1、Unit 19,Thoracic wall、pleura、lung、diaphragm 胸壁、肺、胸膜、纵隔,一.Thoracic wall 胸壁,1. Composition组成,Skin皮肤,Superficial and deep fascia浅、深筋膜,Muscles肌,Vessels and nerves血管和神经,1）Muscles肌肉,Intercostales externi肋间外肌,Intercostales interni肋间内肌,作用：提肋助吸气,作用： 降肋助呼气,Intercostales intimi肋间最内肌,External intercostal membrf
2、ane肋间外膜,Internal intercostal membrfane肋间内膜,2）Vessels and nerves血管和神经,Posterior intercostal A,Intercostal N,Intercostal space 肋间隙,Posterior intercostal v.,Posterior intercostal a.,Intercostal n.,肋间后动脉、肋间后静脉和肋间神经三者的位置关系: 在肋间隙后部：位于肋间隙中间，三者的上、下的排列次序不定。 在肋沟内，自上而下依次为：肋间后静脉、肋间后动脉、肋间神经。.胸膜腔穿刺部位: 在肋间隙后部，进针部位
3、应在下位肋的上缘。 在肋间隙前部，进针部位应在肋间隙的中间。,Internal thoracic artery 胸廓内动脉 descends into thorax 1.2cm lateral to edge of sternum, and ends at the sixth costal cartilage by dividing musculophrenic and superior epigastric arteries,Musculophrenic A肌膈动脉,superior epigastric A 腹壁上动脉,2.Pleura胸膜,Visceral pleura,Parietal
4、 pleura,mediastinal pleura,Diaphragmatic pleura,Costal pleura,Cupula pleura,1）Partes分部, Two pleural layers continue with each other at root of lung forming closed potential space Contains a small amount pleural fluid Subatmospheric pressure in it,2）Pleural cavity 胸膜腔, potential spaces of pleural cav
5、ity which lungs are not occupied in deep respiration,Costodiaphragmatic recess 肋膈隐窝,3） Pleura recesses 胸膜隐窝,Costomediastinal recess 肋纵隔隐窝,Midclavicular lines 锁骨中线,Midaxillary lines腋中线,Scapular line肩胛线,The surface projection of lower border of lung and pleurae,3.Lung 肺,1）Postion 位置,肺位于胸腔内，纵隔两侧，因心位置偏左
6、，故左肺狭长，右肺略宽短,2）Features 形态,Apex of lung 肺尖： 伸向颈根部，高出锁骨内侧1/3上方2.5cm,Base of lung 肺底：又称膈面,Costal surface肋面,Mediastinal surface纵隔面,肺呈圆锥形，有一尖、一底、两面、三缘 。,纵隔面Mediastinal surface中部有长圆形凹陷叫肺门，有支气 管、肺动脉、肺静脉、支气管动脉、支气管静脉、神经和淋巴管出入。 出入肺门的结构被结缔组织包绕，构成肺根root of lung 。肺根内结构的排列：从前向后:上肺静脉、肺动脉、主支气管。,从上向下: 左肺根：肺动脉、左主支气管
7、、上肺静脉、下肺静脉。 右肺根：上叶支气管、肺动脉、主支气管、上肺静脉、下肺静脉。,Hilum of lung肺门,From before backward: V.A. B. From above downward: R.B. A. V. L.A. B. V.,Oblipue fissure斜裂,horizontal fissure水平裂,Superior lobe上叶,Middle lobe中叶,Inferior lobe下叶,Cardiac notch心切迹,Each principal bronchus divides into lobar bronchi (two on the lef
8、t, three on the right), each of which supplies a lobe of lung. Each lobar bronchus then divided into segmental bronchi, which supply specific segments of the lung., Bronchial tree,主支 气管（一级支气管）肺叶支气管（二级支气管）肺段支气管（三级支气管）。 每个肺段支气管及其所属的肺组织，称为支气管肺段，简称肺段Segments of lung。,3. Bronchial tree支气管树,尖段 后段 前段 外侧段 内
9、侧段 尖（上）段 内侧底段 前底段 外侧底段 后底段,尖后段 前段 上舌段 下舌段 尖（上）段 前内底段 外侧底段 后底段,上叶,中叶,下叶,上叶,下叶,外侧底段,外侧底段, Vessels OF lung,Pulmonary A,Pulmonary V, Diaphragm,Sternal part,Costal part,Lumbar part,Central tendon,Lumbocostal triangle,Sternocostal triangle, Shape,Aortic hiatus,Esophageal hiatus,Vena cava foramen, Openings
10、 in the diaphragm,T8,T10,T12,Contraction: the dome moving downward, increases the volume of thoracic cavity which results in inspiration, at the same time the intra-abdominal pressure is increased assists in defecation, vomiting or child birth. Relaxation: the dome returns to the former position, reduces the volume to the thoracic cavity, resulting in expiration., Action:,
