切换至 "中华医学电子期刊资源库"

中华腔镜泌尿外科杂志(电子版) ›› 2018, Vol. 12 ›› Issue (04) : 266 -269. doi: 10.3877/cma.j.issn.1674-3253.2018.04.013

所属专题: 文献

临床研究

精准解剖式肾前筋膜间平面腹腔镜肾癌根治手术的要点分析
梅傲冰1, 孙旭2, 胡瑞洁3, 邱剑光4,(), 贾本忠5, 康婷1, 何翔1, 陈梅1, 孙发5, 梁显泉1   
  1. 1. 550081 贵阳市第二人民医院泌尿外科
    2. 550004 贵阳,贵州医科大学附属医院小儿外科
    3. 550004 贵阳,贵州医科大学
    4. 510655 广州,中山大学附属第六医院泌尿外科
    5. 550004 贵阳,贵州医科大学附属医院泌尿外科
  • 收稿日期:2017-10-31 出版日期:2018-08-01
  • 通信作者: 邱剑光
  • 基金资助:
    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)

Techniques and experiences of precise anatomical inter-prerenal-fascia planes in laparoscopic radical nephrectomy

Aobing Mei1, Xu Sun2, Ruijie Hu3, Jianguang Qiu4,(), Benzhong Jia5, Ting Kang1, Xiang He1, Mei Chen1, Fa Sun5, Xianquan Liang1   

  1. 1. Department of Urology, the Second People's Hospital of Guiyang, Guizhou 550081, China
    2. Department of Pediatric, the Affiliated Hospital of Guizhou Medical University, Guiyang 550004, China
    3. Guizhou Medical University, Guiyang 550004, China
    4. Department of Urology, the Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou 510655, China
    5. Department of Urology, the Affiliated Hospital of Guizhou Medical University, Guiyang 550004, China
  • Received:2017-10-31 Published:2018-08-01
  • Corresponding author: Jianguang Qiu
  • About author:
    Corresponding author: Qiu Jianguang, Email:
引用本文:

梅傲冰, 孙旭, 胡瑞洁, 邱剑光, 贾本忠, 康婷, 何翔, 陈梅, 孙发, 梁显泉. 精准解剖式肾前筋膜间平面腹腔镜肾癌根治手术的要点分析[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2018, 12(04): 266-269.

Aobing Mei, Xu Sun, Ruijie Hu, Jianguang Qiu, Benzhong Jia, Ting Kang, Xiang He, Mei Chen, Fa Sun, Xianquan Liang. Techniques and experiences of precise anatomical inter-prerenal-fascia planes in laparoscopic radical nephrectomy[J/OL]. Chinese Journal of Endourology(Electronic Edition), 2018, 12(04): 266-269.

目的

介绍肾前筋膜间平面行腹腔镜根治性肾切除术(IpLRN)的解剖要点及手术技巧。

方法

回顾性分析2010年10月至2017年5月在贵阳市第二人民医院及贵州医科大学附属医院泌尿外科收治的57例肾癌患者临床资料,术中采用基于层面外科肿瘤根治性切除的概念,评价IpLRN手术过程,总结该手术应遵循的解剖平面理论。

结果

在IpLRN手术过程中存在七个重要的外科平面,在这些无血管平面中游离,57例手术均获成功,术中未出现严重并发症,手术时间55~180 min,平均68 min,出血量0~120 ml,平均19 ml,术后3~7 d出院,平均4 d。57例患者术后随访6~30个月,平均11个月,均无瘤生存。

结论

肾前筋膜间平面是IpLRN手术的重要解剖层面,在肾癌根治术中解剖层次清晰,沿肾前筋膜间平面游离可避免解剖迷失,符合肿瘤学手术原则。

Objective

To investigate the anatomical features and surgical techniques of inter-prerenal-fascia planes in laparoscopic radical nephrectomy(IpLRN).

Methods

Fifty-seven patients with renal cell carcinoma whom treated in urology department of the Second People's Hospital of Guiyang and the Affiliated Hospital of Guizhou Medical University during October 2010 to May 2017 were analyzed retrospectively. Based on the conception of trans-interfascial plane surgery associated with tumor radical resection, the process of the surgery was evaluated and the anatomical plane theory of the IpLRN surgery was summarized.

Results

There were seven important surgical planes in the process of IpLRN surgery. Fifty-seven cases were all successfully anatomized in these vascular-free planes with no serious complications. The mean operative time was 68 min(range 55-180 min), the estimated blood loss was 19 ml(range 0-120 ml), and the mean hospital stay was 4 days(range 3-7 days). The follow-up periods of all of the 57 patients were 6-30 months(average 11 months), all patients survived free of tumor.

Conclusion

Inter-prerenal-fascia planes are important anatomical level of IpLRN surgery. Along the anterior fascia plane can avoid anatomical loss making sure the clear anatomy surgery field in the laparoscopic radical nephrectomy, which is conformed broadly to the principles of oncology surgery.

图1 IpLRN手术与两隙七面
[1]
Clayman RV,Kavoussi LR,Soper NJ, et al. Laparoscopic nephrectomy: initial case report[J]. J Urol, 1991, 146(2): 278-282.
[2]
Gaur DD. Laparoscopic operative retroperitoneoscopy: use of a new device[J]. J Urol, 1992, 148(4): 1137-1139.
[3]
梅傲冰,邱剑光,贾本忠, 等. 腹腔镜下肾前筋膜间平面的临床解剖学研究[J]. 中国临床解剖学杂志, 2013, 31(3): 256-260.
[4]
梅傲冰,邱剑光,贾本忠, 等. 肾前筋膜间平面无血化腹腔镜手术层面的解剖学研究[J/CD]. 中华腔镜泌尿外科杂志(电子版), 2013, 7(3): 86-91.
[5]
邱剑光,陈锡慧,袁晓旭, 等. 腹膜后间隙筋膜分层及筋膜间隙的临床解剖学研究[J]. 中国临床解剖学杂志, 2009, 27(3): 251-255.
[6]
邱剑光,高新. 腹腔镜肾上腺解剖学与手术入路研究[J]. 腹腔镜外科杂志, 2009, 14(8): 573-575.
[7]
Ishikawa K,Nakao S,Nakamuro M, et a1. The retroperitoneal interfascial planes: current overview and future perspectives[J]. Acute Med Surg, 2016, 3(3): 219-229.
[8]
Ishikawa K,Nakao S,Murakami G, et a1.Preliminary embryological study of the radiological concept of retroperitoneal interfascial planes: what are the interfascial planes?[J]. Surg Radiol Anat, 2014, 36(10): 1079-1087.
[9]
Ishikawa K,Tohira H,Mizushima Y, et a1.Traumatic retroperitoneal hematoma spreads through the interfascial planes[J]. J Trauma, 2005, 59(3): 595-608.
[10]
Ishikawa K,Idoguchi K,Tanaka H et al. Classification of acute pancreatitis based on retroperitoneal extension: application of the concept of interfascial planes[J]. Eur J Radiol, 2006, 60(3):445-452.
[11]
Aizenstein RI,Wilbur AC,O’Neil HK. Interfascial and perinephric pathways in the spread of retroperitoneal disease:refined concepts based on CT observations[J]. AJR Am J Roentgenol, 1997, 168(3): 639-643.
[12]
梅傲冰,邱剑光,贾本忠, 等. 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[J]. 中国临床解剖学杂志, 2017, 35(2): 130-136.
[1] 燕速, 霍博文. 腹腔镜食管胃结合部腺癌根治性切除术[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 13-13.
[2] 母德安, 李凯, 张志远, 张伟. 超微创器械辅助单孔腹腔镜下脾部分切除术[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 14-14.
[3] 李国新, 陈新华. 全腹腔镜下全胃切除术食管空肠吻合的临床研究进展[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 1-4.
[4] 李子禹, 卢信星, 李双喜, 陕飞. 食管胃结合部腺癌腹腔镜手术重建方式的选择[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 5-8.
[5] 李乐平, 张荣华, 商亮. 腹腔镜食管胃结合部腺癌根治淋巴结清扫策略[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 9-12.
[6] 陈方鹏, 杨大伟, 金从稳. 腹腔镜近端胃癌切除术联合改良食管胃吻合术重建His角对术后反流性食管炎的效果研究[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 15-18.
[7] 许杰, 李亚俊, 韩军伟. 两种入路下腹腔镜根治性全胃切除术治疗超重胃癌的效果比较[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 19-22.
[8] 李刘庆, 陈小翔, 吕成余. 全腹腔镜与腹腔镜辅助远端胃癌根治术治疗进展期胃癌的近中期随访比较[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 23-26.
[9] 任佳, 马胜辉, 王馨, 石秀霞, 蔡淑云. 腹腔镜全胃切除、间置空肠代胃术的临床观察[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 31-34.
[10] 赵丽霞, 王春霞, 陈一锋, 胡东平, 张维胜, 王涛, 张洪来. 内脏型肥胖对腹腔镜直肠癌根治术后早期并发症的影响[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 35-39.
[11] 李博, 贾蓬勃, 李栋, 李小庆. ERCP与LCBDE治疗胆总管结石继发急性重症胆管炎的效果[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 60-63.
[12] 韩戟, 杨力, 陈玉. 腹部形态CT参数与完全腹腔镜全胃切除术术中失血量的关系研究[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 88-91.
[13] 王庆亮, 党兮, 师凯, 刘波. 腹腔镜联合胆道子镜经胆囊管胆总管探查取石术[J/OL]. 中华肝脏外科手术学电子杂志, 2025, 14(02): 313-313.
[14] 杨建辉, 段文斌, 马忠志, 卿宇豪. 腹腔镜下脾部分切除术[J/OL]. 中华肝脏外科手术学电子杂志, 2025, 14(02): 314-314.
[15] 叶劲松, 刘驳强, 柳胜君, 吴浩然. 腹腔镜肝Ⅶ+Ⅷ段背侧段切除[J/OL]. 中华肝脏外科手术学电子杂志, 2025, 14(02): 315-315.
阅读次数
全文


摘要


AI


AI小编
你好!我是《中华医学电子期刊资源库》AI小编,有什么可以帮您的吗?