肾前筋膜间平面无血腹腔镜上尿路手术入路精准解剖与技巧

doi:10.13418/j.issn.1001-165x.2017.02.003

中国临床解剖学杂志 ›› 2017, Vol. 35 ›› Issue (2): 130-136.doi: 10.13418/j.issn.1001-165x.2017.02.003

肾前筋膜间平面无血腹腔镜上尿路手术入路精准解剖与技巧

梅傲冰^1，2，邱剑光³，　贾本忠⁴，　孙发⁴，　孙旭⁵，　陈梅¹，　梁显泉¹，　何翔¹，　康婷¹，　侯建全²

1.贵州省贵阳市第二人民医院泌尿外科，贵阳   550081；　2.苏州大学附属第一医院泌尿外科，江苏   苏州 215006；
3.中山大学附属第三医院泌尿外科，广州   510630；　4.贵州医科大学附属医院泌尿外科，贵阳 550004；
5.贵州医科大学附属医院小儿外科，贵阳   550004

收稿日期:2016-06-05 出版日期:2017-03-25 发布日期:2017-04-27
通讯作者: 侯建全，教授，主任医师，博士生导师，E-mail: xf192@163.com; 贾本忠，教授，主任医师，硕士生导师，E-mail:gzjbz@aliyun.com
作者简介:梅傲冰(1975-)，男，医学硕士，副主任医师，主要从事泌尿系肿瘤免疫基础与临床研究，泌尿外科手术技术与临床微创解剖学研究，E-mail:meiaobing@163.com
基金资助:
贵州省卫计委科学技术基金资助项目（黔卫发[2013]71号gzwkj2013-1-021)；贵州省科技厅基金资助项目（黔科合J字[2012]2053号）；贵阳市社会发展与民生科技计划基金资助项目（筑科合[20141001]66号）

Technique of precise anatomical study on the bloodless-surgical approach of inter-prerenal-fascia planes in urological laparoscopic operations

MEI Ao-bing ^1，2, QIU Jian-guang³, JIA Ben-zhong⁴, SUN Fa⁴, SUN Xu⁵, Chen Mei¹, LIANG Xan-quan¹, HE Xiang¹, KANG Ting¹, HOU Jian-quan²

1.Department of Urology, The Second People’s Hospital of Guiyang，Guiyang, 550081, China；2. Department of Urology, The First Af?liated Hospital of Soochow University, Suzhou 215006, China; 3. Department of Urology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China；4.Department of Urology, The Affiliated Hospital of Guizhou Medical University, Guiyang 550004, China；5. Department of Pediatric Surgery, The Affiliated Hospital of Guizhou Medical University,Guiyang 550004, China

Received:2016-06-05 Online:2017-03-25 Published:2017-04-27
Contact: HOU Jian-quan，E-mail: xf192@163.com IA Ben-zhong， E-mail: gzjbz @aliyun.com

摘要/Abstract

摘要：

目的　探讨肾前筋膜间平面无血腹腔镜上尿路手术入路精准解剖与技巧（Inter-prerenal-fascia planes in urological laparoscopic operations，IpULO）。方法　采用尸体解剖、320排CT影像解剖研究及临床病例活体腹腔镜手术研究，对IpULO手术中肾前筋膜间平面相关解剖标志在腹腔镜下的形态特点进行观察研究。结果肾前筋膜间平面是肾前间隙多层次的无血管筋膜结构，层面间充满蜘蛛丝网格状白色纤维组织，在IpULO手术过程中存在7个重要的外科平面：Told’t 筋膜间平面、结肠融合筋膜肾前融合筋膜间平面、结肠融合筋膜胰十二指肠前融合筋膜间平面、胰十二指肠后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、肾前肾筋膜前叶下平面。结论 IpULO手术是基于层面外科的精准解剖入路，肾前筋膜间平面是IpULO手术的重要解剖层面，术中能推窗见景，避免解剖迷失。

关键词: 腹腔镜, 肾前筋膜间平面, 精准解剖, 层面外科, 解剖标志

Abstract:

Objective　To investigate the surgical technique of precise anatomical study on the bloodless-surgical approach of inter-prerenal-fascia planes in urological laparoscopic operations（IpULO）.Methods　Autopsies, 320 slice CT scan images, and clinical laparoscopic surgery cases were included in this study to observe the morphological characteristic of the inter-prerenal-fascia planes.　Results　Inter-prerenal-fascia planes are the multiple-layer and avascular fascia in the anterior space of the kidney filled with spider silk lattice-like white fibrous tissue. There are seven important surgical planes involved in the IpULO procedure, which included from top to bottom: the interfascial plane of the Told’t, the plane between the colonic fusion fascia and the prerenal fusion fascia, the plane between the colonic fusion fascia and the prepancreaticoduodenal fusion fascia, the plane between the prerenal fusion fascia and the postpancreaticoduodenal fusion fascia, the plane between the prerenal fusion fascia and the anterior lamella of renal fascia, the plane between the perirenal fat and the anterior lamella of renal fascia, the subfascial plane of the anterior lamella of renal fascia.　Conclusion　Surgical approach is the key to accurate dissection operations like IpULO. Inter-prerenal-fascia planes are an important anatomical level in IpULO surgeric approach, which could significantly reduce erroneous dissection during IpULO procedure.

Key words: Laparoscopic surgery；Inter-prerenal-fascia Planes； , Precise Anatomical；Planes surgery； , Checkmark sign

梅傲冰,邱剑光,贾本忠,孙发,孙旭,陈梅,梁显泉,何翔,康婷,侯建全. 肾前筋膜间平面无血腹腔镜上尿路手术入路精准解剖与技巧[J]. 中国临床解剖学杂志, 2017, 35(2): 130-136.

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肾前筋膜间平面无血腹腔镜上尿路手术入路精准解剖与技巧

Technique of precise anatomical study on the bloodless-surgical approach of inter-prerenal-fascia planes in urological laparoscopic operations

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