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目的探讨在腹腔镜下升、降结肠或肾切除术相关的腹膜后筋膜和筋膜间隙的解剖学特点及毗邻关系,以便正确地寻找、识别和选择安全的筋膜间隙外科平面。方法在腹腔镜下对5具成人新鲜腹部标本,30例腹腔镜下升、降结肠切除术和95例肾切除术中的腹膜后筋膜和筋膜间隙的位置、沟通和毗邻关系进行了观察。结果升、降结肠外侧缘的脏腹膜与壁腹膜之间有一条黄白交界线,沿此线切开腹膜、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。切开融合筋膜,沿此间隙向内分离,可将升结肠或降结肠及原始结肠系膜向内翻起,完成结肠游离;或显露后方的肾前筋膜。肾前筋膜、融合筋膜外侧部与侧锥筋膜之间的间隙为肾旁前筋膜间隙;肾后筋膜、侧锥筋膜与腰方肌筋膜之间的间隙为肾旁后筋膜间隙。肾旁前筋膜间隙与融合筋膜间隙和肾旁后筋膜间隙沟通,通过这些间隙分离,可将肾安全游离。结论黄白交界线为进入融合筋膜间隙的标志,融合筋膜间隙及肾旁前、后筋膜间隙内无重要血管,易于辨认和分离,为腹腔镜下升、降结肠或肾游离的理想外科平面。
Objective To investigate the anatomic features and adjacent relations of retroperitoneal fascia and fascia in laparoscopic ascending, descending colon or nephrectomy in order to find, identify and select a safe surgical plane of fascia gap correctly. Methods The location, communication and adjacent relationship of retroperitoneal fascia and fascia gap in 5 adult fresh abdominal specimens, 30 cases of laparoscopic ascending, descending colon resection and 95 cases of nephrectomy were observed by laparoscopy . Ascending or descending colon of the outer edge of the dirty peritoneal and parietal peritoneal border between a yellow line, along the line cut peritoneal and extraperitoneal tissue, to reveal deep fusion fascia. The potential gap between the fascia and the prerenal fascia is the fusion fascia gap. Incision fusion fascia, along the gap inward separation, the ascending colon or descending colon and the original mesocolon inward turn, complete colon free; or reveal the rear of the anterior fascia. The anterior renal fascia, the fusion between the lateral part of the fascia and the lateral cone fascia gap between the anterior renal fascia; after the fascia, the lateral cone and fascia fascia lameness between the side of the kidney after Fascia gap. Anterior renal fascia gap and fusion fascia gap and renal fascia after the gap communication, through these gaps separation, the kidney can be safe and free. Conclusions The junction of the yellow line and the white line is a sign of entering the fusion fascia. There is no important blood vessel in the fusion fissure space and in the anterolateral and posterior renal fascia. It is easy to identify and separate. It is an ideal surgery for laparoscopic ascending, descending colon or kidney free flat.