系统解剖学系统解剖学systematicanatomy主讲人侯一平教授兰州课件.ppt

1、January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 颈颈 部部一、概述一、概述 二、浅层结构二、浅层结构三、颈部深筋膜三、颈部深筋膜 四、颈前区四、颈前区五、胸锁乳突肌区五、胸锁乳突肌区 六、颈根部六、颈根部七、颈侧区七、颈侧区January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by

2、 YP HOU and YF SONG 一、概述一、概述 境界：境界：内容：内容：January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 颈部分区：颈部分区：项部项部 固有颈部（颈部）固有颈部（颈部）颈前区颈前区 胸锁乳突肌区胸锁乳突肌区 颈侧区颈侧区 January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right

3、reserved by YP HOU and YF SONG 舌骨上区舌骨上区:下颌下三角下颌下三角 颏下三角颏下三角 舌骨下区舌骨下区:颈动脉三角颈动脉三角 肌三角肌三角颈前区：颈前区：January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 胸锁乳突肌区胸锁乳突肌区颈侧区：颈侧区：枕三角枕三角 锁骨上大窝锁骨上大窝January,2007Copyright Depart.Anatomy,School of Medici

4、ne,Lanzhou University.All right reserved by YP HOU and YF SONG 二、二、浅层结构浅层结构1.颈阔肌颈阔肌2.浅静脉浅静脉 3.皮神经皮神经 January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 1.颈阔肌颈阔肌起点：起点：三角肌和三角肌和胸大肌表面的筋胸大肌表面的筋膜。膜。止点：止点：口角口角颈阔肌深面有浅颈阔肌深面有浅静脉和皮神经静脉和皮神经。Januar

5、y,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 2.浅静脉浅静脉 颈前静脉颈前静脉 注入颈外静脉注入颈外静脉 颈外静脉颈外静脉 注入锁骨下静注入锁骨下静脉或静脉角脉或静脉角January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 3.皮神经皮神经(1)为

6、颈丛的皮支为颈丛的皮支:颈横神经颈横神经 耳大神经耳大神经 枕小神经枕小神经 锁骨上神经锁骨上神经 颈部麻醉点：颈部麻醉点：(2)面神经颈支面神经颈支January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 三、颈部深筋膜三、颈部深筋膜 分浅、中、分浅、中、深深 三层。三层。January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.

7、All right reserved by YP HOU and YF SONG 包裹二肌二腺，形包裹二肌二腺，形成肌鞘和腺鞘。成肌鞘和腺鞘。二肌：斜方肌二肌：斜方肌 胸锁乳突肌胸锁乳突肌 二腺：下颌下腺二腺：下颌下腺 腮腮 腺腺 1.深筋膜浅层深筋膜浅层（封套（封套筋膜筋膜）January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 位于舌骨下肌群位于舌骨下肌群的后方，上附的后方，上附于舌骨，下续于舌骨，下续纤维性心包，纤

8、维性心包，分二层包绕甲分二层包绕甲状腺，形成甲状腺，形成甲状腺鞘。状腺鞘。2.深筋膜中层深筋膜中层 （气管前筋膜）（气管前筋膜）January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 上自颅底，下续上自颅底，下续前纵韧带与胸前纵韧带与胸内筋膜，并向内筋膜，并向下外包绕腋血下外包绕腋血管及臂丛，形管及臂丛，形成腋鞘。成腋鞘。3.深层（椎前筋膜）深层（椎前筋膜）January,2007Copyright Depart.Ana

9、tomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 为包绕颈为包绕颈部大血管部大血管和迷走神和迷走神经的筋膜经的筋膜鞘。鞘。颈动脉鞘：颈动脉鞘：January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 颈动脉鞘内上部颈动脉鞘内上部有颈内动脉、下有颈内动脉、下部有颈总动脉，部有颈总动脉，颈内静脉位于动颈内静脉位

10、于动脉的外侧，迷走脉的外侧，迷走神经位于两者之神经位于两者之间的后方。间的后方。January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 颈部的筋膜间隙颈部的筋膜间隙：主要有：主要有：(1)胸骨上间隙胸骨上间隙 (2)气管前间隙气管前间隙 (3)咽后间隙咽后间隙 (4)椎前间隙椎前间隙January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou Univer

11、sity.All right reserved by YP HOU and YF SONG 位于胸骨柄上方位于胸骨柄上方深筋膜浅层的二深筋膜浅层的二层之间。层之间。内有颈前静脉下内有颈前静脉下段、颈静脉弓、段、颈静脉弓、淋巴结、脂肪组淋巴结、脂肪组织等。织等。(1)胸骨上间隙胸骨上间隙January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 位于气管前位于气管前筋膜与气管筋膜与气管之间。之间。通向：通向：向下向下通上纵隔。

12、通上纵隔。(2)气管前间隙气管前间隙January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 甲状腺下静脉甲状腺下静脉 奇静脉丛奇静脉丛 头臂干头臂干 甲状腺最下动脉甲状腺最下动脉 左头臂静脉左头臂静脉 小儿有胸腺上部小儿有胸腺上部 气管前间隙内有气管前间隙内有January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All rig

13、ht reserved by YP HOU and YF SONG 位于椎前筋膜与位于椎前筋膜与咽颅底筋膜之间。咽颅底筋膜之间。内有淋巴结及结内有淋巴结及结缔组织。咽壁侧缔组织。咽壁侧方的部分为咽旁方的部分为咽旁间隙。间隙。(3)咽后间隙咽后间隙January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 位于脊柱颈段位于脊柱颈段与椎前筋膜之与椎前筋膜之间。颈椎结核间。颈椎结核脓肿多积于此脓肿多积于此间隙。向下通间隙。向下通后

14、纵隔。后纵隔。(4)椎前间隙椎前间隙January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG（一）（一）舌骨上区舌骨上区 下颌下三角下颌下三角 颏下三角颏下三角（二）（二）舌骨下区舌骨下区 颈动脉三角颈动脉三角 肌三角肌三角四、颈前区四、颈前区 January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reser

15、ved by YP HOU and YF SONG （一）（一）舌骨上区舌骨上区 1.下颌下三角下颌下三角 周界：周界：位于下颌位于下颌骨下缘与二腹肌骨下缘与二腹肌前、后腹之间。前、后腹之间。January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 主要为下主要为下颌下腺及其周颌下腺及其周围的血管神经。围的血管神经。内容内容January,2007Copyright Depart.Anatomy,School of Med

16、icine,Lanzhou University.All right reserved by YP HOU and YF SONG 浅面有：面静脉浅面有：面静脉 深面有：面动脉深面有：面动脉 内下方有：舌下神经内下方有：舌下神经 舌动脉、舌静脉舌动脉、舌静脉 内上方有：舌神经内上方有：舌神经 下颌下神经节下颌下神经节 下颌下腺周围的结构：下颌下腺周围的结构：January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG （二）（

17、二）舌骨下区舌骨下区颈动脉三角颈动脉三角肌三角肌三角January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 1.颈动脉三角颈动脉三角境界：境界：胸锁乳突肌前缘上份胸锁乳突肌前缘上份 二腹肌后腹二腹肌后腹 肩胛舌骨肌上腹肩胛舌骨肌上腹 January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved b

18、y YP HOU and YF SONG 颈总动脉及其分支颈总动脉及其分支 颈内静脉及其属颈内静脉及其属支支 迷走神经迷走神经 副神经副神经 舌下神经舌下神经 主要内容：主要内容：January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 颈外动脉颈外动脉 颈内动脉颈内动脉 颈总动脉及其分支：颈总动脉及其分支：January,2007Copyright Depart.Anatomy,School of Medicine,La

19、nzhou University.All right reserved by YP HOU and YF SONG 甲状腺上动脉甲状腺上动脉 舌动脉舌动脉 面动脉面动脉 枕动脉枕动脉 颈外动脉的分支：颈外动脉的分支：January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 2.肌三角肌三角 周界：周界：颈前正中线颈前正中线 肩胛舌骨肌上腹肩胛舌骨肌上腹 胸锁乳突肌前缘胸锁乳突肌前缘January,2007Copyright

20、 Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 肌肉：舌骨下肌群肌肉：舌骨下肌群 4对对 功能功能:下降舌骨和喉下降舌骨和喉 胸骨舌骨肌胸骨舌骨肌肩胛舌骨肌肩胛舌骨肌胸骨甲状肌胸骨甲状肌甲状舌骨肌甲状舌骨肌January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 甲状腺甲状腺 甲状旁

21、腺甲状旁腺 气管颈段气管颈段 食管颈段食管颈段内容：内容：January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 甲状腺甲状腺 thyroid gland 1.外形外形:“H”形形 有二个侧有二个侧叶和一个峡部。一半叶和一个峡部。一半以上（约以上（约70%）的人）的人有锥状叶。有锥状叶。January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou Univ

22、ersity.All right reserved by YP HOU and YF SONG 甲状腺位于甲状腺位于喉下部和气管上喉下部和气管上部的两侧。侧叶部的两侧。侧叶上端平甲状软骨上端平甲状软骨中部，下端达第中部，下端达第6气管软骨环；峡气管软骨环；峡部位于第部位于第24气管气管软骨环的前面。软骨环的前面。2.位置位置 January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 3.甲状腺的被膜甲状腺的被膜 甲状腺的表

23、面包有内、甲状腺的表面包有内、外层被膜，即：外层被膜，即：内层：纤维囊内层：纤维囊 （真被膜）（真被膜）外层：甲状腺鞘外层：甲状腺鞘 （假被膜）（假被膜）January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 假被膜增厚形成的假被膜增厚形成的甲状腺悬韧带将甲甲状腺悬韧带将甲状腺连于喉和气管，状腺连于喉和气管，故吞咽时，甲状腺故吞咽时，甲状腺可随喉上、下移动。可随喉上、下移动。January,2007Copyright D

24、epart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 4.甲状腺的毗邻甲状腺的毗邻甲状腺前面邻甲状腺前面邻(层次）层次）皮肤皮肤 浅筋膜浅筋膜 深筋膜浅层深筋膜浅层 舌骨下肌群舌骨下肌群January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 喉喉 气管气管 咽咽 食管食管 喉返神经喉返神经

25、甲状腺侧叶内侧邻：甲状腺侧叶内侧邻：January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 颈鞘及其内容颈鞘及其内容 颈交感干颈交感干 甲状腺侧叶后外侧邻：甲状腺侧叶后外侧邻：January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 5.甲状腺的动脉

26、与喉的神经的关系甲状腺的动脉与喉的神经的关系 甲状腺上动脉与甲状腺上动脉与喉上神经外支伴行，喉上神经外支伴行，在距腺上极约在距腺上极约1 cm 处，二者又分开，故处，二者又分开，故甲状腺手术结扎甲状甲状腺手术结扎甲状腺上动脉时应紧贴腺腺上动脉时应紧贴腺上极进行。上极进行。January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 甲状腺下动脉与喉返神经的关系：甲状腺下动脉与喉返神经的关系：甲状腺下动脉甲状腺下动脉与喉返神经关

27、系密与喉返神经关系密切，左侧喉返神经切，左侧喉返神经位置较深，多经动位置较深，多经动脉后方上行；右侧脉后方上行；右侧喉返神经位置较浅，喉返神经位置较浅，多经动脉前方。多经动脉前方。January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 左右喉返左右喉返神经入喉之前神经入喉之前都经环甲关节都经环甲关节后方，故甲状后方，故甲状软骨下角可作软骨下角可作为寻找喉返神为寻找喉返神经的标志。经的标志。January,2007Copy

28、right Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 在甲状腺手术在甲状腺手术结扎甲状腺下动脉时结扎甲状腺下动脉时应远离腺的下极，避应远离腺的下极，避免伤及喉返神经，引免伤及喉返神经，引起声音嘶哑。起声音嘶哑。同时要注意保留同时要注意保留甲旁状腺。甲旁状腺。January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by Y

29、P HOU and YF SONG 6.甲状腺的静脉甲状腺的静脉 有三对：有三对：甲状腺上静脉甲状腺上静脉 甲状腺中静脉甲状腺中静脉 甲状腺下静脉甲状腺下静脉 January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 作甲状腺手术切口所经过的层次作甲状腺手术切口所经过的层次 皮肤皮肤 浅筋膜浅筋膜 深筋膜浅层深筋膜浅层 舌骨下肌群舌骨下肌群 气管前筋膜气管前筋膜January,2007Copyright Depart.An

30、atomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 气气 管管 颈颈 部部 有 一 定 的 移 动有 一 定 的 移 动性，上段位置表性，上段位置表浅，下段位置深。浅，下段位置深。故常规气管切开故常规气管切开术应保持头正中术应保持头正中位，并尽量后仰。位，并尽量后仰。January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and

31、 YF SONG 气管切开经过层次：气管切开经过层次：皮肤皮肤 浅筋膜浅筋膜 深筋膜浅层深筋膜浅层 胸骨上间隙胸骨上间隙 舌骨下肌群舌骨下肌群 气管前筋膜气管前筋膜January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 气管颈部的毗邻：气管颈部的毗邻：两侧：甲状腺侧叶两侧：甲状腺侧叶 后方：食管后方：食管 气管食管沟内有气管食管沟内有 喉返神经喉返神经 后外侧：颈动脉鞘后外侧：颈动脉鞘 颈交感干颈交感干January,2

32、007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 六、胸锁乳突肌区六、胸锁乳突肌区 位置：位置：主要结构：主要结构：颈袢颈袢January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 组成组成:由颈袢上、由颈袢上、下根在第下根在第6颈颈椎平面汇合椎平面汇合成袢。成

33、袢。颈袢颈袢January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 颈袢上根：由颈颈袢上根：由颈1前支构成。前支构成。颈袢下根：由颈颈袢下根：由颈2、3前支经颈丛发前支经颈丛发出下行构成。出下行构成。January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF S

34、ONG 分布分布:颈颈1发支至甲发支至甲状舌骨肌，袢状舌骨肌，袢上发支至其余上发支至其余3个舌骨下肌个舌骨下肌群。群。January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 七、颈根部七、颈根部 位置：位置：颈部和胸部颈部和胸部之间的过渡之间的过渡区。区。January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right

35、 reserved by YP HOU and YF SONG 纵行结构纵行结构横行结构横行结构 以前斜角肌为标志分为以前斜角肌为标志分为：结构：结构：January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 在前斜角在前斜角肌的前内侧，肌的前内侧，为来源于颈、为来源于颈、胸之间的结胸之间的结构。构。纵行结构：纵行结构：January,2007Copyright Depart.Anatomy,School of Medic

36、ine,Lanzhou University.All right reserved by YP HOU and YF SONG 颈内静脉颈内静脉 颈总动脉颈总动脉 膈神经膈神经 迷走神经迷走神经 颈交感干颈交感干 胸膜顶胸膜顶 胸导管及右胸导管及右 淋巴导管淋巴导管 纵行结构有：纵行结构有：January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 在前斜角肌在前斜角肌的前、后方和的前、后方和外侧，主要是外侧，主要是来源于颈

37、、胸来源于颈、胸与上肢之间的与上肢之间的结构。结构。横行结构：横行结构：January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 锁骨下动脉锁骨下动脉及其分支及其分支 锁骨下静脉锁骨下静脉及其属支及其属支 臂丛臂丛 横行结构有横行结构有January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved b

38、y YP HOU and YF SONG 锁骨下动脉：锁骨下动脉：被前斜角肌分为被前斜角肌分为三段。三段。主要分支有主要分支有：椎动脉椎动脉 胸廓内动脉胸廓内动脉 甲状颈干甲状颈干 甲状腺下动脉甲状腺下动脉 January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 胸 导 管胸 导 管注入左静脉注入左静脉角，右淋巴角，右淋巴导管注入右导管注入右静脉角。静脉角。胸导管及右淋巴导管：胸导管及右淋巴导管：January,2007

39、Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 斜角肌间隙：斜角肌间隙：由前、中斜角由前、中斜角肌和第肌和第1肋之肋之间的空隙。间的空隙。通过结构：通过结构：臂丛臂丛 锁骨下动脉锁骨下动脉 January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 八、颈侧区八、颈侧

40、区 枕三角枕三角 锁骨上三角锁骨上三角January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 枕三角：枕三角：主要结构：主要结构：颈丛皮神经颈丛皮神经 臂丛分支臂丛分支 副神经副神经支配：胸锁乳突肌支配：胸锁乳突肌 斜方肌斜方肌 January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by

41、YP HOU and YF SONG 锁骨上三角：锁骨上三角：主要结构：主要结构：锁骨下动脉锁骨下动脉 锁骨下静脉锁骨下静脉 静脉角静脉角 臂丛臂丛January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 锁骨下静脉：锁骨下静脉：位于锁骨位于锁骨内侧段上方，内侧段上方，锁骨下动脉前锁骨下动脉前面，直径面，直径12cm。January,2007Copyright Depart.Anatomy,School of Medici

42、ne,Lanzhou University.All right reserved by YP HOU and YF SONG 左侧有胸导左侧有胸导管的注入，右管的注入，右侧侧 有右淋巴导有右淋巴导管的注入。管的注入。静脉角静脉角January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 臂丛从颈部斜臂丛从颈部斜角肌间隙经锁骨角肌间隙经锁骨中点后方到腋窝，中点后方到腋窝，临床上作臂丛阻临床上作臂丛阻滞麻醉滞麻醉 常在锁常在锁骨中点上方进行。骨中点上方进行。臂丛臂丛January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 小结小结1.颈部深筋膜的配布及筋膜间隙。颈部深筋膜的配布及筋膜间隙。2.颈动脉鞘。颈动脉鞘。2.甲状腺的毗邻。甲状腺的毗邻。3.甲状腺手术及气管切开手术经过甲状腺手术及气管切开手术经过的层次。的层次。