| Objective: The purposes of this study were to explore the patterns and pathways of diseases spreading around the perirenal spaces and the perivascular central retroperitoneum and determine the anatomy of communication along the medial border of the perirenal spaces, to strive for making clear the medial attachment positions of the posterior renal fasciae, and to go into more details about clarifying the relations between the inside of perirenal spaces and the psoas muscles.Materials and Methods: From October 1999 to November 2001, two hundred patients undergoing spiral CT scanning were subjected in accordance with selected standards. All patients received routine CT scanning and 29 of them got contrast enhanced CT scanning. Routine CT scanning was carried out ranging from diaphragm to pelvic entrance, sometime suitable CT scan range was added in line with clinical need. Focal observation: ①To determine whether the bilateral anterior renal fasciae continue across the midline and where the continuing levels were? and how many ratios of those various levels were? ②To notice the pattern and pathway of disease spreading around the perirenal space and the perivascular central retroperitoneum. ③prerenal fascial plane plays which roles in the diseases between the spread of the perirenal space and the perivascular central retroperitoneum. ④to observe the relations between the perirenal spaces and the psoas muscles, ⑤to observe the medial attachment position of the posterior renal fasciae on the various levels.⑥to review the relations between the perirenal space bridging septum and the occurrence and development of the diseases.Results: Below the superior mesentenc artery plane, there were 59 of 200 cases (29.5%) had continuation between bilateral prerenal fasciae (or prerenal interfascial plane) crossing the midline, but not above it. Only 18 of them had truly involved bilateral perireanal space and the great vascular area in the central retroperitoneum. Fifty of 200 patients (25%) who could be made sure the medial attachment points of the retrorenal fasciae had been observed on the superior pole of kidney plane, renal hilum plane (left renal vein plane) and inferior pole of kidney plane. We found that the medial attachment points of the retrorenal fasciae were on the lower diaphragmatic surface or at the foots of the diaphragm over the superior pole of kidney plane, and at the quadratus lumborum muscle on the renal hilum plane (left renal vein plane) or below the inferior pole of kidney plane, and no cases were at the psoas major muscles There were also 15 of 200 cases (7.5%) involved the same side perirenal space and psoas muscle Among them there were 10 cases of which came from the perirenal space, and 5 cases from the psoas major muscle. Furthermore, there were 64 of 200 patients (32%) (adding up to 86 sides of ) suffering from the diseases in the perirenal spaces (including 22 cases involved the bilateral perirenal spaces at the same time,) who had been observed, and 48 patients (total 67 sides) could been seen the thickened bridging septum in the penrenal spaces. In addition, twenties cases with abundant fat and without lesions in or around the perirenal spaces were selected in this study to observe the normal bridging septum in the perirenal spaces, which were seen and usually 1-2mm thick, a little slighter than the normal renal fasciae.Conclusion. Across the midline prerenal fasciae(or prerenal interfascial plane) may have part connection below the renal tula plane, but not above it The prerenal interfascial plane plays an important role in the diseases between the spread of the perirenal space and the perivascular central retroperitoneum. The insides of the retrorenal fasciae attached at the quadratus lumborurn muscle, and not at the psoas major muscle. Therefore, between the psoas majormuscle and the perirenal space had no renal fasciae to segregate. The spread of perirenal disease between the perirenal space and the peri vascular central retroperitoneum is less, but mainly depe... |
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