1、Introduction of lymphology原版：山東大學醫學院人體解剖教研室補充增加中文2012.5 淋巴系統淋巴系統 Lymphatic System 淋巴管道：毛細淋巴管、淋巴管淋巴管道：毛細淋巴管、淋巴管 、 淋巴干、淋巴導管淋巴干、淋巴導管 lymphlymph vesselvessel淋巴器官：淋巴器官： 淋巴結、脾、胸腺、扁桃體淋巴結、脾、胸腺、扁桃體l lymphaticymphatic organ organ淋巴組織：含大量淋巴細胞（彌散的和淋巴小結）淋巴組織：含大量淋巴細胞（彌散的和淋巴小結） lymphatic tissuelymphatic tissue輔助靜脈

2、回流輔助靜脈回流產生淋巴細胞產生淋巴細胞過濾淋巴液過濾淋巴液參與免疫應答參與免疫應答1 1 回收蛋白質運輸脂肪及營養物質回收蛋白質運輸脂肪及營養物質2 2 清除組織中的紅細胞細菌和異物清除組織中的紅細胞細菌和異物3 3 調節血漿和組織液間的液體平衡調節血漿和組織液間的液體平衡4 4 產生淋巴細胞和漿細胞參與免疫反應產生淋巴細胞和漿細胞參與免疫反應淋巴回流淋巴回流Lymph nodesThe Lymphatic System 淋巴系統淋巴系統ACapVLymphatic-CapillaryLymphaticLymphatic trunksLymphatic ducts（淋巴結）（淋巴干）（淋巴導

3、管）（毛細淋巴管） A assistant system to the vein 輔助靜脈系統回流輔助靜脈系統回流CompositionqLymphatic vessels 淋巴管道淋巴管道 Lymphatic capillary毛細淋巴管毛細淋巴管 Lymph vessels淋巴管淋巴管 Lymphatic trunks (9)淋巴干淋巴干 Lymphatic ducts(2)淋巴導管淋巴導管 thoracic duct 胸導管胸導管 right lymphatic duck右淋巴導管右淋巴導管qLymphatic organs 淋巴器官淋巴器官 Lymph nodes 淋巴結淋巴結 spl

4、een 脾脾 thymus胸腺胸腺 tonsil扁桃體扁桃體, q Lymphatic tissues 淋巴組織淋巴組織Features of structure: Blind end Single layer of overlapping endothelial cells More permeable than that of blood capillary Absent from avascular structures, brain, spinal cord splenic pulp and bone marrowLymphatic vessels 淋巴管道淋巴管道Lymphatic

5、capillary毛細淋巴管毛細淋巴管盲端單層重疊內皮細胞比毛細血管通透性更強腦，脊髓，脾髓，骨髓無此結構軟骨、上皮、牙釉質、角膜與晶狀體等亦無此結構Lymphatic vessel 淋巴管淋巴管Features of structureqThree layered wall similar to, but thinner than vein, qMore numerous valves than in veinqInterposed by lymph node at interval along the courseqArranged in superficial and deep sets

6、Lymphatic vessels 淋巴管道淋巴管道類似三層墻，比靜脈細瓣膜遠多于靜脈中間有淋巴結插入分淺、深兩種淋巴管Lymphatic trunks 淋巴干淋巴干 qright and left jugular trunks (頸干頸干)qright and left subclavian trunks （鎖骨下干鎖骨下干）qright and left bronchomediastinal trunks （支氣管縱隔干支氣管縱隔干）qright and left lumbar trunks （腰干腰干）qintestinal trunk（腸干腸干）Lymphatic vessels 淋巴

7、管道淋巴管道Right lymphatic duct 右淋巴導管右淋巴導管nFormed by union of right jugular, subclavian, and bronchomediastinal trunksnEnds by entering the right venous angle右右靜脈角靜脈角nReceives lymph from right half of head, neck, thorax and right upper limbLymphatic ducts 淋巴導管淋巴導管 Lymphatic vessels 淋巴管道淋巴管道由右頸干，鎖骨下干，支氣管縱

8、膈干聯合構成收集右半腦，頸部，胸，右上肢的淋巴液9、 人的價值，在招收誘惑的一瞬間被決定。2022-3-62022-3-6Sunday, March 06, 202210、低頭要有勇氣，抬頭要有低氣。2022-3-62022-3-62022-3-63/6/2022 8:04:38 PM11、人總是珍惜為得到。2022-3-62022-3-62022-3-6Mar-226-Mar-2212、人亂于心，不寬余請。2022-3-62022-3-62022-3-6Sunday, March 06, 202213、生氣是拿別人做錯的事來懲罰自己。2022-3-62022-3-62022-3-62022-

9、3-63/6/202214、抱最大的希望，作最大的努力。2022年3月6日星期日2022-3-62022-3-62022-3-615、一個人炫耀什么，說明他內心缺少什么。2022年3月2022-3-62022-3-62022-3-63/6/202216、業余生活要有意義，不要越軌。2022-3-62022-3-6March 6, 202217、一個人即使已登上頂峰，也仍要自強不息。2022-3-62022-3-62022-3-62022-3-6pThoracic duct 胸導管胸導管 Begins in front of L1 as a dilated sac, the cisterna c

10、hyli 乳糜池乳糜池, 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 veinLymphatic vessels 淋巴管道淋巴管道起源于第一腰椎前方的乳糜池，

11、由左右腰干和腸干聯合構成穿過膈上的主動脈裂孔，沿著脊柱前方，在胸主動脈和奇靜脈之間上升進入胸腔 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 ronchomediastinal t

12、runksLymphatic vessels 淋巴管道淋巴管道pThoracic duct 胸導管胸導管進入胸腔順時針轉入第五胸椎左側到達頸根部，轉至側面呈弧形彎入左靜脈角進入左靜脈角前，收集左頸干，左鎖骨下干，左支氣管縱膈干的淋巴液pThoracic duct 胸導管胸導管 Just before termination, it receives the left jugular, subclavian and bronchomediastinal trunks Drains lymph from lower limbs, pelvic cavity, abdominal cavity, l

13、eft side of thorax, and left side of the head, neck and left upper limbLymphatic vessels 淋巴管道淋巴管道胸導管引流下肢、盆腔、腹腔、左上肢、左胸部和左頭頸部的淋巴Lymph node 淋巴結淋巴結FeaturesqBean-shaped bodiesqWith afferent lymph vessels輸入淋巴管輸入淋巴管 (entering at the periphery) and efferent lymph vessels輸出淋巴管輸出淋巴管(emerging at the hilus)qArr

14、anged in groups, along the blood vessels or the flexural side of the jointqDivided into superficial and deep groups沿著血管或者關節屈處分布成群的淋巴結分為淺部和深部淋巴結群 Regional Lymph Node局部淋巴結局部淋巴結 is the lymph node where the lymph of the organ or part of the body drainge to firstly Sentinel Lymph Node前哨淋巴結前哨淋巴結(in clinic

15、) Lymph node 淋巴結淋巴結Lymph drainage of the body .Lymph drainage of the head頭部的淋巴引流頭部的淋巴引流 Lymph nodes of head Located at junction of head and neck Consist of occipital, mastoid, parotid, submandibular, submental lymph nodes Drain into deep cervical lymph nodes Submandibular lymph node 下頜下淋巴結下頜下淋巴結 lie

16、s near the submandibular gland, receive lymphatic vessels from the face, nose and mouth頭頸交界處排列由枕淋巴結，乳突淋巴結，腮腺淋巴結，下頜下淋巴結，頦下淋巴結組成流入頸部淋巴結位于下頜下腺附近，接收面，鼻，和嘴的淋巴管Lymph drainage of neck頸部的淋巴引流頸部的淋巴引流 Anterior cervical lymph nodes頸前淋巴結頸前淋巴結 Superficial anterior cervical lymph nodes Deep anterior cervical lymp

17、h nodes Lateral cervical lymph node 頸外側淋巴結頸外側淋巴結 Superficial lateral cervical lymph nodeslie along the external jugular vein Deep lateral cervical lymph nodes頸前淺淋巴結頸前深淋巴結頸外側淺淋巴結頸外靜脈排列頸外側深淋巴結Deep lateral cervical lymph nodes頸外側深淋巴結頸外側深淋巴結 extend along the internal jugular vein from the base of skull

18、to the root of neck divide into Superior deep lateral cervical lymph nodes頸外側上深淋巴頸外側上深淋巴結結 Inferior deep lateral cervical lymph nodes頸外側下深淋巴頸外側下深淋巴結結Lymph drainage of neck頸部的淋巴引流頸部的淋巴引流沿頸內靜脈擴展 從顱底至頸根部Deep lateral cervical lymph nodes頸外側深淋巴結頸外側深淋巴結 receive lymphatic vessels from head, neck, tongue, l

19、arynx, cervical parts of esophagus and trachea, thyroid gland, upper parts of the thoracic wall and breast efferent vessels form the jugular trunk thoracic duct(left) right lymphatic duct (right) Lymph drainage of neck頸部的淋巴引流頸部的淋巴引流 Superior deep lateral cervical lymph nodes 頸外側上深淋巴結頸外側上深淋巴結 Jugulod

20、igastric lymph node 頸內靜頸內靜脈二腹肌淋巴結脈二腹肌淋巴結: lies at the junction of posterior belly of digastric and internal jugular vein Inferior deep lateral cervical lymph nodes 頸外側下深淋巴結頸外側下深淋巴結 Juguloomohyoid lymph node 頸內靜頸內靜脈肩胛舌骨肌淋巴結脈肩胛舌骨肌淋巴結: lies at the junction of the intermediate tendon of omohyoid and int

21、ernal jugular vein Supraclavicular lymph nodes 鎖骨上鎖骨上淋巴結淋巴結: lie along the subclavian arteryLymph drainage of neck頸部的淋巴引流頸部的淋巴引流The lymphatic drainage of upper limb 上肢的淋巴引流上肢的淋巴引流 Lymphatic vessels Superficial lymphatic vessels 淺淋巴管 伴隨淺靜脈 注入滑車上淋巴結和腋淋巴結 Deep lymphatic vessels 深淋巴管 伴隨深靜脈 注入腋淋巴結 lymph

22、nodes Cubital lymph node滑車上淋巴結 Axillary lymph node腋淋巴結Axillary lymph nodes 腋淋巴結The axillary lymph nodes mey be divided into lateral ln.外側淋巴結外側淋巴結 pectoral ln.胸肌淋巴結胸肌淋巴結 subscapular ln.肩胛下淋巴結肩胛下淋巴結 central ln.中央淋巴結中央淋巴結 apical ln.尖淋巴結尖淋巴結lateral ln.pectoral ln.subscapular ln.central ln.apical ln.subc

23、lavian trunkThe lymphatic drainage of thorax胸部的淋巴引流胸部的淋巴引流The lymphatic drainage of thoracic wall To axillary lymph nodes To parasternal lymph nodes胸骨旁淋巴結胸骨旁淋巴結 (along internal thoracic vessels) To intercostals lymph nodes肋間淋巴結肋間淋巴結 from deeper structuresThe lymphatic drainage of thorax胸部的淋巴引流胸部的淋巴引

24、流lymph nodes of the thoracic contents lymph nodes of trachea, bronchi and lungsPulmonary lymph nodes肺淋巴肺淋巴結結lie in the angles of bifurcation of branching lobar bronchiBronchopulmonary hilar lymph nodes支氣管肺門淋巴結支氣管肺門淋巴結lie in the hilus of the lungTracheobronchial lymph nodes氣管支氣管淋巴結氣管支氣管淋巴結situated ab

25、ove or below the bifurcation of tracheaParatracheal lymph nodes 氣管氣管旁淋巴結旁淋巴結along each side of the tracheaParatracheal lymph nodes Anterior mediastinal lymph node縱隔前淋巴結縱隔前淋巴結 lies anterior to the large blood vessels of thoracic cavity and pericardium; the efferents unite with those of paratracheal l

26、ymph nodes, to form the right and left bronchomediastinal trunks 支氣管縱隔干支氣管縱隔干. The left bronchomediastinal trunk terminates in thoracic duct, and right in the right lymphtic duct Posterior mediastinal lymph nodes縱隔后淋巴結縱隔后淋巴結 lie along the esophagus and thoracic aortaThe lymphatic drainage of thorax胸

27、部的淋巴引流胸部的淋巴引流The lymphatic drainage of abdomen 腹部的淋巴引流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 abdomenaxillary lymph nodesuperficial inguinal lymph nod

28、eLymphatic drainage of abdominal viscera Lumbar lymph nodes 腰淋巴結腰淋巴結 Lie on posterior abdominal wall, along the abdominal aorta and inferior vena cava Receive lymph from kidneys, suprarenal glands, testes, ovarirs, fundus of uterus, ovary, and common iliac nodes Their efferent vessel form the right

29、and left lumbar trunks The lymphatic drainage of abdomen 腹部的淋巴引流 Celiac lymph nodes 腹腔淋巴結腹腔淋巴結 situated around the celiac trunk Superior mesenteric lymph node 腸系膜上淋巴結腸系膜上淋巴結 situated around superior mesenteric a. Inferior mesenteric lymph node 腸系膜下淋巴結腸系膜下淋巴結 situated around inferior mesenteric a. In

30、testinal trunk 腹腔干腹腔干 formed by efferent vessel of celiac, superior and inferior mesenteric lymph nodesThe lymphatic drainage of abdomen 腹部的淋巴引流The lymphatic drainage of pelvis 盆部的淋巴引流盆部的淋巴引流Internal iliac lymph node 髂內淋巴結髂內淋巴結 Surround internal iliac vessels Receive lymph from pelvic viscera, perin

31、eum, buttock and back of thighExternal iliac lymph nodes 髂外淋巴結髂外淋巴結 Lie along external iliac artery Receive lymph from lower limb and some parts of pelvic visceraThe lymphatic drainage of pelvis 盆部的淋巴引流盆部的淋巴引流Sacral lymph node 骶淋巴結骶淋巴結llocate along middle sacral a. and lateral sacral a.lReceive lymp

32、h from posterior pelvic wall ,rectum,prostate or uterusCommon iliac lymph node髂總淋髂總淋巴結巴結 Lie along common iliac artery Receive afferents from all the above nodes Efferents pass to lumbar lymph node lymph drainage of lower limb下肢的淋巴下肢的淋巴 lymphatic vessels Superficial lymphatic Deep lymphatic Lymph no

33、des Superficial lymph node 腹股溝淺淋巴結 Deep lymph node 腹股溝深淋巴結 lymph drainage of lower limb下肢的淋巴下肢的淋巴pSuperficial lymph node腹股溝腹股溝淺淋巴結淺淋巴結may be divided into two groups Upper group: below the inguinal lig.腹股溝韌帶腹股溝韌帶 Lower group: around the terminal part of great saphenous v.大隱靜脈大隱靜脈 Receive lymph from l

34、ower part of abdominal wall,perineum 會陰會陰and lower limb with the exception of region drained by popliteal ln.腘淋腘淋巴結巴結lymph drainage of lower limb下肢的淋巴下肢的淋巴pdeep lymph node 腹股溝深淋巴腹股溝深淋巴結結 Locate around the proximal end of femoral v. Receive lymph from deep lymphatic vessels of lower limb and the effe

35、rentlymphatic vessels of superficial inguinal ln.腹股溝淺腹股溝淺淋巴結淋巴結 Their efferent lymphatic vessels empty into external iliac ln.髂外淋髂外淋巴結巴結 Popliteal ln.腘淋巴結腘淋巴結 Embedded in the fatty connective tissue of popliteal fossa Receive superficial lymphatic vessels from posterolateral part of calf小腿小腿, and fr

36、om deep lymphatic vessels accompanying anterior and posterior tibial a. Efferents pass to the deep inguinal ln.腹股溝深淋巴結腹股溝深淋巴結lymph drainage of lower limb下肢的淋巴下肢的淋巴Celiac lymph nodesSuperior mesenteric lymph node 腸系膜腸系膜上淋巴結上淋巴結Inferior mesenteric lymph node 腸系膜下淋巴結腸系膜下淋巴結Spleen 脾qLocation Left epigas

37、tric regionbetween 9th-11th ribin line of 10th ribqFeaturesDiaphragmatic surfaceVisceral surface - Splenic Hilum Anterior extremityPosterior extremitySuperior border- Splenic Notch Inferior borderqFunction Thymus 胸腺Featrues qConsists of two elongated lobesqIs large organ in the fetusqOccupies the thoracic cavity behind the sternumqSecrete lymphopoietinClinic