咽部的解剖Anatomy of pharynx.doc

咽部的解剖Anatomy of pharynx

• 1. 分部parts: 鼻咽 nasopharynx:咽鼓管咽口 eustachial orifice ,圆枕 torus tubalis, 咽隐窝pharyngeal recess,腺样体 adenoid 口咽 oropharynx: 咽峡 fauces,咽侧索 lateral chorda,舌扁桃体 lingual tonsil 喉咽 hypopharynx: 会厌谷 vallecular epiglottica,梨状窝 piriform fossa,环后隙retrocricoid space
• 2. 淋巴组织 lymphatic tissue 内环 inner loop 外环 outer loop 腭扁桃体 palatine tonsilla 腺样体 adenoid
咽的生理physiology of pharynx

• 1.呼吸功能 repiratory function
• 2.吞咽功能 swallowing function
• 3.语言形成 formation of speech
• 4.保护功能 protection
• 5.调节中耳压力 modulation of air pressure of middle ear
• 6.扁桃体的免功能 immune function of tonsilla
喉的解剖Anatomy of larynx
• 1.喉软骨 laryngeal cartilage 单个one: 会厌软骨 epiglottic cartilage,甲状软骨 thyroid cartilage,环状软骨cricoid cartilage 成对 double:杓状软骨 arytenoid cartilage,小角软骨 cornicular cartilage,楔状软骨 cuniform cartilage

喉肌 muscle of the larynx
• 杓会厌肌 aryepiglottic muscle 杓肌 arytenoid muscle 环杓后肌 posterior cricoarytenoid muscle 环杓侧肌 lateral cricoarytenoid muscle 环甲肌 cricothyroid muscle 甲杓肌 thyroarytenoid muscle 甲状会厌肌 thyroepiglottic muscle
• 2.喉腔 laryngeal cavity:3 portions 声门上区 supraglottic portion: 会厌epiglottis,勺会厌襞 aritenoepiglottic fold,勺区 arytenoid area,假声带 false vocal cord 声门区 glottic portion: 声带vocal cord 声门裂fissure of glottis 前联合anterior commisure 声门下区 infraglottic portion: 声门旁区 glottic portion:

• 3.喉的血管 blood vessel of larynx 喉上动脉 superior laryngeal artery 环甲动脉 cricothyroid artery 喉下动脉 inferior laryngeal artery
• 4.淋巴 lymphatics of larynx
• 声门上区supraglottic portion:淋巴管丰富lymphatic ducts are abundant,引流至颈深淋巴结上群drainage to upper group of deep cervical lymph nodes
• 声门下区infraglottic portion:淋巴管不丰富lymphatic ducts are not abundant,引流至颈深淋巴结下群drainage to lower group of deep cervical lymph nodes
• 声门区glottic portion:基本无淋巴管few lymphatic ducts

• 5.神经nerves:迷走神经vagus nerve 喉上神经 superior laryngeal nerve 内支inner beanches 外支outer branches支配环甲肌 cricothyroid muscle 喉返神经recurrent laryngeal nerve 除环甲肌以外喉肌laryngeal muscles except for cricothyroid muscle
喉的生理physiology of larynx

• 1.呼吸 respiration
• 2.发音 phonation
• 3.保护 protection
• 4.屏气 holding breath
急性化脓性扁桃体炎Acute suppurative tonsillitis

• 1.病因etiology
• 外部因素external factors:溶血性链球菌hemolytic streptococcus,其它细菌others bacteria,腺病毒adenoid virus
• 内因internal factors:抵抗力下降resistence decreasing
• 2.流行病epidemiology:传染性infectivity
• 3.临床表现clinical manifestation a.急性卡他性扁桃体炎acute catarral tonsillitis b.急性化脓性扁桃体炎acute suppurative tonsillitis
• 4.诊断和鉴别诊断Diagnosis and differencial diagnsis
• a.诊断diagnosis:症状和体症symptoms and signs
• b.鉴别诊断differencial diagnsis:咽白喉diphteria fauci,奋森氏咽峡炎Vicent angina(ulceromembranous angina),粒细胞减少性咽峡炎hypoleukocytic angina,猩红热scarlet fever
• 5.并发症Complication: a.局部并发症local complication:扁桃体周围脓肿peritonsillar abscess b.全身并发症general complication:风湿热rheumatic fever,急性关节炎acute arthritis,心肌炎cardiomyosis,急性肾炎acute nephritis
• 6.预防prevention
• 7.治疗treatment
• 慢性扁桃体炎Chronic tonsillitis
• 1.病因etiology
• 2.病理pathology
• 3.症状symptoms
• 4.检查examination
• 5.并发症complication:the same as acute tonsillitis
• 6.诊断diagnosis
• 7.治疗treatment
腺样体肥大adenoid vegetation
• 1.临床表现clinical manifestation
• a.局部症状local symptoms:1.耳ear 2.鼻nose 3.咽喉和下呼吸道pharynx larynx and lower respiratory tract 4.腺样体面容Adenoid expression
• b.全身症状general symptoms
• 2.检查examination:1. 腺样体面容adenoid expression 2.口咽检查oropharygeal examination 3.前鼻镜检查anterior nasoscope 4.纤维鼻咽镜Nasopharygo-fibroscope 5.触诊palpation 6.X-ray
• 3.治疗treatment
鼻咽癌Nasopharyngeal carcinoma
• 1.病因etiology: a:遗传因素genetic factors b.病毒因素virus factors c.环境因素environmental factors
• 2.临床表现clinical manifestation
• 早期症状early symptoms:
• 1.出血bleeding
• 2.鼻堵塞nose:obstruction
• 3.耳部症状ear symptoms
• 4.颈淋巴结肿大enlargement of cervical lymph nodes
• 晚期症状 late symptoms:
• (1).头痛headache
• (2).颅神经症状Symptoms of cranial nerve
• 3.检查Examination (1)鼻咽镜nasopharyngeal-scope (2)CT (3)X-ray
• 4.诊断diagnosis a.活检biopsy b.细胞涂片sliding of cells c.EB病毒抗体antibody of EB virus d.误诊率高missed diagnosis is high e.鉴别诊断
• 5.治疗treatment (1)放疗radiation:important method (2)化疗chemotherapy (3)手术surgery
喉癌Laryngeal carcinoma
• 1.病因etiology a.吸烟smoking b.饮酒drinking c.空气污染air pollution d.病毒感染virus infection e.癌前病变precancerous lesions f.激素hormone
• 2.病理pathology (1)鳞癌占90%squamous cell carcinoma:90% (2)分型types:3型3 types 声门上癌supraglottic carcinoma 声门癌glottic carcinoma 声门下癌infraglottic carcinoma (3)原位癌carcinoma in situ (4)继发癌secondary carcinoma
• 3.临床表现clinical manifestation
• (1)音哑hoarseness
• (2)喉痛sore throat
• (3)异物感sensation of foreign body
• (4)呼吸困难dyspnea
• (5)吞咽困难dysphagia
• (6)血痰blood spitting
• 声门上癌supraglottic carcinoma:early :异物感sensation of foreign body ,喉痛sore throat,吞咽困难dysphagia,血痰blood spitting
• 声门癌glottic carcinoma:音哑hoarseness,呼吸困难dyspnea
• 声门下癌infraglottic carcinoma: 早期无症状,咳嗽,血痰 early no symptoms,cough,blood spitting 晚期呼吸困难,侵犯环甲膜,甲状腺late:dyspnea,invasion of cricothyroid membrane,thyroid gland

• 4.扩散和转移spread and metastasis:3 types (1)直接扩散direct spreading (2)淋巴转移lymphatic metastasis (3)血行转移blood metastasis
• 5.检查examination (1)体格检查physical examination:喉体膨大,会厌前间隙饱满enlargement of larynx,fullness of pre-epiglottic space (2)间接喉镜,纤维喉镜,喉动态镜indirect laryngoscope,fibro-laryngoscope,laryngostroboscopy
• 6.诊断diagnosis (1)病史:40岁以上,音哑4周以上history:above 40 years old,hoarseness,above 4 weeks (2)活检biopsy (3)X-ray,CT
• 鉴别诊断differential diagnosis (1)喉结核laryngeal tuberculosis (2)喉梅毒laryngeal syphilis (3)喉乳头状瘤laryngeal papilloma
• 7.治疗treatment (1)放疗radiation: a.1期病变stage 1 lesion b.不适合手术not suitable to operation (2)手术surgury:全喉切除术total laryngectomy,喉部分切除术partial laryngectomy,颈廓清neck resection (3)激光laser:KTP
喉阻塞Laryngeal obstruction
• 1.病因etiology a.感染Infection b.外伤injury c.异物foreign body d.水肿edema e.肿瘤tumors f.畸形deformity g.声带麻痹vocal cord paralysis
临床表现Clinical manifestation
• a.吸气期呼吸困难 inspiratory dyspnea
• b.吸气期喉鸣 inspirarory laryngeal stridor
• c.吸气期软组织凹陷 inspiratory recess of soft tissue
• d.音哑 hoarseness
• f.紫绀 cyanosis
检查examination:4度
• 1度.平静时无症状,运动和哭闹时轻度症状rest:no symptoms,motion and crying:mild symptoms
• 2度. 平静时轻度症状, 运动和哭闹时加重rest: mild symptoms,motion:agggravating
• 3度.严重吸气期呼吸困难severe inspirarory dyspnea
• 4度.极度吸气期呼吸困难more severe inspiratory dyspnea
诊断和鉴别诊断diagnosis and differential diagnosis
• (1)病史,症状,体征history ,symptoms,signs
• (2)根据程度决定是否取材去除病因according to the degree,reasons should be detected or not
• 鉴别诊断differential diagnosis
治疗treatment
• 10.保守治疗conservative treatment
• 40.立即气管切开或环甲膜切开immediate tracheostomy or intercricothyrotomy
• 20-30.根据条件和病因according to the conditions and etiology a.炎症inflammation:先保守,不好转气管切开conservation,tracheostomy

b.异物,手术foreign body:operation
咽后脓肿:切开,引流retropharyngeal abscess:incision and drainage
c.肿瘤,双侧喉返神经麻痹,喉外伤不能立即 去除病因,应气管切开tumor,bilateral recurrent nerve paralysis,,injury of larynx,can not be resolved immediately tracheotomy
气管切开术Tracheotomy
• anatomy解剖 1.气管trachea 2.软组织soft tissue 3.血管blood vessel 4.甲状腺峡部isthmus of thyroid gland
适应症indication
• 1.喉阻塞laryngeal obstruction
• 2.下呼吸道阻塞和肺水肿Obstruction of lower respiratory tract and ischeotomy
• 3.预防性气管切开preventive tracheotomy
步骤 procedures
• 1.体位posture
• 2.消毒disinfection
• 3.麻醉anesthesia
• 4.切口incision
• 5.分离软组织separation of soft tissue
• 6.暴露气管exposing of trachea
• 7.气管切开tracheotomy
• 8.插入套管insertion of cannula
• 9.缝合和固定suture and fixation
术后护理postoperative nursing
• 1.保持内套管通畅keep inner cannula unobstructed
• 2.保持下呼吸道通畅keep lower respiratory tract unobstructed
• 3.切口消毒antiseption of incision
• 4.预防脱管prevent seperation of cannula
• 5.拔管decannulation:堵管 48小时后48 hours later after obstruction
并发症Complication
• 1.皮下气肿subcutaneous emphysema
• 2.纵隔气肿mediastinal emphysema
• 3.气胸pneumatothorax
• 4.出血bleeding
• 5.拔管困难Difficulty in decannulation
环甲膜切开Intercricothyrotomy

耳部 EAR

• 解剖anatomy
• 外耳the external ear (1) 耳廓auricle (2) 外耳道external acoustic meatus 外耳道软骨部 external cartilaginous meatus 外耳道骨部 external bony meatus 外耳的血液和神经 blood and nerve supply of the external ear
中耳 middle ear
• 鼓室 tympanic cavity 上,中,下鼓室 epitympanum mesotypanum hypotympanum
• 6个壁 6 walls
外壁 outer wall
• 由鼓膜和上鼓室骨部外侧形成 formed chiefly by the tympanic membrane and the outer bony wall of the epitympanum
• 鼓膜分为紧张部和松弛部 tympanic membrane:pars tensa and pars flaccida
• 鼓膜由三层组织构成 tympanic membrane consists of three layers 外层为上皮层an outer epithelium 中间为弹力组织 a middle elastic tissue 内层为粘膜层 an inner mucous membrane
• 标志 marks of the drum of the ear 脐部 umbo, 锤骨短突 short process of malleus, 锤前皱襞 anterior melleolar fold, 锤后皱襞 posterior malleolar fold, 光锥 cone of light, 锤骨柄 handle of malleus
• 内壁 inner wall 鼓岬 promontory,前庭窗 vestibular window(oval windows), 蜗窗 cochlear window(round window), 水平半规管horizontal semicircular canal
• 前壁 anterior wall 咽鼓管开口opening of the Eustachian Tube 鼓膜张肌 canal of the tensor tympani muscle
• 后壁 posterior wall
• 上壁 upper wall 鼓室盖 tegmen tympani
• 下壁 lower wall
• 中耳含3块听小骨 middle ear contains three ossicles 锤骨 malleus,砧骨 incus,镫骨 stapes
• 中耳肌肉包括鼓膜张肌和镫骨肌 muscle of the middle ear:the tensor tympanic muscle,stapedius muscles
• 中耳的血液和神经支配 blood and nerve supply of the middle ear blood supply 鼓室丛 tympanic plexus, 鼓索神经 chorda tympanic nerve
• 咽鼓管 pharyngotympanic tube
• 鼓窦 typanic antrum
• 乳突 mastoid process: 气化型 pneumatic type 板障型 diploetic type 硬化型 sclerotic type 混合型 mixed type
内耳 the inner ear
• 迷路 inner ear(labyrinth) 骨迷路 osseous labyrinth 膜迷路 membranous labyrinth: 内淋巴 endolymph 外淋巴 perilymph
• 骨迷路 osseous labyrinth: 前庭 vestibule,骨半规管 osseous semicircular canals,蜗管 cochlea
• 膜迷路 membranous labyrinth: 椭圆囊 utricle,球囊 saccule，膜半规管membranous semicircular canals,膜蜗管membraneous cochlear duct
• 内耳血液 blood supply of inner ear
耳生理 physiology of the ear
• 中耳生理 the middle ear mechanism
• 耳蜗生理 cochlear mechanism
• 听觉生理 physiology of hearing 气导 air conduction 骨导 bone conduction
外耳疾病 diseases of external ear
分泌性中耳炎 secretory otitis media
• 定义definition
• 病因etiology
• 1.咽鼓管功能不良insufficiency of Eustachian tube (1)机械性堵塞mechanical obsruction (2)功能障碍dysfunction
• 2.感染infection
• 3.免疫反应immune responce
• 病理 pathology
• 表现 manifestation
• 1.听力减退 Hearing loss,deafness
• 2.缺乏疼痛 absence of pain
• 3.耳鸣 tinnitus
• 检查 examination
• 1.鼓膜 the tympanic membrane
• 2.听力检查 hearing examination
• 诊断 diagnosis
• 鉴别诊断 differential diagnosis
• 1.鼻咽部 nasopharyngeal tumors
• 2.脑脊液耳漏 cerebrospinal fistula
• 3.其它 others
治疗 treatment
• 1.鼓膜穿刺 puncture of tympanic membrane
• 2.鼓膜切开 myrigotomy
• 3.鼓膜置管术 the tube in situ in the tympanic membrane
• 4.保持鼻腔通畅 keep nasal cavity unobstructed

• 5.咽鼓管吹张 eustachian tube inflation
• 6.病因治疗 etiology treatment
• 7.治疗鼻咽部疾病 treatment of nasopharyngeal disease
• 8.抗生素antibiotics
• 9.激素 hormone
急性化脓性中耳炎acute suppurative otitis media
• 定义 difinition
• 感染源 sources of infection
• 1.咽鼓管Eustachian tube is the chief route (1)上呼吸道急性感染acute infetion of upper respiratory system (2)传染病infectious disease (3)游泳swimming (4)婴幼儿infantile
• 2.外耳道和鼓膜 external meatus and tympanic membrane
• 3.血行感染 blood infetion
• 病理 pathology
• 症状 symptoms
• 1.全身症状 general symptoms
• 2.疼痛 pain
• 3.耳聋和耳鸣 deafness and tinnitus
• 4.分泌物 discharge
• 预防 prevention
• 治疗 treatment
• 1.全身治疗general treatment (1)抗生素 antibiotics (2)滴鼻剂 drop nose (3)休息 rest
• 2.局部治疗 local treatment
• 穿孔前 before perforation (1) 滴鼻剂drop nose (2) 鼓膜切开术 myringotomy
• 穿孔后 after perforation (1)洗耳 washing ear (2)滴耳,水溶性 drop ear:water-soluble (3)当分泌物减少时,用酒精或甘油滴耳剂 when discharge decrease,glycerine or alcohol-soluble otic drop can be used (4)控制感染后,穿孔可愈合.如果不愈合,可行鼓膜修补术 after controlling of infection,perforation can heal.If perforation did not heal,myringoplsty should be undertaken
• 3.病因治疗Etiology treatment
慢性化脓性中耳炎chronic suppurative otitis media
• 定义 definition
• 病因 etiology
• 病理和临床表现 pathology and manifestation
• 1.单纯性 simple
• 2.骨疡性 caries
• 3.胆脂瘤 cholesteatoma
• 先天性胆脂瘤 congenital cholesteatoma
• 后天性胆脂瘤 acquired cholesteatoma
• 鉴别诊断 differential diagnosis
• (1)中耳癌 cancer of middle ear
• (2)中耳结核 tuberculosis otitis media
• 治疗 treatment
• 1.病因治疗 etiology treatment
• 2.局部治疗 local treatment
耳源性并发症otogenic complication
• 病因etiology
• 1.中耳炎类型 Type of otitis media
• 2.细菌 bacteriology
• 3.病人机体抵抗力 resistence of patients
• 4.局部因素 local factors
• 传播途径 speading way
• 1.血液循环 circulation of blood
• 2.循破坏的骨壁 destruction of bone wall
• 3.正常的解剖途径 normal anatomical route
分类 classification
• 1.颅外并发症 extra cranial complications (1)耳后骨膜下脓肿 postauricular subperiosteal abscess (2)贝佐氏脓肿 Bezold’s abscess (3)迷路炎 labyrinthitis (4)面瘫 facial nerve paralysis (5)岩尖炎 petrositis
• 颅内并发症 intracranial complication
• （1）硬膜外脓肿 extradural/perisinus abscess
• （2）乙状窦 lateral sinus thrombosis
• （3）脑膜炎 otitic meningitis
• （4）脑脓肿 cerebral abscess （
• 5）硬膜下脓肿 subdural abscess
• （6）脑积水 otitic hydrocephalus
• （7）脑疝 brain herniation
• 诊断 diagnosis
• 1.病史 history of diseases
• 2.局部检查 local examination
• 3. 颅外和颅内并发症 extra cranial and intra cranial complications
• 4.X-ray and CT or MRI
• 5.类型 type of complication
• 治疗 treatment
• 1.手术 operation
• 2.抗生素 antibiotics
迷路炎 labyrinthitis
• 1.限局性迷路炎circumscribed labyrinthitis or fistula of labyrinthitis
• 病理 pathology
• 表现 manifestation 1.眩晕 vertigo 2.眼震 nystagmus 3.听力损失 hearing loss 4.漏孔试验 fistula test 5.ENG
治疗 treatment
（1）抗生素 antibiotics
（2）手术 operation
2.浆液性迷路炎 serous labyrinthitis
病理 pathology
表现 manifestation
1.眩晕 vertigo
2.眼震 nystugmus
• 3.听力损失 hearing loss
• 4.疼痛 pain
• 鉴别诊断 differential diagnosis
• 治疗 treatment
• 3.化脓性迷路炎 suppurative labyrinthitis
• 病理 pathology
• 表现 manifestation 1.眩晕 vertigo 2.平衡失调 dysfunction of equilibrium 3.耳鸣耳聋 tinnitus and deafness 4.眼震 nystagmus 5.体温 temperature 6. 漏孔试验 fistula test
• 治疗treatment
• 1.抗生素 antibiotics
• 2.手术 operation
• 3.补液 supplyment of fluid
脑脓肿 brain abscess
• 1.感染途径 infection way
• 2.病理 pathology
• 3.表现 manifestation
• 4.诊断 diagnosis
• 5.鉴别诊断 differential diagnosis
• 6.治疗 treatment

鼻科学

第一章 鼻应用解剖学及生理学
外鼻、鼻腔、鼻窦
呼吸功能
保护功能
嗅觉功能
声音共鸣功能
第一节　鼻应用解剖学Anatomy of nose
鼻（nose)由外鼻、鼻腔、鼻窦组成
一、外鼻 （external nose ）
外鼻的一些解剖名称 ：鼻根nasal root、鼻尖nasal apex、鼻梁nasal bridge、鼻背nasal dorsum、鼻翼alae nasi、鼻底basis nasi 、前鼻孔anterior nares、鼻小柱colum