Toldt’s间隙的CT影像解剖学观察及临床意义  

Anatomical observation of Toldt's gap in CT images and clinical significance

作　　者：欧阳满照[1] 陈小伍[2] 丁自海[3] 朱达坚[2] 剧永乐[2] 伍锦浩[2] 陆光生[2] 李泳[2] 

机构地区：[1]广东医学院,广东湛江524023 [2]南方医科大学附属顺德第一人民医院,广东顺德528300 [3]南方医科大学解剖学教研室,广州510515

出　　处：《中国临床解剖学杂志》2013年第2期161-164,共4页Chinese Journal of Clinical Anatomy

基　　金：广东省科技计划项目(2011B031800036);国家自然科学基金(31171153)

摘　　要：目的术前通过CT影像识别Toldt’s间隙，为腹腔镜结直肠癌手术寻找正确的外科平面，从而制订具有前瞻眭的个性化术式。方法通过对南方医科大学附属顺德第一人民医院2010年1月-2012年6月246例腹腔镜结直肠癌手术患者的术前CT影像及术中镜下所见对照观察，确认Toldt’s间隙的位置、沟通和毗邻关系。结果术前CT影像观察到：升降结肠系膜后叶与。肾前筋膜融合成的线影即为Toldt’s线。结直肠癌术前cT所显示的Toldt’s筋膜间隙与术中所见具有较好的一致性（Kappa值为0．718）。腹腔镜结直肠癌手术时沿此线切开，以肾前筋膜为参照面，即可建立正确的外科平面。结论①术前CT影像可指导术中构建正确的Toldt’s间隙外科平面，保持肾前筋膜的完整性；②CT可提示肿瘤是否侵犯Toldt’s间隙平面，对于制订个性化术式和预后评估具有前瞻性意义。Objective To choose the optimal surgical plane through preoperative anatomical observation and recognition of Toldt＇s gap in CT images, so that perspective customized surgical approach can be made. Methods 246 patients underwent laparoscopic surgery for colorectal cancer in Shunde First People＇s Hospital affiliated to Southern Medical University from January 2010 to June 2012 were chosen, location, communication and adjacent structures of Toldt＇s gap in preoperative CT images and direct intraoperative laparoscopy images was observed and compared. Results The fusion of the posterior wall of the ascending and descending mesocolon to the anterior renal fascia was identified in the CT images as the Toldt＇s line. Good consistency of Toldt＇s fascial spacein preoperative CT images and intraoperative view was obtained （Kappa = 0.718）. By incising along this line while referencing to the retromesenteric plane during the laparoscopic surgery for colorectal cancer, correct surgical plane can be established. Conclusion Preoperative CT scan can be adopted to identify the correct Toldt＇s space as the surgical plane and preserve the integrity of the prerenal fascia. CT scan can indicate whether there is any tumor invasion to Toldt＇s space, which is of great perspective significance in formulating customized surgical plan and assessing the prognosis.

关 键 词：腹腔镜 结直肠癌 Toldt’s间隙 外科平面 影像解剖学 

分 类 号：R816.7[医药卫生—放射医学]