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肾前筋膜间平面无血化腹腔镜手术层面的解剖学研究
Anatomic research on retromesenteric planes of bloodless and the anatomical laparoscopic surgery
【摘要】 目的探讨腹腔镜下肾前筋膜间平面的活体形态解剖和毗邻关系,总结和阐述肾前筋膜间平面相关的解剖分层,以便为腹腔镜下上尿路手术中寻找安全正确的外科解剖层面,进行无血化解剖性手术操作提供筋膜解剖学依据。方法经腹腔入路3例,经腹膜后腔入路25例,其中肾上腺肿瘤切除术11例、肾切除术8例、肾癌根治术2例、肾部分切除术2例、肾盂输尿管成形术3例、输尿管上段结石2例。术前进行320排CT影像解剖分析肾筋膜结构。术中对镜下肾前筋膜间层面解剖结构及毗邻关系认真分析、仔细辨别。术后反复观看视频,反复讨论,并将研究理论应用于手术实践中。绘制解剖图片、展示肾前筋膜间平面解剖、设计新的手术入路。结果肾前筋膜间平面在胚胎学上也称为系膜后平面,肾前筋膜间平面包括结肠融合筋膜肾前融合筋膜间平面、肾前融合筋膜肾筋膜前叶间平面、肾筋膜前叶肾脂肪囊外平面,是多层次的无血管筋膜结构。在手术中选择经肾旁前间隙解剖大层面入路,循筋膜间隙及肾前筋膜间平面进入正确的解剖层面精细操作,保持镜下术野清晰,进行无血化解剖性手术处理,便捷、精准到达目标器官。在腹腔镜下肾前筋腹间平面内可观察到充满蜘蛛丝网格状白色纤维组织,直视下操作能得到一个更大的手术工作间隙和无血管游离平面。结论肾前筋膜间平面是肾脏和肾上腺外科手术时前入路的安全层面。循肾前筋膜间平面直视下辨别肾前筋膜及毗邻脏器,为无血化解剖性腹膜后脏器微创手术带来新的视野和理念,
【Abstract】 Objective To explore the anatomical and adjacent relationship of the prerenalinter-fascia plane in laparoscopic, in order to provide fascial anatomic evidence for a holy plane and acorrect anatomy level access for laparoscopic upper urinary tract anatomy and bloodless operation bylaparoscopic. Methods 28 patients, 3 accepted operation by intraperitoneal access and 25 byretroperitoneal access were analysed, in which adrenalectomy were 11 cases, nephrectomy were 8 cases,ureteropelvic angioplasty were 3 cases, radical nephrectomy were 2 cases, partial nephrectomy were 2 cases,upper ureteral calculi were 2 cases. Previous to the operation, examine each patient by 320 -slice spiral CTto analyze the anatomy of renal fascia structure. After rigorous analysis of the anterior renal fascia planeintraoperatively, careful observation of the video after operation, and repeated discussions, we designed thenew surgical approach. Results Planes of prerenal inter-fascia are also called retromesenteric planes inembryology, including plane between colonal fusion fascia and prerenal fusion fascia; plane betweenprerenal fusion fascia and anterior lamella of renal fascia; plane between colonal fusion fascia andprepancreaticduodenal fusion fascia; plane between prerenal fusion fascia and postpancreaticduodenal fusionfascia; plane between perirenal fat and anterior lamella of renal fascia. The planes can be seen as tissues ofspider silk screen trellis, between the neighboring fascias form some no vascular structure. Through theseplanes, surgeons can easily achieve a clean surgical field and a bloodless anatomy in laparoscopic surgeryto reach the target organ more conveniently and accurately. Conclusion Retromesenteric plane is asecurity plane for kidney and adrenal gland surgery. Through these planes, renal and adjacent organs canbe discrimination directly. Dissection through this planes also easy to perform, and can achieve bloodlessanatomy. It brings a new horizon and concept for renal minimally invasive surgery.
【Key words】 Laparoscopic; Anterior pararenal space; Retromesenteric planes; Prerenal fusion fascia; Anatomy; bloodless; Planes surgery;
- 【文献出处】 中华腔镜泌尿外科杂志(电子版) ,Chinese Journal of Endourology(Electronic Edition) , 编辑部邮箱 ,2013年02期
- 【分类号】R699
- 【被引频次】24
- 【下载频次】486