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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。
Objective To investigate the accuracy and safety of inter-prerenalfascia planes in urological laparoscopic operations (IpULO). Methods The autopsy, 320-slice CT image anatomical study and clinical livelihood laparoscopic surgery were performed to observe the morphological characteristics of laparoscopic anatomic landmarks in IpULO before and after laparoscopic surgery. Results The anterior prerenal plane was a multi-layer avascular fascia with anterior renal interstitial space. The layers were filled with spider silk-like white fibrous tissue. During the IpULO procedure, there were 7 important surgical planes: Told’t fascia Intersurface, Colon Fusion Fascia Prerenal Fusion Fascia Plane, Colon Fusion Fascia Pancreaticoduodenal Fusion Fascia Plane, Pancreaticoduodenal Fusion Fascia Prerenal Fusion Fascia Interplanar Plane, Prerenal Fusion fascia mesangial anterior placental plane, kidney fascia anterior leaflet outside the fat capsule, anterior renal fascia anterior leaflet plane. Conclusions IpULO surgery is a precise anatomic approach based on the level of surgery. The anterior prerenal plane is an important anatomic aspect of IpULO surgery. The operation can push the window and avoid the loss of anatomy.