摘要
目的:观察后腹腔镜下肾筋膜的应用解剖分型,为泌尿外科后腹腔镜手术的深入开展提供活体形态学基础。方法:2000年2月～2009年2月,对453例行后腹腔镜根治性肾切除术。术中采用自制气囊扩张腹膜后间隙,建立人工气腹后,常规清理腹膜外脂肪组织,观察肾筋膜外侧延伸和附着的后腹腔镜下解剖特点,并用照片和(或)视频的方式记录解剖学特征。421例镜下肾筋膜外侧延伸和附着方式的解剖资料记录完整。结果:肾筋膜外侧延伸和附着的镜下解剖形态分为三型,Ⅰ型:肾前、后筋膜在肾外侧融合成单一的侧锥筋膜;Ⅱ型:肾后筋膜的外侧份分为前、后两层,前层于肾外侧续于肾前筋膜,后层向外侧续为侧锥筋膜,肾前筋膜和侧锥筋膜亦相延续;Ⅲ型:肾前、后筋膜分别经肾前和肾后行向外侧,观察不到侧锥筋膜结构。421例手术观察肾后筋膜外侧延伸和附着方式的后腹腔镜下分型,其中Ⅰ型93例(22%),Ⅱ型最常见,273例(65%),Ⅲ型55例(13%)。本组结果与文献报道的小样本尸体研究结果存在差异。结论:肾后筋膜外侧延伸和附着方式的后腹腔镜下分型研究有利于正确定位肾旁前间隙(肾前筋膜和后腹膜之间的间隙)。根据不同的肾筋膜结构类型,选择合适的分离层面准确地解剖该间隙,可减少腹膜间位器官损伤,降低手术风险。
Objective：To observe the retroperitoneoscopic anatomical types of lateral extension and attachment of renal fascia, to provide the in vivo morphological anatomical data for further development of retroperitoneoscopic surgery. Methods： From February 2000 to February 2009, retroperitoneoscopic radical nephrectomy was performed in 453 patients. A home-made balloon was used for retroperitoneal space enlargement. After the pneumo peritoneum was established, pararenal adipose tissues were cleaned up conventionally. Then the retroperitoneoseopieal anatomical features of lateral extension and attachment of renal fascia were observed, and were recorded in terms of video or picture. Anatomical data were documented completely and analyzed retrospectively in all 421 cases. Results：A total of three types of lateral extension and attachment of renal fascia were identified in the present study. Type Ⅰ ： the anterior renal fascia and posterior renal fascia fused into a single lateroconal fascia in the later al aspect of the kidney. Type Ⅱ ： the posterior renal fascia could be separated into two layers, the inner layer conlinuous with the anterior renal fascia and the outer continuous with the lateroconal fascia, the anterior renal fascia also with the lateroconal fascia. TypeⅢ： the posterior renal fascia extended to the parietal peritoneum in the lat eral aspect of the kidney and lateroconal fascia could not be observed. Observing the retroperitoneoseopical types of lateral extension and attachment of renal fascia in 42t cases, type Ⅰ 93 cases （ 22%o）, type Ⅱ is the most fre quent, 273 cases （65%）, and typeⅢ 55 cases （13%）. These were different from formerly researchers＇ by means of small size cadaverie or operative study. Conclusions： Study on retroperitoneoscopic anatomical types of lateral extension and attachment of renal fascia is useful for correct location of anterior pararenal space between the parie tal peritoneum and the anterior renal fascia. Appropriate method should be chosen
出处
《临床泌尿外科杂志》
北大核心
2009年第5期330-334,共5页
Journal of Clinical Urology
基金
国家杰出青年科学基金(No:30725040)
关键词
肾筋膜
解剖
腹腔镜
renal fascia
anatomy
laparoscopic
