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【摘要】　目的　探讨后腹腔镜手术的应用解剖学基础。　方法　选择国人成人尸体20具,男性 12具,女性8具。对其侧腹壁神经、血管和后腹膜间隙结构与后腹腔镜进路之间的距离进行测量。 结果　髂嵴距腰下三角顶点的距离:男性:左侧(4·02±1·26) cm,右侧(3·83±0·90) cm;女性:左侧 (3·90±0·37) cm,右侧(3·87±0·37) cm。髂腹下神经距髂嵴的距离:男性:左侧(0·82±0·13) cm,右侧 (0·84±0·08) cm;女性:左侧(0·94±0·06) cm,右侧(0·93±0·10) cm。肋下神经距肋缘下的距离,在腋 后线和腋中线:男性:左侧分别为(0·79±0·26) cm、(1·65±1·12) cm,右侧分别为(0·78±0·30) cm、 (1·59±1·07) cm;女性:左侧分别为(0·61±0·14) cm、(1·37±0·89) cm,右侧分别为(0·64±0·13) cm、 (1·32±0·95) cm。肾下极水平输尿管距腰大肌外缘的距离:男性:左侧(2·24±0·67) cm,右侧(2·19± 0·73) cm;女性:左侧(2·00±0·23) cm,右侧(1·91±0·13) cm。输尿管髂血管交界处距腰大肌外缘的 距离:男性:左侧(3·91±0·59) cm,右侧(3·76±0·53) cm;女性:左侧(3·43±0·31) cm,右侧(3·85± 0·43) cm。　结论　临床上选择髂嵴上2 cm腰下三角顶点作为后腹腔镜手术第1穿刺点,第12肋缘 下2 cm腋后线作为第2穿刺点,第12肋缘下2 cm水平腋前线作为第3穿刺点可以避免损伤腹壁的 血管和神经,易于到达肾脏及输尿管,有其解剖学的理论基础。

【关键词】　解剖学,局部;　外科手术;　腹腔镜检查 

【Abstract】　Objective　To discover the anatomical basis of retroperitoneoscopic surgery.　Methods Twenty Chinese adult cadavers including 12 and 8 woman were anatomized. The relationship between nerves, vessels of the lateral abdominal wall, retroperitoneal structures and the path of retroperitoneoscopic surgery were measured.　Results　In male cadavers, the distance between the iliac crest and trigonum lumbale was 4·02± 1·26 cm on the left, and 3·83±0·90 cm an the right. The distance between the iliac crest and iliohypogastricus nerve was 0·82±0·13 cm on the left and 0·84±0·08 cm on the right.The distance between the subcostal nerve andⅫrib in the posterior axillary line and midaxillary line was 0·79±0·26 cm, 1·65±1·12 cm on the left and 0·78±0·30 cm,1·59±1·07 cm on the right respectively. The distance between the ureter of inferior pole of kidney and extra-border of psoas was 2·24±0·67 cm on the left and 2·19±0·73 cm on the right. The distance between crossing of the ureter and iliac vessels and extra-border of psoas was 3·91±0·59 cm on the left and 3·76±0·53 cm on the right. In female cadavers,the distance between the iliac crest and trigonum lumbale was 3·90±0·37 cm on the left and 3·87±0·37 cm on the right. The distance between the iliac crest and iliohypogastricus nerve was 0·94±0·06 cm on the left and 0·93±0·10 cm on the right.The distance between the subcostal nerve andⅫrib in the posterior axillary line and midaxillary line was 0·61±0·14 cm and 1·37±0·89 cm on the left and 0·64±0·13 cm, 1·32±0·95 cm on the right respectively·The distance between the ureter of inferior pole of kidney and extra-border of psoaswas 2·00±0·23 cm on the left and 1·91±0·13 cm on the right· The distance between crossing of the ureter and iliac vessels and extra-border of psoas was 3·43±0·31 cm on the left and 3·85±0·43 cm on the right.　Conclusions　The top of the trigonum lumbale which is 2 cm above the iliac crest selected as the first point and 2 cm inferior to theⅫrib in the posterior axillary line selected as the second point is the anatomical basis for retroperitoneoscopic surgery. It can reduce the opportunityto injury nerves, vessels and retroperitoneal structures while making retroperitoneoscopic surgery easy.

【Key words】　Anatomy, regional;　Surgical proccdures, operative;　Laparoscopy 　

后腹腔镜技术对腹膜后器官的手术具有其独到 的优势,近年来,该技术无论是在国内或是国外都得 到了迅速发展。为使该技术进一步开展,我们进行 了后腹腔镜进路的应用解剖学研究。报告如下。

材料与方法

选择国人成人尸体20具,其中男性12具,女性 8具。对其侧腹壁后腹腔镜入路的解剖学标志,后 腹腔镜入路与侧腹壁肋缘下血管、神经和髂腹下神 经走行之间的关系,后腹腔镜入路与后腹膜脏器、腰 大肌、输尿管间的关系进行测量。

结果

后腹腔镜入路各解剖学标志之间距离测量结 果:(1)髂嵴距腰下三角顶点的距离;(2)肾脏下缘距 腰下三角顶点的距离;(3)髂腹下神经在腋后线、腋 中线、腋前线距肋缘下的距离;(4)髂腹下神经距髂 嵴的距离;(5)肋下神经在腋后线和腋中线距肋缘下 的距离;(6)后腹腔(人为定义为自膈脚至小骨盆入 口处)的长度和最大宽度;(7)输尿管在肾下极水平 及髂血管交界处距腰大肌外缘的距离;(8)为第二穿 刺点(选择腋后线12肋下缘下方2 cm)至肾脏的距 离见表1。