生理学报告2走近阑尾剖析.ppt

阑尾,周二11组 许涵濛 易澍,外科医生躺在一张临时搭出来的竹床上，他的妻子坐在旁边的藤椅里，他们的两个孩子，我哥哥和我，并肩坐在一条长凳上，听我们的父亲在说每个人肚子里都有的那一条阑尾，他说他每天最少也要割掉二十来条阑尾，最快的一次他只用了十五分钟，十五分钟就完成了一次阑尾手术，将病人的阑尾唰地一下割掉了。 我们问，割掉以后怎么办呢？ “割掉以后？”我父亲挥挥手说，“割掉以后就扔掉。” “为什么扔掉呢？” 我父亲说：“阑尾一点屁用都没有。” 我父亲看了我一会，说：“你说得也对，你们说得都对，肺，胃，心脏，还有十二指肠，结肠，大肠，直肠什么的都有用，就是这阑尾，这盲肠末端上的阑尾你们知道阑尾有什么用？” 我哥哥抢先学父亲的话说了，他说：“阑尾一点屁用都没有。”,The appendix (or vermiform appendix; also cecal or caecal appendix; vermix; or vermiform process) is a blind-ended tube（盲管） connected to the cecum（盲肠）, from which it develops embryologically. The cecum is a pouchlike structure（囊袋状结构） of the colon（结肠）, located at the junction of the small and the large intestines（大肠和小肠）. The term “vermiform“ （蠕虫状的）comes from Latin and means “worm-shaped“.,The appendix was first depicted in Western medicine by Leonardo Da Vinci in his dissection sketches in 1492. A valve for the cecum?,所处位置 location,The appendix is usually located in the lower right quadrant of the abdomen（下腹）, near the right hip bone（髋骨）. The base of the appendix is located 2 cm beneath the ileocecal valve（回盲瓣） that separates the large intestine from the small intestine. Its position within the abdomen corresponds to a point on the surface known as McBurneys point（麦氏点）.,umbilicus脐 anterior superior iliac spine髂前上棘,While the base of the appendix is at a fairly constant location2 cm below the ileocecal valve, the tip of the appendix can be variably locatedin the pelvis（骨盆）, outside the peritoneum（腹膜） or behind the cecum.,The human appendix averages 9 cm in length but can range from 2 to 20 cm. The diameter of the appendix is usually between 7 and 8 mm.,结构 structure“酒坛子”,到了晚上睡觉的时候，我们经常听到他埋怨我们的母亲，他说： “说起来你给我生了两个儿子，其实你是生了两条阑尾，平日里一点用都没有，到了紧要关头害得我差点丢了命。”,Although it has been long accepted that the immune tissue surrounding the appendix and elsewhere in the gutcalled gut associated lymphoid tissue（肠道相关淋巴组织）carries out a number of important functions, explanations were lacking for the distinctive shape of the appendix and its apparent lack of specific importance and function as judged by an absence of side effects following its removal. Therefore, the notion that the appendix is only vestigial（退化的，残余的） became widely held.,Maintaining gut flora 肠道菌群的避难所,William Parker, Randy Bollinger, and colleagues at Duke University proposed in 2007 that the appendix serves as a haven for useful bacteria when illness flushes those bacteria from the rest of the intestines. This proposal is based on a new understanding of how the immune system supports the growth of beneficial intestinal bacteria, in combination with many well-known features of the appendix, including its architecture, its location just below the normal one-way flow of food and germs in the large intestine, and its association with copious amounts of immune tissue. Research performed at Winthrop University-Hospital showed that individuals without an appendix were four times more likely to have a recurrence of Clostridium difficile colitis(梭菌结肠炎),The appendix, therefore, may act as a “safe house” for commensal (“good”) bacteria. This reservoir of gut flora could then serve to repopulate the digestive system following a bout of dysentery（痢疾，腹泻） or cholera（霍乱）.,The appendix has more recently been identified as an important component of mammalian mucosal immune function（哺乳动物的黏膜免疫功能）, particularly B-lymphocyte-mediated（由B淋巴细胞介导的） immune responses and extrathymically derived T-lymphocytes（胸腺外起源的T淋巴细胞）. This structure helps in the proper movement and removal of waste matter in the digestive system, contains lymphatic vessels（淋巴管） that regulate pathogens（病原体）, and lastly, might even produce early defences that prevent deadly diseases. Additionally, it is thought that this may provide more immune defences from invading pathogens and getting the lymphatic systems B and T-cells to fight the viruses and bacteria that infect that portion of the bowel（肠） and training them, so that immune responses are targeted and more able to reliably and less dangerously fight off pathogens.,Lymphatic system 免疫系统的一部分,常见阑尾疾病急性阑尾炎,临床表现 常见病因 并发症 目前主要治疗方法,1、急性阑尾炎临床表现,腹痛：典型的急性阑尾炎早期阶段为中上腹和脐周疼痛，疼痛感较弥散，常常不能确切定位，但数小时后腹痛转移并固定于右下腹。 胃肠道症状：在早期可能由于反射性胃痉挛而有恶心、呕吐等症状。 多数病人白细胞和嗜中性粒细胞计数增高。 （细菌感染）,1.梗阻 阑尾为一细长的盲管，梗阻会使管腔内压增高，压迫阑尾壁阻碍血液向远端运输，致使阑尾粘膜受损。在此基础上管腔内细菌侵入受损部位，引发感染。 2.感染 阑尾腔因与盲肠相通，因此具有较多的大肠杆菌和厌氧菌。若阑尾黏膜稍有损伤，细菌侵入管壁，引起不同程度的感染。,2、急性阑尾炎常见病因（1）,3.胃肠功能障碍 胃肠道功能障碍引起内脏神经反射，导致阑尾肌肉和血管痉挛，若超过正常强度，可以产生阑尾管腔狭窄、血供障碍、黏膜受损，细菌入侵而致急性炎症。 4、其他因素 饮食习惯、遗传因素等,2、急性阑尾炎常见病因（2）,3、急性阑尾炎并发症,1.腹膜炎