肾前筋膜间平面无血腹腔镜上尿路手术入路精准解剖与技巧

发布时间：2018-02-15 20:32

本文关键词： 腹腔镜肾前筋膜间平面精准解剖层面外科解剖标志　出处：《中国临床解剖学杂志》2017年02期 　论文类型：期刊论文

【摘要】：目的探讨肾前筋膜间平面无血腹腔镜上尿路手术入路精准解剖与技巧(Inter-prerenalfascia planes in urological laparoscopic operations,IpULO)。方法采用尸体解剖、320排CT影像解剖研究及临床病例活体腹腔镜手术研究,对IpULO手术中肾前筋膜间平面相关解剖标志在腹腔镜下的形态特点进行观察研究。结果肾前筋膜间平面是肾前间隙多层次的无血管筋膜结构,层面间充满蜘蛛丝网格状白色纤维组织,在IpULO手术过程中存在7个重要的外科平面:Told’t筋膜间平面、结肠融合筋膜肾前融合筋膜间平面、结肠融合筋膜胰十二指肠前融合筋膜间平面、胰十二指肠后融合筋膜肾前融合筋膜间平面、肾前融合筋膜肾筋膜前叶间平面、肾筋膜前叶肾脂肪囊外平面、肾前肾筋膜前叶下平面。结论IpULO手术是基于层面外科的精准解剖入路,肾前筋膜间平面是IpULO手术的重要解剖层面,术中能推窗见景,避免解剖迷失。
[Abstract]:Objective to investigate the accurate anatomy and technique of interpreexisting fascia planes in urological laparoscopic operation IpULOA via laparoscopic upper urinary approach in the prerenal interfascial plane. Methods Anatomy of cadaveric dissection with 320 row CT image and clinical case with in vivo laparoscopic surgery were studied. The morphological characteristics of anatomic markers related to the prerenal interfascial plane in IpULO operation were observed and studied under laparoscopy. Results the prerenal interfascial plane was a multilevel vascularized fascia structure in the prerenal space. There are seven important surgical plane: Toldt interfascial plane and colonic fusion fascia prerenal interfascial plane during IpULO operation. Colonic fusion fascia anterior fusion fascia plane, posterior pancreaticoduodenal fusion fascia anterior fusion fascia plane, anterior renal fascia fusion fascia anterior interlobar plane, renal fascial anterior lobar renal fat capsule plane, colonic fusion fascia anterior fusion fascia interfascial plane, pancreaticoduodenal posterior fusion fascia anterior fusion fascia interfascial plane. Conclusion IpULO operation is a precise anatomical approach based on plane surgery, and the plane of prerenal fascia is an important anatomical layer of IpULO surgery. During the operation, the window can be pushed to avoid dissection loss.
【作者单位】：贵州省贵阳市第二人民医院泌尿外科;苏州大学附属第一医院泌尿外科;中山大学附属第三医院泌尿外科;贵州医科大学附属医院泌尿外科;贵州医科大学附属医院小儿外科;
【基金】：贵州省卫计委科学技术基金资助项目(黔卫发[2013]71号gzwkj2013-1-021) 贵州省科技厅基金资助项目(黔科合J字[2012]2053号) 贵阳市社会发展与民生科技计划基金资助项目(筑科合[20141001]66号)
【分类号】：R699;R322.6

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