后腹腔镜根治性肾切除术中的筋膜间隙层面解剖研究  

A Study of Fascia and Space Anatomy Layers in Retroperitoneal Laparoscopic Radical Nephrectomy

作　　者：吴广圳 王启飞[1] 李泉林[1] 车翔宇[1] 姜涛[1] 张志伟[1] 郑伟[1] 陈骁驰[1] 陈峰[1] 汤奇祯[1] 郑磊[1] WU Guang-zhen WANG Qi-fei LI Quan-lin et al(Department of Urology, the First Affiliated Hospital of Dalian Medical University, Dalian 116011, China)

机构地区：[1]大连医科大学附属第一医院泌尿外科,辽宁大连116011

出　　处：《医学与哲学（B）》2017年第8期53-56,共4页Medicine & Philosophy(B)

摘　　要：通过对腹膜后腔筋膜间隙层面解剖的研究总结,在后腹腔镜根治性肾切除术中寻找安全正确的解剖层面,进行无血化解剖性手术操作,改进游离、切除肾脏的手术技巧。2016年3月~2017年3月收治61例局限性肾癌患者,其中左侧33例,右侧28例;肿瘤直径3.4cm^7.5cm,平均5.6cm。通过寻找显露肾旁前间隙、腰肌前间隙、肾筋膜前叶肾前融合筋膜间隙等无血管平面,实施无血化解剖性肾切除手术。61例手术均获成功,无中转开放手术。手术时间43min^98min,平均61min;出血量30ml^150ml,平均75ml;术后4d^8d出院。7例发生腹膜破裂,5例发生肾上腺腺体轻微撕裂,少量出血,无输血,无其他严重并发症发生。根据腹膜后腔筋膜间隙层面解剖的特点,通过辨认及分离肾旁前间隙、腰肌前间隙、肾筋膜前叶肾前融合筋膜间隙等无血管层面,可充分显露手术空间,在直视下辨别毗邻关系,可无血化解剖性实施手术,术中出血少,避免周围毗邻脏器损伤及大出血等并发症。该方法安全有效、节省时间,值得在临床推广应用。To study fascia and space anatomy layers in retroperitoneum, in order to find correct methods in bloodless and the anatomical retroperitoneal laparoscopic radical nephrectomy （LRN）, and improve operation skills.From march 2016 to march 2017, a total of 61 patients were analyzed who underwent retroperitoneal laparoscopic radical nephrectomy, 33 tumors were located in left kidney, and 28 in the right kidney, the diameter of renal tumor was 3.4cm^7.5cm, with the mean diameter was 5.6cm, we complement bloodless and the anatomical retroperitoneal LRN by exposing and separating relatively bloodless planes such as anterior pararenal space, pre-psoas space, the space between anterior lamella and prerenal fusion fascia.All 61 operations were successfully operated, with no case transferred to open operation.The mean operative time was 61 min （range from 43 to 98 min）, and the mean intraoperative blood loss was 75ml （range from 30 to 150ml）, all patients discharged from hospital on 4 to 8 days after surgery.Rupture of peritoneum were 7 cases had rupture of peritoneum, adrenal gland laceration and slight bleeding were 5 cases.No case had blood transfusion and other severe complications during surgery.On the basis of fascia and space anatomy layers in retroperitoneum, through identifying and separating relatively bloodless planes such as anterior pararenal space, pre-psoas space, the space between anterior lamella and prerenal fusion, we can exposing the operation space, renal and adjacent organs can be discrimination directly.Dissection through this planes also easy to perform, so we can complement operaion bloodlessly and anatomically.This method is a safe and effective procedure, it can decrease operation time, blood loss and complication rates effectively, and provide a better choice for the patient whom demand radical nephrectomy.

关 键 词：后腹腔镜根治性肾切除术 腹膜后腔筋膜间隙 层面解剖 

分 类 号：R699.2[医药卫生—泌尿科学]