咽部的解剖Anatomyofpharynx.docx

咽部的解剖Anatomyofpharynx.docx

《咽部的解剖Anatomyofpharynx.docx》由会员分享，可在线阅读，更多相关《咽部的解剖Anatomyofpharynx.docx（36页珍藏版）》请在冰豆网上搜索。

咽部的解剖Anatomyofpharynx

咽部的解剖Anatomyofpharynx

•1.分部parts:

鼻咽nasopharynx:

咽鼓管咽口eustachialorifice,圆枕torustubalis,咽隐窝pharyngealrecess,腺样体adenoid口咽oropharynx:

咽峡fauces,咽侧索lateralchorda,舌扁桃体lingualtonsil喉咽hypopharynx:

会厌谷vallecularepiglottica,梨状窝piriformfossa,环后隙retrocricoidspace

•2.淋巴组织lymphatictissue内环innerloop外环outerloop腭扁桃体palatinetonsilla腺样体adenoid

咽的生理physiologyofpharynx

•1.呼吸功能repiratoryfunction

•2.吞咽功能swallowingfunction

•3.语言形成formationofspeech

•4.保护功能protection

•5.调节中耳压力modulationofairpressureofmiddleear

•6.扁桃体的免功能immunefunctionoftonsilla

喉的解剖Anatomyoflarynx

•1.喉软骨laryngealcartilage单个one:

会厌软骨epiglotticcartilage,甲状软骨thyroidcartilage,环状软骨cricoidcartilage成对double:

杓状软骨arytenoidcartilage,小角软骨cornicularcartilage,楔状软骨cuniformcartilage

喉肌muscleofthelarynx

•杓会厌肌aryepiglotticmuscle杓肌arytenoidmuscle环杓后肌posteriorcricoarytenoidmuscle环杓侧肌lateralcricoarytenoidmuscle环甲肌cricothyroidmuscle甲杓肌thyroarytenoidmuscle甲状会厌肌thyroepiglotticmuscle

•2.喉腔laryngealcavity:

3portions声门上区supraglotticportion:

会厌epiglottis,勺会厌襞aritenoepiglotticfold,勺区arytenoidarea,假声带falsevocalcord声门区glotticportion:

声带vocalcord声门裂fissureofglottis前联合anteriorcommisure声门下区infraglotticportion:

声门旁区glotticportion:

•3.喉的血管bloodvesseloflarynx喉上动脉superiorlaryngealartery环甲动脉cricothyroidartery喉下动脉inferiorlaryngealartery

•4.淋巴lymphaticsoflarynx

•声门上区supraglotticportion:

淋巴管丰富lymphaticductsareabundant,引流至颈深淋巴结上群drainagetouppergroupofdeepcervicallymphnodes

•声门下区infraglotticportion:

淋巴管不丰富lymphaticductsarenotabundant,引流至颈深淋巴结下群drainagetolowergroupofdeepcervicallymphnodes

•声门区glotticportion:

基本无淋巴管fewlymphaticducts

•5.神经nerves:

迷走神经vagusnerve喉上神经superiorlaryngealnerve内支innerbeanches外支outerbranches支配环甲肌cricothyroidmuscle喉返神经recurrentlaryngealnerve除环甲肌以外喉肌laryngealmusclesexceptforcricothyroidmuscle

喉的生理physiologyoflarynx

•1.呼吸respiration

•2.发音phonation

•3.保护protection

•4.屏气holdingbreath

急性化脓性扁桃体炎Acutesuppurativetonsillitis

•1.病因etiology

•外部因素externalfactors:

溶血性链球菌hemolyticstreptococcus,其它细菌othersbacteria,腺病毒adenoidvirus

•内因internalfactors:

抵抗力下降resistencedecreasing

•2.流行病epidemiology:

传染性infectivity

•3.临床表现clinicalmanifestationa.急性卡他性扁桃体炎acutecatarraltonsillitisb.急性化脓性扁桃体炎acutesuppurativetonsillitis

•4.诊断和鉴别诊断Diagnosisanddifferencialdiagnsis

•a.诊断diagnosis:

症状和体症symptomsandsigns

•b.鉴别诊断differencialdiagnsis:

咽白喉diphteriafauci,奋森氏咽峡炎Vicentangina（ulceromembranousangina）,粒细胞减少性咽峡炎hypoleukocyticangina,猩红热scarletfever

•5.并发症Complication:

a.局部并发症localcomplication:

扁桃体周围脓肿peritonsillarabscessb.全身并发症generalcomplication:

风湿热rheumaticfever,急性关节炎acutearthritis,心肌炎cardiomyosis,急性肾炎acutenephritis

•6.预防prevention

•7.治疗treatment

•慢性扁桃体炎Chronictonsillitis

•1.病因etiology

•2.病理pathology

•3.症状symptoms

•4.检查examination

•5.并发症complication:

thesameasacutetonsillitis

•6.诊断diagnosis

•7.治疗treatment

腺样体肥大adenoidvegetation

•1.临床表现clinicalmanifestation

•a.局部症状localsymptoms:

1.耳ear2.鼻nose3.咽喉和下呼吸道pharynxlarynxandlowerrespiratorytract4.腺样体面容Adenoidexpression

•b.全身症状generalsymptoms

•2.检查examination:

1.腺样体面容adenoidexpression2.口咽检查oropharygealexamination3.前鼻镜检查anteriornasoscope4.纤维鼻咽镜Nasopharygo-fibroscope5.触诊palpation6.X-ray

•3.治疗treatment

鼻咽癌Nasopharyngealcarcinoma

•1.病因etiology:

a:

遗传因素geneticfactorsb.病毒因素virusfactorsc.环境因素environmentalfactors

•2.临床表现clinicalmanifestation

•早期症状earlysymptoms:

•1.出血bleeding

•2.鼻堵塞nose:

obstruction

•3.耳部症状earsymptoms

•4.颈淋巴结肿大enlargementofcervicallymphnodes

•晚期症状latesymptoms:

•

（1）.头痛headache

•

（2）.颅神经症状Symptomsofcranialnerve

•3.检查Examination

（1）鼻咽镜nasopharyngeal-scope

（2）CT（3）X-ray

•4.诊断diagnosisa.活检biopsyb.细胞涂片slidingofcellsc.EB病毒抗体antibodyofEBvirusd.误诊率高misseddiagnosisishighe.鉴别诊断

•5.治疗treatment

（1）放疗radiation:

importantmethod

（2）化疗chemotherapy（3）手术surgery

喉癌Laryngealcarcinoma

•1.病因etiologya.吸烟smokingb.饮酒drinkingc.空气污染airpollutiond.病毒感染virusinfectione.癌前病变precancerouslesionsf.激素hormone

•2.病理pathology

（1）鳞癌占90%squamouscellcarcinoma:

90%

（2）分型types:

3型3types声门上癌supraglotticcarcinoma声门癌glotticcarcinoma声门下癌infraglotticcarcinoma（3）原位癌carcinomainsitu（4）继发癌secondarycarcinoma

•3.临床表现clinicalmanifestation

•

（1）音哑hoarseness

•

（2）喉痛sorethroat

•（3）异物感sensationofforeignbody

•（4）呼吸困难dyspnea

•（5）吞咽困难dysphagia

•（6）血痰bloodspitting

•声门上癌supraglotticcarcinoma:

early:

异物感sensationofforeignbody,喉痛sorethroat,吞咽困难dysphagia,血痰bloodspitting

•声门癌glotticcarcinoma:

音哑hoarseness,呼吸困难dyspnea

•声门下癌infraglotticcarcinoma:

早期无症状,咳嗽,血痰earlynosymptoms,cough,bloodspitting晚期呼吸困难,侵犯环甲膜,甲状腺late:

dyspnea,invasionofcricothyroidmembrane,thyroidgland

•4.扩散和转移spreadandmetastasis:

3types

（1）直接扩散directspreading

（2）淋巴转移lymphaticmetastasis（3）血行转移bloodmetastasis

•5.检查examination

（1）体格检查physicalexamination:

喉体膨大,会厌前间隙饱满enlargementoflarynx,fullnessofpre-epiglotticspace

（2）间接喉镜,纤维喉镜,喉动态镜indirectlaryngoscope,fibro-laryngoscope,laryngostroboscopy

•6.诊断diagnosis

（1）病史:

40岁以上,音哑4周以上history:

above40yearsold,hoarseness,above4weeks

（2）活检biopsy（3）X-ray,CT

•鉴别诊断differentialdiagnosis

（1）喉结核laryngealtuberculosis

（2）喉梅毒laryngealsyphilis（3）喉乳头状瘤laryngealpapilloma

•7.治疗treatment

（1）放疗radiation:

a.1期病变stage1lesionb.不适合手术notsuitabletooperation

（2）手术surgury:

全喉切除术totallaryngectomy,喉部分切除术partiallaryngectomy,颈廓清neckresection（3）激光laser:

KTP

喉阻塞Laryngealobstruction

•1.病因etiologya.感染Infectionb.外伤injuryc.异物foreignbodyd.水肿edemae.肿瘤tumorsf.畸形deformityg.声带麻痹vocalcordparalysis

临床表现Clinicalmanifestation

•a.吸气期呼吸困难inspiratorydyspnea

•b.吸气期喉鸣inspirarorylaryngealstridor

•c.吸气期软组织凹陷inspiratoryrecessofsofttissue

•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:

nosymptoms,motionandcrying:

mildsymptoms

•2度.平静时轻度症状,运动和哭闹时加重rest:

mildsymptoms,motion:

agggravating

•3度.严重吸气期呼吸困难severeinspirarorydyspnea

•4度.极度吸气期呼吸困难moresevereinspiratorydyspnea

诊断和鉴别诊断diagnosisanddifferentialdiagnosis

•

（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accordingtothedegree,reasonsshouldbedetectedornot

•鉴别诊断differentialdiagnosis

治疗treatment

•10.保守治疗conservativetreatment

•40.立即气管切开或环甲膜切开immediatetracheostomyorintercricothyrotomy

•20-30.根据条件和病因accordingtotheconditionsandetiologya.炎症inflammation:

先保守,不好转气管切开conservation,tracheostomy

b.异物,手术foreignbody:

operation

咽后脓肿:

切开,引流retropharyngealabscess:

incisionanddrainage

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,bilateralrecurrentnerveparalysis,,injuryoflarynx,cannotberesolvedimmediatelytracheotomy

气管切开术Tracheotomy

•anatomy解剖1.气管trachea2.软组织softtissue3.血管bloodvessel4.甲状腺峡部isthmusofthyroidgland

适应症indication

•1.喉阻塞laryngealobstruction

•2.下呼吸道阻塞和肺水肿Obstructionoflowerrespiratorytractandischeotomy

•3.预防性气管切开preventivetracheotomy

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separationofsofttissue

•6.暴露气管exposingoftrachea

•7.气管切开tracheotomy

•8.插入套管insertionofcannula

•9.缝合和固定sutureandfixation

术后护理postoperativenursing

•1.保持内套管通畅keepinnercannulaunobstructed

•2.保持下呼吸道通畅keeplowerrespiratorytractunobstructed

•3.切口消毒antiseptionofincision

•4.预防脱管preventseperationofcannula

•5.拔管decannulation:

堵管48小时后48hourslaterafterobstruction

并发症Complication

•1.皮下气肿subcutaneousemphysema

•2.纵隔气肿mediastinalemphysema

•3.气胸pneumatothorax

•4.出血bleeding

•5.拔管困难Difficultyindecannulation

环甲膜切开Intercricothyrotomy

耳部EAR

•解剖anatomy

•外耳theexternalear

（1）耳廓auricle

（2）外耳道externalacousticmeatus外耳道软骨部externalcartilaginousmeatus外耳道骨部externalbonymeatus外耳的血液和神经bloodandnervesupplyoftheexternalear

中耳middleear

•鼓室tympaniccavity上,中,下鼓室epitympanummesotypanumhypotympanum

•6个壁6walls

外壁outerwall

•由鼓膜和上鼓室骨部外侧形成formedchieflybythetympanicmembraneandtheouterbonywalloftheepitympanum

•鼓膜分为紧张部和松弛部tympanicmembrane:

parstensaandparsflaccida

•鼓膜由三层组织构成tympanicmembraneconsistsofthreelayers外层为上皮层anouterepithelium中间为弹力组织amiddleelastictissue内层为粘膜层aninnermucousmembrane

•标志marksofthedrumoftheear脐部umbo,锤骨短突shortprocessofmalleus,锤前皱襞anteriormelleolarfold,锤后皱襞posteriormalleolarfold,光锥coneoflight,锤骨柄handleofmalleus

•内壁innerwall鼓岬promontory,前庭窗vestibularwindow（ovalwindows）,蜗窗cochlearwindow（roundwindow）,水平半规管horizontalsemicircularcanal

•前壁anteriorwall咽鼓管开口openingoftheEustachianTube鼓膜张肌canalofthetensortympanimuscle

•后壁posteriorwall

•上壁upperwall鼓室盖tegmentympani

•下壁lowerwall

•中耳含3块听小骨middleearcontainsthreeossicles锤骨malleus,砧骨incus,镫骨stapes

•中耳肌肉包括鼓膜张肌和镫骨肌muscleofthemiddleear:

thetensortympanicmuscle,stapediusmuscles

•中耳的血液和神经支配bloodandnervesupplyofthemiddleearbloodsupply鼓室丛tympanicplexus,鼓索神经chordatympanicnerve

•咽鼓管pharyngotympanictube

•鼓窦typanicantrum

•乳突mastoidprocess:

气化型pneumatictype板障型diploetictype硬化型sclerotictype混合型mixedtype

内耳theinnerear

•迷路innerear（labyrinth）骨迷路osseouslabyrinth膜迷路membranouslabyrinth:

内淋巴endolymph外淋巴perilymph

•骨迷路osseouslabyrinth:

前庭vestibule,骨半规管osseoussemicircularcanals,蜗管cochlea

•膜迷路membranouslabyrinth:

椭圆囊utricle,球囊saccule，膜半规管membranoussemicircularcanals,膜蜗管membraneou