胃周筋膜间隙对腹腔镜入路的意义  

Guidance of the perigastric fascial space on the laparoscopic approach

作　　者：金国梁 王哲鹏 段树全[2] 师梦伟 郑连生[2] JIN Guoliang;WANG Zhepeng;DUAN Shuquan;SHI Mengwei;ZHENG Liansheng(Graduate School of BaoTou Medical College,Baotou 014040,China;Digestive Minimally Invasive Center the Second Affiliated Hospital of Baotou Medical College,Inner Mongolia University of science and technology)

机构地区：[1]包头医学院研究生学院,内蒙古包头014040 [2]包头医学院第二附属医院消化微创中心

出　　处：《包头医学院学报》2021年第10期66-70,共5页Journal of Baotou Medical College

基　　金：包头医学院科学研究基金—扬帆计划(BYJJ-YF-2018028)。

摘　　要：目的:研究观察胃周筋膜间隙的解剖学特点及血管走行特点,为指导腹腔镜胃癌根治术提供安全的手术入路。方法:对2例成人新鲜尸体标本、5具福尔马林浸泡标本、50例腹腔镜下胃癌根治术中的胃周筋膜及筋膜间隙的形态特点及重要血管的走行特点进行了观察研究。结果:通过解剖发现,胰前筋膜间隙空间较大,适合开腹及腹腔镜手术的入路,胃后筋膜间隙与脾胃间隙、肝胃间隙相通,通过三个层面入路,可以进入无血管及神经走行的间隙,从而达到全胃的完整切除。结论:胃周、胰腺周围的筋膜间隙错综复杂但又互相连通,只有对这些筋膜间隙熟悉,才能制定合理的手术入路。胃周筋膜间隙的解剖学研究应用于腹腔镜胃癌根治术,不仅能提高手术的效率,而且还可以减少出血、损伤血管及神经等副损伤发生。Objective:To study and observe the anatomical characteristics of the perigastric fascial space and the characteristics of blood vessels,so as to provide a safe surgical approach for guiding laparoscopic radical gastric cancer surgery.Methods:The morphological characteristics of the fascia and the space of the fascia and the passage of the important blood vessels were observed in 2 adult fresh cadaver specimens,5 formalin soaked specimens and 50 cases of laparoscopic radical gastrectomy.Results:Through anatomy,it was found that the anterior pancreatic fascial space was large and suitable for open and laparoscopic surgery.The posterior gastric fascial space was connected with the spleen and stomach space and the liver and stomach space.Through the three-level approach,the space without blood vessels and nerves could be entered,so as to achieve complete gastrectomy.Conclusion:The fascial spaces around the stomach and pancreas are intricate but interconnected.Only by familiarizing with these fascial spaces can we formulate a reasonable surgical approach.The anatomical study of the perigastric fascial space can be applied to laparoscopic radical gastric cancer surgery.It not only improves the efficiency of the operation,but also reduces the occurrence of side injuries such as bleeding,damage to blood vessels and nerves.

关 键 词：胃癌 融合筋膜 筋膜间隙 

分 类 号：R73[医药卫生—肿瘤]