通过对腹膜后腔筋膜间隙层面解剖的研究总结,在后腹腔镜根治性肾切除术中寻找安全正确的解剖层面,进行无血化解剖性手术操作,改进游离、切除肾脏的手术技巧。2016年3月~2017年3月收治61例局限性肾癌患者,其中左侧33例,右侧28例;肿瘤直径3.4cm~7.5cm,平均5.6cm。通过寻找显露肾旁前间隙、腰肌前间隙、肾筋膜前叶肾前融合筋膜间隙等无血管平面,实施无血化解剖性肾切除手术。61例手术均获成功,无中转开放手术。手术时间43min~98min,平均61min;出血量30ml~150ml,平均75ml;术后4d~8d出院。7例发生腹膜破裂,5例发生肾上腺腺体轻微撕裂,少量出血,无输血,无其他严重并发症发生。根据腹膜后腔筋膜间隙层面解剖的特点,通过辨认及分离肾旁前间隙、腰肌前间隙、肾筋膜前叶肾前融合筋膜间隙等无血管层面,可充分显露手术空间,在直视下辨别毗邻关系,可无血化解剖性实施手术,术中出血少,避免周围毗邻脏器损伤及大出血等并发症。该方法安全有效、节省时间,值得在临床推广应用。 Through the summary of the anatomy of the interfacial cavities and interspaces, we sought to find safe and correct anatomical planes in retroperitoneal radical nephrectomy, perform the bloodless dissection operation and improve the operation skills of free and excision of the kidneys. From March 2016 to March 2017, 61 patients with localized renal cell carcinoma were treated, including 33 cases on the left and 28 cases on the right. The diameter of the tumor ranged from 3.4cm to 7.5cm with an average of 5.6cm. Aneurysm-free anatomic nephrectomy was performed by finding avascular planes such as the anterior renal plexus space, anterior pyloric space, and the anterior fascia anterior fascicular space. 61 cases were successful surgery, no transit open surgery. Surgery time 43min ~ 98min, an average of 61min; bleeding 30ml ~ 150ml, an average of 75ml; 4d ~ 8d after discharge. Peritoneal rupture occurred in 7 cases, slight tearing of the adrenal gland in 5 cases, a small amount of bleeding, no blood transfusion and no other serious complications. According to the anatomical characteristics of the interfacial cavities, the space of anterior renal parenchyma, anterior pyloric space, anterior renal fascia anterior fascia gap and other avascular planes can fully reveal the surgical space, Under visual identification adjacent to the relationship, non-destructive anatomical implementation of surgery, less bleeding, to avoid adjacent organs adjacent to injury and bleeding and other complications. The method is safe and effective, saving time and is worth popularizing in clinic.