腹膜后间隙筋膜分层及筋膜间隙的临床解剖学研究  

Clinical anatomy of fasciae and fascial spaces in retroperitoneal cavity

作　　者：邱剑光[1] 陈锡慧[2] 袁晓旭[1] 司徒杰[1] 高新[1] 吴涛[3] 丁自海[3] 

机构地区：[1]中山大学附属第三医院泌尿外科 [2]中山大学附属第三医院手术室,广州510630 [3]南方医科大学微创外科解剖学研究所,广州510515

出　　处：《中国临床解剖学杂志》2009年第3期251-255,共5页Chinese Journal of Clinical Anatomy

摘　　要：目的:观察研究肾周腹膜后间隙的筋膜分层及筋膜间隙。方法:综合采用微创解剖、断层解剖、影像解剖和临床腹腔镜手术研究。包括断层标本1例;新鲜冰冻尸体手术解剖3例(左侧模拟腹腔镜左肾游离手术,右侧模拟开放肾游离手术);CT/MRI肾、肾上腺平扫+三维重建25例;腹腔镜手术55例。结果:肾前筋膜分3层,包括结肠融合筋膜、肾前融合筋膜和肾筋膜前叶。肾后筋膜分两层,包括侧锥筋膜和肾筋膜后叶。肾前、后筋膜光滑延续,形成肾筋膜间隙,其内容纳肾周脂肪、肾和肾盂输尿管鞘。肾盂输尿管鞘内容纳肾盂输尿管和肾盂输尿管周围脂肪。侧锥筋膜与腹横筋膜形成肾旁间隙,其内填充肾旁脂肪。肾前融合筋膜、腰肌筋膜和侧锥筋膜包绕形成肾周间隙,该间隙包括肾筋膜间隙及其上、下方的肾上腺间隙和生殖血管间隙。结肠系膜的脏腹膜和结肠融合筋膜形成结肠间隙。胰十二指肠前、后融合筋膜形成胰十二指肠间隙。肾周间隙和肾旁间隙为原生腹膜后间隙,胰十二指肠间隙和结肠间隙为次生腹膜后间隙。结论:肾前、后筋膜均为多层膜结构。腹膜后间隙借各层筋膜形成层叠状的空间。Objectives： To explore anatomic features of fasciae and fascial spaces in retroperitoneal cavity. Methods： in this study, 1 antiseptic specimens was analyzed by sectional anatomy method, 3 freezing specimans were removed kidneys by simulating laparoscopic nephrectomy on left kidneys and open nephrectomy on right kidneys, while CT/MRI images of 25 patients, as well 55 cases of clinically practiced laparoscopic operation were collected and analyzed. R.Reaults： Renal fascia composed of anterior and posterior layers. The posterior renal fascia composed of superficial layer （ lateral conal fascia） and the deep one （ posterior lamella）. Lateral conal fascia extended from transversalis fascia. Lateral conal fascia and transversalis fascia encircled the pararenal fat. The cavity formed by these two fascias was called pararenal space. The anterior renal fascia composed of colonal fusion fascia, prerenal fusion fascia and anterior lamella. The two layers of fusion fascia were fusion renmant of embryologic retroperitoneal parietal peritoneum and colonic mesentery, respectively. The anterior and posterior lamella of renal fascia continued with each otfier to form an enclosed cavity which surrounded kidney and perirenal fat. Perirenal fat did not enclose renal pelvis and ureter, which were covered by distinct peripyeloureteric sheath and peripyeloureteric fat. Peri-renal fascias divided the retroperitoneal space into different fascia compartments and fascia planes. Prerenal fusion fascia divided the retroperitoneal space into 2 domain compartments： initial retroperitoneal space and secondary retroperitoneal space. Sequentially, lateral conal fascia divided initial retroperitoneal space into perirenal and pararenal space. Perirenal space composed of adrenal space, renal fascia space and the spermetic space. Secondary retroperitoneal space was laminated with colonal space anteriorly and pancreaticduodenal space posteriorly. Conclusions： Renal fasciae are multilayer structures, which deride the retroperitoneal

关 键 词：腹膜后间隙 肾周间隙 腹腔镜 肾筋膜 侧锥筋膜 临床解剖学 

分 类 号：R323.3[医药卫生—人体解剖和组织胚胎学]