側方垂直切開法 (筋無切断)

主として尿管切石術のための新しい手術手技

抄録

1. The skin incision is started just below the lower edge of the 11th rib and a little anterior to the tip of the 12th rib. It is then carried straightly downward until reaching to the iliac crest.
2. The underlying fascia is exposed enough to visualize the direction of the muscle fibers and is opened just between the latissimus dorsi and external oblique muscle.
3. Then Fascia transversalis will easily be exposed by reflecting the latissimus dorsi muscle backward and anterior oblique muscle forward.
4. Fascia transversalis is incised vertically and one enters the retroperitoneal space without difficulty. Care must be taken not to injure the 12th intercostal nerve and vessels.
5. Adipose capsule and Gerota's fascia are incised and opened.
6. Then the peritoneum is reflected foreward, the ureter will usually be carried with it and may be visualized with the aid of deep retraction.
7. The ureterolithotomy will be performed thru a small longitudinal incision in usual manner.
8. Before closing the ureteral incision, a ureteral catheter or small rubber catheter will be passed upwards and downwards to exclude any other ureteral obstructions. It is convenient to have a small catheter in the ureter upon suturing the ureteral incision.
9. This incision is most applicable to the ureterolithotomy at the level of L₂-L₅.
10. This incision is applicable not only to the ureterolithotomy, but also, as showed in the Table 2, to the nephropexy, nephrostomy, open kidney biopsy and nephrectomy, if there are no marked adhesions to surrounding tissues.