淋巴系統(tǒng)0課件

1、January, 2019Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG 淋巴系統(tǒng)Lymphatic system 蘭州大學(xué)基礎(chǔ)醫(yī)學(xué)院人體解剖學(xué)教研室January, 2019Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG 全身的淋巴管和淋巴結(jié)示意圖January

2、, 2019Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG 第一節(jié) 總 論淋巴系統(tǒng)由淋巴管道、淋巴組織和淋巴器官組成。淋巴管道和淋巴結(jié)的淋巴竇內(nèi)含有淋巴液，簡稱為淋巴。淋巴系統(tǒng)是心血管系統(tǒng)的輔助系統(tǒng)，協(xié)助靜脈引流組織液。此外，淋巴器官和淋巴組織具有產(chǎn)生淋巴細(xì)胞，過濾淋巴和進(jìn)行免疫應(yīng)答的功能。January, 2019Copyright Depart. Anatomy, School of Medicine, Lanzhou Un

3、iversity. All right reserved by YP HOU and YF SONG 淋巴的循環(huán)過程示意圖 心臟 淋巴導(dǎo)管 動脈 靜脈 毛細(xì)血管 淋巴干 組織間隙 毛細(xì)淋巴管 淋巴管 細(xì)胞 January, 2019Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG 淋巴系統(tǒng)一、淋巴系統(tǒng)的組成和結(jié)構(gòu)特點二、淋巴回流的因素三、淋巴側(cè)支循環(huán)January, 2019Copyright Depart. Anatomy, S

4、chool of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG 淋巴管道淋巴組織淋巴器官一、淋巴系統(tǒng)的組成和結(jié)構(gòu)特點January, 2019Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG 毛細(xì)淋巴管淋巴管淋巴干（9條）淋巴導(dǎo)管（2條）（一）淋巴管道January, 2019Copyright Depart. Anatomy, Sch

5、ool of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG 毛細(xì)淋巴管（lymphatic capillary）以膨大的盲端起始，互相吻合成毛細(xì)淋巴管網(wǎng)，匯入淋巴管。淋巴管（lymphatic vessel ）由毛細(xì)淋巴管吻合而成，注入淋巴結(jié)。其管壁結(jié)構(gòu)與靜脈相似，內(nèi)有瓣膜，可防止淋巴液回流，外觀呈串珠樣。淋巴管分為淺、深淋巴管兩類，之間有豐富的交通。January, 2019Copyright Depart. Anatomy, School of Medicine, Lanzhou Univers

6、ity. All right reserved by YP HOU and YF SONG 淋巴干（lymphatic trunk）由淋巴結(jié)發(fā)出的淋巴管在膈下和頸根部匯合而成。其包括腰干、支氣管縱隔干、鎖骨下干、頸干各兩條和一條腸干，共九條。淋巴導(dǎo)管（lymphatic duct）淋巴干合成兩條淋巴導(dǎo)管，即胸導(dǎo)管和右淋巴導(dǎo)管，分別注入左、右靜脈角。January, 2019Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG 淋巴干和

7、淋巴導(dǎo)管January, 2019Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG （二）淋巴組織彌散淋巴組織 （消化道和呼吸道粘膜固有層）淋巴小結(jié) 孤立淋巴濾泡 集合淋巴濾泡 淋巴小結(jié)January, 2019Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG （三）

8、淋巴器官淋巴器官包括：淋巴結(jié)胸腺脾臟扁桃體January, 2019Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG 淋巴結(jié) 淋巴結(jié)（lymph node）為大小不一的圓形或橢圓形灰紅色小體，一側(cè)隆凸，另一側(cè)凹陷，凹陷中央處為淋巴結(jié)門。淋巴結(jié)門有神經(jīng)和血管出入。與淋巴結(jié)凹側(cè)相連的淋巴管稱輸入淋巴管，出淋巴結(jié)門的淋巴管稱輸出淋巴管。January, 2019Copyright Depart. Anatomy, School of M

9、edicine, Lanzhou University. All right reserved by YP HOU and YF SONG 形態(tài)：圓形或橢圓形灰紅色小體數(shù)目：不恒定，青年人約400500個。位置：可分為淺淋巴結(jié)和深淋巴結(jié)，多沿血管 排列，位于關(guān)節(jié)的屈側(cè)和體腔的隱藏部 位。功能：濾過淋巴、產(chǎn)生淋巴細(xì)胞和進(jìn)行免疫應(yīng) 答。January, 2019Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG 淋巴結(jié)結(jié)構(gòu)January

10、, 2019Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG 二、淋巴回流的因素回流量：安靜時，每小時約120ml淋巴入血參與回流的因素： 淋巴管泵動脈搏動肌肉收縮與運動胸腔負(fù)壓運動和按摩January, 2019Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG 三、

11、淋巴側(cè)支循環(huán)淋巴管之間有豐富的交通支，參與構(gòu)成淋巴側(cè)支循環(huán)。當(dāng)炎癥、寄生蟲、異物或腫瘤栓子阻塞淋巴管，外傷或手術(shù)切斷淋巴管時，淋巴經(jīng)交通支回流，形成淋巴側(cè)支循環(huán)。側(cè)支循環(huán)的功能：優(yōu)點：炎癥和外傷時，側(cè)支保證了正常組織和病變組織的淋巴回流；缺點：淋巴側(cè)支通路可成為病變擴散或腫瘤轉(zhuǎn)移的途徑。January, 2019Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG 第二節(jié) 淋巴導(dǎo)管 January, 2019Copyright Dep

12、art. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG 一、 胸導(dǎo)管胸導(dǎo)管（thoracic duct）是全身最大的淋巴管。長度：30-40cm起止：乳糜池（平12下緣）-左靜脈角行程：自12胸椎下緣上行，經(jīng)主動脈裂孔 進(jìn)胸腔；在脊柱前方行至頸部。收集范圍：兩下肢、盆腹部、左胸部、左上肢、左頭頸部，即全身3/4部分的淋巴。January, 2019Copyright Depart. Anatomy, School of Medicine, Lanzhou Uni

13、versity. All right reserved by YP HOU and YF SONG 乳糜池位于第一腰椎前方,呈囊狀膨大,接受左、右腰干和腸干。胸導(dǎo)管在乳糜池處接受左、右腰干和腸干，在注入左靜脈角處接受左頸干、左鎖骨下干和左支氣管縱隔干。胸導(dǎo)管有豐富交通支，在臨床上有重要意義。January, 2019Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG 胸導(dǎo)管示意圖January, 2019Copyright Depa

14、rt. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG 胸導(dǎo)管的位置January, 2019Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG 二、 右淋巴導(dǎo)管右淋巴管（right lymphatic duct）由右頸干、右鎖骨下干和右支氣管縱隔干，注入右靜脈角。長度：1-1.5cm起止：右側(cè)三條淋巴

15、干匯合點-右靜脈角收集范圍：右肺、右半心、右半胸廓、右上肢、右頭頸部，即全身部分的淋巴。January, 2019Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG 右淋巴導(dǎo)管示意圖January, 2019Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG 淋巴導(dǎo)管收納

16、范圍January, 2019Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG 第三節(jié) 淋巴結(jié)的位置和淋巴引流范圍一、頭頸部的淋巴管和淋巴結(jié)二、上肢淋巴管和淋巴結(jié)三、胸部淋巴管和淋巴結(jié)四、下肢淋巴管和淋巴結(jié)五、盆部淋巴管和淋巴結(jié)六、腹部淋巴管和淋巴結(jié)January, 2019Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right re

17、served by YP HOU and YF SONG 一、頭頸部的淋巴管和淋巴結(jié)頭部淋巴結(jié)枕淋巴結(jié)乳突淋巴結(jié)腮腺淋巴結(jié)下頜下淋巴結(jié)頦下淋巴結(jié)January, 2019Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG 頸部淋巴結(jié)頸前淋巴結(jié)頸前淺淋巴結(jié)頸前深淋巴結(jié)喉前淋巴結(jié)甲狀腺淋巴結(jié)氣管前淋巴結(jié)氣管旁淋巴結(jié)頸外側(cè)淋巴結(jié)頸外側(cè)淺淋巴結(jié)頸外側(cè)深淋巴結(jié)頸外側(cè)上深淋巴結(jié)：頸內(nèi)靜脈二腹肌淋巴結(jié)；頸內(nèi)靜脈肩胛舌骨肌淋巴結(jié)；副神經(jīng)淋巴結(jié)頸外側(cè)

18、下深淋巴結(jié)：鎖骨上淋巴結(jié)；斜角肌淋巴結(jié)；Virchow淋巴結(jié)；咽后淋巴結(jié)January, 2019Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG 頸淺淋巴結(jié)January, 2019Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG 頸深淋巴結(jié)January, 201

19、9Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG 二、上肢淋巴管和淋巴結(jié)肘淋巴結(jié)淺群，即：滑車上淋巴結(jié)深群鎖骨下淋巴結(jié)腋淋巴結(jié)胸肌淋巴結(jié)外側(cè)淋巴結(jié)肩胛下淋巴結(jié)中央淋巴結(jié)尖淋巴結(jié)January, 2019Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG 上肢淋巴管和淋

20、巴結(jié)January, 2019Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG 三、胸部淋巴管和淋巴結(jié)胸壁淋巴結(jié)胸骨旁淋巴結(jié)肋間淋巴結(jié)膈上淋巴結(jié)胸腔器官淋巴結(jié)縱隔前淋巴結(jié)縱隔后淋巴結(jié)氣管、支氣管和肺的淋巴結(jié)肺淋巴結(jié)支氣管肺淋巴結(jié)氣管支氣管淋巴結(jié)氣管旁淋巴結(jié)January, 2019Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right

21、 reserved by YP HOU and YF SONG January, 2019Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG January, 2019Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG 四、下肢淋巴管和淋巴結(jié)腘淋巴結(jié)腹股溝淋巴結(jié)腹股溝淺淋

22、巴結(jié)腹股溝深淋巴結(jié)January, 2019Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG 下肢淋巴管和淋巴結(jié)January, 2019Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG January, 2019Copyright Depart. Anatomy,

23、School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG 五、盆部淋巴管和淋巴結(jié)髂內(nèi)淋巴結(jié)骶淋巴結(jié)髂外淋巴結(jié)髂總淋巴結(jié)January, 2019Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG 盆部淋巴管和淋巴結(jié)（男性）盆部淋巴管和淋巴結(jié)（女性）January, 2019Copyright Depart. Anatomy, Sc

24、hool of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG January, 2019Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG 六、腹部淋巴管和淋巴結(jié)腹壁淋巴結(jié)臍平面以上淺、深群臍平面以下淺、深群腰淋巴結(jié)腹腔器官淋巴結(jié)沿腹腔干及其分支排列的淋巴結(jié)沿腸系膜上動脈及其分支排列的淋巴結(jié)沿腸系膜下動脈及其分支排列的淋巴結(jié)January

25、, 2019Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG January, 2019Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG January, 2019Copyright Depart. Anatomy, School of Medicine, Lanzh

26、ou University. All right reserved by YP HOU and YF SONG 腸系膜淋巴結(jié)January, 2019Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG January, 2019Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG 肺的淋巴引流食管的淋巴引流胃的淋巴引流肝的淋巴引流直腸的淋巴引流子宮的淋巴引流乳房的淋巴引流第四節(jié) 部分器官的淋巴引流January, 2019Copyright Depart. Anatomy, School of Medicine, Lanzhou University. A