上部尿路手術における背面垂直切開法(Gil-Vernet法)による神経麻痺について

Abstract

The most prevailed oblique lumbotomy has some disadvantages, such as pain, postoperative wound hernia and adhesion. In order to avoid these demerits, posterior vertical lumbotomy has been used for removing renal and ureteral calculi. According to Gil-Vernet, it was said that there were no paresthesia and paralysis of oblique muscles because no nerve was generally sectioned. Among 115 patients that were operated on by posterior vertical lumbotomy for 10 years from 1966 to 1976, 33 had hypesthesia and paresthesia on iliacal, inguinal and scrotal regions and 6 had paralysis of the lower abdominal muscles. These complications were caused by damage to iliohypogastric and ilioinguinal nerves. In 26 of 33 patients (79%) hypesthesia and paresthesia disappeared within 6 months, while in 7 of 33 patients (21 %) these continued over 6 months, sometimes a year or more, accompanied with paralysis of the lower abdominal muscles. We should take much care of these two nerves on this excellent incision.