Culligan Kevin, Walsh Stewart, Dunne Colum, Walsh Michael, Ryan Siobhan, Quondamatteo Fabio, Dockery Peter, Coffey J Calvin
*Department of Surgery, Centre for Interventions in Infection, Inflammation and Immunity (4i), Graduate Entry Medical School, University Hospitals Group Limerick, Limerick, Ireland †Department of Mechanical, Aeronautical and Biomedical Engineering and the Materials and Surface Science Institute, University of Limerick, Limerick, Ireland ‡Skin and Extracellular Matrix Research Group at Anatomy Unit, School of Medicine and §Anatomy Unit, School of Medicine, National University of Ireland Galway, Galway, Ireland; and ¶Department of Surgery, University Hospital Limerick, Graduate Entry Medical School, University of Limerick, Limerick, Ireland.
Ann Surg. 2014 Dec;260(6):1048-56. doi: 10.1097/SLA.0000000000000323.
Colonic mobilization requires separation of mesocolon from underlying fascia. Despite the surgical importance of planes formed by these structures, no study has formally characterized their microscopic features. The aim of this study was to determine the histological and electron microscopic appearance of mesocolon, fascia, and retroperitoneum, prior to and after colonic mobilization.
In 24 cadavers, samples were taken from right, transverse, descending, and sigmoid mesocolon. In 12 cadavers, specimens were stained with hematoxylin and eosin (3 sections) or Masson trichrome (3 sections). In the second 12 cadavers, lymphatic channels were identified by staining immunohistochemically for podoplanin. The ascending mesocolon was assessed with scanning electron microscopy. The above process was first conducted with the mesocolon in situ. The mesocolon was then surgically mobilized, and the process was repeated on remaining structures.
The microscopic structure of mesocolon and associated fascia was consistent from ileocecal to mesorectal level. A surface mesothelium and underlying connective tissue were evident throughout. Fibrous septae separated adipocyte lobules. Where apposed to retroperitoneum, 2 mesothelial layers separated mesocolon and underlying retroperitoneum. A connective tissue layer occurred between these (ie, Toldt's fascia). Lymphatic channels were evident both in mesocolic connective tissue and Toldt's fascia. After surgical separation of mesocolon and fascia both remained contiguous, the fascia remained in situ and the retroperitoneum undisturbed.
The findings demonstrate that the contiguous mesocolon and retroperitoneum are separated by mesothelial and connective tissue layers. These properties generate the surgical planes (ie, meso- and retrofascial planes) exploited in colonic and mesocolic mobilization.
结肠游离需要将结肠系膜与深层筋膜分离。尽管这些结构形成的平面在手术中很重要，但尚无研究正式描述其微观特征。本研究的目的是确定结肠游离前后结肠系膜、筋膜和腹膜后的组织学及电子显微镜下表现。
在24具尸体中，从右半结肠、横结肠、降结肠和乙状结肠系膜取材。在12具尸体中，标本用苏木精和伊红染色（3个切片）或马松三色染色（3个切片）。在另外12具尸体中，通过免疫组织化学染色检测足板蛋白来识别淋巴管。用扫描电子显微镜评估升结肠系膜。上述过程首先在结肠系膜原位进行。然后通过手术游离结肠系膜，对其余结构重复该过程。
从回盲部到直肠系膜水平，结肠系膜和相关筋膜的微观结构是一致的。整个区域可见表面间皮和下方的结缔组织。纤维间隔将脂肪小叶分开。在与腹膜后相邻处，两层间皮将结肠系膜与下方的腹膜后分开。两者之间有一层结缔组织（即Toldt筋膜）。淋巴管在结肠系膜结缔组织和Toldt筋膜中均可见。手术分离结肠系膜和筋膜后，两者仍相邻，筋膜仍在原位，腹膜后未受干扰。
研究结果表明，相邻的结肠系膜和腹膜后被间皮和结缔组织层分隔。这些特性形成了结肠和结肠系膜游离术中所利用的手术平面（即系膜和筋膜后平面）。
