作者：陈仕才

单位：广州医科大学附属肿瘤医院胃肠肿瘤外科，广东 广州 510095

Authors: Chen Shicai

Unit: Department of Gastrointestinal Tumor Surgery, Affiliated Cancer Hospital and Institute of Guangzhou Medical University, Guangzhou 510095, Guangdong, China

摘要：

我们在前期研究中率先提出了腹膜退缩理论以区别于有100多年历史的腹膜融合理论，去除了融合筋膜的困扰，大大简化了对腹部筋膜与层面的认识；并以Toldt筋膜为例说明了肠系膜黏附区域的典型结构，即结肠固有筋膜-系膜筋膜平面-Toldt筋膜（腹膜外筋膜）-筋膜后平面-Gerota筋膜。然而，肠系膜不同区域的黏附方式并不完全相同。本文以大网膜为例，结合Toldt筋膜阐明了腹膜融合理论仍存在的一些疑问，并在明确游离肠系膜基本结构的前提下提出了不同肠系膜区域的两种黏附方式，包括厚实区域的黏附方式（对抗作用）及菲薄区域的黏附方式（吸附作用），从而更合理地解释腹部不同部位筋膜与层面的形成过程。

关键词： 腹膜退缩理论；肠系膜；腹膜外筋膜；大网膜

Abstract：

In our previous research, we have first proposed the peritoneum retreat theory to distinguish from the peritoneum fusion theory with a history of over 100 years. Due to the removal of the confusion caused by fusion fascia, the understanding of abdominal fasciae and layers has been greatly simplified. And taking Toldt’s fascia as an example, the typical histological structures of the mesenteric adhesion area is explained, including the fascia propria of the mesentery, mesofascial plane, Toldt’s fascia (extraperitoneal fascia), retrofascial plane, and Gerota fascia. However, the adhesion mode of different areas of the mesentery is not completely the same. This article takes the greater omentum as an example and combines it with Toldt’s fascia to illustrate some of the remaining doubts in the peritoneum fusion theory. Based on a clear understanding of the basic structure of the free mesentery, two types of adhesion modes are proposed for different mesenteric regions, including the adhesion mode in thick areas (antagonistic effect) and the adhesion mode in thin areas (adsorption effect), in order to more reasonably explain the formation process of fasciae and layers in different location of the abdomen.

Key Words:  Peritoneum retreat theory; Mesentery; Extraperitoneal fascia; Greater omentum