淋巴系统 lymphatic system

1. 淋巴系统lymphatic system

2. 目 录 概 述 淋巴管道 毛细淋巴管 淋巴管 淋巴干 淋巴导管 淋巴结 脾和胸腺

3. 一、概 述 • 淋巴系统的组成： • 淋巴管道 lymphatic ducts • 淋巴组织 lymphatic tissue • 淋巴器官 lymphatic organs： 包括淋巴结、脾、胸腺和扁桃体 图 返回目录

4. 淋巴系统的功能 • 协助静脉系统引流组织液 • 产生淋巴细胞 • 滤过淋巴液 • 参与免疫应答 • 淋巴的构成

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6. 二、淋巴管道 lymphatic ducts • 毛细淋巴管 lymphatic capillary • 构成 • 结构特点 • 淋巴管lymphatic vessel • 分类 • 输入淋巴管 • 输出淋巴管 返回目录

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8. lymph node (Small oval or bean-shaped bodes • Afferent vessels enter the node on its convex surface, and efferent vessels leave the node at its concave surface－the hilum • Arranged in groups, along the blood vessels • Regional nodes • is the lymph node where the lymph of the organ or part of the body drainage to firstly

9. 淋巴干lymphatic trunks • 构成 • 九条淋巴干: 颈 干 jugular trunks 锁骨下干 subclavian trunks 支气管纵隔干 bronchomadiastinal trunks 腰 干lumbar trunks 成 对 淋巴干 不成对 肠 干 intestinal trunk 返回目录

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12. 淋巴导管lymphatic ducts • 胸导管 thoracic duct • 构成 • 行程 • 注入 • 收纳范围 • 右淋巴导管right lymphatic duct • 构成 • 收纳范围 返回目录

13. Lymphatic ducts Right lymphatic duct • Formed by union of right jugular, subclavian, and bronchomediastinal trunks • Ends by entering the right venous angle • Receives lymph from right half of head, neck, thorax and right upper limb

14. Thoracic duct • Begins in front of L1 as a dilated sac, the cisterna chyli , which formed by joining of left and right lumbar trunks and intestinal trunk • Enter thoracic cavity by passing through the aortic hiatus of the diaphragm and ascends along on the front of the vertebral column, between thoracic aorta and azygos vein

15. Thoracic duct • Travels upward, veering to the left at the level of T5 • At the roof of the neck, it turns laterally and arches forwards and descends to enter the left venous angle • Just before termination, it receives the left jugular, subclavian and bronchomediastinal trunks

16. Thoracic duct • Drains lymph from lower limbs, pelvic cavity, abdominal cavity, left side of thorax, and left side of the head, neck and left upper limb

17. 三、淋巴结 lymphatic node • 形态：呈椭圆形或圆形，全身约400~450个 • 分群：根据位置可分为： • 浅淋巴结 superficial lymphatic nodes • 深淋巴结 profundal lymphatic nodes • 局部淋巴结 regional lymphatic node： 指引流某一器官或部位淋巴的第一级淋巴结， 临床上又称为哨位淋巴结。 返回目录

18. 全身各部的淋巴结 1.头颈部淋巴结 • 头部淋巴结 • 颈部淋巴结 • 颈前淋巴结 • 颈外侧淋巴结 颈外侧浅淋巴结 颈外侧深淋巴结

19. 颈内静脉二腹肌淋巴结 （角淋巴结） 颈内静脉肩胛舌骨肌淋巴结 锁骨上淋巴结 斜角肌淋巴结 （Virchow淋巴结）

20. The lymphatic drainageof head Lymph nodes of head • Located at junction of head and neck • Consist of • Occipital lymph nodes • Mastoid lymph nodes • Parotid lymph nodes ★Submandibular lymph nodeslies near the submandibular gland, receive lymphatic vessels from the face, nose and mouth • submental lymph nodes • Drain into deep cervical lymph nodes

21. Lymph nodes of the neck Anterior cervical ln. • Superficial anterior cervical lymph nodes • Deep anterior cervical lymph nodes Lateral cervical ln. ★Superficial lateral cervical ln. －lie along the external jugular vein ★ Deep lateral cervical ln. －extend along the internal jugular vein

22. Lymph nodes of the neck ★Deep lateral cervical ln. • Extend along the internal jugular vein from the base of skull to the root of neck • Divided into superior deep lateral cervical ln. and inferior deep lateral cervical ln. • Receive lymphatic vessels from head, neck, tongue, larynx, cervical parts of esophagus and trachea, thyroid gland, upper parts of the thoracic wall and breast • Efferent vessels form the jugular trunk • Left jugular trunk joins the thoracic duct • Right jugular trunk joins the right lymphatic duct

23. Lymph nodes of the neck Superior deep lateral cervical ln.Jugulodigastric ln. • Lies at the junction of posterior belly of digastric and internal jugular vein • Drain the nasopharynx, palatine tonsil and root of tongue Inferior deep lateral cervical ln.Juguloomohyoid ln. • Lies at the junction of the intermediate tendon of omohyoid and internal jugular vein • Drain the apex of tongue

24. Lymph nodes of the neck Inferior deep lateral cervical ln. Supraclavicular lymph nodes • Lie along transverse cervical a. & v. • palpable in the supraclavicular fossa. The most notable supraclavicular lymph node is Virchow's node. which can contain metastasis of visceral (abdominal) tumor. • Retropharyngeal ln. • Lying vertically behind the pharynx • drain nasopharyngeal lymph

25. 2.上肢的淋巴结 • 肘淋巴结 • 腋淋巴结 • 胸肌淋巴结 • 外侧淋巴结 • 肩胛下淋巴结 • 中央淋巴结 • 尖淋巴结

26. Lymph nodes of upper limb • Cubital lymph node • lies above medial epicondyle of humerus • Receive lymph vessels from forearm • Axillary lymph node • arranged in five groups

27. Axillary lymph nodes • Axillary lymph nodes vary in size from a pin-head to a large bean. • They are arranged in five groups.

28. Axillary lymph nodes Pectoral lymph nodesLying along the lower border of pectoralis minor behind the pectoralis major • Receive lymph vessels from the lateral quadrants of the breast and superficial vessels from the anterolateral abdominal wall above the level of the umbilicus

29. Axillary lymph nodes Lateral lymph nodesAlong medial side distal part of axillary vein • Receives lymph from upper limb

30. Axillary lymph nodes Subscapular lymph node • Lying along subscapular vessels, in front of the subscapularis • Receive superficial lymph vessels from the back, down as far as the level of the iliac crests • Efferents of above three groups pass to central lymph node

31. Axillary lymph nodes Central lymph node • Lying in the center of the axilla in the axillary fat • Receive lymph from the above three nodes • Efferents pass to apical lymph node

32. Axillary lymph nodes Apical lymph node infraclavicular lymph nodes Lying at the apex of the axilla at the lateral border of the fist rib • Receive lymph of the efferent lymph vessels from all the other axillary nodes • The efferents of the apical nodes form the subclavian trunk

33. Axillary lymph nodes Efferents form subclavian trunk, the right subclavian trunk joins the right lymphatic duct; left usually drains directly into thoracic duct Apical ln. Subclavian trunk Central ln. Pectoral ln. Lateral ln. Subscapular ln.

34. Lymphatic drainage of thorax The lymphatic drainage of thoracic wall • To axillary lymph nodes • To parasternal lymph nodes (along internal thoracic vessels) • To intercostals lymph nodes from deeper structures

35. 3.胸部淋巴结 • 胸壁淋巴结 • 纵隔前淋巴结 • 纵隔后淋巴结 • 气管、支气管和肺淋巴结

36. lymph nodes of the thorax • Pulmonary ln. lie in the angles of bifurcation of branching lobar bronchi • Bronchopulmonary hilar ln.－lie in the hilums of the lung • Tracheobronchial ln.－situated above or below the bifurcation of trachea • Paratracheal ln.－along each side of the trachea

37. lymph nodes of the thorax • Anterior mediastinal lymph node • Lies anterior to the large blood vessels of thoracic cavity and pericardium • The efferents unite with those of paratracheal lymph nodes and parasternal lymph nodes to form the right and left bronchomediastinal trunks • The left bronchomediastinal trunk terminates in thoracic duct, and right in the right lymphtic duct • Posterior mediastinal lymph nodes lie along the esophagus and thoracic aorta

38. Lymph nodes of lower limb Popliteal ln. • Embedded in the fatty connective tissue of popliteal fossa • Receive superficial lymphatic vessels from posterolateral part of calf, and from deep lymphatic vessels accompanying anterior and posterior tibia a. • Efferents pass to the deep inguinal ln.

39. Lymph nodes of lower limb Superficial inguinal lymph nodesSuperior group: • Lies just distal to the inguinal ligament • Receive lymph vessels from anterior abdominal wall below umbilicus, gluteal region, perineal region, external genital organs • Inferior group: • Lies vertical along the terminal great saphenous v. • Receives all superficial lymph vessels of lower limb, except for those from the posterolateral part of calf • Efferent vessels drain into the deep inguinal ln. or external iliac ln.

40. Lymph nodes of lower limb Deep inguinal lymph nodes • Lie medial to the femoral v. • Receive deep lymph vessels of lower limb, perineal region, and efferent vessels from the superficial inguinal ln. • Drain into the external iliac ln.

41. Lymph nodes of pelvis • Internal iliac lymph node • Surround internal iliac vessels • Receive afferents from pelvic viscera, perineum, buttock and back of thigh • External iliac lymph nodes • Lie along external iliac artery • Receive afferents from lower limb and some parts of pelvic viscera • Sacral lymph node • locate along middle sacral a. and lateral sacral a. • Receive lymph from posterior pelvic wall ,rectum,prostate or uterus • Common iliac lymph node • Lie along common iliac artery • Receive afferents from all the above nodes • Efferent pass to lumbar lymph node

42. Lymph nodes of abdomen Lymphatic drainage of abdominal wall • To axillary lymph node from region above umbilicus • To superficial inguinal lymph node from region below umbilicus • To lumbar lymph node from post wall of abdomen

43. Lymph nodes of abdomen Lymphatic drainage of abdominal viscera • Lumbar lymph nodes • Lie on posterior abdominal wall, along the abdominal aorta and inferior vena cava • Receive lymph from kidneys, suprarenal glands, testes, ovaries, fundus of uterus, uterine tubes, and common iliac nodes • Right and left lumbar trunks formed by efferent vessel • Paired viscera－drain to the lumbar lymph nodes

44. Lymph nodes of abdomen • Right and left gastric ln. lie along the same vessels and finally to the celiac ln. • Right and left gastroomental ln. lie along the same vessels, the former drain into subpyloric ln., the latter drain into splenic ln. • Suprapyloric and subpyloric ln. receive lymphatics from pyloric part and finally to the celiac ln. • Splenic ln. receive lymphatics from fundus and left third of stomach, and finally to the celiac ln. • Celiac lymph nodes －situated around the celiac trunk

45. Lymph nodes of abdomen • Superior mesenteric lymph node －situated around superior mesenteric a. • Inferior mesenteric lymph node －situated around inferior mesenteric a. • Intestinal trunk －formed by efferent vessel of celiac, superior and inferior lymph nodes

46. 四、脾和胸腺 • 脾spleen • 形态 • 位置 • 功能 返回目录

47. Spleen • Shape • The largest single mass of lymphoid tissue in the body • Reddish in color • Location: • lies in the left hypochondriac region (between stomach and diaphragm) deep to the 9th to 11th rib • its long axis corresponds roughly to the 10th rib • Its lower pole extends forward only as far as the midline and cannot be palpated on clinical examination

48. Spleen • Two surfaces • Diaphragmatic: smooth, convex • Visceral: concave, hilum of spleen • Two extremities • Anterior－wider • Posterior－rounder • Two border • Superior－has 2-3 splenic notch, which serve as a landmark on palpation when it is enlarge; normally it is not palpable • Inferior－rounder

49. 胸腺 thymus • 形态 • 位置 • 功能 返回目录

50. Thymus The thymus is partly in the neck and partly in the thorax. It comprises one to three lobes, each of which consists of numerous lobules containing lymphocytes, which are important in the development and maintenance of the immune system. The cervical part of the thymus lies on the anterior and lateral sides of the trachea, whereas the thoracic part lies posterior to the superior portion of the sternum. The organ has a profuse blood supply and lymphatic drainage. The thymus reaches its greatest size at puberty and then begins to regress. Much of its substance is replaced by fat and fibrous tissue, but thymic tissue never disappears completely. Function:to develop lymph cell