上部尿路結石症の研究 : 第1報腎内腎盂切石術に関する検討

概要

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When renal calculi are too large to be easily removed through an incision in the renal pelvis or when the extrarenal part of the renal pelvis is very small, it has been customary to approach the stone through an incision in the renal parenchyma. Intrarenal pyelolithotomy was performed in 8 patients with renal calculi. The patients were placed on the usual lateral position with the loin angled over a cushion. The kidney was approached by the oblique lumbotomy incision parallel with the transverus abdominis muscle and about 1 cm below the 12th rib, from 5 cm lateral to the spinous processes in back downward and forward to the lateral border of the rectus muscle. The kidney was dissected free from the surrounding adipose tissue by sharp and blunt dissection. The posterior aspect of the renal pelvis was exposed. The renal parenchyma overlying the renal pelvis was gently pushed away with an elevatorium. The edge of the reflected renal parenchyma was grasped with small retractors. If aberrant vessels appear during the dissection of the fatty tissue on the posterior aspect of the extrarenal and intrarenal pelvis, they should be carefully clamped and ligated. Especially, removal of staghorn calculus necessitated dissection of all the renal parenchyma overlying the intrarenal pelvis.
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