腎切石術における腎実質縫合法の研究

Abstract

The principle of treatment for staghorn calculi and the indication of nephrolithotomy have been described. In nephrolithotomy, operative technique, especially the method of parenchymal suture, has several variations but there is no convulsive method.In 1967, Dr. Taguchi originally designed a new method of parenchymal suture and he has performed it in more than 50 patients with good result. In his operation, closure of the renal parenchymal incision is made with one layer interrupted suture from pelvic mucosa to renal capsule by 2-0 plain cat gut. Hemostatic suture or ligation and the suture of pelvic mucosa are not necessary. Therefore, the operative technique is very simple and the clamp time of renal pedicle can be shortened.The ways of renal parenchymal suture in nephrolithotomy were classified into 6 groups. They were:1. The method without suture at alla) sutureless nephrotomyb) wrapping kidney in Oxycel gauze2. The method of capsular suturea) interrupted or continuous suture of renal capsule onlyb) subcapsular circular suture3. The method of interposition of muscle, fatty tissue or others4. Mattress suture and its variationsa) horizontal mattress sutureb) vertical mattress suturec) plate suture5. The method of parenchymal suture other than mattress suturea) U-shaped suture in margin of renal incisionb) interrupted suture of renal parenchyma6. Anatrophic nephrotomy (by Boyce, W. H. et al)One layer interrupted suture of renal wound originally designed by Dr. Taguchi belongs to the group 5-b, but it is considered the simplest and the most advanced technique.