解剖学胸壁肺及胸膜膈解剖.ppt

解剖学胸壁肺及胸解剖学胸壁肺及胸膜膈解剖膜膈解剖一一.Thoracicwall胸壁胸壁1.Composition组成组成Skin皮肤皮肤Superficialanddeepfascia浅、深筋膜浅、深筋膜Muscles肌肌Vesselsandnerves血管和神经血管和神经1）Muscles肌肉肌肉Intercostalesexterni肋间外肌肋间外肌Intercostalesinterni肋间内肌肋间内肌作用：提肋助吸气作用：提肋助吸气作用：作用：降肋助呼气降肋助呼气Intercostalesintimi肋间最内肌肋间最内肌Externalintercostalmembrfane肋间外膜肋间外膜Internalintercostalmembrfane肋间内膜肋间内膜2）Vesselsandnerves血管和神经血管和神经PosteriorintercostalAIntercostalNIntercostalspace肋间隙肋间隙Posteriorintercostalv.Posteriorintercostala.Intercostaln.肋间后动脉、肋间后静脉和肋间神经三者的位置关系肋间后动脉、肋间后静脉和肋间神经三者的位置关系:在肋间隙后部：位于肋间隙中间，三者的上、下的排列次序不定。在肋间隙后部：位于肋间隙中间，三者的上、下的排列次序不定。在肋沟内，自上而下依次为：肋间后静脉、肋间后动脉、肋间神经在肋沟内，自上而下依次为：肋间后静脉、肋间后动脉、肋间神经。.胸膜腔穿刺部位胸膜腔穿刺部位:在肋间隙后部，进针部位应在下位肋的上缘。在肋间隙后部，进针部位应在下位肋的上缘。在肋间隙前部，进针部位应在肋间隙的中间。在肋间隙前部，进针部位应在肋间隙的中间。Internalthoracicartery胸廓内动脉胸廓内动脉descendsintothorax1.2cmlateraltoedgeofsternum,andendsatthesixthcostalcartilagebydividingmusculophrenicandsuperiorepigastricarteriesMusculophrenicA肌膈动脉肌膈动脉superiorepigastricA腹壁上动脉腹壁上动脉2.Pleura胸膜胸膜VisceralpleuraParietalpleuramediastinalpleuraDiaphragmaticpleuraCostalpleuraCupulapleura1）Partes分部分部TwopleurallayerscontinuewitheachotheratrootoflungformingclosedpotentialspaceContainsasmallamountpleuralfluidSubatmosphericpressureinit2）Pleuralcavity胸膜腔胸膜腔potentialspacesofpleuralcavitywhichlungsarenotoccupiedindeeprespirationCostodiaphragmaticrecess肋膈隐窝肋膈隐窝3）Pleurarecesses胸膜隐窝胸膜隐窝Costomediastinalrecess肋纵隔隐窝肋纵隔隐窝Midclavicularlines锁骨中线锁骨中线Midaxillarylines腋中线腋中线Scapularline肩胛线肩胛线ThesurfaceprojectionoflowerborderoflungandpleuraeLowerborderMidclavicularlinesMidaxillarylinesScapularlineLungs6thrib8thrib10thribPleura8thrib10thrib12thrib11thrib3.Lung肺肺1）Postion位置位置肺位于胸腔内，纵隔两肺位于胸腔内，纵隔两侧，因心位置偏左，故侧，因心位置偏左，故左肺狭长，右肺略宽短左肺狭长，右肺略宽短2）Features形态形态Apexoflung肺尖：肺尖：伸向颈根部，高出锁骨内侧伸向颈根部，高出锁骨内侧1/3上方上方2.5cmBaseoflung肺底：又称膈面肺底：又称膈面Costalsurface肋面肋面Mediastinalsurface纵隔面纵隔面肺呈圆锥形，有一尖、一底、两面、三缘肺呈圆锥形，有一尖、一底、两面、三缘。纵纵隔面隔面Mediastinalsurface中部有长圆形凹陷叫肺肺门门，有支气 管、肺动脉、肺静脉、支气管动脉、支气管静脉、神经和淋巴管出入。出入肺门的结构被结缔组织包绕，构成肺根肺根rootoflung。肺根内结构的排列：从前向后:上肺静脉、肺动脉、主支气管。从上向下:左肺根：肺动脉、左主支气管、上肺静脉、下肺静脉。右肺根：上叶支气管、肺动脉、主支气管、上肺静脉、下肺静脉。Hilumoflung肺门肺门Frombeforebackward:V.A.B.Fromabovedownward:R.B.A.V.L.A.B.V.Oblipuefissure斜裂斜裂horizontalfissure水平裂水平裂Superiorlobe上叶上叶Middlelobe中叶中叶Inferiorlobe下叶下叶Cardiacnotch心切迹心切迹Eachprincipalbronchusdividesintolobarbronchi(twoontheleft,threeontheright),eachofwhichsuppliesalobeoflung.Eachlobarbronchusthendividedintosegmentalbronchi,whichsupplyspecificsegmentsofthelung.Bronchialtree 主支主支 气管气管（一级支气管）（一级支气管）肺叶支气管（二级肺叶支气管（二级支气管）支气管）肺段支肺段支气管（三级支气管）气管（三级支气管）。每个肺段支每个肺段支气管及其所属的肺气管及其所属的肺组织，称为组织，称为支气管支气管肺段肺段，简称，简称肺段肺段Segments of lung。3.Bronchialtree支气管树支气管树尖段尖段后段后段前段前段外侧段外侧段内侧段内侧段尖（上）段尖（上）段内侧底段内侧底段前底段前底段外侧底段外侧底段后底段后底段尖后段尖后段前段前段上舌段上舌段下舌段下舌段尖（上）段尖（上）段前内底段前内底段外侧底段外侧底段后底段后底段上叶上叶中叶中叶下叶下叶上叶上叶下叶下叶外外侧侧底底段段外外侧侧底底段段VesselsOFlungPulmonaryAPulmonaryVDiaphragmSternalpartCostalpartLumbarpartCentraltendonLumbocostaltriangleSternocostaltriangleShapeAortichiatusEsophagealhiatusVenacavaforamenOpeningsinthediaphragmT8T10T12Contraction:thedomemovingdownward,increasesthevolumeofthoraciccavitywhichresultsininspiration,atthesametimetheintra-abdominalpressureisincreasedassistsindefecation,vomitingorchildbirth.Relaxation:thedomereturnstotheformerposition,reducesthevolumetothethoraciccavity,resultinginexpiration.Action: