乳腺解剖课件12

乳腺是皮下结构 包括乳腺 纤维组织 脂肪组织 在皮肤上覆盖乳晕以及乳头 Adiposetissue fat 脂肪 Nipple乳头 Areola乳晕 乳腺Milkglands 结缔组织Fibroustissue TheportionofthebreastthatextendstowardorintotheunderarmoraxillaisreferredtoastheaxillarytailofthebreastorthetailofSpence 乳房延伸至腋下部分称为腋尾 Axillarytail TailofSpence 有一层结缔组织称为乳腺浅筋膜 它覆盖乳腺实体组织 乳房位于胸腔前表面 被下面的肋骨和肌肉支撑 在乳腺的下方是胸小肌 胸小肌是较小 位置较深的肌肉 在乳房的旁侧和后侧的较宽的胸大肌 Alayerofconnectivetissuecalledthesuperficialfasciaofthebreastsurroundstheparenchymaofthebreast Thebreastliesontheanteriorsurfaceofthethoraciccagesupportedbytheunderlyingribsandmuscles Immediatelydeeptothebreastarethepectoralismuscles Thepectoralisminorisasmallermoredeeplysituatedmuscle Thepectoralismajormuscleisabroadmusclethatliesadjacentandimmediatelyposteriortothebreast Thepectoralismajorandminormusclesarebothsurroundedbyalayeroffasciareferredtoasdeepfascia Thesuperficiallayerofthedeepfasciaofthepectoralismajormuscleisincontactwiththedeeplayerofthesuperficialfasciathatsurroundsthebreast Thesetwosurfacesnormallyglideoveroneanotherallowingawoman sbreasttomove Ifanythingweretooccurthatpreventedthistypeofnormalmotionthebreastbecomesimmobileandisreferredtoas fixed Specifically thissituationmayoccurifacancergrowsfromthebreastintotheselayers 胸大肌和胸小肌被深筋膜包裹 胸大肌深筋膜的表面接触到包裹乳腺的浅筋膜的深层 Thearterialbloodsupplytothebreastoriginatesfrombranchesoftheaxillary internalthoracicandsubclavianarteries Thevenousdrainageofthebreastemptiesintobranchesoftheinternalthoracic axillaryandintercostalveins 乳腺血供来自腋窝 胸内和锁骨下动脉 静脉引流自胸内 腋窝和肋间静脉 Lymphisafluidthatfiltersbetweenthecellsoftissueandthendrainsintoitsownsetoftransportchannels Lymphfluidmaycarryinfectiousorganisms toxinsorcancerouscells Thechannelsthatcarrythelymphfluidarereferredtoaslymphatics Theselymphaticsusuallytravelnearorwiththevascularsupplyofatissue Smalllymphaticsdrainintolargerlymphaticsandeventuallyallthelymphaticfluidemptiesintooneofthelargeveinsinthethoraciccavity Alongthecourseoftheselymphaticchannelsaresofttissuestructurescalledlymphglandsornodes Thelymphglandsactasfilterstoremoveharmfulsubstancesfromthelymphfluid 淋巴是在组织间进行过滤的液体 它流入自己的输送渠道 淋巴液载送感染性有机物 毒素和癌细胞 载送淋巴液的渠道称为淋巴管 这些淋巴管通常在组织周围流动并且将组织维管联结 小的淋巴管流入大的淋巴管 并且最终所有的淋巴液流入胸腔的某个大血管 在这些淋巴管道的路程中有一些软组织称为淋巴腺或淋巴结 这些淋巴结象过滤器一样过滤淋巴液中的有害物质 Themajorityofthelymphaticfluidfromabreastdrainstotheipsilateralaxilla Theaxillaisrichinbothlymphaticchannelsandlymphnodes Asmallportionofthelymphaticdrainagefromtheinferomedialbreastparenchymawilldraintothelymphaticsystemassociatedwiththeinternalthoracicvessels 乳腺的大部分淋巴液流入腋窝淋巴 腋窝富含淋巴管和淋巴结 小部分乳腺内下侧淋巴液引流入胸内脉管的淋巴系统 Forconventiontheaxillarylymphnodesaredividedintothreegroups 1 Pectoralorlevel1 inferiortopectoralisminorattachment 第一站淋巴结 胸小肌下 2 Centralorlevel2 posteriortopectoralisminorattachment 第二站淋巴结 胸小肌后 3 Apicalorlevel3 superiortopectoralisminorattachment 第三站淋巴结 胸小肌上 Itisbelievedthatthemajorityofthelymphdrainagefromthebreasttowardtheaxillatravelstothelevel1axillarynodesthentothelevel2axillarynodesandthentothelevel3axillarynodes 普遍认为大部分的乳腺的腋窝淋巴引流都是从第一站到第二站到第三站 Theglandsofthebreastarearrangedintocollectionscalledlobules Thesecretionsoftheglandsofeachlobuledrainintoatubecalledalobularduct 乳房的腺体结合成小叶 小叶腺体的分泌物流入小叶管 Lobule Lobularduct Manylobulestogetherformalobeofthebreast Theductthatcarriesthesecretionsfromallthelobulesinalobeisreferredtoasalobarduct 许多个小叶汇聚成乳叶 小叶分泌物汇聚流入乳管 Lobarduct Lactiferoussinus ampulla Lobe Abreastcontains15 18lobesandtherefore15 18lobarducts Thelobarductsarealsoreferredtoaslactiferousducts Eachlactiferousducthasanopeningonthesurfaceofthenipple Thereisadilatedregionineachlactiferousductjustdeeptothesurfaceofthenipple Thisdilatedareaisreferredtoastheampulla 一个乳房有15 18个乳叶和15 18个乳管 乳管也称为乳汁输送管 每个乳汁输送管在其乳头处有一个开口 在乳头深处 每个乳汁输送管都有一个膨胀部位 称为壶腹 Lobularduct Lobarduct Lactiferousduct Lobule Ampulla Nipple Overtime duetofactorsscientistpoorlyunderstand thecellsinthebreastlobulesandductsmayundergochanges Someofthesechangesincreaseawoman sriskofdevelopingbreastcancerwhileotherchangesarecancerous Tounderstandthesechangeslet slookataductincrosssection Thisviewiswhatitwouldbeseenifapieceofbreasttissuewereremovedfromthebreastandthenexaminedunderamicroscope 随着时间推移 由于某些无法解释的原因 乳腺小叶和乳管会发生变化 有些变化会增加妇女罹患乳腺癌的风险 而有些变化本身就是癌变 要了解这些变化 让我们来看一看乳腺的横截面 Inanormalductthecellsliningtheductwillbeoneortwolayersthick Thesecellswillhavesimilarsizeandshape 正常的乳管有1 2层细胞 这些细胞有相似的大小和形状 Insomewomen extracellswillgrowintheduct Thelatintermforexcessishyperandthetermforgrowthisplasia soaconditionwithexcessgrowthisreferredtoashyperplasia InthiscasethespecifictermwouldbeductalhyperplasiaThisconditionconfersnoincreaseriskfordevelopingbreastcancer 有些妇女 乳管内生长了额外的细胞 这称为增生 乳管内增生 乳管内增生 Sometimestheexcessgrowthwithintheductincludessomeveryabnormaloratypicalcells ThisconditionisreferredatypicalductalhyperplasiaorADH Thepresenceofthisconditioninawoman sbreastincreasesherriskofdevelopingabreastcancerinherlifetime Individually theseatypicalcellsmayresemblecancercells Themoreabnormalandatypicalanindividualcellthemoreitresemblesacancercell 有时 额外的细胞包括不正常或不典型的细胞 这些细胞增加了妇女得乳腺癌的风险 单个来说 这些不典型细胞类似癌细胞 不典型增生 Iftherearemanyatypicalcellstheentireductmaybefilledwiththeseabnormal atypicalcells Thisconditionisactuallyanearlybreastcancer ItisreferredtoasductalcarcinomainsituorDCIS Theoretically thecancercellsareonlylocatedwithintheductandhavenotspreadoutoftheaffectedduct Somephysiciansrefertothisconditionasa pre cancer Thisisincorrect thisisindeedalocalizedbreastcancer 如果乳管内有许多不典型细胞 直至整个乳管都充满了不正常不典型的细胞 这其实是早期的乳腺癌 称为乳管内原位癌 乳管内原位癌DCIS IfDCISisnottreatedthecancercellswilleventuallybreakoutoftheductandinvadethebreasttissue Thisisreferredtoasinvasiveductalcarcinoma 如果原位癌没有得到治疗 癌细胞会最终突破乳管 侵犯乳腺组织 称为浸润性乳管癌 浸润性乳管癌 Ifexcessgrowthoccursinthelobulestheconditionisreferredtoa