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1、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 lymph
2、atic 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
3、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 aryepigl
4、ottic 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 aritenoepiglotti
5、c 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 lar
6、yngeal 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 •
7、 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 resp
8、iration • 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infecti
9、vity • 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
10、),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 tonsilliti
11、s • 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
12、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 carcinom
13、a • 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
14、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
15、)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
16、 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 spi
17、tting • 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 cricot
18、hyroid 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 l
19、aryngoscope,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trea
20、tment (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tu
21、mors 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 a
22、nd 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 deg
23、ree,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
24、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 ti
25、ssue 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.
26、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
27、 • 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
28、 • 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
29、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 el
30、astic 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
31、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 conta
32、ins 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
33、 • 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
34、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
35、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
36、 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
37、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
38、 • 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)
39、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 treatme
40、nt • 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 decr
41、ease,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 etiolo
42、gy • 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 treat
43、ment • 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
44、 • 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 •
45、 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
46、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 labyrin
47、thitis 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 vertig
48、o 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
49、 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
50、 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
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