Mirilas Petros, Skandalakis John E
Centers for Surgical Anatomy and Technique, Emory University School of Medicine, Atlanta, Georgia 30322, USA.
Am Surg. 2010 Jan;76(1):33-42.
The extraperitoneal space extends between peritoneum and investing fascia of muscles of anterior, lateral and posterior abdominal and pelvic walls, and circumferentially surrounds the abdominal cavity. The retroperitoneum, which is confined to the posterior and lateral abdominal and pelvic wall, may be divided into three surgicoanatomic zones: centromedial, lateral (right and left), and pelvic. The preperitoneal space is confined to the anterior abdominal wall and the subperitoneal extraperitoneal space to the pelvis. In the extraperitoneal tissue, condensation fascias delineate peri- and parasplanchnic spaces. The former are between organs and condensation fasciae, the latter between this fascia and investing fascia of neighboring muscles of the wall. Thus, perirenal space is encircled by renal fascia, and pararenal is exterior to renal fascia. Similarly for the urinary bladder, paravesical space is between the umbilical prevesical fascia and fascia of the pelvic wall muscles-the prevesical space is its anterior part, between transversalis and umbilical prevesical fascia. For the rectum, the "mesorectum" describes the extraperitoneal tissue bound by the mesorectal condensation fascia, and the pararectal space is between the latter and the muscles of the pelvic wall. Perisplanchnic spaces are closed, except for neurovascular pedicles. Prevesical and pararectal (presacral) and posterior pararenal spaces are in the same anatomical level and communicate. Anterior to the anterior layer of the renal fascia, the anterior interfascial plane (superimposed and fused mesenteries of pancreas, duodenum, and colon) permits communication across the midline. Thus parasplanchnic extraperitoneal spaces of abdomen and pelvis communicate with each other and across the midline.
腹膜外间隙位于腹膜与腹前、外侧及后壁和盆腔壁肌肉的包绕筋膜之间，呈环形围绕腹腔。腹膜后间隙局限于腹后壁和外侧壁以及盆腔壁，可分为三个外科解剖区域：中央内侧区、外侧区（左右两侧）和盆腔区。腹膜前间隙局限于腹前壁，而盆腔的腹膜下间隙则为腹膜外间隙。在腹膜外组织中，致密筋膜界定了脏周间隙和脏旁间隙。前者位于器官与致密筋膜之间，后者位于该筋膜与相邻腹壁肌肉的包绕筋膜之间。因此，肾周间隙被肾筋膜所环绕，肾旁间隙位于肾筋膜外侧。膀胱的情况类似，膀胱旁间隙位于脐膀胱前筋膜与盆腔壁肌肉的筋膜之间——膀胱前间隙是其前部，位于腹横筋膜与脐膀胱前筋膜之间。对于直肠，“直肠系膜”描述了由直肠系膜致密筋膜所包绕的腹膜外组织，直肠旁间隙位于该筋膜与盆腔壁肌肉之间。除神经血管蒂外，脏周间隙是封闭的。膀胱前间隙、直肠旁（骶前）间隙和肾旁后间隙处于同一解剖层面且相互连通。在肾筋膜前层前方，筋膜前间隙平面（胰腺、十二指肠和结肠的重叠融合系膜）允许跨中线连通。因此，腹盆腔的脏旁腹膜外间隙相互连通且可跨中线连通。
