肾周筋膜层面解剖与后腹腔镜解剖性肾筋膜外肾切除术的临床研究:附12例报告(附视频)  

Clinic study on anatomy of perirenal fascia and anatomical retroperitoneoscopic nephrectomy outside renal fascia: Report of 12 cases

作　　者：盛明雄[1] 王德娟[2] 陈锡慧[3] 雷华[2] 邱剑光[2] 

机构地区：[1]福建医科大学附属闽东医院泌尿外科,福安355000 [2]中山大学附属第三医院泌尿外科,广州510630 [3]中山大学附属第三医院不孕不育科,广州510630

出　　处：《中华腔镜泌尿外科杂志（电子版）》2011年第6期31-33,共3页Chinese Journal of Endourology(Electronic Edition)

摘　　要：目的研究腹膜后筋膜间隙分层及其在腹腔镜下肾切除术中的应用,探讨后腹腔镜下筋膜外肾切除术的疗效。方法 2010年1月至2010年10月我们选择肾前融合筋膜肾筋膜间隙作为肾前方的手术平面,腰肌前间隙作为肾后方的手术平面,行后腹腔镜下筋膜外解剖性肾切除术12例,对临床资料、影像资料和手术录像等进行分析。结果所有病例均手术成功,平均手术时间90±35min,平均术中出血量60±12ml。术中未出现大出血和周围脏器损伤等并发症。术后平均24h下床活动,术后平均住院日6d。结论后腹腔镜下筋膜外解剖性肾切除术具有解剖层次清晰,容易游离,术中出血少,手术时间短,并发症少和安全有效等优点。肾前融合筋膜肾筋膜间隙可作为肾前方手术平面,腰肌前间隙可作为肾后方手术平面。Objective To explore layers of fascial spaces in retroperitoneal cavity and its application on laparoscopic nephrectomy, and evaluate the effect of laparoscopic nephrectomy outside renal fascia. Methods From January to October in 2010, a total of 12 patients underwent laparoscopic nephrectomy outside renal fascia. The space between fusion fascia before kidney and renal fascia was chosed as the operate plane before kidney. Psoas anterior diastema was chosed as the operate plane after kidney. The clinical data, images and operation recordings were analyzed. Results A1l patients were successfully operated. The mean operative time and estimated blood loss were 90±35 min and 110±40 ml. There were no serious complications. Average days to ambulation were 24 hours. The mean postoperative hospital stay was 6 days. Conclusions Anatomical retroperitoneoscopic nephrectomy outside renal fasci is a safe and effective procedure with clear anatomic layers and easy liberation. It can decrease operation time and blood loss effectively and can decrease the rate of complication remarkably. The space between fusion fascia before kidney and renal fascia can be chosed as the operate plane before kidney. Psoas anterior diastema can be chosed as the operate plane after kidney.

关 键 词：腹腔镜 肾切除术 肾前融合筋膜 肾筋膜 

分 类 号：R699.2[医药卫生—泌尿科学]