解剖学课件16胸壁肺及胸膜膈解剖

Unit 19 Thoracic wall、pleura 、lung、diaphragm 胸 壁、肺、胸膜、纵隔 一.Thoracic wall 胸壁 1. Composition组成 Skin皮肤 Superficial and deep fascia浅、深筋膜 Muscles肌 Vessels and nerves血管和神经 1）Muscles肌肉 Intercostales externi肋间外肌 Intercostales interni肋间内肌 作用：提肋助吸气 作用： 降肋助呼气 Intercostales intimi肋间最内肌 External intercostal membrfane肋间外膜 Internal intercostal membrfane肋间内膜 2）Vessels and nerves血管和神经 Posterior intercostal A Intercostal N Intercostal space 肋间隙 Posterior intercostal v. Posterior intercostal a. Intercostal n. 肋间后动脉、肋间后静脉和肋间神经三者的位置关系: 在肋间隙后部：位于肋间隙中间，三者的上、下的排列次序不定。 在肋沟内，自上而下依次为：肋间后静脉、肋间后动脉、肋间神经 。 .胸膜腔穿刺部位: 在肋间隙后部，进针部位应在下位肋的上缘。 在肋间隙前部，进针部位应在肋间隙的中间。 Internal thoracic artery 胸廓内动脉 descends into thorax 1.2cm lateral to edge of sternum, and ends at the sixth costal cartilage by dividing musculophrenic and superior epigastric arteries Musculophrenic A肌膈动脉 superior epigastric A 腹壁上动脉 2.Pleura胸膜 Visceral pleura Parietal pleura mediastinal pleura Diaphragma tic pleura Costal pleura Cupula pleura 1）Partes分部 Two pleural layers continue with each other at root of lung forming closed potential space Contains a small amount pleural fluid Subatmospheri c pressure in it 2）Pleural cavity 胸膜腔 potential spaces of pleural cavity which lungs are not occupied in deep respiration Costodiaphragmatic recess 肋膈隐窝 3） Pleura recesses 胸膜隐窝 Costomediastinal recess 肋纵隔隐窝 Midclavicular lines 锁骨中线 Midaxillary lines腋中线 Scapular line肩胛线 The surface projection of lower border of lung and pleurae Lower border Midclavicular lines Midaxillary lines Scapular line Lungs6th rib 8th rib10th rib Pleura8th rib10th rib12th rib 11th rib 3.Lung 肺 1）Postion 位置 肺位于胸腔内，纵隔两 侧，因心位置偏左，故 左肺狭长，右肺略宽短 2）Features 形态 Apex of lung 肺尖： 伸向颈根部，高出锁骨内侧1/3上方2.5cm Base of lung 肺底：又称膈面 Costal surface肋面 Mediastinal surface纵隔面 肺呈圆锥形，有一尖、一底、两面、三缘 。 纵纵隔面Mediastinal surface中部有长圆形凹陷叫肺 门门，有支气 管、肺动脉、肺静脉、支气管动脉、支 气管静脉、神经和淋巴管出入。 出入肺门的结构被结 缔组织 包绕，构成肺根root of lung 。 肺根内结构的排列： 从前向后:上肺静脉、肺动脉、主支气管。 从上向下: 左肺根：肺动脉、左主支气管、上肺静脉、 下肺静脉。 右肺根：上叶支气管、肺动脉、主支气管、 上肺静脉、下肺静脉。 Hilum of lung肺门 From before backward: V.A. B. From above downward: R.B. A. V. L.A. B. V. Oblipue fissure 斜裂 horizontal fissure水平裂 Superior lobe上叶 Middle lobe中叶 Inferior lobe下叶 Cardiac notch心切迹 Each principal bronchus divides into lobar bronchi (two on the left, three on the right), each of which supplies a lobe of lung. Each lobar bronchus then divided into segmental bronchi, which supply specific segments of the lung. Bronchial tree 主支 气管（ 一级支气管）肺 叶支气管（二级支 气管）肺段支气 管（三级支气管） 。 每个肺段支 气管及其所属的肺 组织，称为支气管 肺段，简称肺段 Segments of lung 。 3. Bronchial tree支气管树 尖段 后段 前段 外侧段 内侧段 尖（上）段 内侧底段 前底段 外侧底段 后底段 尖后段 前段 上舌段 下舌段 尖（上）段 前内底段 外侧底段 后底段 上叶 中叶 下叶 上叶 下叶 外侧底段 外侧底段 Vessels OF lung Pulmonary A Pulmonary V Diaphragm Sternal part Costal part Lumbar part Central tendon Lumbocostal triangle Sternocostal triangle Shape Aortic hiatus Esophageal hiatus Vena cava foramen Openings in the diaphragm T8 T10 T12 Contraction: the dome moving downward, increases the volume of thoracic cavity which results in inspiration, at the same time the intra- abdominal pressure is increased assists in defe