穿刺の基礎と選択的腎生検

Abstract

An experimental study of puncture technology for the kidney: We investigated the strength characteristics of tissues which are penetrated by the puncture needle for the kidney using a tension test. The tensile strength of the fascia, the muscle, the renal capsule, the renal parenchyma and the renal pelvis were 13.9, 1.1, 29.5, 0.5 and 21.4 kg/cm2, respectively. As the strengths differ, the needles for each tissue clearly need to be changed. Needle tip shape and needle material for kidney puncture were investigated by compression test, acryl resin injection into the renal vasculature, stereo-microscopy and scanning electron microscopy. These investigations revealed that the most suitable needle tip was a sharp cone shape, and material with a smooth surface and some flexibility such as Derlin seemed to be the most appropriate for the puncture needle for the kidney. Using the acryl resin injection method, stereo-microscopy and scanning electron microscopy, we studied the relative safety of single stage puncture and the repeated dilatation method to establish percutaneous nephrostomy. Single stage puncture seems to cause less damage to the kidney than the repeated dilatation method. Selective renal biopsy: A new puncture system using real-time ultrasound was developed at our clinic in 1978. The puncture procedure is monitored in 2 dimensional real-time images by a mechanical sector scanner equipped with an attachment for needle guidance. The application of the system to percutaneous renal biopsy is called "selective renal biopsy" because the specimen can be obtained selectively from any portion of the kidney.(ABSTRACT TRUNCATED AT 250 WORDS)