腹腔镜胃肠外科相关筋膜的解剖学研究

Based on findings that there were fascial spaces extending in all directions around mesorectum and mesogastrium, we try to explore fascial spaces around and in mesenteries of abdominal alimentary canals, as well as landmarks of these natural surgical spaces for laparoscopic gastrointestinal surgery. Close anatomical relations between presacral fascia and hypogastric nerve, between prerenal fascia and abdominal aortic plexus were observed and gave rise to our proposal of hypothesis of histological relations between transverse fascial system and abdominal autonomic nerves. Anatomical relations between transverse fascial system and vascular sheaths of gastrointestinal vessels were also presumed base on primary observation. Cadavers of fetuses and adults, image database of visual human, radiological database of healthy persons, patients undergoing laparoscopic gastrointestinal surgery will be studied by morphological methods of gross anatomy, sheet plastination sectional anatomy, histology, iconography, as well as laparoscopy; to clarify laparoscopic topography of fusion fascial spaces and intramesenteric spaces; and to evaluate anatomical and histological relations of transverse fascial system to autonomic nerves, and to vascular sheath of gastrointestinal vessels. As key theory of Anatomy of Laparoscopic Gastrointestinal Surgery, advancement of theory of fascial anatomy may improve surgical and training practice, as well as further exploration of three dimentional reconstruction of laparoscopic gastrointestinal operation.

我们已经证明直肠和胃系膜周围存在相互交通的筋膜间隙；那么，这些间隙在腹部消化管系膜周围和内部如何分布？存在哪些标志指引我们鉴定这些腹腔镜胃肠手术的天然外科间隙呢？我们发现骶前筋膜和腹下神经、肾前筋膜和腹主动脉丛之间密切的解剖学联系，并首次提出腹横筋膜系统与腹部自主神经之间存在组织学联系的假说。我们根据初步观察结果，推测腹横筋膜系统与胃肠血管鞘之间可能存在解剖学联系。为此，本项目拟采取大体解剖学、组织塑化断层解剖学、组织学、影像学和腹腔镜等形态学手段；观察胎儿和成人尸体、可视人数据库、体检健康者资料、接受腹腔镜胃肠手术的病人等一系列对象，进一步阐明融合筋膜间隙和系膜内间隙的腔镜下局部解剖学特点；获得腹横筋膜与自主神经、与胃肠血管鞘之间组织学关系的证据，从新的角度审视腹横筋膜的功能。充实筋膜解剖这一《腹腔镜胃肠外科解剖学》的关键理论，指导腹腔镜胃肠手术的实施、培训和进一步的数字化三维重建。