腹腔镜下左半结肠切除术相关筋膜平面的解剖观察

Anatomical observations on left colectomy related fascia planes in laparoscopies

目的:探讨左半结肠切除术相关筋膜的解剖学特点和外科平面的鉴别方法。临床资料和方法:2003～2004年南方医院普通外科施行的腹腔镜左半结肠切除术15例,病例均为左半结肠癌。对腹腔镜下左半结肠后外侧、中线侧和直肠后外侧相关筋膜的解剖特点和镜下定位标志进行观察和描述。结果:在乙状结肠第一曲外侧缘肠壁与左侧腰大肌筋膜之间存在一个固定的粘连带,它是左侧Toldt’s线的尾侧端点。左半结肠系膜后外侧存在肾前筋膜;中线侧存在主动脉前筋膜;直肠系膜后外侧存在盆筋膜壁层。这三个部位的筋膜相互延续。结论:乙状结肠和左侧腰大肌筋膜之间的粘连带是左半结肠切除术外侧分离的起点。肾前筋膜是衬贴于左半结肠和直肠系膜后面的一层连续筋膜,在不同的解剖位置有不同的表现形式。左半结肠切除术的外科平面统一于结直肠系膜与连续的肾前筋膜之间。

Objective： To explore the anatomical nature of the left colectomy related fascias and the access to identify the surgical planes. Clinical data and Methods： Laparoscopic left colectomies carried out in the Department of General Surgery, Nanfang Hospital from 2003 to 2004, on 15 left colonic cancer patients were observed and analyzed on the anatomical natures of fascias posterolateral, middle to the left colon, posterolateral to the rectum, as well as the laparoscopic location markers. Results： The ever observed adhering band between the lateral wall of the 1st bend of the sigmoid colon and the fascia of the left psoas major was the caudal end of the left Toldt＇s line. There were prerenal fascia posterolateral to the left mesocolon, preaortic fascia median to the left mesocolon, parietal layer of the pelvic fascia posterolateral to the mesorectum, which continued at different sites. Conclusion： Adhering band between the sigmoid colon and the left gluteus maximus is the outset in the lateral dissection in the left coloectomy. The prerenal fascia displaying different appearances at different anatomical sites is a continuous fascial layer that covers the left mesocolon and mesorectum posterolaterally. The surgical planes in the left colectomy are between the colorectal mesenteries and the continuous prerenal fascia.