腹腔镜下肾前筋膜间平面的临床解剖学研究

Applied anatomy of prerenal interfascial planes under the laparoscope

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。

Objective To explore in vivo the anatomical stratifications ofprerenal 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.