摘要
目的 探讨俯卧位背侧入路腹腔镜肾上腺手术操作中寻找“血管路标”和构建“系膜页脊”的解剖理念运用。方法 回顾性分析2022年9月-2025年3月大理大学第一附属医院泌尿外科收治62例行俯卧位背侧入路腹腔镜手术患者的术中腹腔镜视频资料及围手术期指标。从视频中作总结:先游离显露膈下肾上腺区域的术野;然后寻找以膈下静脉(左侧)和下腔静脉(右侧)作为“血管路标”的解剖标识,游离出腺体内侧面;游离腺体外侧面并于外侧面分辨游离肾上腺下方层面,然后利用解剖标识回找并显露中央静脉;游离出腺体的腹膜面至腺体内侧的血管缘,构建出以腺体的“梳状血管”样动脉弓网及中央静脉组成的“系膜页脊”;最后行肾上腺全切或部分切除。结果 本组患者均顺利完成手术,无术中术后并发症,其中手术时间(32.48±6.02)min,术中失血量15(10~25 mL),术后住院时间3(3~4 d)。结论寻找“血管路标”和构建“系膜页脊”的解剖理念运用为俯卧位背侧入路腹腔镜肾上腺手术方式提供了流程化参考,利于术式优化及手术质量提高。
Objective To explore the application of anatomical concepts for searching for"vascular landmarks"and constructing"mesenteric ridge"during prone dorsal approach laparoscopic adrenalectomy.Methods A retrospective analysis was conducted on 62 patients who underwent prone dorsal approach laparoscopic surgery in the First Affiliated Hospital of Dali University from Sep.2022 to Mar.2025.Intraoperative laparoscopic video data and perioperative indicators were reviewed.From the videos,summaries were made as follows:First,exposed the surgical field of subdiaphragmatic adrenal region by dissection.Then,identified the anatomical landmarks using inferior phrenic vein(left side)and inferior vena cava(right side)as"vascular landmarks,"and dissected the medial aspect of gland.Dissected adrenal gland from lateral side and identified the lower plane of adrenal gland on lateral side,then used the anatomical landmarks to relocate and expose central vein.Detached from the peritoneal plane of gland to vascular margin on the inner side of gland,constructing a"mesenteric ridge"composed of an arterial arch network resembling"comb-like blood vessels"on the inner side of gland and central vein.Finally,performed total or partial adrenalectomy.Results All surgeries were successfully completed without intraoperative or postoperative complications.The average operation time was(32.48±6.02)min,intraoperative blood loss was 15(10~25 mL),and postoperative hospital stay was 3(3~4)days.Conclusions The anatomical concepts of identifying"vascular landmarks"and constructing"mesenteric ridges"provide a standardized reference for laparoscopic adrenal surgery via prone dorsal access,facilitating surgical technique optimization and quality improvement.
作者
杨立
肖芝松
郑宝寿
张爱建
李云鹏
李杏杰
Yang Li;Xiao Zhisong;Zheng Baoshou;Zhang Aijian;Li Yunpeng;Li Xingjie(Department of Urology,the First Affiliated Hospital of Dali University,Dali 671000,Yunnan Province,China)
出处
《中国临床解剖学杂志》
北大核心
2026年第1期85-89,共5页
Chinese Journal of Clinical Anatomy
基金
大理大学第一附属医院学科队伍建设项目(DFYZD2024009)。
关键词
俯卧位
腹腔镜
解剖
肾上腺手术
Prone position
Laparoscopy
Anatomy
Adrenal surgery
