Holistic view of surgery based on membrane anatomy for gastrointestinal tumor / 中华胃肠外科杂志

The mesentery is a continuous unity and the operation of digestive carcinoma is the process of mesenteric resection. This paper attempts to simplify the formation process of all kinds of fusion fascia in the process of digestive tract embryogenesis, and to illuminate the continuity of fusion fascia with a holistic concept. This is helpful for beginners to reversely dissect the fusion fascia and maintain the correct surgical plane during operation, and to achieve the purpose of complete mesenteric resection.

Local anatomical characteristics of complete mesocolic excision in the right hemicolectomy / 中华消化外科杂志

Objective To investigate the local anatomical characteristics of the associated membrane and mesangial space in the complete mesocolic excision (CME) of right hemicolectomy and provide the surgical practical anatomical evidence to CME.Methods The experimental study was conducted.Department of Anatomy of Capital Medical University provided 20 adult cadavers.The surgical pictures came from Beijing Friendship Hospital of Capital Medical University.The local anatomy of CME in 20 cadavers was simulated after fascia perfusion.Observation indicators:(1) the local anatomy of the visceral fascia and parietal fascia was studied by simulating the operation of CME in cadaver specimens;(2) observing the integrity and barrier action of the visceral layer of the membrane after fascia perfusion solution freezing;(3) distribution and variation of superior vessels of rightsemi mesocolon.Results (1) The local anatomy of the visceral fascia and parietal fascia was studied by simulating the operation of CME in cadaver specimens:posterior lobe of the interposition mesocolon merged completely with visceral fascia,parietal fascia and front fascia of duodenum,and superior mesenteric vein (SMV) and superior mesenteric artery (SMA) were found.The ureters and reproductive vessels were covered with Gerota fascia,with a complete membrane structure.The specimens from simulated CME in 20 adult cadavers and CME of right hemicolectomy accorded with a requirement of CME.(2) Observing the integrity and barrier action of the visceral layer of the membrane after fascia perfusion solution freezing:posterior lobe of the right-semi mesocolon merged completely with visceral fascia,with a complete parietal fascia structure and without exudation of fascia perfusion solution.The right ureter and reproductive vessels were completely covered with Gerota fascia.The serosal surface of right-semi mesocolon maintained integity,with exudation of fascia perfusion solution.(3) Distribution and variation of superior vessels of right-semi mesocolon:major blood vessels of right-semi colon included superior mesenteric vessels,including SMA and SMV.The major branches of vessels included ileocolic artery,right colic artery,middle colic artery,right and left branches of middle colic artery,ileocolic vein,middle colic vein and gastrocolic stem.The gastrocolic stem and main stem of right colic artery had more variations.Conclusion The posterior lobe of the interposition mesocolon merges with fascia,and complete visceral fascia,can be separated,these provide anatomical evidences for safety and radical resection of right hemicolectomy based on following the principles of CME.

Study of laparoscopic anatomical features of retroperitoneal cavity around kidney and surgical access for laparoscopy / 中华泌尿外科杂志

Objective To study the anatomical feature s of the retroperitoneal cavity around kidney under laparoscope and to provide ana tomical guidance for laparoscopic surgery. Methods Lapar oscopic renal and ureteral operations were performed on 241 patients (145 men an d 96 women; age range,16-75 years;mean age,45.3 years).Through the videos and ph otographs of these operations,the anatomical features were analyzed.The atlas wa s drawn and surgical access was designed. Results Under laparoscope lateral conal fascia continues from the fascia of quadratus lumborum at its lateral border.This fascia covers posterior lamella of Gerota’s fascia and fuses into transversalis fascia beneath peritoneum. Fusion fascia lies befor e anterior lamella of Gerota’s fascia. It extends laterally and disappears grad ually to the lateral reflexion of peritoneum.The plane between fusion fascia and anterior lamella of Gerota's fascia, the plane between lateral conal fascia and posterior lamella of Gerota’s fascia, the plane before the quadratus lumborum and psoas major, are all vessel-free planes.Lateral border of colon,peritoneum and fusion fascia form a triangle lateral to colon.Fusion fascia,lateral conal f ascia and Gerota’s fascia form a vessel-free triangle. Conclusions Dissection through the vessel-free planes prevents laparoscopic op erations from bleeding and organ injury.Full understanding of the laparoscopic a natomical features of the retroperitoneal cavity around kidney provides the anat omic theoretical basis for laparoscopic operations.