局部解剖学课件：局部解剖学thorax

1、胸 部,THE THORAX,Summarization 概述 Thoracic wall 胸壁 Pleura and pleural cavity 胸膜与胸膜腔 Lungs 肺 Mediastinum（1） 纵隔,主要内容 Main Contents,一、概述 Summarization,境界 The boundary 分部 The regions 表面标志 The surface landmark 胸部标志线 The Lines of orientation on the Thorax,胸部是躯干的上部，位于颈部与腹部之间。 The thorax (chest) is the upper

2、part of the trunk between the neck and the abdomen,1. Boundary,其上界是从颈静脉切迹沿锁骨上缘至肩峰，然后至第七颈椎棘突的连线。,1. Boundary,下界为剑突、肋弓、第11肋前端、第12肋下缘和第12胸椎棘突的连线。,1. Boundary,两外侧界为三角肌的前、后缘。,1. Boundary,Thoracic wall and cavity,2.Region,The thoracic wall consists of skin, fascia, nerves, vessels, muscles, and bones.,The

3、 thoracic cavity, surrounded by the thoracic wall, contains the lungs, pleura and pleural cavity and mediastinum,颈静脉切迹 The jugular notch 胸骨角The sternal angle (of Louis) 剑突The xiphoid process 肋弓The costal margin (costal arch) 胸骨下角The infrasternal angle 锁骨 The clavicle 肩胛骨下角The inferior angle of scapu

4、la 乳头The nipple,3.表面标志 Surface Landmarks,The jugular notch,颈静脉切迹,Xiphoid process,剑 突,Costal arch,肋 弓,costal arch,The infrasternal ( subcostal) angle,胸 骨 下 角,肩胛骨下角 The inferior angle of scapula,剑 肋 角,经剑肋角的心包（液）穿刺术,Nipple,胸 骨 角 The sternal Angle (of Louis),The sternal angle marks the following items,T

5、he lower border of the 4th thoracic vertebra,向后平对第4胸椎下缘；,The level where the trachea divides into the right and left principal (main) bronchi.,气管分为左、右主支气管的水平，即气管杈水平；, The second constriction of the esophagus,平左主支气管与食管交叉处，即食管的第2狭窄处；, The origin and end of the aortic arch,平主动脉弓的起、止处；,The ligamentum ar

6、teriosum joins the left pulmonary artery to the aortic arch,动脉韧带连与左肺动脉与主动脉弓之处；,The azygos vein enters the superior vena cava,奇静脉汇入上腔静脉处；, The boundary line between the superior and inferior mediastina, 上、下纵隔的分界线；,4.The Lines of Orientation on the Thorax,(1) The anterior median line 前正中线 (2) The ster

7、nal line 胸骨线 (3) The midclavicular line 锁骨中线 (4) The parasternal line 胸骨旁线 (5) The anterior axillary line腋前线 (6) The midaxillary line 腋中线 (7) The posterior axiltary line腋后线 (8) The scapular line 肩胛线 (9) The posterior median line后正中线,胸 部 标 志 线,The Lines of Orientation on the Thorax,parasternal line,s

8、ternal line,The thoracic wall may be divided into The superficial structures The deep structures 胸壁可分为浅层结构和深层结构。,二、胸 壁 The Thoracic Wall,（一）The Superficial Structures,The skin 皮肤 The superficial fascia 浅筋膜 The superficial blood vessels 浅血管 The cutaneous nerves皮神经 The superficial lymphatic vessels浅淋巴

9、管 The breast 乳房,乳房由皮肤、纤维组织、脂肪组织和乳腺构成。,乳房：,1.位置：,位于第2（3）第6（7）肋高度，浅、深筋膜之间。乳房后间隙,2.形态结构：,乳房悬韧带： 乳房结缔组织中有许多纤维束、两端附着于皮肤和胸肌筋膜，称乳房悬韧带。,3.淋巴回流：,（1）外侧部和中央部： 汇入胸肌淋巴结，是乳房淋巴回流的主要途径,（2）上部： 注入尖淋巴结和锁骨上淋巴结,（3）内侧部： 注入胸骨旁淋巴结，浅淋巴管与对侧的相吻合,（5）内下部：通过腹壁和膈下的淋巴管与肝的淋巴管 相交通。,（4）深部：注入胸肌间淋巴结或尖淋巴结,深筋膜 deep fascia 胸壁浅层肌 superior

10、muscles of thoracic wall 肋及肋间隙 ribs and intercostal space 胸内筋膜 internal thoracic fascia,（二）The Deep Structures,1. 深 筋 膜 deep fascia,Clavipectoral fascia,Suspensory ligament of axilla,锁胸筋膜及其穿行结构,Clavipectoral fascia,is pierced by the cephalic vein头静脉, lymphatic vessels淋巴管,thoracoacromial artery and v

11、ein胸肩峰动、静脉, lateral pectoral nerve胸外侧神经. “二进二出”,The pectoralis major 胸大肌 The subclavius 锁骨下肌 The pectoralis minor 胸小肌 The serratus anterior 前锯肌 The obliquus externus abdominis 腹外斜肌 The trapezius 斜方肌 The rhomboids 菱形肌 The latissimus dorsi 背阔肌 The transversus thoracis 胸横肌 The rectus abdominis 腹直肌 The

12、intercostal muscles 肋间肌,2. The muscles,The intercostal muscles 肋间肌 Nerves 神经 Vessels 血管(the intercostal vessels 肋间血管, the internal thoracic vessels 胸廓内血管),3. The intercostal Spaces,（1）The intercostal muscles, The external intercostal muscle and membrane The internal intercostal muscle and membrane T

13、he innermost intercostal muscle,肋间外膜,肋间外肌,肋间内肌,肋间最内肌,肋间内膜,（2）The course and Relationship of the intercostal Nerve and Vessels,Anterior and posterior intercostal artery,胸廓内动脉,胸主动脉,肋间后动脉,肋间前动脉,在达肋角之前，肋间血管和神经位于肋间隙中部，彼此排列关系不恒定；然后行于肋沟内、肋间内肌与肋间最内肌之间。,Before reaching to the costal angle, the intercostal ne

14、rve and vessels run in the middle of the intercostal space and their arrangement is inconstant; Then they lie between the innermost and internal intercostal muscles.,4. 胸内筋膜,Internal thoracic fascia,在肋角内侧： 在肋角之前：,行胸膜腔穿刺术（抽液）在何部位进行？,不宜穿刺；,可在肋间隙的中部或肋上缘稍上方进针。,临床行胸膜腔穿刺术（抽液）常选在肩胛线或腋后线、第7或8肋间隙中部或肋上缘稍上方进针。

15、,施行胸膜腔穿刺术需经过哪些层次？,Skin 皮肤,superficial fascia 浅筋膜,deep fascia 深筋膜,superficial muscles of the thoracic wall胸壁肌,rib and intercostal muscles 肋间肌, endothoracic fascia 胸内筋膜, parietal pleura.壁胸膜,第三节 膈 （自学）,脏胸膜 visceral (or pulmonary) pleura 壁胸膜 The parietal pleura can be subdivided into: 肋胸膜 costal pleura

16、膈胸膜 diaphragmatic pleura 胸膜顶 cupula of pleura 纵隔胸膜 The mediastinal pleura 胸膜腔pleural cavity,胸膜隐窝 pleural recess 肺韧带 pulmonary ligament,四、Pleura and Pleural Cavity,脏胸膜,壁胸膜,胸膜腔,胸膜顶,肋胸膜,膈胸膜,肋膈隐窝,纵隔胸膜,肋纵隔隐窝 costomediastinal recess 肺韧带 pulmonary ligament,pulmonary ligament,肺韧带,在胸骨角水平以上或第4肋软骨水平以下。两侧胸膜前界之间

17、距离较大，分别称为胸膜上间区（胸腺区）和胸膜下间区（心包区）。 Above the sternal angle and below the level of the 4th costal cartilage, the distance between two pleural reflections is larger. These two intervals are called the superior intermediate region (triangle of thymus) and the inferior intermediate region (triangle of peri

18、cardium) of pleura respectively.,The Pleural Reflections,胸膜前界的体表投影,Triangle of Thymus 胸腺三角,triangle of pericardium 心包三角,胸腺三角 和心包三角,心包（抽液）穿刺术,胸膜下界的体表投影,胸膜下界的体表投影,肺根：为出入肺门的主支气管、肺动脉、肺静脉、支气管动脉和静脉、肺丛以及淋巴管等结构的总称，表面包以胸膜 。 The root of lung is formed by the principal bronchus, the pulmonary artery, the pulmo

19、nary veins, the bronchial arteries and veins, the pulmonary plexuses of nerves and the lymphatic vessels. These structures are held together by mediastinal connective tissue and surrounded by the pleura.,五、The Lungs,肺 门 和 肺 根,Right Lung,Left Lung,V. A.B.,V. A. B.,前后:,前后:,肺 门 和 肺 根,Right Lung,Left Lu

20、ng,上下： BAV,上下：A B A V,*,*,The Relationships of the Root of the Lungs,左肺根的毗邻,主动脉弓 (自前后),肺韧带,左迷走神经 胸主动脉,左膈神经 心包膈血管,奇静脉弓 (自后前),肺韧带,右迷走神经 奇静脉,上腔静脉 右膈神经 心包膈血管 部分心包 右心房,右肺根的毗邻,（三）支气管肺段 每一肺段支气管及其所属的肺组织称支气管肺段，简称肺段。肺段呈锥形，底位于肺表面，尖朝向肺门。,右肺有10个肺段，左肺有8个肺段。,右肺：,上叶,尖段,后段,前段,中叶,外侧段 内侧段,下叶： 上段 内侧底段 外侧底段 后底段,左肺：,上叶,尖

21、后段 前段 上舌段 下舌段,下叶： 上段 内侧前底段 外侧底段 后底段,六、纵 隔 Mediastinum,纵隔的概念、境界、分区 纵隔的左、右侧面 上纵隔,纵 隔,概念：纵隔是左、右纵隔胸膜之间所有器官、结构和结缔组织的总称，包括心、心包、出入心的大血管、胸腺和神经、淋巴等。 境界：纵隔的左、右侧界为左、右纵隔胸膜，下界为膈，上界为胸廓下口，前界为胸骨，后界为脊柱胸段。 分区（四分法）：以胸骨角平面为界分为上、下纵隔；下纵隔又以心包的前、后壁为界分为前、中、后纵隔。,1.概念与境界,Superior mediastinum,Inferior mediastinum,境界与分区,anterio

22、r mediastinum,middle mediastinum,posterior mediastinum,纵隔左侧面,左肺根及其毗邻 食管上三角 食管下三角,食管上三角 构成：由左锁骨下动脉、主动脉弓和脊柱围成； 内容：有食管上份和胸导管。,纵隔左侧面,左肺根及其毗邻 食管上三角 食管下三角,食管下三角 构成：由心包、胸主动脉和膈围成； 内容：有食管下份。,纵隔右侧面,右肺根及其毗邻 食管与右纵隔胸膜的关系,主要内容 Main Contents,Inferior mediastinum 下纵隔 Anterior mediastinuum 前纵隔 Middle mediastinum 中纵隔

23、 Posterior mediastinum 后纵隔 Mediastinal lymph nodes 纵隔淋巴结 Diaphragm 膈,一、前 纵 隔Anterior Mediastinum,位置 Position 内容 Contents,位置Position:：This is a narrow space between the sternum and the anterior wall of pericardium. 位于胸骨与心包前壁之间。,Contents 内容：内有胸腺下部、胸廓内血管及其分支、纵隔前淋巴结和疏松结缔组织。,二、中纵隔Middle Mediastinum,Position 位置 Contents 内容,Position 位置：It lies between the anterior and posterior wall of pericardium. 位于心包前、后壁之间。,Contents 内容: 内有心包、心、出入心的大血管根部、奇静脉弓、膈神经、心包膈血管、心丛和淋巴结等。,1.心包,心包裸区,心内注射,心包（抽液）穿刺术,2.心包腔和心包窦,三、后纵隔Posterior Medias