目的 研究正常左侧肾旁后间隙（left posterior pararenal space，LPPrS）的CT表现。 方法 对1具尸体标本行左侧肾旁前间隙乳胶灌注制作断面标本，观察双侧肾旁后间隙的解剖学特点并记录灌注剂在LPPrS的弥散情况；分析50例正常成人腹部CT资料，观察LPPrS的形态及脂肪厚度、LPPrS血管显示情况及其与左侧肾后筋膜的关系；测量左侧肾静脉水平LPPrS脂肪厚度的最大值以及第2腰椎体水平腹壁皮下脂肪面积，并分析二者的相关性。 结果 （1）标本轴位断层灌注剂进入左侧肾后筋膜间平面后沿LPPrS的纤维分隔蔓延。肾旁后间隙呈弯月状，见多条血管。（2）轴位CT图像上LPPrS可见多条血管影，主要位于左肾外侧、后方；血管可穿过肾后筋膜。LPPrS可见纤细的分隔，显示欠清。LPPrS的形态呈弯月状；左侧肾静脉水平，LPPrS脂肪最厚处位于左肾外侧、后方，平均厚度为0.77 cm。第2腰椎体水平皮下脂肪面积平均为112.37 cm2，二者具有正相关性（r=0.283，P<0.05）。 结论 LPPrS具有特殊的解剖学特点。关注LPPrS的CT表现有助于LPPrS病变及其邻近脏器病变的影像学诊断和治疗。
Abstract
Objective To study the computed tomography (CT) manifestations of normal left posterior pararenal space (LPPrS). Methods (1) One cadaver was perfused with latex into the left anterior pararenal space. The anatomical characteristics of the bilateral posterior pararenal space was observed and the diffusion of perfusion agent in the LPPrS was recorded. (2) The abdominal CT data of 50 normal adult were analyzed to observe the morphology and fat thickness of LPPrS, the vascular display of LPPrS and its relationship with the left posterior renal fascia. The maximal fat thickness of LPPrS at the level of left renal vein and the subcutaneous fat area at the level of the second lumbar vertebra were measured, and their correlation was analyzed. Results (1) After entering into the interfacial planes of the left posterior renal fascia, the axial tomography perfusion agent spread along the fiber separation of LPPrS. The posterior pararenal space was menisus in shape with multiple vessels. (2) On the axial CT images, multiple vascular shadows were detected in the LPPrS and mainly located in the lateral and posterior left kidney. The blood vessels passed through the left posterior renal fascia. CT images showed slender separation in the LPPrS. The average maximal fat thickness at the left renal vein level and the subcutaneous fat area at the second lumbar vertebra level were 0.77 cm and 112.37 cm2. The relationship of them was positive (r=0.283, P<0.05). Conclusions The LPPrS has its own anatomical features. Paying attention to the CT manifestation of the LPPrS is helpful to the imaging diagnosis and treatment of LPPrS lesions and adjacent organs.
关键词
肾旁后间隙 /
/
/
解剖 /
/
/
X线计算机 /
/
/
体层摄影术
Key words
Posterior pararenal space /
/
/
/
Anatomy /
/
/
/
X-ray computed /
/
/
/
Tomography
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
[1] Dodds WJ, Darweesh RM, Lawson TL, et al. The retroperitoneal spaces revisited[J]. AJR Am J Roentgenol, 1986, 147(6): 1155-1161. DOI: 10.2214/ajr.147.6.1155.
[2] 董鹏, 王滨, 葛艳明, 等. 腰肌病变累及肾旁后间隙的CT表现[J]. 中国医学影像技术, 2007, 23(8): 1218-1220. DOI: 10.3321/j.issn:1003-3289.2007.08.033.
[3] Pallares CD, Griener T, Vaughan S. Ureaplasma urealyticum disseminated multifocal abscesses in an immunocompromised adult patient: a case report[J]. BMC Infect Dis, 2020, 20(1): 47-50. DOI: 10.1186/s12879-020-4771-z.
[4] Peng XQ, Li ZW, Zhou L, et al. Giant posterior pararenal schwannoma: A case report and review of literature[J]. Mol Clin Oncol, 2018, 9(3): 325-328. DOI: 10.3892/mco.2018.1664.
[5] 钱庆鹏, 于广海. 肾旁后间隙的形态研究及其对后腹腔镜手术的意义[J]. 现代中西医结合杂志, 2010, 19(17): 2086-2087, 2090. DOI: 10.3969/j.issn.1008-8849.2010.17.003.
[6] 苏容万, 张家伟, 孙东翀, 等. 后腹膜返折韧带在后腹腔镜根治性肾切除术中的应用价值[J]. 中华腔镜泌尿外科杂志(电子版), 2019, 13(6): 397-399, 409. DOI: 10.3877/cma.j.issn.1674-3253.2019.06.009.
[7] 涂颖珊, 王倩倩, 王雅琴, 等. 肾后筋膜解剖分层的CT研究[J]. 实用放射学杂志, 2017, 33(5): 720-721, 749. DOI: 10.3969/j.issn.1002-1671.2017.05.018.
[8] Al-Dasuqi K, Irshaid L, Mathur M. Radiologic-pathologic correlation of primary retroperitoneal neoplasms[J]. Radiographics, 2020, 40(6): 1631-1657. DOI: 10.1148/rg.2020200015.
[9] 崔慧, 辛顺宝, 刘凤杰, 等. 横结肠系膜腹膜下间隙与肾旁前间隙通连关系的解剖学研究[J]. 中国临床解剖学杂志, 2010, 28(5): 504-506.
[10] 陈洪群, 陈游洲, 郑梅, 等. 定量计算机断层摄影术测定中国人群多中心体脂指标与高血压水平的相关性研究[J]. 中国循环杂志, 2018, 33(4): 341-345. DOI: 10.3969/j.issn.1000-3614.2018.04.007.
[11]王玲, 汪伟, 邓微, 等. 定量CT测量腹部脂肪面积及分布的重复性研究[J]. 中国骨质疏松杂志, 2012, 18(11): 999-1003. DOI: 10.3969/j.issn.1006-7108.2012.11.008.
[12]张瑾, 宋彬, 严志汉, 等. 急性胰腺炎腹壁受累的CT表现及临床意义[J]. 四川大学学报(医学版), 2003, 34(4): 766-769. DOI: 10.3969/j.issn.1672-173X.2003.04.052.
[13]闵鹏秋, 严志汉, 杨恒选, 等. 急性胰腺炎累及肾旁后间隙的螺旋CT表现及其解剖基础[J]. 中华放射学杂志, 2005, 39(4): 379-382. DOI: 10.3760/j.issn:1005-1201.2005.04.011.
[14]王雅琴, 王倩倩, 杨春波, 等. AP侵及肾旁后间隙的CT表现及其解剖学基础[J]. 医学影像学杂志, 2017, 27(5): 852-854. CNKI: SUN:XYXZ.0.2017-05-021.
[15]Raptopoulos V, Touliopoulos P, Lei QF, et al. Medial border of the perivrenal space: CT and anatomic correlation[J]. Radiology, 1997, 205(3): 777-784. DOI: 10.1148/radiology.205.3.9393535.
基金
潍坊市科技发展计划项目（2020YX036）；山东省科学技术发展计划（政策引导类）（2012YD18106）
PDF(1682 KB)
京ICP备08002354号-3
