1、Concept Pleura Shape of lung Dissection of superior mediastinum,Dept. of Human Anatomy, Guangxi Medical University Lao Ming 0310/0804,Thorax,Thoracic cavity(1),Thoracic cage: Formed by sternum,ribs,thoracic vertebrae, Thoracic cavity:Formed by thoracic cageContents: lungs, pleural cavitymediastinum,
2、 muscles of thorax Pectoralis major Pectoralis minor Serratus anterior Intercoastales externi Intercoastales interni diaphragm muscles of abdomen Rectus abdominis Obliquus externus abdominis Obliquus internus abdominis transversus abdominis,Pleura,(Moved of the anterior thoracic wall),Anterior margi
3、n formed: Triangle of thymus Triangle of pericardium (Have no covering of pleura),The line of reflection of pleurae,Projection of inferior margin of lungs and pleura,Pleural cavity：between parietal pleura and visceral pleura，contain a film of fluid，negative pressure. not communicates with left and r
4、ight one,Costodiaphragmatic recess：costal and diaphragmatic pleura reflection，when standing and seating，its the lowest place of the pleural cavity.,Pleural recess: the cavity of the parietal pleural reflection does not occupied by expanded lung in deep breathing,Costomediastinal recess：costal and me
5、diastinal pleura reflection. Obvious only on left side,Costal surface Diaphragmatic surfaceAnt. border （cardiac notch of left lung， Lingual of left lung） Post. border Inf. border,Shape of lungs：half conical, right lung shorter and wider,Apex of lungextend to about 2-3cm above medial one-third of the
6、 clavicle,Mediastinal surface （hilum of lung，root of lung）,Base of lung,Concept: The structures Entering and leaving the hilum of lungs surrounded by pleura,The root of the lung,The relationship of pulmonary root,above,In front,behind,Left phrenic N Pericardiacophrenic A.V,Aortic arch,Thoracic aorta
7、 Left vagus N,Right phrenic N Pericardiacophrenic A.V,Arch of azygos V,Azygos V Right vagus N,Leftright,Procedure 1. cut through 1st to 12th ribs just post.to midaxillary line 2. elevate the upper end of ant. thoracic wall push away the parietal pleura from the thoracic wall and pericardium, cut thr
8、ough the internal thoracic A 3. cut through the three flat muscles of abdomen along midaxillary line and attachment of diaphragm 4. push away the parietal peritoneum from the abdominal wall until to the level of umbillium 5. Cut through the pulmonary root from before backwardclose to the hilum of th
9、e lungs, take out of lungs,Reflect anterior thoracic and abdominal wall,Observation 1.Internal surface of anterior thoracic wall:internal thoracic A, transverse thoracic M 2. The part of pleura, anterior margin of pleura, triangle of thymus , pericardium and their contents 3. Costodiaphragmatic rece
10、ss, Costomediastinal recess 4. Position、shape of lungs(apex,base,three surfaces, lobe,arrangement of the structures in hilum of lung),and relationship of root of lungs, 5. Intercostal nerve and blood vessels,All the organs and structures between right and left pleural sacs,Mediastinum,Concept,Part（f
11、our-area）,Sup.mediastinum,Ant.mediastinum,mid.mediastinum,Inf.mediastinum,The main contents of superior mediastinum,1.Thymus or remnants 2. Superior vena cava, L & R Brachiocephalic V, Phrenic N, Vagus N 3.Aortic arch and its branches,Brachiocephalic trunk,L. common carotid, L. subclavian A, 4.Trach
12、ea, Esophagus,Thoracic duct, Sympathetic trunk,(four strata, from before backward),BoundariesIn front: L phrenic NBack :L.vagus NLower: L pulmonary AContentsArterial ligamentL recurrent laryngeal N,Ductus arterious triangle,Location in left side of superior mediastinum,Dissection of superior mediast
13、inum,Procedure 1.strip the mediastinal pleura from both sides 2.clean thymus or remnants,reflect it upward 3.clean in turn superior vena cava,L. and R.brachiocephelic V from lower upward 4.clean phrenic N, vagus N from neck downward 5.on left side, clean the ductus arterious trianglelook for L.phren
14、ic N, L vagus N,and L pulmonary A,arterial ligament , L. recurrent laryngeal N 6.on right side, look for azygos arch, azygos V 7.clean aortic arch and its three branches, trachea,Esophagus, sympathetic trunk,Observation: Understand the concept of mediastinum Main contents of superior mediastinum Ductus arterial triangle,left recurrent N,
