肾旁后间隙的形态研究及其对后腹腔镜手术的意义  

Morphology study of posterior pararenal space and influence of it in retroperitoneal laparoscopic surgery

作　　者：钱庆鹏[1] 于广海[1] 

机构地区：[1]辽宁省大连市中心医院,辽宁大连116033

出　　处：《现代中西医结合杂志》2010年第17期2086-2087,2090,共3页Modern Journal of Integrated Traditional Chinese and Western Medicine

摘　　要：目的研究肾旁后间隙的边界、形态及其对后腹腔镜手术的意义。方法本院2009年1—12月实施后腹腔镜手术80例,术前行螺旋CT平扫＋三维重建,观察肾旁后间隙存在的比例,肾旁后间隙的形态,肾旁后间隙内肾旁脂肪的厚度,肾旁后间隙的前后边缘。结果CT上肋尖下平面91.3%-95%,髂骨上缘平面86.3%-90%可见肾旁后间隙存在。肾旁脂肪最厚部位在腹部外侧或后外侧,肋尖下平面最大厚度为左（14±6.0）mm,右（14.6±7.3）mm,髂骨上缘平面最大厚度为左（20.4±12.6）mm,右（26.2±9.7）mm。CT断面上肾旁后间隙的形态为新月形或三角形,方向主要为前后走行。肾旁后间隙的后界在腰大肌外缘或腰方肌表面,均位于竖脊肌外缘线以内。肾旁后间隙的前界即肾后筋膜前缘腹壁附着点,大多数位于腋前线附近。结论肾旁后间隙在肋尖下缘部位脂肪分布宽,但厚度稍薄,髂骨上缘厚度稍大但脂肪分布窄。采用IUPU法和气囊扩张法建立腹膜后腔都应以了解肾旁后间隙的解剖形态为基础。Objective It is to study the border and morphology of the posterior pararenal space and the influence of it in retroperitoneal laparoscopic surgery.Methods 80 patients had undergone retroperitoneal laparoscopic surgery from January 2009 to December 2009.The presence,morphology and border of the posterior pararenal space as well as the thickness of the pararenal fat in it were observed on CT scans.Results On CT scans,the posterior pararenal space was present in 91.3%~95% cases at the level of bottom edge of 12th rib and 86.3%~90% at the level of upper edge of ilium.The maximum thickness of the pararenal fat,located at the lateral or posterolateral part of the abdomen,was（14±6.0） mm in the left and（14.6±7.3） mm in the right at the level of 12th rib and（20.4±12.6） mm in the left and（26.2±9.7） mm in the right at the level of ilium.The contour of the posterior pararenal space,running mainly in anterior-posterior direction,looked like crescent or triangle.The medial border of the posterior pararenal space was the quadratus lumborum muscle or the psoas muscle,within the rim of the paraspinal muscle.The anterior border was the fusion position of the posterior renal fascia with the abdominal wall,mostly at the site of the anterior axillary line.Conclusion The pararenal fat pad is wide and thin at rib level and thick but narrow at ilium level.Anatomic configuration of the posterior pararenal space is the basis of both the IUPU and the balloon dilation techniques used in building retroperitoneal cavity.

关 键 词：肾旁后间隙 后腹腔镜 手术 

分 类 号：R322.492[医药卫生—人体解剖和组织胚胎学]