1、Introduction of lymphology原版：山东大学医学院人体解剖教研室补充增加中文2012.5 淋巴系统淋巴系统 Lymphatic System 淋巴管道：毛细淋巴管、淋巴管淋巴管道：毛细淋巴管、淋巴管 、淋巴干、淋巴导管淋巴干、淋巴导管 lymphlymph vesselvessel淋巴器官：淋巴器官：淋巴结、脾、胸腺、扁桃体淋巴结、脾、胸腺、扁桃体l lymphaticymphatic organ organ淋巴组织：含大量淋巴细胞（弥散的和淋巴小结）淋巴组织：含大量淋巴细胞（弥散的和淋巴小结）lymphatic tissuelymphatic tissue辅助静脉回流辅
2、助静脉回流产生淋巴细胞产生淋巴细胞过滤淋巴液过滤淋巴液参与免疫应答参与免疫应答1 1 回收蛋白质运输脂肪及营养物质回收蛋白质运输脂肪及营养物质2 2 清除组织中的红细胞细菌和异物清除组织中的红细胞细菌和异物3 3 调节血浆和组织液间的液体平衡调节血浆和组织液间的液体平衡4 4 产生淋巴细胞和浆细胞参与免疫反应产生淋巴细胞和浆细胞参与免疫反应淋巴回流淋巴回流Lymph nodesThe Lymphatic System 淋巴系统淋巴系统ACapVLymphatic-CapillaryLymphaticLymphatic trunksLymphatic ducts（淋巴结）（淋巴干）（淋巴导管）（
3、毛细淋巴管）A assistant system to the vein 辅助静脉系统回流辅助静脉系统回流CompositionqLymphatic vessels 淋巴管道淋巴管道 Lymphatic capillary毛细淋巴管毛细淋巴管 Lymph vessels淋巴管淋巴管 Lymphatic trunks(9)淋巴干淋巴干 Lymphatic ducts(2)淋巴导管淋巴导管 thoracic duct 胸导管胸导管 right lymphatic duck右淋巴导管右淋巴导管qLymphatic organs 淋巴器官淋巴器官 Lymph nodes 淋巴结淋巴结 spleen 脾
4、脾 thymus胸腺胸腺 tonsil扁桃体扁桃体,q Lymphatic tissues 淋巴组织淋巴组织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 capillary
5、毛细淋巴管毛细淋巴管盲端单层重叠内皮细胞比毛细血管通透性更强脑，脊髓，脾髓，骨髓无此结构软骨、上皮、牙釉质、角膜与晶状体等亦无此结构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 setsLymphatic v
6、essels 淋巴管道淋巴管道类似三层墙，比静脉细瓣膜远多于静脉中间有淋巴结插入分浅、深两种淋巴管Lymphatic trunks 淋巴干淋巴干 qright and left jugular trunks (颈干颈干)qright and left subclavian trunks （锁骨下干锁骨下干）qright and left bronchomediastinal trunks （支气管纵隔干支气管纵隔干）qright and left lumbar trunks （腰干腰干）qintestinal trunk（肠干肠干）Lymphatic vessels 淋巴管道淋巴管道Right
7、 lymphatic duct 右淋巴导管右淋巴导管nFormed by union of right jugular,subclavian,and bronchomediastinal trunksnEnds by entering the right venous angle右右静脉角静脉角nReceives lymph from right half of head,neck,thorax and right upper limbLymphatic ducts 淋巴导管淋巴导管 Lymphatic vessels 淋巴管道淋巴管道由右颈干，锁骨下干，支气管纵膈干联合构成收集右半脑，颈部，
8、胸，右上肢的淋巴液pThoracic duct 胸导管胸导管 Begins in front of L1 as a dilated sac,the cisterna chyli 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 col
9、umn,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，由左右腰干和肠干联合构成穿过膈上的主动脉裂孔，沿着脊柱前方，在胸主动脉和奇静脉之间上升进入胸腔 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 befo
10、re termination,it receives the left jugular,subclavian and ronchomediastinal trunksLymphatic vessels 淋巴管道淋巴管道pThoracic duct 胸导管胸导管进入胸腔顺时针转入第五胸椎左侧到达颈根部，转至侧面呈弧形弯入左静脉角进入左静脉角前，收集左颈干，左锁骨下干，左支气管纵膈干的淋巴液pThoracic duct 胸导管胸导管 Just before termination,it receives the left jugular,subclavian and bronchomediasti
11、nal trunks Drains lymph from lower limbs,pelvic cavity,abdominal cavity,left side of thorax,and left side of the head,neck and left upper limbLymphatic vessels 淋巴管道淋巴管道胸导管引流下肢、盆腔、腹腔、左上肢、左胸部和左头颈部的淋巴Lymph node 淋巴结淋巴结FeaturesqBean-shaped bodiesqWith afferent lymph vessels输入淋巴管输入淋巴管(entering at the peri
12、phery)and efferent lymph vessels输出淋巴管输出淋巴管(emerging at the hilus)qArranged in groups,along the blood vessels or the flexural side of the jointqDivided into superficial and deep groups沿着血管或者关节屈处分布成群的淋巴结分为浅部和深部淋巴结群 Regional Lymph Node局部淋巴结局部淋巴结 is the lymph node where the lymph of the organ or part of
13、 the body drainge to firstly Sentinel Lymph Node前哨淋巴结前哨淋巴结(in clinic)Lymph node 淋巴结淋巴结Lymph drainage of the body.Lymph drainage of the head头部的淋巴引流头部的淋巴引流 Lymph nodes of head Located at junction of head and neck Consist of occipital,mastoid,parotid,submandibular,submental lymph nodes Drain into deep
14、cervical lymph nodes Submandibular lymph node 下颌下淋巴结下颌下淋巴结 lies near the submandibular gland,receive lymphatic vessels from the face,nose and mouth头颈交界处排列由枕淋巴结，乳突淋巴结，腮腺淋巴结，下颌下淋巴结，颏下淋巴结组成流入颈部淋巴结位于下颌下腺附近，接收面，鼻，和嘴的淋巴管Lymph drainage of neck颈部的淋巴引流颈部的淋巴引流 Anterior cervical lymph nodes颈前淋巴结颈前淋巴结Superficia
15、l anterior cervical lymph nodesDeep anterior cervical lymph nodes Lateral cervical lymph node 颈外侧淋巴结颈外侧淋巴结Superficial lateral cervical lymph nodeslie along the external jugular veinDeep lateral cervical lymph nodes颈前浅淋巴结颈前深淋巴结颈外侧浅淋巴结颈外静脉排列颈外侧深淋巴结Deep lateral cervical lymph nodes颈外侧深淋巴结颈外侧深淋巴结 extend
16、 along the internal jugular vein from the base of skull to the root of neck divide into Superior deep lateral cervical lymph nodes颈外侧上深淋巴颈外侧上深淋巴结结 Inferior deep lateral cervical lymph nodes颈外侧下深淋巴颈外侧下深淋巴结结Lymph drainage of neck颈部的淋巴引流颈部的淋巴引流沿颈内静脉扩展 从颅底至颈根部Deep lateral cervical lymph nodes颈外侧深淋巴结颈外侧深
17、淋巴结 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 thoracic duct(left)right lymphatic duct (right)Lymph drainage of neck颈部的淋巴引流颈部的淋巴引流 Superior deep later
18、al cervical lymph nodes 颈外侧上深淋巴结颈外侧上深淋巴结Jugulodigastric lymph node 颈内静颈内静脉二腹肌淋巴结脉二腹肌淋巴结:lies at the junction of posterior belly of digastric and internal jugular vein Inferior deep lateral cervical lymph nodes 颈外侧下深淋巴结颈外侧下深淋巴结Juguloomohyoid lymph node 颈内静颈内静脉肩胛舌骨肌淋巴结脉肩胛舌骨肌淋巴结:lies at the junction of
19、 the intermediate tendon of omohyoid and internal jugular veinSupraclavicular lymph nodes 锁骨上锁骨上淋巴结淋巴结:lie along the subclavian arteryLymph drainage of neck颈部的淋巴引流颈部的淋巴引流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 浅淋巴管 伴随浅静脉 注入滑车上淋巴结和腋淋巴结 Deep
20、lymphatic vessels 深淋巴管 伴随深静脉 注入腋淋巴结 lymph nodes Cubital lymph node滑车上淋巴结 Axillary lymph node腋淋巴结Axillary lymph nodes 腋淋巴结The axillary lymph nodes mey be divided into lateral ln.外侧淋巴结外侧淋巴结 pectoral ln.胸肌淋巴结胸肌淋巴结 subscapular ln.肩胛下淋巴结肩胛下淋巴结 central ln.中央淋巴结中央淋巴结 apical ln.尖淋巴结尖淋巴结lateral ln.pectoral l
21、n.subscapular ln.central ln.apical ln.subclavian 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胸骨旁淋巴结胸骨旁淋巴结(along internal thoracic vessels)To intercostals lymph nodes肋间淋巴结肋间淋巴结 from deeper structuresThe l
22、ymphatic drainage of thorax胸部的淋巴引流胸部的淋巴引流lymph nodes of the thoracic contents lymph nodes of trachea,bronchi and lungsPulmonary lymph nodes肺淋巴肺淋巴结结lie in the angles of bifurcation of branching lobar bronchiBronchopulmonary hilar lymph nodes支气管肺门淋巴结支气管肺门淋巴结lie in the hilus of the lungTracheobronchial
23、 lymph nodes气管支气管淋巴结气管支气管淋巴结situated above or below the bifurcation of tracheaParatracheal lymph nodes 气管气管旁淋巴结旁淋巴结along each side of the tracheaParatracheal lymph nodes Anterior mediastinal lymph node纵隔前淋巴结纵隔前淋巴结 lies anterior to the large blood vessels of thoracic cavity and pericardium;the effere
24、nts unite with those of paratracheal lymph nodes,to form the right and left bronchomediastinal trunks 支气管纵隔干支气管纵隔干.The left bronchomediastinal trunk terminates in thoracic duct,and right in the right lymphtic duct Posterior mediastinal lymph nodes纵隔后淋巴结纵隔后淋巴结 lie along the esophagus and thoracic aor
25、taThe lymphatic drainage of thorax胸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
26、 nodesuperficial inguinal lymph nodeLymphatic drainage of abdominal viscera Lumbar lymph nodes 腰淋巴结腰淋巴结 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 eff
27、erent vessel form the right and left lumbar trunks The lymphatic drainage of abdomen 腹部的淋巴引流 Celiac lymph nodes 腹腔淋巴结腹腔淋巴结 situated around the celiac trunk Superior mesenteric lymph node 肠系膜上淋巴结肠系膜上淋巴结 situated around superior mesenteric a.Inferior mesenteric lymph node 肠系膜下淋巴结肠系膜下淋巴结 situated aroun
28、d inferior mesenteric a.Intestinal 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 髂内淋巴结髂内淋巴结 Surround internal iliac vessels Receive lymph f
29、rom pelvic viscera,perineum,buttock and back of thighExternal iliac lymph nodes 髂外淋巴结髂外淋巴结 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 骶淋巴结骶淋巴结llocate along middle sacral a.and lateral
30、sacral a.lReceive lymph from posterior pelvic wall,rectum,prostate or uterusCommon iliac lymph node髂总淋髂总淋巴结巴结 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 De
31、ep lymphatic Lymph nodes Superficial lymph node 腹股沟浅淋巴结 Deep lymph node 腹股沟深淋巴结 lymph drainage of lower limb下肢的淋巴下肢的淋巴pSuperficial lymph node腹股沟腹股沟浅淋巴结浅淋巴结may be divided into two groups Upper group:below the inguinal lig.腹股沟韧带腹股沟韧带 Lower group:around the terminal part of great saphenous v.大隐静脉大隐静脉 R
32、eceive lymph from lower part of abdominal wall,perineum 会阴会阴and lower limb with the exception of region drained by popliteal ln.腘淋腘淋巴结巴结lymph drainage of lower limb下肢的淋巴下肢的淋巴pdeep lymph node 腹股沟深淋巴腹股沟深淋巴结结 Locate around the proximal end of femoral v.Receive lymph from deep lymphatic vessels of lower
33、 limb and the efferentlymphatic vessels of superficial inguinal ln.腹股沟浅腹股沟浅淋巴结淋巴结 Their efferent lymphatic vessels empty into external iliac ln.髂外淋髂外淋巴结巴结 Popliteal ln.腘淋巴结腘淋巴结 Embedded in the fatty connective tissue of popliteal fossa Receive superficial lymphatic vessels from posterolateral part o
34、f calf小腿小腿,and from deep lymphatic vessels accompanying anterior and posterior tibial a.Efferents pass to the deep inguinal ln.腹股沟深淋巴结腹股沟深淋巴结lymph drainage of lower limb下肢的淋巴下肢的淋巴Celiac lymph nodesSuperior mesenteric lymph node 肠系膜肠系膜上淋巴结上淋巴结Inferior mesenteric lymph node 肠系膜下淋巴结肠系膜下淋巴结Spleen 脾qLoca
35、tion Left epigastric 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 information
