咽部的解剖Anatomy of pharynx.docx

1、咽部的解剖Anatomy of pharynx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

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

3、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 cricoar

4、ytenoid 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 co

5、rd 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

6、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 be

7、anches 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:

8、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

9、.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

10、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

11、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N

12、asopharyngeal 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S

13、ymptoms 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

14、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secondar

15、y 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

16、,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

17、)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 diagn

18、osis (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eti

19、ology 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

20、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

21、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.

22、异物,手术foreign body:operation 咽后脓肿:切开,引流retropharyngeal abscess:incision and drainagec.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ist

23、hmus 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trach

24、eotomy 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 obstruct

25、ion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 b

26、ony 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 ten

27、sa 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

28、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

29、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

30、 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 ca