肾周腹膜后隙腔镜下解剖特征及其临床应用

Study of laparoscopic anatomical features of retroperitoneal cavity around kidney and surgical access for laparoscopy

目的 研究腹腔镜下肾周腹膜后隙解剖学特点 ,为腹腔镜手术提供解剖学依据。 方法 行腹腔镜肾输尿管手术 2 4 1例 ,通过手术录像和照片分析术中所见解剖学结构及结构间相互关系。 结果 腹腔镜下可清晰观察到侧锥筋膜和融合筋膜。侧锥筋膜由腰方肌筋膜向前延伸而成 ,被覆于肾筋膜后叶浅面 ,在侧腹膜返折处向前延续为腹横筋膜 ;融合筋膜位于肾筋膜前叶前方 ,向外侧延伸并消失于侧腹膜反折前方的腹膜外组织中。肾筋膜前叶与融合筋膜之间、肾筋膜后叶与侧锥筋膜之间、腰方肌与腰大肌前方均为无血管平面。结肠外缘、腹膜和融合筋膜组成结肠外侧三角 ,融合筋膜、肾筋膜和侧锥筋膜形成一无血管三角区。 结论 通过无血管平面的解剖学入路 ,可以提高手术安全性 ,减少出血和副损伤。建立腹腔镜下整体解剖学概念 ,可为手术规范的建立提供解剖学依据。

Objective To study the anatomical feature s of the retroperitoneal cavity around kidney under laparoscope and to provide ana tomical guidance for laparoscopic surgery. Methods Lapar oscopic renal and ureteral operations were performed on 241 patients (145 men an d 96 women; age range,16-75 years;mean age,45.3 years).Through the videos and ph otographs of these operations,the anatomical features were analyzed.The atlas wa s drawn and surgical access was designed. Results Under laparoscope lateral conal fascia continues from the fascia of quadratus lumborum at its lateral border.This fascia covers posterior lamella of Gerota’s fascia and fuses into transversalis fascia beneath peritoneum. Fusion fascia lies befor e anterior lamella of Gerota’s fascia. It extends laterally and disappears grad ually to the lateral reflexion of peritoneum.The plane between fusion fascia and anterior lamella of Gerota's fascia, the plane between lateral conal fascia and posterior lamella of Gerota’s fascia, the plane before the quadratus lumborum and psoas major, are all vessel-free planes.Lateral border of colon,peritoneum and fusion fascia form a triangle lateral to colon.Fusion fascia,lateral conal f ascia and Gerota’s fascia form a vessel-free triangle. Conclusions Dissection through the vessel-free planes prevents laparoscopic op erations from bleeding and organ injury.Full understanding of the laparoscopic a natomical features of the retroperitoneal cavity around kidney provides the anat omic theoretical basis for laparoscopic operations.