淋巴系统.ppt

January,2007,CopyrightDepart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG,淋巴系统Lymphaticsystem,兰州大学基础医学院人体解剖学教研室,January,2007,CopyrightDepart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG,全身的淋巴管和淋巴结示意图,January,2007,CopyrightDepart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG,第一部分,淋巴总论,January,2007,CopyrightDepart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG,淋巴系统概论,一、淋巴系统组成二、淋巴的生成及功能三、淋巴回流的因素四、淋巴侧支循环,January,2007,CopyrightDepart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG,一、淋巴系统组成,淋巴管道淋巴组织淋巴器官,January,2007,CopyrightDepart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG,淋巴管道,毛细淋巴管淋巴管淋巴干（9条）淋巴导管（2条）,January,2007,CopyrightDepart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG,毛细淋巴管（lymphaticcapillary）以膨大的盲端起始，互相吻合成毛细淋巴管网，汇入淋巴管。淋巴管（lymphaticvessel）由毛细淋巴管吻合而成，注入淋巴结。其管壁结构与静脉相似，内有瓣膜，可防止淋巴液回流，外观呈串珠样。淋巴管分为浅、深淋巴管两类，之间有丰富的交通。,January,2007,CopyrightDepart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG,淋巴干（lymphatictrunk）由淋巴结发出的淋巴管在膈下和颈根部汇合而成。其包括腰干、支气管纵隔干、锁骨下干、颈干各两条和一条肠干，共九条。淋巴导管（lymphaticduct）淋巴干合成两条淋巴导管，即胸导管和右淋巴导管，分别注入左、右静脉角。,January,2007,CopyrightDepart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG,淋巴干和淋巴导管,January,2007,CopyrightDepart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG,淋巴组织,弥散淋巴组织（消化道和呼吸道粘膜固有层）淋巴小结（肠壁的淋巴滤泡;阑尾壁内淋巴小结）,January,2007,CopyrightDepart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG,淋巴组织,January,2007,CopyrightDepart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG,淋巴器官,淋巴结胸腺脾脏扁桃体,January,2007,CopyrightDepart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG,淋巴结,淋巴结（lymphnode）为大小不一的圆形或椭圆形灰红色小体，一侧隆凸，另一侧凹陷，凹陷中央处为淋巴结门。淋巴结门有神经和血管出入。与淋巴结凸侧相连的淋巴管称输入淋巴管，出淋巴结门的淋巴管称输出淋巴管。,January,2007,CopyrightDepart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG,形态：圆形或椭圆形灰红色小体数目：不恒定，青年人约400500个。位置：可分为浅淋巴结和深淋巴结，多沿血管排列，位于关节的屈侧和体腔的隐藏部位。功能：滤过淋巴、产生淋巴细胞和进行免疫应答。,January,2007,CopyrightDepart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG,淋巴结结构,January,2007,CopyrightDepart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG,胸腺,胸腺（thymus）是中枢淋巴器官。位置：胸腔前上部（上纵隔前方）大小：新生儿1015克；性成熟期2540克；老年1015克。形态：成锥形，分不对称左右两叶作用：培育、选择和向周围淋巴器官和淋巴组织输送T淋巴细胞；参与内分泌功能。,January,2007,CopyrightDepart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG,胸腺的位置与形态,January,2007,CopyrightDepart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG,脾,脾（spleen）人体最大的淋巴器官。位置：左季肋部、胃底与膈之间；左911肋深面,长轴与第10肋一致。形态：暗红色、质软脆、长卵圆形。结构：脏、膈两面，前、后两端，上、下两缘。脾门、脾切迹、副脾（20%）。作用：具有储血、造血、清除衰老红细胞和进行免疫应答的功能。,January,2007,CopyrightDepart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG,脾的膈面,January,2007,CopyrightDepart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG,脾的脏面,January,2007,CopyrightDepart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG,二、淋巴液的生成过程及其功能,细胞或组织间的组织液进入毛细淋巴管后成为淋巴液。淋巴管道和淋巴结的淋巴窦内含有淋巴液简称淋巴。,January,2007,CopyrightDepart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG,淋巴液,细胞或组织间的组织液进入毛细淋巴管后成为淋巴液。由于毛细淋巴管的通透性比毛细血管大，组织液中未能返回到毛细血管的大分子物质经各级淋巴管再送回到血循环。,January,2007,CopyrightDepart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG,淋巴的循环过程示意图,心脏淋巴导管动脉静脉毛细血管淋巴干组织间隙毛细淋巴管淋巴管细胞,January,2007,CopyrightDepart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG,淋巴系统功能,将没被静脉回吸收的组织液、大分子物质回收后再送回静脉参加循环。造血：产生淋巴细胞、过滤淋巴液，进行免疫应答的功能。,January,2007,CopyrightDepart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG,三、淋巴回流的因素,回流量：安静时，每小时约120ml淋巴入血参与回流的因素：淋巴管泵动脉搏动肌肉收缩与运动胸腔负压运动和按摩,January,2007,CopyrightDepart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG,四、淋巴侧支循环,淋巴管之间有丰富的交通支，参与构成淋巴侧支循环。当炎症、寄生虫、异物或肿瘤栓子阻塞淋巴管，外伤或手术切断淋巴管时，淋巴经交通支回流，形成淋巴侧支循环。侧支循环的功能：优点：炎症和外伤时，侧支保证了正常组织和病变组织的淋巴回流；缺点：淋巴侧支通路可成为病变扩散或肿瘤转移的途径。,January,2007,CopyrightDepart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG,第二部分,淋巴导管各论,January,2007,CopyrightDepart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG,胸导管,胸导管（thoracicduct）是全身最大的淋巴管。长度：30-40cm起止：乳糜池（平12下缘）-左静脉角行程：自12胸椎下缘上行，经主动脉裂孔进胸腔；在脊柱前方行至颈部。收集范围：两下肢、盆腹部、左胸部、左上肢、左头颈部，即全身3/4部分的淋巴。,January,2007,CopyrightDepart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG,乳糜池位于第一腰椎前方,呈囊状膨大,接受左、右腰干和肠干。胸导管在乳糜池处接受左、右腰干和肠干，在注入左静脉角处接受左颈干、左锁骨下干和左支气管纵隔干。胸导管有丰富交通支，在临床上有重要意义。,January,2007,CopyrightDepart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG,胸导管示意图,January,2007,CopyrightDepart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG,胸导管的位置,January,2007,CopyrightDepart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG,右淋巴导管,右淋巴管（rightlymphaticduct）由右颈干、右锁骨下干和右支气管纵隔干，注入右静脉角。长度：1-1.5cm起止：右侧三条淋巴干汇合点-右静脉角收集范围：右肺、右半心、右半胸廓、右上肢、右头颈部，即全身部分的淋巴。,January,2007,CopyrightDepart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG,右淋巴导管示意图,January,2007,CopyrightDepart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG,第三部分,淋巴结的位置及其淋巴引流范围,January,2007,CopyrightDepart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG,一、头颈部的淋巴结,头部淋巴结枕淋巴结耳后淋巴结，即：乳突淋巴结腮腺淋巴结下颌下淋巴结颏下淋巴结,January,2007,CopyrightDepart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG,头部淋巴结,January,2007,CopyrightDepart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG,颈部淋巴结颈前淋巴结颈前浅淋巴结颈前深淋巴结喉前淋巴结甲状腺淋巴结气管前淋巴结气管旁淋巴结颈外侧淋巴结颈外侧浅淋巴结颈外侧深淋巴结颈外侧上深淋巴结：颈内静脉二腹肌淋巴结；颈内静脉肩胛舌骨肌淋巴结；副神经淋巴结颈外侧下深淋巴结：锁骨上淋巴结；斜角肌淋巴结；Virchow淋巴结；咽后淋巴结,January,2007,CopyrightDepart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG,颈浅淋巴结,January,2007,CopyrightDepart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG,颈深淋巴结,January,2007,CopyrightDepart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG,二、上肢淋巴管和淋巴结,肘淋巴结浅群，即：滑车上淋巴结深群锁骨下淋巴结腋淋巴结胸肌淋巴结外侧淋巴结肩胛下淋巴结中央淋巴结尖淋巴结,January,2007,CopyrightDepart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG,上肢淋巴管和淋巴结,January,2007,CopyrightDepart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG,三、胸部淋巴管和淋巴结,胸壁淋巴结胸骨旁淋巴结肋间淋巴结膈上淋巴结胸腔器官淋巴结纵隔前淋巴结纵隔后淋巴结气管、支气管和肺的淋巴结肺淋巴结支气管肺淋巴结气管支气管淋巴结气管旁淋巴结,January,2007,CopyrightDepart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG,纵隔淋巴结,January,2007,CopyrightDepart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG,January,2007,CopyrightDepart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG,January,2007,CopyrightDepart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG,四、下肢淋巴管和淋巴结,膕淋巴结腹股沟淋巴结腹股沟浅淋巴结腹股沟深淋巴结,January,2007,CopyrightDepart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG,下肢淋巴管和淋巴结,January,2007,CopyrightDepart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG,January,2007,CopyrightDepart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG,五、盆部淋巴管和淋巴结,髂内淋巴结骶淋巴结髂外淋巴结髂总淋巴结,January,2007,CopyrightDepart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG,January,2007,CopyrightDepart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG,January,2007,CopyrightDepart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG,六、腹部淋巴管和淋巴结,腹壁淋巴结脐平面以上浅、深群