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2021/3/111Unit 19Thoracic wall、pleura、lung、diaphragm 胸壁、胸壁、肺、胸膜、纵隔肺、胸膜、纵隔2021/3/112一一.Thoracic wall 胸壁胸壁1.Composition组成组成Skin皮肤皮肤Superficial and deep fascia浅、深筋膜浅、深筋膜Muscles肌肌Vessels and nerves血管和神经血管和神经2021/3/1131）Muscles肌肉肌肉Intercostales externi肋间外肌肋间外肌Intercostales interni肋间内肌肋间内肌作用：提肋助吸气作用：提肋助吸气作用：作用：降肋助呼气降肋助呼气2021/3/114Intercostales intimi肋间最内肌肋间最内肌External intercostal membrfane肋间外膜肋间外膜Internal intercostal membrfane肋间内膜肋间内膜2021/3/1152021/3/1162）Vessels and nerves血管和神经血管和神经Posterior intercostal AIntercostal N2021/3/1172021/3/118Intercostal space 肋间隙肋间隙Posterior intercostal v.Posterior intercostal a.Intercostal n.2021/3/119肋间后动脉、肋间后静脉和肋间神经三者的位置关系肋间后动脉、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。.胸膜腔穿刺部位胸膜腔穿刺部位:在肋间隙后部，进针部位应在下位肋的上缘。在肋间隙后部，进针部位应在下位肋的上缘。在肋间隙前部，进针部位应在肋间隙的中间。在肋间隙前部，进针部位应在肋间隙的中间。2021/3/1110Internal thoracic artery胸廓内动脉胸廓内动脉descends into thorax 1.2cm lateral to edge of sternum,and ends at the sixth costal cartilage by dividing musculophrenic and superior epigastric arteries2021/3/1111MusculophrenicA肌膈动脉肌膈动脉superior epigastric A腹壁上动脉腹壁上动脉2021/3/11122.Pleura胸膜胸膜Visceral pleuraParietal pleuramediastinal pleuraDiaphragmatic pleuraCostal pleuraCupula pleura1）Partes分部分部2021/3/1113 Two pleural layers continue with each other at root of lung forming closed potential spaceContains a small amount pleural fluidSubatmospheric pressure in it 2）Pleural cavity 胸膜腔胸膜腔2021/3/1114 potential spaces of pleural cavity which lungs are not occupied in deep respirationCostodiaphragmatic recess 肋膈隐窝肋膈隐窝3）Pleura recesses 胸膜隐窝胸膜隐窝 Costomediastinal recess肋纵隔隐窝肋纵隔隐窝2021/3/1115Midclavicular lines锁骨中线锁骨中线Midaxillary lines腋中线腋中线Scapular line肩胛线肩胛线2021/3/1116The surface projection of lower border of lung and pleurae Lower borderMidclavicular linesMidaxillary lines Scapular lineLungs6th rib 8th rib10th ribPleura8th rib10th rib12th rib11th rib2021/3/11172021/3/11183.Lung 肺肺 1）Postion 位置位置肺位于胸腔内，纵隔两肺位于胸腔内，纵隔两侧，因心位置偏左，故侧，因心位置偏左，故左肺狭长，右肺略宽短左肺狭长，右肺略宽短2021/3/11192）Features 形态形态Apex of lung 肺尖：肺尖：伸向颈根部，高出锁骨内侧伸向颈根部，高出锁骨内侧1/3上方上方2.5cm Base of lung肺底：又称膈面肺底：又称膈面Costal surface肋面肋面Mediastinal surface纵隔面纵隔面肺呈圆锥形，有一尖、一底、两面、三缘肺呈圆锥形，有一尖、一底、两面、三缘。2021/3/1120 纵隔面纵隔面Mediastinal surface中部有长圆形凹陷叫肺门肺门，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、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。2021/3/1121Hilum of lung肺门肺门From before backward:V.A.B.From above downward:R.B.A.V.L.A.B.V.2021/3/1122Oblipue fissure斜裂斜裂horizontal fissure水平裂水平裂Superior lobe上叶上叶Middle lobe中叶中叶Inferior lobe下叶下叶Cardiac notch心切迹心切迹2021/3/1123 Each principal bronchus divides into lobar bronchi(two on the left,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 tree2021/3/1124 主支主支 气管气管（一级支气管）（一级支气管）肺叶支气管（二级肺叶支气管（二级支气管）支气管）肺段支肺段支气管（三级支气气管（三级支气管）。管）。每个肺段支每个肺段支气管及其所属的肺气管及其所属的肺组织，称为组织，称为支气管支气管肺段肺段，简称，简称肺段肺段Segments of lung。3.Bronchial tree支气管树支气管树2021/3/1125尖段尖段后段后段前段前段外侧段外侧段内侧段内侧段尖（上）段尖（上）段内侧底段内侧底段前底段前底段外侧底段外侧底段后底段后底段尖后段尖后段前段前段上舌段上舌段下舌段下舌段尖（上）段尖（上）段前内底段前内底段外侧底段外侧底段后底段后底段上叶上叶中叶中叶下叶下叶上叶上叶下叶下叶2021/3/1126外侧底段外侧底段外侧底段外侧底段2021/3/11272021/3/1128 Vessels OF lungPulmonary APulmonary V2021/3/1129 DiaphragmSternal partCostal partLumbar partCentral tendonLumbocostal triangleSternocostal triangle Shape 2021/3/1130Aortic hiatusEsophageal hiatusVena cava foramen Openings in the diaphragmT8T10T122021/3/1131Contraction: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:
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