课件：纵隔断层解剖.ppt

,2019,-,1,纵 隔 断 层 解 剖纵 隔 断 层 解 剖 Sectional anatomy of mediastinum,山东大学解剖学教研室 刘菲,2019,-,2,summary,concept： 左、右纵隔胸膜间的器官、结构和结缔组织的总称。 Position & boundaries: 位于胸腔正中偏左、分隔左、右胸膜囊和肺。 前界为胸骨和肋软骨内侧部分后方为脊柱胸段，两侧为纵隔胸膜，上为胸廓上口、下为膈。,2019,-,3,Sup.,Inf.,Ant.,Mid.,Pos.,Sternal angle,Manubrium sterni,diaphragm,2019,-,4,Sympathetic trunk,Azygos V.,Vagus N.,esophagus,diaphragm,Sup.vena cava,R.P.A.,R.P.V.,pericardium,R.Principal bronchus,2019,-,5,Vagus N.,L.P.V.,pericardium,L.Principal bronchus,diaphragm,L.P.A.,Phrenic N.,thymus,Aortic arch,L.Subclavian A.,Thoracic aorta,2019,-,6,superior mediastinum：,由前向后大致可分为五层： 第一层为胸腺 第二层左、 右头臂静脉和上腔静脉 第三层有主动脉弓及其三大分支、膈神经和迷走神经 第四层为气管 第五层为食管,2019,-,7,2019,-,8,inferior mediastinum （1） anterior mediastinum：有胸腺下部、胸膜囊前部、纵隔前淋巴结、 胸骨心包韧带及疏松结缔组织。,2019,-,9,inferior mediastinum （2）middle mediastinum ：有心包、心及出入心的大血管根部、奇静脉弓等。,2019,-,10,（3）posterior mediastinum,位于心包后壁与下位8个胸椎之间，上平胸骨角，下达膈。 其内纵行排列的器官有主支气管、食管胸部、胸主动脉、胸导管、奇静脉，半奇静脉、副半奇静脉、迷走神经，胸交感干等。,2019,-,11,2019,-,12,2019,-,13,2019,-,14,Manubrium sterni,Sup.vena cava,pericardium,R.auricle,L.auricle,Ascending aorta,Aortic arch,R.ventricle,L.ventricle,R.,L.brachiocephalic V.,2019,-,15,Sup.vena cava,pericardium,Ascending aorta,R.ventricle,L.ventricle,R.auricle,Pulmonary trunk,L.Subclavian A.,L.C.carotid A.,Brachiocephalic trunk,aorticopulmonary window,2019,-,16,Coronary sinus,Middle cardiac V.,Small cardiac V.,great cardiac V.,L.atrium,2019,-,17,Pos.view of heart,aorticopulmonary window,2019,-,18,Transvers sinus ,Oblique sinus .,2019,-,19,房间隔和室间隔,室间隔可分为膜部和肌部,室间隔膜部,肌部,2019,-,20,The transvers section of mediastinum,2019,-,21,Transverse section through venous angles,E,A,A,A,T,RBV,LBV,2019,-,22,2019,-,23,Transverse section through sternoclavicular joint,E,LBV,A,A,A,T,RBV,2019,-,24,2019,-,25,Transverse section through 1th. Sternocostal synochodrosis,E,A,A,A,T,LBV,RBV,2019,-,26,2019,-,27,2019,-,28,Transverse section through sup. part of aortic arch,E,RBV,A,A,A,T,LBV,2019,-,29,血管前间隙,气管前间隙,2019,-,30,Transverse section through aortic arch,E,SVC,AA,T,2019,-,31,2019,-,32,2019,-,33,胸骨角平面的标志意义： 1.通过第二胸肋关节； 2.为上、下纵膈的分界线； 3.向后平对第4胸椎下缘； 4.平对主动脉弓的起端和止端； 5.气管杈出现，左主支气管与食管相交，食管的第二个狭窄； 6.奇静脉与奇静脉弓出现，向前汇入上腔静脉； 7.主动脉肺动脉窗出现； 8.胸导管由右转向左行；,2019,-,34,Transverse section through aorticopulmonary window,E,AV,SVC,a a,TA,T,2019,-,35,主动脉肺动脉窗： 左外侧界为纵膈胸膜； 内侧界为气管； 前方为主动脉升部； 后方为食管和主动脉胸部； 此区内含有：动脉韧带，动脉韧带淋巴结（左下气管旁Ln或弓下Ln）和左喉返神经,2019,-,36,2019,-,37,Transverse section through L.pulmonary A.,LPB,E,SVC,a a,LPA,TA,AV,RPB,2019,-,38,2019,-,39,Transverse section through R.pulmonary A.,E,SVC,a a,LPA,RPA,TA,RPB,LPB,PT,2019,-,40,2019,-,41,Transverse section through L.auricle,E,SVC,a a,RPA,TA,RPB,LPB,PT,心包横窦,2019,-,42,心包横窦： 为心包腔在主动脉、肺动脉后方与上腔静脉、左心房前壁前方间的间隙。窦的前壁为主动脉、肺动脉；后壁是上腔静脉和左心房；上为右肺动脉；下面为房室间的浆膜返折。,2019,-,43,2019,-,44,Transverse section through R. sup.pulmonary V.,E,V,V,A,RV,LA,SVC,a a,RPA,RPB,V,2019,-,45,2019,-,46,Transverse section through R. inf.pulmonary V.,E,TA,RV,LA,a a,2019,-,47,2019,-,48,Transverse section through aortic orifice,E,RV,LA,RA,A O,TA,2019,-,49,2019,-,50,Transverse section through fossa ovalis,E,RV,LV,LA,RA,TA,心包斜窦,2019,-,51,心包斜窦：位于左心房后壁，左右肺静脉，下腔静脉与心包后壁之间的心包腔。手术需要阻断下腔静脉血流时，可经斜窦下部进行。,2019,-,52,2019,-,53,2019,-,54,Transverse section through 8th thoracic vertebra,E,RV,LV,LA,RA,TA,2019,-,55,2019,-,56,Transverse section through coronary sinus,E,IVC,RV,LV,TA,冠状窦,2019,-,57,2019,-,58,Transverse section through sup.part of 9th thoracic vertebra,E,IVC,RV,LV,TA,2019,-,59,2019,-,60,Transverse section through cardiac apex,E,IVC,RV,TA,2019,-,61,2019,-,62,Transverse section through second porta hepatis,E,IVC,RV,TA,2019,-,63,心脏四个腔的识别： 左心房：位于食管前方 右心房：上腔静脉向下延续 右心室：肺动脉干向下延续 左心室：与升主动脉相连,2019,-,64,Doppler ultrasound of heart,2019,-,65,A,L,R,P,E,2019,-,66,A,L,R,P,E,2019,-,67,A,L,R,P,E,2019,-,68,A,L,R,P,E,2019,-,69,A,L,R,P,E,2019,-,70,A,L,R,P,2019,-,71,A,L,R,P,E,2019,-,72,2019,-,73,纵隔淋巴结断层解剖,2019,-,74,纵隔淋巴结断层解剖,纵隔淋巴结 在CT上表现为纵隔内一定部位内出现的无强化的软组织密度影，多呈圆或椭圆形。 在CT上正确认识纵隔淋巴结 对于肺癌术前的分期诊断有重要的意义。,2019,-,75,纵隔淋巴结分区,目前分区多采用美国胸科学会肺淋巴结图（AST）。 分区主要为： “一竖、四横、一斜”,2019,-,76,竖线指气管的正中垂线，区分左右Ln群 第1条横线为经主动脉弓上缘的水平线，区分上方的2区和下面的4区 第2条横线为经奇静脉弓上缘的水平线，区分右侧的4R和10R区 第3条横线为经气管隆嵴上缘的水平线，区分4L和10L 第4条横线为经左肺下叶支气管起始部的水平线，区分7区和11L 斜线为自右肺上叶支气管起始部斜向右上的线，为10R和11R的分界,2019,-,77,2L and 2R：左、右上气管旁Ln 3A and 3P:血管前Ln和气管后Ln 4L and 4R：左、右下气管旁Ln 5：主动脉肺Ln 6：前纵膈Ln 7：隆嵴下Ln 8：食管旁Ln 9：肺韧带Ln 10L and 10R：左支气管旁Ln，右气管支气管Ln 11：肺内Ln,2019,-,78,右上气管旁L,左上气管旁L,右下气管旁L,左下气管旁L,右气管支气管L,左支气管旁L,左肺内L,右肺内L,隆嵴下L,8区 食管旁L,X区 锁骨上L,肺韧带L,6区 前纵隔L未显示,2019,-,79,主动脉肺L,前纵隔L 6区,2019,-,80,肺癌的淋巴转移分三站：,N1 为10、11区； N2 为29区； N3 为远处淋巴结。 一般认为第10区和第4区是预测肺癌可切除性和生存率的关键部位。,2019,-,81,后面内容直接删除就行 资料可以编辑修改使用 资料可以编辑修改使用 资料仅供参考，实际情况实际分析,感谢您的观看和下载,The user can demonstrate on a projector or computer, or print the presentation and make it