摘要：
目的 研究盆腹壁的内脏及其筋膜关系,为普外科腹腔镜腹膜前疝修补手术及腹腔镜结直肠癌根治术提供应用解剖指导.方法 对西安交通大学医学部解剖教研室提供的10具尸体(男性9具,女性1具),按照腹腔镜手术的方式对腹股沟区腹膜前间隙以及结直肠周围间隙进行解剖和观察.结果肾前筋膜和肾后筋膜在外侧方向包绕精索血管和输精管并以生殖血管和侧锥筋膜为外侧边界,继续向下从内环向外穿出.该筋膜深浅2层共同向内下延续为骶前筋膜,并沿盆侧壁包绕精囊腺和前列腺;该筋膜在脐内侧襞处其浅层向膀胱后壁延伸,其深层向膀胱前壁方向延伸.腹横筋膜在腹壁下动脉两侧是延续的,并继续向腹前壁和腹后壁延伸.通过解离肾后筋膜延续至骶骨前方的筋膜,可将直肠、膀胱、前列腺、精囊腺等器官完整地从骶骨表面揭离.骶骨表面的筋膜与腹横筋膜延续.有骶神经从骶骨表面筋膜穿出,向盆侧壁与盆从汇合.结论 (1)存在1个独立的包绕肾脏、输尿管、输精管、精索血管、腹下神经、精囊腺、前列腺以及膀胱下部的泌尿生殖筋膜系统,生殖血管和侧椎筋膜是其外侧界限,并有一部分筋膜随着生殖血管和输精管穿出内环,左右两侧筋膜至少在髂血管分叉处以下是相互融合连续.(2) Bogros间隙和Retzius间隙是同一个间隙,可统称为腹盆壁内脏间隙.(3)泌尿生殖筋膜将直肠后方与骶骨表面筋膜之间的间隙分为直肠后间隙和骶前间隙.%Objectives To precisely carry out preperitoneal hernia repair and radical surgery of colorectal cancer with laparoscope,we explored the relationship between viscera and their corresponding facias.Methods Preperitoneal space of inguina region and surrounding space of colorectum under the way of laparoscopic surgery were completed in ten cadavers (9 males,1 females),which were from medicine collage of Xi'an Jiaotong University.Results Laterally,the anterior and posterior renal fascia (RF) enveloped spermatic vessels and vas deferens and terminated at the genital vessels and lateral facia.Then the anterior and posterior RF downwardly penetrated the inguinal ring,after which the superficial and deep layers continued as presacral fascia in the inferior and superior.The continued RF enveloped seminal vesical and prostate along lateral pelvic walls.The superficial layer of continued RF expanded to posterior bladder wall passing media umbilical fold.However,the deep layer expanded to anterior bladder wall.Transversalis fascia crossed the back of inferior epigastric artery and expanded to anterior and posterior abdominal wall.Rectum,bladder,prostate and seminal vesical could be separated from sacral surface by stripping the fascia in front of sacrum expanded from posterior RF.The facia lying on the surface of sacrum was continued from transversalis facia.Sacral nerves wore out the surface facia of sacrum and merge to pelvic plexus along lateral pelvic wall.Conclusion (1) There is an independent urogenital facia (UGF) system which envelope kidney,ureter,vas deferens,spermatic vessels,hypogastric nerves,seminal vesicle,prostate and the bottom of bladder.The lateral boundary of the independent facia is genital vessels and lateral facia,in which part of the independent facia penetrate inguinal ring.And the independent facia locating at both sides mix together at least below iliac vessel branch.(2) The Bogros' space and Retzius' space is naturally the same space,which could be termed as viscera-pelvic space.(3) UGF divides the space between retrorectum and transvasalis facia on the sacral surface into retrorectal space and presacral space.
