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1、January, 2007,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,淋巴系统 Lymphatic system,兰州大学基础医学院人体解剖学教研室,January, 2007,Copyright 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结示意图,Ja
2、nuary, 2007,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,第一节 总 论,淋巴系统由淋巴管道、淋巴组织和淋巴器官组成。 淋巴管道和淋巴结的淋巴窦内含有淋巴液，简称为淋巴。 淋巴系统是心血管系统的辅助系统，协助静脉引流组织液。 此外，淋巴器官和淋巴组织具有产生淋巴细胞，过滤淋巴和进行免疫应答的功能。,January, 2007,Copyright Depart. Anatomy, School of Medicine
3、, Lanzhou University. All right reserved by YP HOU and YF SONG,淋巴的循环过程示意图,心脏 淋巴导管 动脉 静脉 毛细血管 淋巴干 组织间隙 毛细淋巴管 淋巴管 细胞,January, 2007,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,淋巴系统,一、淋巴系统的组成和结构特点 二、淋巴回流的因素 三、淋巴侧支循环,January, 2007,Copyright
4、Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,淋巴管道 淋巴组织 淋巴器官,一、淋巴系统的组成和结构特点,January, 2007,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,毛细淋巴管淋巴管 淋巴干（9条） 淋巴导管（2条）,（一）淋巴管道,January, 2007,Co
5、pyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,毛细淋巴管（lymphatic capillary）以膨大的盲端起始，互相吻合成毛细淋巴管网，汇入淋巴管。 淋巴管（lymphatic vessel ）由毛细淋巴管吻合而成，注入淋巴结。其管壁结构与静脉相似，内有瓣膜，可防止淋巴液回流，外观呈串珠样。淋巴管分为浅、深淋巴管两类，之间有丰富的交通。,January, 2007,Copyright Depart. Anatomy, Scho
6、ol of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,淋巴干（lymphatic trunk）由淋巴结发出的淋巴管在膈下和颈根部汇合而成。其包括腰干、支气管纵隔干、锁骨下干、颈干各两条和一条肠干，共九条。 淋巴导管（lymphatic duct）淋巴干合成两条淋巴导管，即胸导管和右淋巴导管，分别注入左、右静脉角。,January, 2007,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right r
7、eserved by YP HOU and YF SONG,淋巴干和淋巴导管,January, 2007,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,（二）淋巴组织,弥散淋巴组织 （消化道和呼吸道粘膜固有层） 淋巴小结 孤立淋巴滤泡 集合淋巴滤泡 淋巴小结,January, 2007,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All
8、right reserved by YP HOU and YF SONG,（三）淋巴器官,淋巴器官包括： 淋巴结 胸腺 脾脏 扁桃体,January, 2007,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,淋巴结,淋巴结（lymph node）为大小不一的圆形或椭圆形灰红色小体，一侧隆凸，另一侧凹陷，凹陷中央处为淋巴结门。淋巴结门有神经和血管出入。 与淋巴结凹侧相连的淋巴管称输入淋巴管，出淋巴结门的淋巴管称输出淋巴管。,Ja
9、nuary, 2007,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,形态：圆形或椭圆形灰红色小体 数目：不恒定，青年人约400500个。 位置：可分为浅淋巴结和深淋巴结，多沿血管 排列，位于关节的屈侧和体腔的隐藏部 位。 功能：滤过淋巴、产生淋巴细胞和进行免疫应 答。,January, 2007,Copyright Depart. Anatomy, School of Medicine, Lanzhou University
10、. All right reserved by YP HOU and YF SONG,淋巴结结构,January, 2007,Copyright 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：安静时，每小时约120ml淋巴入血 参与回流的因素： 淋巴管泵 动脉搏动 肌肉收缩与运动 胸腔负压 运动和按摩,January, 2007,Copyright Depart. Anatomy, School of Medicine
11、, Lanzhou University. All right reserved by YP HOU and YF SONG,三、淋巴侧支循环,淋巴管之间有丰富的交通支，参与构成淋巴侧支循环。当炎症、寄生虫、异物或肿瘤栓子阻塞淋巴管，外伤或手术切断淋巴管时，淋巴经交通支回流，形成淋巴侧支循环。 侧支循环的功能： 优点：炎症和外伤时，侧支保证了正常组织和病变组织的淋巴回流； 缺点：淋巴侧支通路可成为病变扩散或肿瘤转移的途径。,January, 2007,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All r
12、ight reserved by YP HOU and YF SONG,第二节 淋巴导管,January, 2007,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,一、 胸导管,胸导管（thoracic duct）是全身最大的淋巴管。 长度：30-40cm 起止：乳糜池（平12下缘）-左静脉角 行程：自12胸椎下缘上行，经主动脉裂孔 进胸腔；在脊柱前方行至颈部。 收集范围：两下肢、盆腹部、左胸部、左上肢、左头颈部，即全身3/4
13、部分的淋巴。,January, 2007,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,乳糜池位于第一腰椎前方,呈囊状膨大,接受左、右腰干和肠干。 胸导管在乳糜池处接受左、右腰干和肠干，在注入左静脉角处接受左颈干、左锁骨下干和左支气管纵隔干。 胸导管有丰富交通支，在临床上有重要意义。,January, 2007,Copyright Depart. Anatomy, School of Medicine, Lanzhou Uni
14、versity. All right reserved by YP HOU and YF SONG,胸导管示意图,January, 2007,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,胸导管的位置,January, 2007,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and
15、YF SONG,二、 右淋巴导管,右淋巴管（right lymphatic duct）由右颈干、右锁骨下干和右支气管纵隔干，注入右静脉角。 长度：1-1.5cm 起止：右侧三条淋巴干汇合点-右静脉角 收集范围：右肺、右半心、右半胸廓、右上肢、右头颈部，即全身部分的淋巴。,January, 2007,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,右淋巴导管示意图,January, 2007,Copyright Depart. A
16、natomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,淋巴导管收纳范围,January, 2007,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,第三节 淋巴结的位置 和淋巴引流范围,一、头颈部的淋巴管和淋巴结 二、上肢淋巴管和淋巴结 三、胸部淋巴管和淋巴结 四、下肢淋巴管和淋巴结 五、盆部淋巴管和淋巴结
17、 六、腹部淋巴管和淋巴结,January, 2007,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,一、头颈部的淋巴管和淋巴结,头部淋巴结 枕淋巴结 乳突淋巴结 腮腺淋巴结 下颌下淋巴结 颏下淋巴结,January, 2007,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and Y
18、F SONG,颈部淋巴结 颈前淋巴结 颈前浅淋巴结 颈前深淋巴结 喉前淋巴结 甲状腺淋巴结 气管前淋巴结 气管旁淋巴结 颈外侧淋巴结 颈外侧浅淋巴结 颈外侧深淋巴结 颈外侧上深淋巴结：颈内静脉二腹肌淋巴结；颈内静脉肩胛舌骨肌淋巴结；副神经淋巴结 颈外侧下深淋巴结：锁骨上淋巴结；斜角肌淋巴结；Virchow淋巴结；咽后淋巴结,January, 2007,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,颈浅淋巴结,January,
19、2007,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,颈深淋巴结,January, 2007,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,二、上肢淋巴管和淋巴结,肘淋巴结 浅群，即：滑车上淋巴结 深群 锁骨下淋巴结 腋淋巴结 胸肌淋巴结 外侧淋巴结 肩胛下
20、淋巴结 中央淋巴结 尖淋巴结,January, 2007,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,上肢淋巴管和淋巴结,January, 2007,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,三、胸部淋巴管和淋巴结,胸壁淋巴结 胸骨旁淋巴结 肋间淋巴结
21、膈上淋巴结 胸腔器官淋巴结 纵隔前淋巴结 纵隔后淋巴结 气管、支气管和肺的淋巴结 肺淋巴结 支气管肺淋巴结 气管支气管淋巴结 气管旁淋巴结,January, 2007,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,January, 2007,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HO
22、U and YF SONG,January, 2007,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,四、下肢淋巴管和淋巴结,腘淋巴结 腹股沟淋巴结 腹股沟浅淋巴结 腹股沟深淋巴结,January, 2007,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,下肢
23、淋巴管和淋巴结,January, 2007,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,January, 2007,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,五、盆部淋巴管和淋巴结,髂内淋巴结 骶淋巴结 髂外淋巴结 髂总淋巴结,January, 2007
24、,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,January, 2007,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,January, 2007,Copyright Depart. Anatomy, School of Medicine, Lanzhou
25、University. All right reserved by YP HOU and YF SONG,六、腹部淋巴管和淋巴结,腹壁淋巴结 脐平面以上浅、深群 脐平面以下浅、深群 腰淋巴结 腹腔器官淋巴结 沿腹腔干及其分支排列的淋巴结 沿肠系膜上动脉及其分支排列的淋巴结 沿肠系膜下动脉及其分支排列的淋巴结,January, 2007,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,January, 2007,Copyright
26、 Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,January, 2007,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,肠系膜淋巴结,January, 2007,Copyright Depart. Anatomy, School of Medicine, Lanzhou Uni
27、versity. All right reserved by YP HOU and YF SONG,January, 2007,Copyright 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 直肠的淋巴引流 子宫的淋巴引流 乳房的淋巴引流,第四节 部分器官的淋巴引流,January, 2007,Copyright Depart. Anatomy, School of Medicine,
28、Lanzhou University. All right reserved by YP HOU and YF SONG,January, 2007,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,第五节 胸腺,胸腺 thymus 是中枢淋巴器官，培育、选择和向周围淋巴器官和淋巴组织输送T淋巴细胞；此外，胸腺还有内分泌功能。,January, 2007,Copyright Depart. Anatomy, School of M
29、edicine, Lanzhou University. All right reserved by YP HOU and YF SONG,第六节 脾,脾（spleen）人体最大的淋巴器官。 位置：左季肋部、胃底与膈之间；左911肋深 面,长轴与第10肋一致。 形态：暗红色、质软脆、长卵圆形。 结构：脏、膈两面，前、后两端，上、下两缘。 脾门、脾切迹、副脾（20%）。 作用：具有储血、造血、清除衰老红细胞和进行 免疫应答的功能。,January, 2007,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. Al
30、l right reserved by YP HOU and YF SONG,脾的膈面,January, 2007,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,脾的脏面,January, 2007,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,思考题,试述胸导管的起始、经行、主要属支及收集范围,