腹腔镜下降结肠腹膜后筋膜的解剖学观察  

Anatomical observation on retroperitoneal fascia of descending colon using laparoscopy

作　　者：余志和[1] 李永浩[1] 吴汉明[1] 丁自海[2] 

机构地区：[1]中山市黄圃人民医院,广东中山528429 [2]南方医科大学微创外科解剖学研究所,广东广州510515

出　　处：《解剖学研究》2015年第6期498-500,519,共4页Anatomy Research

基　　金：广东省中山市科技项目(20122A013);国家自然科学基金(311711533)

摘　　要：目的探讨在腹腔镜下降结肠切除术相关的腹膜后融合筋膜和筋膜间隙的解剖学特点及毗邻关系，以正确识别和选择安全的筋膜间隙外科平面。方法在腹腔镜下对6具成人新鲜腹部标本，20例腹腔镜下降结肠切除术中的腹膜后筋膜和筋膜间隙的位置、结构特点和毗邻关系进行了观察。结果沿降结肠外侧缘的融合线切开腹膜、腹膜外组织，即可显露深面的融合筋膜。融合筋膜与肾前筋膜之间的潜在间隙为融合筋膜间隙。沿此间隙由外向内分离，可将降结肠及其原始结肠系膜翻起，完成降结肠游离。融合筋膜为一菲薄的疏松结缔组织膜，可分离成不完全连续的两层，肾前筋膜不易分层。结论融合线为到达融合筋膜，进入融合筋膜的标志。在融合筋膜间隙建立腹腔镜下外科平面时，不可在融合筋膜内分离，也不能在肾前筋膜中分离，以便外科平面正确的建立在融合筋膜间隙内。Objective To explore the topography and anatomical nature of the retroperitoneal fascia and fascial space in laparoseopic descending colectomy and to set up methodologies to identify surgical planes. Methods Six adult man cadavers were observed laparoscopically. In addition, totally 30 patients undergoing laparoseopic rift eolectomy, were observed on the fusion fascia and fusion fascial space with reference to location, distribution and topography. Results Between the visceral and parietal peritoneum, lateral to the descending colon, there was a fusion line, along which cutting into the peritonemn and extraperitoneal tissue unveiled the fusion fascia. The fusion fascia and prerenal fascia enclosed a fusion fascia space full of loose connective tissue. Dissection along the fusion fascial space easily mobilized the descending colon and their primitive mesocolon, and also unveiled the prerenal fascia posteriorly. fusion fascia spaces located between fusion fascia and the prerenal fascia.were delineated by the prerenal fascia, the fusion fascia, the. Conclusion The fusion lines can be regarded as landmarks to access the fusion fascia space, and can be regarded as an ideal surgical plane for laparoscopic left colectomy, fusion fascia and prerenal fascia were inseparable,for set up sate surgical planes.

关 键 词：腹膜后筋膜 融合筋膜 降结肠 腹腔镜 临床解剖学 

分 类 号：R322.45[医药卫生—人体解剖和组织胚胎学]