~ nt ra{qalwi~ dkrrnag `qw, Wja c`tw d`cc`lwadjln{qa nt ra}`tnwn`lnlf wja }kwnalw `r rawr`frkga }ikdacalw, Kl kiwarlkwna cawj`g nt }ratalwag nl vjndjwjara nt l` laag w` ra}`tnwn`l wja }kwnalw,
 Ckwarnkit klg cawj`gt8
 Nl k qrawarki c`gai)
 
k g`qoia#H dkwjawar vkt }ikdag o~ caklt ` cagnki nldntn`l nlw` k t}adnkii~ gatnflag ganda d`ltntwnlf ` wvaaxart klg wv` fqngavnrat, Wja ganda nt tnwqkwag nltnga kl alg`#wrknlar, Bna qr`i`fntwt) akdj vnwj gnaralw ik}kr`td`}~ wrknlnl iaait) vara akiqkwag nl raikwn`l w` wja akta vnwj vjndjwja~ }ar`rcag wja wadjln{qa klg wja kc`qlw ` wncaac}i`~ag,
 _atqiwt8
Caklt klg twklgkrg gankwn`l ` kii gkwk vara 4,62>2 klg ?,4;22) rat}adwnai~, Cnlncqc wnca vkt;,71 cnlqwat klg ckzncqc wnca vkt ;7,76 cnlqwat, L`gnaraldat vara `qlg kc`lf cakl kiqat rafntwarag `r wja 1 }krwndn}kwnlf qr`i`fntwt,
 Gntdqttn`l8
G`qoia#H dkwjawar }ikdacalw wjr`qfj qrawarki  nldntn`l nl ik}kr`td`}~ nt wrkgnwn`lkii~ k gnbdqiw }r`dagqra nl vjndj wja }kwnalw nt `wal ra}`tnwn`lag `r rawr`frkga }ikdacalw aal wj`qfj wjnt nldraktat c`rongnw~) kc`qlw ` ckwarnkit qtag klg ialfwj ` wnca nl tqrfar~, Akt~  }ikdacalw nt }`ttnoia vnwj wja lav wadjln{qa klg nl wja qwqra ra}`tnwn`lnlf ` wja }kwnalw nl ik}kr`td`}nd tqrfar~ vnii oa k`ngag,
D`ldiqtn`lt8
Vnwj wjnt lav wadjln{qa) wrknlag qr`i`fntwtdkl tkai~ klg aktni~ }ikda k g`qoia#H dkwjawar) c`tw  }r`okoi~ ragqdnlf o`wj c`rongnw~ klg ialfwj ` wnca nl tqrfar~,
; J`t}nwki _afn`lki ’Rkialwãl Fôcax Bkrãkt– NTTTWA) Fqkgkikhkrk)Hkintd`, Cîznd`, ? Lqa` J`t}nwki Dnni ga Fqkgkikhkrk,T`indnwqg ga t`orawnr`t8 Gr, @ckr Rkigat Ikrat, Lkdn`lat Qlngkt L`,1?6: Nlwarn`r ;? D,], 71;;=) Xk}`}kl) Hkintd`, Waiîb`l`t 444 ;6= 2=6? ~ 2? ;1 6> >6=, D`rra` aiadwrôlnd`8 `ckrkigatMj`wckni,d`c
Lqak wîdlndk }krk ik d`i`dkdnôlga dkwîwar g`oia ’H–) k wrkît ga qlknldntnôl ga qrîwar al ik}kr`td`}nkaz}arncalwki al ql c`gai` nlklnckg`
 Rkigît#Ikrat @
;
) Tëldjax#Cahãk ]
?
) Drqx#Lqrndqco` A
?
) Dkrkhki#Fkrdãk _
?
 
4;=
 _a Caz Qr`i ?==:52:*2.84=>#4;4
 Rkigît#Ikrat @
aw ki,
Lqak wîdlndk }krk ik d`i`dkdnôl ga dkwîwar g`oia ’H–) k wrkît ga qlk nldntnôlga qrîwar al ik}kr`td`}nk az}arncalwki al ql c`gai` nlklnckg`
 
 KLWADAGALWAT
I`t dkwîwarat qrawarkiat g`oia ’H– *DQGH. t`l qlk ja#rrkcnalwk cq~ øwni) frkdnkt k ik d`i`dkdnôl ga îtw`tta }arcnwa anwkr atwal`tnt qrawarkiat) }r`c`ar ikdndkwrnxkdnôl qrawarki) kinnkr }r`dat`t `otwrqdwn`tqrnlkrn`t a nldiqt` gralkr d`iaddn`lat wkiat d`c`qrnl`ckt,
;)?
Gatga) ;>62 Ckrgnt nlwr`gqh` ql dkwîwarrkgn`}kd` d`l cac`rnk {qa gk ai kldikha }krk anwkrtq cnfrkdnôl jkdnk kokh`,
4
Jktwk ik adjk ta jkl ga#tkrr`iikg` krn`t c`gai`t ga dkwîwarat qrawarkiat aldqatwnôl ga dkingkg ~ ckwarnkiat)
7
tnl acokrf` ta jklcklwalng` wrkgndn`lkicalwa tôi` g`t wîdlndkt }krk ikd`i`dkdnôl ga dkwîwar tnalg` }`r ãk klwarôfrkgk ` ra#wrôfrkgk,_adnalwacalwa) ta gatdrnonô qlk wîdlndk l`a#g`tk }`r Cqlaar Ejkl ~ d`it,) }krk ai dkwawarntc`gqrklwa ik}kr`td`}nk rawr`}arnw`laki al qrawar`in#w`w`cãk ~ ta gac`twrô tar ëdnicalwa ra}r`gqdnoia ~ rë}ngk, Atwk wîdlndk gatdrnoa ik qwninxkdnôl ga qldkoia fqãk `rgnlkrn` nlwr`gqdng` }`r j`~`t ikwarkiatgai DQGH) c`gndkg` d`l }qlwkt dnafkt) }krk krckrazwarlkcalwa a nlwr`gqdnr al wr`dkr ga 1 }qifkgkt)}ktklg` ik }qlwk nlarn`r }`r ik iqx qrawarki ki cntc`wnac}` {qa }ktk }`r ik }qlwk }r`zncki jkdnk tntwackd`iadw`r tq}arn`r, Bnlkicalwa) qlk ax }`tndn`lkg`ai dkwîwar ta azwrka ai dkoia fqãk gahklg` i` intw` }krktqwqrkr qrîwar,
1
Ik d`i`dkdnôl ga dkwîwar g`oia ’H– al dnrqfãk ik}k#r`tdô}ndk jk gac`twrkg` walar dikrkt alwkhkt) Fkqr ~ d`it,) gac`twrkr`l {qa al qrawar`inw`w`cãk ik}kr`tdô#}ndk ai wnac}` ga qfk ga `rnlk tnl dkwîwar ark ga 1,1gãkt ~ d`l d`i`dkdnôl ga DQGH ark ga 4,? gãkt,
2
Ta tkoa {qa ik d`i`dkdnôl wrkgndn`lki ga dkwîwar g`#oia ’H– }`r nldntnôl qrawarki) k wrkît ga ãk ik}kr`tdô#}ndk at ql }r`dagncnalw` gnãdni) gaong` k atw` cqdj`taz}arw`t al ik}kr`td`}nk jkl `}wkg` }`r rad`i`dkr ki}kdnalwa al inw`w`cãk ~ d`i`dkr ai dkwîwar }`r ãk ra#wrôfrkgk) tnl acokrf`) atw` }qaga tnflndkr kfrafkrc`roningkg) nltqc`t ~ wnac}` {qnrørfnd`,
 
@OHAWNR@
Gawarcnlkr tn ik lqak wîdlndk at aadwnk }krk d`i`dkrql dkwîwar g`oia ’H– k wrkît ga qlk nldntnôl ga ql c`#gai` nlklnckg` ga qrîwar al ql
alg`#wrknlar 
}krk dnrqfãkik}kr`tdô}ndk,
 
CKWA_NKI ^ CÎW@G@T
Ta ahadqwk atwqgn` az}arncalwki, Qwninxklg` ql c`ga#i` nlklnckg` ga qrîwar ~ ql alg`wrknlar }krk dnrqfãkik}kr`tdô}ndk, ]krwndn}kr`l dnld` cîgnd`t d`l gntwnl#w`t lnaiat ga alwralkcnalw` al qr`i`fãk *gn}i`ckg`)nltwrqdw`r)
 aii`vtjn}
) }rkdwndklwa ~ kqw`alwralkcnal#w` al ik}kr`td`}nk., Dkgk ql` ga i`t }krwndn}klwat rak#inxô ik lqak wîdlndk al ;= `dktn`lat wrkt qlk oraanlwr`gqddnôl gai }r`dagncnalw`, Ta cngnô dqrk gak}ralgnxkha) wnac}`t ga }r`dagncnalw` ~ wnac}` nlgn#ngqki atwëlgkr lki,Ta rakinxk d`i`dkdnôl ga DQGH al
alg`#wranlar 
) qwn#inxklg` ai c`gai` nlklnckg` {qa d`ltwk ga dqkwr`côgqi`t8 ;, C`gai` qrîwar al iëwaz gntaûkg` }krk atwa at#wqgn`8 }`r cagn` ga iëwaz d`l nc}ratnôl gaqrîwar ga 4= dc ga ikrf`) iqx qrawarki ga 1r ~ fr`t`r ga }krag ga ; cc, Ki qrîwar }rank#calwa) al tq }krwa cagnk) ta rakinxk nldntnôl}`r ik dqki ta d`i`dkrë DQGH, ]`r tq d`c}`#tndnôl gk qlk wazwqrk oiklgk ~ gaindkgk) kinl~adwkr ;dd ga fai iqorndklwa gk atdalkrn`lkwqrki *
`w`;
.,?, Côgqi` ga fqãkt d`lgqdw`rkt8 g`t dkoiat fqãkt)d`l qlk }qlwk baznoia }krk d`lgqdnrta }`r iqxqrawarki d`l tafqrngkg, Fqãk ;5 at fqãk ga wn}`Oalwx`l ga =,4:r ~ fqãk ?5 at fqãk talt`r ga=,4: r *
`w` ?
.,4, Côgqi` }krk d`rwa8 *
`w` 4
. }nlxk ga d`rwa ca#gn` `ki t`ora DQGH) atwa gnt}`tnwn` ga d`rwa)
 Ea~ v`rgt8
Ik}kr`td`}~) g`qoia#H dkwjawar) lav wadjln{qa,
D`ldiqtn`lat8
Ik lqak wîdlndk ga d`i`dkdnôl }ar#cnwa k qrôi`f`t d`l alwralkcnalw` al ik}kr`td`}nkd`i`dkr ai dkwîwar g`oia ’H– al `rck ëdni ~ tafqrk,Kgacët) }r`okoiacalwa) gntcnlqnrë c`roningkg ~ wnac}`t `}arkw`rn`t,
]kikorkt dika8
ik}kr`td`}nk) dkwîwar g`oia ’H–) lqakwîdlndk,
 
 _a Caz Qr`i ?==:52:*2.84=>#4;4
 Rkigît#Ikrat @
aw ki,
Lqak wîdlndk }krk ik d`i`dkdnôl ga dkwîwar g`oia ’H–) k wrkît ga qlk nldntnôlga qrîwar al ik}kr`td`}nk az}arncalwki al ql c`gai` nlklnckg`
4;;
gntaûkg` }krk atwa }r`~adw`) wnala ik dk}kdngkgga d`rwkr ai DQGH) tnl gatwqokri`, Ik }nlxk wnalaqlk nc}ratnôl al ik dkrk nlarn`r {qa tqhawk kidkwîwar cnalwrkt qlk dkrk tq}arn`r d`l `rckga dqûk) okhk jkdnalg` ql d`rwa ga 1 cc gakldj`) ~ }r`qlgngkg ga ; cc,7, Côgqi` ga d`rwa ga fqãk Oalwx`l ~ korkxk#cnalw` }krk wrkddnôl8 al ik }krwa }`twarn`rga ik }nlxk ga d`rwa) azntwa ql ërak ga d`rwa ~ k}iktwkcnalw` gai klnii` tqhawkg`r {qa dqalwkd`l qlk nc}ratnôl g`lga ta d`i`dk ql klnii`ga cawki ckiakoia atwarninxkoia) {qa k tq axatwë h` k `wr` klnii` ckiakoia }`r ql jni` gal~i`l) ai dqki }arcnwa wrkddn`lkr rcacalwa ikfqãk d`rwkgk, Qlk ax {qa ta gadnga ai ikrf`{qa gaoa iiakr ik fqãk løcar` ?) ta nlwr`gqdaki ërak ga d`rwa d`l ql klnii` ckiakoia jktwk ailnai g`lga tarë ladatkrn`) }ratn`lklg` rca#calwa ik }nlxk }krk d`ltafqnr lkicalwa qlkfqãk d`rwk d`l ai klnii` tqhaw` rcacalwa ~ l`rac`noia ki jni` ga l~i`l }krk tq wrkddnôl ta#fqrk,Qlk ax i`dkinxkg` ai qrîwar al c`lnw`r) ta rad`l`danldntnôl al }krwa cagnk ga îtwa) ta cnga ai lnai gadkwîwar {qa {qnara alnkrta jkdnk ikg` tq}arn`r a nla#rn`r, Ta d`i`dk ai dkwîwar t`ora ik nc}ratnôl ga ik }nlxkga d`rwa) }krk }ratn`lkr rcacalwa ~ d`ltafqnr ql d`r#wa ga cagn` `ki {qa l` gatwqoa, Ta ckrdk ai wkckû`ga fqãk løcar` ? d`i`dklg` ai klnii` ga kdar` ckiakoiajktwk ai lnai gatakg`) }ratn`lklg` rcacalwa d`l ik}krwa }`twarn`r ga ik cntck }nlxk gai gnt}`tnwn` }krkd`ltafqnr d`rwa *
`w` 7
., Ta tqhawk ki cntc` wnac}` gaiazwrac` }r`zncki ga ik fqãk d`l atwa klnii` ckiakoia{qa atwë qlng` k ik `wrk fqãk k wrkît ga kco`t klnii`tcawëind`t, Ta nlwr`gqda }`r ai cntc` kfqhar` kcoktfqãkt alnklg` fqãk ? jkdnk tafcalw` d`rw` gai dkwîwar
B`w` ;,
Cgai ga qîwa a iëwaz,
B`w` ?,
Doiat fqã d niit ciaoiat a jni,
B`w` 7,
Gnt}tnwn ~ dwîwa cg intw } tq nfat } wôd,
B`w` 4,
]nx goia qdnô dw dwîwa ~ doiat fqã,
B`w` 1,
_awng fqã d ai gnt}tnwn tôi d wddnô gai jni,

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