《局部解剖学》课件：胸腔

1、Review,Carotid triangle,Boundaries Contents,Carotid sinus & Carotid glomus,Boundaries Contents Relation of the thyroid gland,Muscular triangle,Superior laryngeal a. & External branch of superior laryngeal n. Inferior thyroid artery & Recurrent laryngeal n.,A. of thyroid gland & N of larynx,Relations

2、 of trachea in the neck,Layers anteriorly to the trachea. Layers anteriorly to the thyroid gland.,Root of the neck,Contents Relations of the Cupula of pleura,1. Which structure did not within the carotid sheath?,Common carotid artery Internal jugular vein Internal carotid Vagus nerve Sympathetic tru

3、nk,Internal branch of superior laryngeal External branch of superior laryngeal Trigeminal (三叉神经) Facial (面神经) Maxillary (上颌神经),2. The nerve supplies the laryngeal mucous membrane above the fissure of glottis(声门裂) is,Ansa cervicalis External branch of the superior laryngeal Inferior laryngeal (喉下神经)

4、Internal branch of the superior laryngeal Recurrent laryngeal (喉返神经),3. Following surgery on the thyroid gland, a patient complains of hoarseness (声嘶)and weakness of voice. What nerve may have been injured?,Accessory (副神经) Ansa cervicalis Facial Hypoglossal (舌下神经) Phrenic (膈神经),4. An abscess (脓肿) wa

5、s surgically removed from the middle of the occipital triangle on the right side. During recovery, the patient noticed that her shoulder drooped and she could no longer raise her right hand above her head to brush her hair. Which nerve has been cut?,5. Which nerve is not emerge at the midpoint of th

6、e posterior margin of the sternocleidomastoid.,Phrenic nerve Great auricular nerve Transverse nerve of neck Supraclavicular nerves Lesser occipital nerve,6. Which of the following structure pass through the scalene fissure,Brachial plexus Subclavian vein Cervical plexus Vertebral artery Phrenic nerv

7、e,胸腔：胸膜、肺与上纵隔Pleura, Lung & Superior mediastinum,Department of human anatomy September 16, 2020,Objectives,The division and recesses of pleura. The projection of the pleura and the lung The relation of root of the lung The concept and divisions of the mediastinum The contents of superior mediastinum

8、. Boundaries and contents of the ductus arteriosus triangle,Chapter 3 The thorax胸部,Consist of : Thoracic wall 胸壁 Thoracic cavity胸腔,Chapter 3 The thorax 胸部,Thoracic wall胸壁 Formed by sternum, ribs, thoracic vertebrae Consist of : Thoracic cage Skin, fasciae, muscles, blood vessels and nerves,Section 1

9、 The thorax,Thoracic cavity胸腔 Formed by thoracic cage Consist of : Lung 肺 Pleural cavity胸膜腔 Mediastinum 纵隔,Section 4 The pleura胸膜,1. Introduction Serous membrane Possesses excretive and absorbing function. Division: Visceral pleura脏胸膜 Parietal pleura壁胸膜,Subdivision of parietal pleura: Cupula of pleu

10、ra胸膜顶 Costal pleura肋胸膜 Diaphragmatic pleura膈胸膜 Mediastinal pleura纵隔胸膜,The pleura,Cupula of pleura胸膜顶,Extends 23cm above the medial one-third of the clavicle.,2. The pleural cavity胸膜腔,A potential space ,formed by visceral and parietal pleura. Normally contains a small amount of pleural fluid. (less t

11、han 50ml) It is different from thoracic cavity.,2. The pleural cavity胸膜腔,Features : During quiet breathing, the pleural pressure is negative, and it is below atmospheric pressure.,Pleural recesses胸膜隐窝,Costodiaphragmatic recess 肋膈隐窝 Costomediastinal recess 肋纵隔隐窝 Phrenicomediastinalrecess 膈纵隔隐窝,3. The

12、 pleural reflection,The dome of pleura, the sternal and costal lines of reflection are clinically important. The line of pleural reflection includes: The anterior margin The posterior margin The inferior margin,3. The pleural reflection,Anterior margin formed: Triangle of thymus胸腺区 Triangle of peric

13、ardium心包区 Features: Have no covering of pleura,The inferior margin of pleura,Midclavian line -the 8th rib Midaxillary line -the 10th rib Scapular line -the 12th rib,Section 5 The lung 肺,1.1 Position and external features: In its own pleural sac within the thoracic cavity. Separated from each other b

14、y the mediastinum It has an apex, a base, three Surfaces and three Borders.,1.2 Surface projection,Apex of lung: Extends 23cm above the medial one-third of the clavicle. The inferior margin ： Midclavian line -the 6th rib Midaxillary line -the 8th rib Scapular line -the 10th rib,The hilum of lung Lie

15、s near the center of the medial surface of the lung. Structures at the hilum including :The bronchi支气管, Pulmonary vessels, Bronchial vessels, Lymph vessels, Nerves enter and leave the lung,2. Structures结构,2. Structures结构,Root of the lung The arrangement (from anterior backwards)： Pulmonary vein Pulm

16、onary artery Bronchus (记为：VAB静动支),Root of the lung The arrangement of left lung (From above downwards) Pulmonary artery Pulmonary vein Bronchus （As: AVB）,2. Structures结构,Root of the lung The arrangement of right lung (From above downwards) Superior lobar bronchus Pulmonary artery Inferior lobar bron

17、chus Pulmonary vein,2. Structures结构,3. The bronchopulmonary segments,Each principal bronchus divides into secondary bronchi to the lobes of the lung. Each segment has its own segmental bronchus, artery and vein.,3. The bronchopulmonary segments,Its apex towards the hilum of the lung and the base at

18、the lung surface. 10 segments each lung Bronchial tree.,3. The bronchopulmonary segments,Apical segment尖段 posterior segment后段 Anterior segment前段 Superior lingular segment上舌段 Inferior lingular segment下舌段 Superior segment上段 Medial segment内侧底段 Anterior segment前底段 Lateral basal segment外侧底段 Posterior bas

19、al segment后底段,3. The bronchopulmonary segments,Apical segment尖段 Posterior segment后段 Anterior segment前段 Lateral segment外侧段 Medial segment内侧段 Superior segment上段 Medial basal segment 内侧底段 Anterior basal segment 前底段 Lateral basal segment 外侧底段 Posterior basal segment 后底段,3. The bronchopulmonary segments,

20、4. Blood, nerve and lymph drainage,Blood vessels Pulmonary vessels Bronchial vessels Lymph drainage Pulmonary lymph nodes Bronchial lymph nodes Nerve supply: Vagus nerve,Section 6 Mediastinum纵隔,1. Introduction Definition定义: All the organs, tissues and structures between right and left mediastinal pl

21、eurae.,1. Boundaries境界 Anterior: sternum and costal cartilages Posterior: thoracic vertebrae Both sides: mediastinal pleurae Superior: thoracic inlet Inferior: diaphragm,Section 6 Mediastinum纵隔,2. Divisions of mediastinum,Be subdivided by a horizontal plane from Sternal angle to Intervertebral disc

22、between the 4th and 5th thoracic vertebrae. Divided into two mediastinum Superior mediastinum 上纵隔 Inferior mediastinum下纵隔,2. Divisions of mediastinum,Subdivision of inferior mediastinum Anterior mediastinum前纵隔 Middle mediastinum 中纵隔 Posterior mediastinum后纵隔,3. Lateral view of the mediastinum,Left si

23、de左侧面观 Two triangle： *Superior triangle of esophagus食管上三角： Form by left subclaviar artery, aortic arch and vertebral collumn. Content: Thoracic duct Esophagus,3. Lateral view of the mediastinum,Left side左侧面观 Two triangle： * Inferior triangle of esophagus ： Formed by Pericadium, thoracic artery, and

24、diaphragm Content: Esophagus,4. Relation of the root of left lung,Anterior ： Pericardium 心包 Left phrenic nerve Pericardiacophrenic a. Posterior ： Vagus nerve迷走神经 Thoracic aorta胸主动脉 Thoracic sympathetic trunk胸交感干 Great splanchnic nerve,4. Relation of the root of left lung,Superior ： Aortic arch and i

25、ts branches主动脉弓及其分支 Left recurrent laryngeal nerve,Anterior ： Pericardium 心包 Right phrenic nerve 右膈神经 Pericardiacophrenic vessel 心包膈血管,5. Relation of the root of right lung,Posterior ： Right vagus nerve右迷走神经 Esophagus食管 Azygos vein奇静脉 Thoracic sympathetic trunk胸交感干 Great splanchnic nerve,5. Relation

26、 of the root of right lung,Superior： Right brachiocephalic vein右头臂静脉 Arch of azygos vein Superior vena cava上腔静脉 Trachea气管and Esophagus 食管 Inferior： Inferior vena cava,5. Relation of the root of right lung,2. Superior mediastinum上纵隔,2.1 Position: From the thoracic inlet胸廓上口 to the horizontal plane of

27、 from sternal angle to intervertebral disc between the 4th and 5th thoracic vertebrae.,2.2 Contents,The thymus or its remnant胸腺 Brachiocephalic veins左、右头臂静脉 Superior vena cava上腔静脉 Phrenic and vagus nerves迷走神经和膈神经 Aorta and its three branches主动脉弓 Trachea and esophagus Thoracic duct胸导管,2.3 Layers,Ante

28、rior layer (thymus-venous layer胸腺静脉层) Thymus Brachiocephalic vein Superior vena cava,2.3 Layers,Medial layer (arterious layer动脉层) Aortic arch and its branches主动脉弓及其分支 Vagus nerve迷走神经 Phrenic nerve膈神经,2.3 Layers,Posterior layer (ductus layer管道层) Trachea气管 Esophagus食管 Thoracic duct胸导管 Left recurrent l

29、aryngeal nerve 左喉返神经, Thymus,Lies between the sternum and the trachea Consist of two lobes: left and right lobe. Secrete Thymin Relation of thymus Anterior Posterior, Superior vena cava,Form by the right and left brachiocephlic vein. At the level of the lower crosses over the right root of lung and

30、enters the atrium., Aortic arch,Branches 分支： Brachiocephalic trunk头臂干 Left common carotid artery左颈总动脉 Left subclavian arteries左锁骨下动脉, Relations of aortic arch,Anterior左前方： Pleura胸膜 Lung 肺 Phrenic nerve膈神经 Pericardiacophrenic vessels 心包膈血管 Vagus nerve迷走神经, Relations of aortic arch,Posterior右后方： Trach

31、ea Esophagus Left recurrent nerve Thoracic duct胸导管 Deep cardiac plexus迷走神经心深丛, Relations of aortic arch,Superiorly Its three branches Left brachiocephalic vein左头臂静脉 Thymus 胸腺, Relations of aortic arch,Inferiorly Pulmonary artery肺动脉 Arterial ligament 动脉韧带 Left recurrent nerve左喉返神经 Left principal bron

32、chus Superficial cardiac plexus迷走神经心浅丛, Trachea and principle bronchi,The trachea bifurcates into left and right principal bronchi at the level of the sternal angle. Features： Left Right, Ductus arteriosus triangle,动脉导管三角 Boundaries Anterior Border: Left phrenic nerve Posterior Border: Left vagus ne

33、rve Inferior Border: Left pulmonary artery, Ductus arteriosus triangle,Contents Arterial ligament动脉韧带 Arterial duct动脉导管 The left recurrent laryngeal nerve左喉返神经 Superficial cardiac plexuses迷走神经心浅丛,Ductus arteriosus,下纵隔Inferior mediastinum,Department of human anatomy September 16, 2020,Objectives,The

34、contents of inferior mediastinum. The projection of heart. The pericardium and pericardial cavity. The relation of esophagus. Azygos vein and its tributaries.,Inferior mediastinum,Including : Anterior mediastinum 前纵隔 Middle mediastinum 中纵隔 Posterior mediastinum 后纵隔,1. Anterior mediastinum,Position N

35、arrow space between the sternum and pericardium,1. Anterior mediastinum,Contents The lower portion of thymus胸腺or the remnant of thymus Internal thoracic vessels and their branches Anterior mediastinal lymph nodes Loose connective tissue Abnormal thyroid gland异位甲状腺,2. Middle mediastinum,Position Betw

36、een the anterior and posterior mediastinum Contents Pericardium心包 The heart The roots of great blood vessels passing to and from the heart Phrenic nerve Pericardiophrenic vessels 心包膈血管,2.1 The pericardium,Consists of : Fibrous pericardium Serous pericardium Serous pericardium Parietal layer Visceral

37、 layer Pericardial cavity,2.1 The pericardium,Consists of : Fibrous pericardium Serous pericardium Serous pericardium Parietal layer Visceral layer Pericardial cavity,Anteroinferior sinus of the pericardium Oblique sinus of the pericardium Transverse sinus of the pericardium,The sinuses of pericardi

38、um,2.2 The heart,Position External features Apex Base Left (right) auricle Pulmonary trunk Arterial cone Ascending aorta Superior vena cava,3. Posterior mediastinum,Position Between the pericardium and lower eight thoracic vertebrae,3. Posterior mediastinum,Contents : Principal bronchi Thoracic aort

39、a Thoracic duct Azygos and hemiazygos veins Vagus nerve Sympathetic trunk Posterior mediastinal lymph node,3.1 Esophagus,Three physiological constrictions Behind the aortic arch Behind the left principal bronchus Passing through the esophagus hiatus of diaphragm,3.1.1 Relation of esophagus,Anteriorl

40、y Trachea Ldft recurrent laryngeal nerve Left principal bronchus Pericardium Diaphragm,3.1.1 Relation of esophagus,Posteriorly Intercostal arteries Azygos vein and hemiazygos veins Thoracic duct Loose connective tissue,3.1.1 Relation of esophagus,Left side Left common carotid artery Left subclavian

41、artery Aortic arch Thoracic aorta The superior part of thoracic duct Left mediastinal pleura,3.1.1 Relation of esophagus,Left side Azygos vein and its arch Right mediastinal pleura,3.1.1 Features of esophagus,Lack of serous membrane in thoracic part，hard to cure Blood vessel is small，lesser anastomo

42、sis吻合 Submucous venous plexus粘膜下静脉丛 in submucosa of lower part of esophagus,3.2 The branches of thoracic aorta,Parietal branches: Posterior intercostal A (3th 11th pairs) Subcostal A Visceral branches: Bronchial A Esophageal A,3.2.1 Relation of thoracic aorta,Anteriorly ： Left root of the 左肺根 perica

43、rdium心包 食管 Posterior vein： Hemiazygos vein半奇静脉 Accessory hemiazygos vein 副半奇静脉,3.2.1 Relation of thoracic aorta,Left ： Pleura Right ： Azygos vein Thoracic duct,3.3 The thoracic duct,Route: cisterna chyliaortic hiatus posterior mediastnium Left venous angle,Ant.mediastinal LN（along aortic arch） Paratracheal LN Trac