腹腔镜下腹膜后筋膜间隙外科平面的解剖观察

目的 探讨在腹腔镜下升、降结肠或肾切除术相关的腹膜后筋膜和筋膜间隙的解剖学特点及毗邻关系,以便正确地寻找、识别和选择安全的筋膜间隙外科平面. 方法在腹腔镜下对5具成人新鲜腹部标本,30例腹腔镜下升、降结肠切除术和95例肾切除术中的腹膜后筋膜和筋膜间隙的位置、沟通和毗邻关系进行了观察.结果升、降结肠外侧缘的脏腹膜与壁腹膜之间有一条黄白交界线,沿此线切开腹膜、腹膜外组织,即可显露深面的融合筋膜.融合筋膜与肾前筋膜之间的潜在间隙为融合筋膜间隙.切开融合筋膜,沿此间隙向内分离,可将升结肠或降结肠及原始结肠系膜向内翻起,完成结肠游离;或显露后方的肾前筋膜.肾前筋膜、融合筋膜外侧部与侧锥筋膜之间的间隙为肾旁前筋膜间隙;肾后筋膜、侧锥筋膜与腰方肌筋膜之间的间隙为肾旁后筋膜间隙.肾旁前筋膜间隙与融合筋膜间隙和肾旁后筋膜间隙沟通,通过这些间隙分离,可将肾安全游离. 结论 黄白交界线为进入融合筋膜间隙的标志,融合筋膜间隙及肾旁前、后筋膜间隙内无重要血管,易于辨认和分离,为腹腔镜下升、降结肠或肾游离的理想外科平面.

Anatomical research on surgical plane of retroperitoneal fascia space using laparoscopy

Objective To explore the topography and anatomical nature of the retroperitoneal fascia and fascial space in laparoscopic left colectomy，right colectomy，or nephrectomy and to set up methodologies to identify surgical planes. Methods Five unembalmed adult cadavers were observed laparoscopically. In addition, totally 30 patients undergoing laparoscopic left or right colectomy，as well as 95 patients undergoing laparoscopic nephrectomy were observed on the fusion fascia and fusion fascial space with reference to location，distribution and topography. Results Between the visceral and parietal peritoneum, lateral to the ascending or the descending colon，there was a yellow white borderline，along which cutting into the peritoneum and extraperitoneal tissue unveiled the fusion fascia. The fusion fascia and prerenal fascia enclosed a fusion fascia space full of loose connective tissue. Dissection along the fusion fascial space easily mobilized the ascending and descending colon and their primitive mesocolon， and also unveiled the prerenal fascia posteriorly. The anterior pararenal spaces were delineated by the prerenal fascia，the lateroconal fascia and the lateral extension of the fusion fascia，and the posterior pararenal space by the posterior layer of renal faascia，the lateroconal fascia and the lumbar quadrate muscular fascia. Mobilization of the kidney was also achieved by dissecting into the anterior and the posterior pararenal spaces to the renal hilum. Conclusion The yellow white borderlines can be regarded as landmarks to access the