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1、January, 2007Copyright 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兰州大学基础医学院人体解剖学教研室January, 2007Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG 全身的
2、淋巴管和淋巴结示意图January, 2007Copyright 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, 2007Copyright Depart. Anatomy, School of
3、 Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG 淋巴的循环过程示意图 心脏心脏 淋巴导管淋巴导管 动脉动脉 静脉静脉 毛细血管毛细血管 淋巴干淋巴干 组织间隙组织间隙 毛细淋巴管毛细淋巴管 淋巴管淋巴管 细胞细胞 January, 2007Copyright 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
4、的因素三、淋巴侧支循环January, 2007Copyright 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, 2007Copyright 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
5、条）（一）淋巴管道January, 2007Copyright 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, 2007Copyright
6、Depart. Anatomy, School 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, 2007Copyright Depart. Anatomy, School of Medicine, Lanzhou Unive
7、rsity. All right reserved by YP HOU and YF SONG 淋巴干和淋巴导管January, 2007Copyright 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 孤立淋巴滤泡孤立淋巴滤泡 集合淋巴滤泡集合淋巴滤泡 淋巴小结淋巴小结January, 2007Copyright Depart. Anatomy, School of Medici
8、ne, Lanzhou University. All 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, 2007Copyright 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
9、，出淋巴结门的淋巴管称输出淋巴管。January, 2007Copyright 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, 2007Copyright Depart. Anatomy, School of Medicine, Lanzh
10、ou University. All right reserved by YP HOU and YF SONG 淋巴结结构January, 2007Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG 二、淋巴回流的因素l回流量：安静时，每小时约120ml淋巴入血l参与回流的因素： a)淋巴管泵b)动脉搏动c)肌肉收缩与运动d)胸腔负压e)运动和按摩January, 2007Copyright Depart. Anatomy, Sch
11、ool of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG 三、淋巴侧支循环l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。l侧支循环的功能：u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；u缺点：淋巴侧支通路可成为病变扩散或肿瘤转移的途径。January, 2007Copyright Depart. Anatomy, School of Medicine, Lanzhou Univ
12、ersity. All right reserved by YP HOU and YF SONG 第二节 淋巴导管 January, 2007Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG 一、 胸导管l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
13、部，即全身3/4部分的淋巴。January, 2007Copyright 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, 2007Copyright Depart. Anatomy, School of Medicine, Lanzhou U
14、niversity. All right reserved by YP HOU and YF SONG 胸导管示意图January, 2007Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG 胸导管的位置January, 2007Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF
15、 SONG 二、 右淋巴导管l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, 2007Copyright 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, 2007Copyright Depart. Anatomy, S
16、chool of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG 淋巴导管收纳范围January, 2007Copyright 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六、腹部淋巴管和淋巴结Januar
17、y, 2007Copyright 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, 2007Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG 颈部淋巴结颈部淋巴结颈前淋巴结1
18、.颈前浅淋巴结2.颈前深淋巴结a)喉前淋巴结b)甲状腺淋巴结c)气管前淋巴结d)气管旁淋巴结颈外侧淋巴结1.颈外侧浅淋巴结2.颈外侧深淋巴结a)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b)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, 2007Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG 颈浅淋巴结January, 2007Copyright
19、 Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG 颈深淋巴结January, 2007Copyright 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1.浅群，即：滑车上淋巴结2.深群锁骨下淋巴结腋淋巴结1.胸肌淋巴结2.外侧淋巴结3.肩胛下淋巴结4.中央淋巴结5.尖淋
20、巴结January, 2007Copyright 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, 2007Copyright 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1.胸骨旁淋巴结2.肋间淋巴结3.膈上淋巴结胸腔器官淋巴结1.
21、纵隔前淋巴结2.纵隔后淋巴结3.气管、支气管和肺的淋巴结a.肺淋巴结b.支气管肺淋巴结c.气管支气管淋巴结d.气管旁淋巴结January, 2007Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG January, 2007Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SO
22、NG January, 2007Copyright 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1.腹股沟浅淋巴结2.腹股沟深淋巴结January, 2007Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG 下肢淋巴管和淋巴结January
23、, 2007Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG January, 2007Copyright 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, 2007Copyright Depart. Anat
24、omy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG 盆部淋巴管和淋巴结（男性）盆部淋巴管和淋巴结（女性）January, 2007Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG January, 2007Copyright 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1.脐平面以上浅、深群2.脐平面以下浅、深群3.腰淋巴结腹腔器官淋巴结1.沿腹腔干及其分支排列的淋巴结2.沿肠系膜上动脉及其分支排列的淋巴结3.沿肠系膜下动脉及其分支排列的淋巴结January, 2007Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG January, 2007Copyrig
26、ht Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG January, 2007Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG 肠系膜淋巴结January, 2007Copyright Depart. Anatomy, School of Medicine, Lanzhou Univ
27、ersity. All right reserved by YP HOU and YF SONG January, 2007Copyright 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, 2007Copyright Depart. Anatomy, School of Medicine, Lanzhou Uni
28、versity. All right reserved by YP HOU and YF SONG January, 2007Copyright 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, 2007Copyright Depart. Anatomy, School of Medicine, Lanzh
29、ou University. All right reserved by YP HOU and YF SONG 第六节 脾l脾（spleen）人体最大的淋巴器官。u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。u形态：暗红色、质软脆、长卵圆形。u结构：脏、膈两面，前、后两端，上、下两缘。 脾门、脾切迹、副脾（20%）。u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, 2007Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG 脾的膈面January, 2007Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG 脾的脏面January, 2007Copyright 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
