腹腔镜下肾前筋膜间平面的临床解剖学研究

中国临床解剖学杂志 ›› 2013, Vol. 31 ›› Issue (3): 256-260.

腹腔镜下肾前筋膜间平面的临床解剖学研究

梅傲冰¹，　邱剑光²，　贾本忠¹，　顾昌世¹，　孙发¹黄永红¹，　程昊³，　余资江³，　张飘尘⁴，　沈桂权⁴

1.贵阳医学院附属医院泌尿外科, 贵阳 550004； 2.中山大学附属第三医院泌尿外科, 广州 510630；
3.贵阳医学院解剖教研室, 贵阳 550004； 4.贵阳医学院附属医院影像科, 贵阳 550004

收稿日期:2012-12-06 出版日期:2013-05-25 发布日期:2013-06-06
通讯作者: 贾本忠，主任医师、教授，硕士生导师， E-mail: gzjbz@　yahoo.com.cn E-mail:meiaobing@163.com
作者简介:梅傲冰(1975-)，男，河南驻马店人，医学硕士，主要从事泌尿系肿瘤及临床微创手术解剖学研究
基金资助:
贵州省科技厅基金资助项目(黔科合J字[2012]2053号);贵阳市社会发展与民生科技计划基金资助项目（筑科合[2012103]37号）

Applied anatomy of prerenal interfascial planes under the laparoscope

MEI Ao-bing¹, QIU Jian-guang², JIA Ben-zhong¹, GU Chang-shi¹, SUN Fa¹, HUANG Yong-hong¹, CHENG Hao³, YU Zi-jiang³, ZHANG Piao-chen⁴, SHEN Gui-quan⁴

1.Department of Urology Surgery，the Affiliated Hospital of Guiyang Medical College，Guiyang 550004； 2.Department of Urology Surgery，the Third Affiliated Hospital of Sun Yat-sen University，Guangdong Guangzhou 510630; 3. Department of Anatomy，Guiyang Medical College Guiyang 550004 ; 4.Department of Radiology, the Affiliated Hospital of Guiyang Medical College，Guiyang 550004

Received:2012-12-06 Online:2013-05-25 Published:2013-06-06

摘要/Abstract

摘要：

目的　探讨腹腔镜下肾前筋膜间平面的活体形态解剖分层，寻找安全正确的外科解剖层面。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。术中及术后对镜下肾前筋膜间层面解剖结构及毗邻关系分析辨别。结果　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。腹腔镜下可见层面间充满蜘蛛丝网格状白色纤维组织。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。沿这些平面可实施无血化解剖性腹膜后脏器微创手术。

关键词: , 腹腔镜, 肾旁前间隙, 肾前筋膜间平面, 肾前融合筋膜, 层面外科

Abstract:

Objective　To explore in vivo the anatomical stratifications of prerenal interfascial planes under the laparoscope in search of the optimal "holy plane" of surgery.　Methods　A total of 28 cases were involved in this study undergoing the following procedures using the abdominal cavity approach in 3 cases and retroperitoneal cavity approach in 25 cases: 11 cases of adrenal tumor resection, 8 cases of nephrectomy, 2 cases of partial nepherectomy, 2 cases of radical resection of renal carcinoma, 3 cases of pyeloureteroplasty and 2 cases of removement of the upper ureteral calculus. Each patient underwent 320-row CT imaging preoperatively to analyze the anatomy of renal fascia. Sectional anatomical structure and adjoining relationships of the anterior renal fascia under the laparoscope were observed and analyzed intra-operatively and post-operatively, respectively. Results Prerenal interfascial planes are multiple, comprising the plane between the colonal fusion fascia and the prerenal fusion fascia, the plane between the prerenal fusion fascia and the anterior lamella of renal fascia, the plane between the colonal fusion fascia and the prepancreaticduodenal fusion fascia , the plane between the prerenal fusion fascia and the postpancreaticduodenal fusion fascia, the plane between the perirenal fat and the anterior lamella of renal fascia. They are avascular multiplanar fasciae, among the spaces of which the cobweb-like latticed white fiber fill.　Conclusion　Prerenal interfascial plane is a secure plane for anterior surgical approach related to the kidney and the adrenal gland .Through these planes, minimally invasive surgeries with little blood loss of retroperitoneal organs can be performed.

Key words: Laparoscopic, Anterior pararenal space, Prerenal interfascial planes, Prerenal fusion fascia, Planes surgery

中图分类号:

R322.61

梅傲冰, 邱剑光, 贾本忠, 顾昌世, 孙发, 黄永红, 程昊, 余资江, 张飘尘, 沈桂权. 腹腔镜下肾前筋膜间平面的临床解剖学研究[J]. 中国临床解剖学杂志, 2013, 31(3): 256-260.

MEI Ao-Bing, QIU Jian-Guang, GU Ben-Zhong, GU Chang-Shi, SUN Fa, HUANG Yong-Gong, CHENG Hao, TU Zi-Jiang, ZHANG Piao-Chen, CHEN Gui-Quan. Applied anatomy of prerenal interfascial planes under the laparoscope[J]. Chinese Journal Of Clinical Anatomy, 2013, 31(3): 256-260.

参考文献

[1] Skandalakis JE, Colborn GL, Weidman TA, et al. Retroperitoneum
[M]// Skandalakis JE ed. Skandalakis' Surgical Anatomy:The Embryologic and Anatomic Basis of Modern Surgery. Athens, Greece: Paschalidis Medical Publications, 2004:553-577.

[2] Takahashi R, Furubayashi N, Nakamura M, et al. Surgical considerations of the renal fascia and the retroperitoneal space around the kidney
[J]. J Bodyw Mov Ther, 2012,16(3):392-396.

[3] Mirilas P, Skandalakis JE. Surgical anatomy of the retroperitoneal spaces--part I: embryogenesis and anatomy
[J]. Am Surg, 2009, 75(11):1091-1096.

[4] Dodds WJ, Darweesh RM, Lawson TL, et al. The retroperitoneal spaces revisited.
[J]. Am J Roentgenol,1986,147(6):1155-1161.

[5] Mirilas P, Skandalakis JE. Surgical anatomy of the retroperitoneal spaces Part II: the architecture of the retroperitoneal space
[J]. Am Surg, 2010, 76(1):33-42.

[6] 张旭, 傅斌, 郎斌, 等. 后腹腔镜解剖性肾上腺切除术
[J]. 中华泌尿外科杂志, 2007, 28(1):5-8.

[7] 张旭. 解剖性腹膜后腹腔镜肾上腺切除术的手术方法和技巧
[J].临床泌尿外科杂志，2007, 22(8)：561-563.

[8] Molmenti EP, Balfe DM, Kanterman RY, et al. Anatomy of the retroperitoneum: observations of the distribution of pathologic fluid collections
[J]. Radiology,1996, 200(1):95-103.

[9] Aizenstein RI, WilburAC, O’Neil HK. Interfascial and perinephric pathways in the spread of retroperitoneal disease: refined concepts based on CT observations
[J]. Am J Roentgenol, 1997, 168 (3) : 639 - 643.

[10]钟世镇，韩永坚，刘牧之.临床解剖学丛书：腹盆腔分册
[M ]. 北京：人民卫生出版社，1992: 411.

[11]邱剑光, 高新, 朱建国, 等. 肾周腹膜后隙腔镜下解剖特征及其临床应用
[J]. 中华泌尿外科杂志, 2005, 26(2):91-93.

[12]邱剑光, 高新, 湛海伦, 等. 后腹腔建立扩大与整理技术的临床解剖学研究
[J]. 中国临床解剖学杂志, 2005, 23(6):627-630.

[13]邱剑光, 陈锡慧, 袁晓旭, 等. 腹膜后间隙筋膜分层及筋膜间隙的临床解剖学研究
[J]. 中国临床解剖学杂志, 2009, 27(3):251-255.

[14] Congdon ED．The cone of renal fascia in the adult white male
[J]．Anat Rec，1941，80(4)：289-313．

[15] Raptopoulos V，Kleinman P，Marks S Jr，et a1．Renal fascial pathway：posterior extension of pancreatic effusions within the anterior pararenal space
[J]．Radiology，1986，158(2)：367-374.

[16] 董鹏，王滨，刘文娟，等.肾前筋膜间平面的CT研究及其临床意义
[J].实用放射学杂志, 2007, 23(10):1322-1324.

[17] 董鹏，李进，崔慧，等. 多排螺旋CT对肾后筋膜内侧附着的解剖学评估
[J]．中国组织工程研究与临床康复,2009，13(4)：793-796．

[18] 闵鹏秋. 急性胰腺炎病变及其扩散途径的CT表现
[J]．中国医学计算机成像杂志，2002, 8(4):238-242.

[19] 李晚君，崔东，艾立新，等. 急性胰腺炎累及肾筋膜间平面的螺旋CT表现及其解剖学基础
[J].中国CT和MRI杂志， 2011，9(2)：42-44.

[20] 漆锐,周翔平 ,陈卫霞，等.多层螺旋CT对成人活体肾筋膜向上附着的解剖研究
[J].四川大学学报（医学版）, 2012, 43(2):196-199.

[21] 梅傲冰，邱剑光，贾本忠，等.肾周筋膜及间隙解剖与腔镜外科研究进展
[J].中国临床解剖学杂志，2012, 30(6)：712-714.