015胸腔1-胸膜、肺、上纵隔.ppt

局部解剖学 胸部的局部解剖与操作（2） Summarization 概述 Thoracic wall 胸壁 Pleura and pleural cavity 胸膜与胸膜腔 Lungs 肺 Mediastinum（1） 纵隔 临床行胸膜腔穿刺术（抽液）常选在肩胛线或腋后线、第7或8肋间隙中部或肋上缘稍上方进针。 脏胸膜 visceral or pulmonary pleura 壁胸膜 The parietal pleura can be subdivided into: 肋胸膜 costal pleura 膈胸膜 diaphragmatic pleura 胸膜顶 cupula of pleura 纵隔胸膜 The mediastinal pleura 胸膜腔pleural cavity,胸膜隐窝 pleural recess 肺韧带 pulmonary ligament 肋纵隔隐窝 costomediastinal recess 肺韧带 pulmonary ligament pulmonary ligament 在胸骨角水平以上或第4肋软骨水平以下。两侧胸膜前界之间距离较大，分别称为胸膜上间区（胸腺区）和胸膜下间区（心包区）。 Above the sternal angle and below the level of the 4th costal cartilage, the distance between two pleural reflections is larger. These two intervals are called the superior intermediate region triangle of thymus and the inferior intermediate region triangle of pericardium of pleura respectively. 胸膜前界的体表投影 肺根：为出入肺门的主支气管、肺动脉、肺静脉、支气管动脉和静脉、肺丛以及淋巴管等结构的总称，表面包以胸膜 。 The root of lung is formed by the principal bronchus, the pulmonary artery, the pulmonary veins, the bronchial arteries and veins, the pulmonary plexuses of nerves and the lymphatic vessels. These structures are held together by mediastinal connective tissue and surrounded by the pleura. The chief structures composing the root of each lung are arranged in a similar manner . 肺根内主要结构的排列 from front backwards on both sides: the superior pulmonary vein in front, the pulmonary artery in the middle and the bronchus with the bronchial vessels on its posterior aspect behind.由前→后为上肺静脉、肺动脉、主支气管。 from above downwards on the two sides: on the right side, their arrangement is superior lobar bronchus, pulmonary artery, middle and inferior lobar bronchus, and pulmonary vein. on the left side, they are the pulmonary artery, the bronchus, and the lower most structure the pulmonary vein.自上→下：左侧为肺动脉、主支气管、上肺静脉；右侧为上叶支气管，肺动脉、下叶支气管、肺上静脉。左、右肺下静脉位置最低，在肺手术中切断肺韧带时应加以保护。 五、纵 隔 Mediastinum 纵隔的概念、境界、分区 纵隔的左、右侧面 上纵隔 1.概念与境界 1.境界与分区 纵 隔 概念：纵隔是左、右纵隔胸膜之间所有器官、结构和结缔组织的总称，包括心、心包、出入心的大血管、胸腺和神经、淋巴等。 境界：纵隔的左、右侧界为左、右纵隔胸