Transcript 4淋巴系

淋巴系统
lymphatic system
目 录
概 述
淋巴管道
毛细淋巴管
淋巴管
淋巴干
淋巴导管
淋巴结
脾和胸腺
一、概
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述
淋巴系统的组成：
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淋巴管道 lymphatic ducts
淋巴组织 lymphatic tissue
淋巴器官 lymphatic organs：
包括淋巴结、脾、胸腺和扁桃体
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图
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淋巴系统的功能
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协助静脉系统引流组织液
产生淋巴细胞
滤过淋巴液
参与免疫应答
淋巴的构成
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二、淋巴管道 lymphatic ducts
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毛细淋巴管 lymphatic capillary
 构成
 结构特点
淋巴管 lymphatic vessel
 分类
 输入淋巴管
 输出淋巴管
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淋巴结
lymph node
(Small oval or bean-shaped bodes
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Afferent vessels enter the node on
its convex surface, and efferent
vessels leave the node at its
concave surface－the hilum
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Arranged in groups, along the
blood vessels
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Regional nodes
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is the lymph node where the
lymph of the organ or part of
the body drainage to firstly
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淋巴干 lymphatic trunks
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构成
九条淋巴干:
成 对
淋巴干
不成对
颈 干 jugular trunks
锁骨下干 subclavian trunks
支气管纵隔干 bronchomadiastinal trunks
腰 干 lumbar trunks
肠
干 intestinal trunk
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淋巴导管 lymphatic ducts
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胸导管 thoracic duct
 构成
 行程
 注入
 收纳范围
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右淋巴导管 right lymphatic duct
 构成
 收纳范围
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Lymphatic ducts
Right lymphatic duct
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Formed by union of right jugular,
subclavian, and bronchomediastinal
trunks
Ends by entering the right venous angle
Receives lymph from right half of head, neck,
thorax and right upper limb
 Thoracic duct
 Begins in front of L1 as a dilated
sac, the cisterna chyli , 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
vein
Thoracic duct
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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
bronchomediastinal
trunks
 Thoracic duct
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Drains lymph from lower
limbs, pelvic cavity,
abdominal cavity, left side
of thorax, and left side of the
head, neck and left upper
limb
三、淋巴结 lymphatic node
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形态：呈椭圆形或圆形，全身约400~450个
分群：根据位置可分为：
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浅淋巴结 superficial lymphatic nodes
深淋巴结 profundal lymphatic nodes
局部淋巴结 regional lymphatic node：
指引流某一器官或部位淋巴的第一级淋巴结，
临床上又称为哨位淋巴结。
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全身各部的淋巴结
1.头颈部淋巴结
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头部淋巴结
颈部淋巴结
颈前淋巴结
 颈外侧淋巴结
颈外侧浅淋巴结
颈外侧深淋巴结
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颈内静脉二腹肌淋巴结
（角淋巴结）
颈内静脉肩胛舌骨肌淋巴结
锁骨上淋巴结
斜角肌淋巴结
（Virchow淋巴结）
The lymphatic drainage of head
Lymph nodes of head
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Located at junction of head and neck
Consist of
 Occipital lymph nodes
 Mastoid lymph nodes
 Parotid lymph nodes
★ Submandibular lymph nodes
lies near the submandibular
gland, receive lymphatic vessels
from the face, nose and mouth
 submental lymph nodes
Drain into deep cervical lymph
nodes
Lymph nodes of the neck
Anterior cervical ln.
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Superficial anterior cervical lymph
nodes
Deep anterior cervical lymph
nodes
Lateral cervical ln. ★
Superficial lateral cervical ln. －
lie along the external jugular vein
★ Deep lateral cervical ln. －extend
along the internal jugular vein
Lymph nodes of the neck
★ Deep lateral cervical ln.
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Extend along the internal jugular vein from the
base of skull to the root of neck
Divided into superior deep lateral cervical ln. and
inferior deep lateral cervical ln.
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
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Left jugular trunk joins the thoracic duct
Right jugular trunk joins the right lymphatic
duct
Lymph nodes of the neck
Superior deep lateral cervical ln.
Jugulodigastric ln.
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Lies at the junction of posterior belly of
digastric and internal jugular vein
Drain the nasopharynx, palatine tonsil
and root of tongue
Inferior deep lateral cervical ln.
Juguloomohyoid ln.
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Lies at the junction of the intermediate
tendon of omohyoid and internal jugular
vein
Drain the apex of tongue
Lymph nodes of the neck
Inferior deep lateral
cervical ln.
Supraclavicular lymph nodes
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Lie along transverse cervical a.
& v.
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palpable in the supraclavicular
fossa. The most notable
supraclavicular lymph node is
Virchow's node. which can
contain metastasis of visceral
(abdominal) tumor.
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Retropharyngeal ln.
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Lying vertically behind the
pharynx
drain nasopharyngeal lymph
2.上肢的淋巴结
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肘淋巴结
腋淋巴结
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胸肌淋巴结
外侧淋巴结
肩胛下淋巴结
中央淋巴结
尖淋巴结
Lymph nodes of upper limb
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Cubital lymph node
lies above medial epicondyle of humerus
Receive lymph vessels from forearm
Axillary lymph node
arranged in five groups
Axillary lymph nodes
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Axillary lymph nodes vary
in size from a pin-head to a
large bean.
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They are arranged in five
groups.
Axillary lymph nodes
Pectoral lymph nodes
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Lying along the lower
border of pectoralis minor
behind the pectoralis major
Receive lymph vessels
from the lateral quadrants
of the breast and
superficial vessels from the
anterolateral abdominal
wall above the level of the
umbilicus
Axillary lymph nodes
Lateral lymph nodes
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Along medial side distal
part of axillary vein
Receives lymph from upper
limb
Axillary lymph nodes
Subscapular lymph
node
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Lying along subscapular
vessels, in front of the
subscapularis
Receive superficial lymph
vessels from the back,
down as far as the level of
the iliac crests
Efferents of above three
groups pass to central
lymph node
Axillary lymph nodes
Central lymph node
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Lying in the center of the
axilla in the axillary fat
Receive lymph from the
above three nodes
Efferents pass to apical
lymph node
Axillary lymph nodes
Apical lymph node
infraclavicular lymph
nodes
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Lying at the apex of the
axilla at the lateral border
of the fist rib
Receive lymph of the
efferent lymph vessels from
all the other axillary nodes
The efferents of the apical
nodes form the subclavian
trunk
Axillary lymph nodes
Efferents form subclavian trunk,
the right subclavian trunk joins
the right lymphatic duct; left
Apical ln.
usually drains directly into
thoracic duct
Subclavian trunk
Central ln.
Pectoral ln.
Lateral ln.
Subscapular ln.
Lymphatic drainage of thorax
The lymphatic drainage of
thoracic wall
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To axillary lymph nodes
To parasternal lymph nodes (along
internal thoracic vessels)
To intercostals lymph nodes from
deeper structures
3.胸部淋巴结
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胸壁淋巴结
纵隔前淋巴结
纵隔后淋巴结
气管、支气管
和肺淋巴结
lymph nodes of the thorax
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Pulmonary ln. lie in the angles of
bifurcation of branching lobar bronchi
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Bronchopulmonary hilar ln. －
lie in the hilums of the lung
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Tracheobronchial ln. －situated
above or below the bifurcation of
trachea
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Paratracheal ln. －along each side
of the trachea
lymph nodes of the thorax
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Anterior mediastinal lymph
node
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Lies anterior to the large blood vessels
of thoracic cavity and pericardium
The efferents unite with those of
paratracheal lymph nodes and
parasternal lymph nodes to form the
right and left bronchomediastinal
trunks
The left bronchomediastinal trunk
terminates in thoracic duct, and right in
the right lymphtic duct
Posterior mediastinal lymph
nodes lie along the esophagus and
thoracic aorta
Lymph nodes of lower limb
Popliteal ln.
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Embedded in the fatty connective
tissue of popliteal fossa
Receive superficial lymphatic
vessels from posterolateral part of
calf, and from deep lymphatic
vessels accompanying anterior and
posterior tibia a.
Efferents pass to the deep inguinal
ln.
Lymph nodes of lower limb
Superficial inguinal lymph nodes
Superior group:
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Lies just distal to the inguinal ligament
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Receive lymph vessels from anterior
abdominal wall below umbilicus, gluteal
region, perineal region, external genital
organs
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Inferior group:
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Lies vertical along the terminal great
saphenous v.
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Receives all superficial lymph vessels of
lower limb, except for those from the
posterolateral part of calf
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Efferent vessels drain into the deep inguinal
ln. or external iliac ln.
Lymph nodes of lower limb
Deep inguinal lymph nodes
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Lie medial to the femoral v.
Receive deep lymph vessels of
lower limb, perineal region, and
efferent vessels from the
superficial inguinal ln.
Drain into the external iliac ln.
Lymph nodes of pelvis
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Internal iliac lymph node
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Surround internal iliac vessels
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Receive afferents from pelvic viscera,
perineum, buttock and back of thigh
External iliac lymph nodes
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Lie along external iliac artery
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Receive afferents from lower limb and
some parts of pelvic viscera
Sacral lymph node
locate along middle sacral a. and lateral sacral a.
Receive lymph from posterior pelvic
wall ,rectum,prostate or uterus
Common iliac lymph node
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Lie along common iliac artery
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Receive afferents from all the above nodes
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Efferent pass to lumbar lymph node
Lymph nodes of abdomen
Lymphatic drainage of abdominal
wall
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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 abdomen
Lymph nodes of abdomen
Lymphatic drainage of
abdominal viscera
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Lumbar lymph nodes
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Lie on posterior abdominal
wall, along the abdominal
aorta and inferior vena cava
Receive lymph from kidneys,
suprarenal glands, testes,
ovaries, fundus of uterus,
uterine tubes, and common
iliac nodes
Right and left lumbar trunks
formed by efferent vessel
Paired viscera－drain to the
lumbar lymph nodes
Lymph nodes of abdomen
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Right and left gastric ln. lie
along the same vessels and finally
to the celiac ln.
Right and left gastroomental ln.
lie along the same vessels, the
former drain into subpyloric ln.,
the latter drain into splenic ln.
Suprapyloric and subpyloric ln.
receive lymphatics from pyloric
part and finally to the celiac ln.
Splenic ln. receive lymphatics
from fundus and left third of
stomach, and finally to the celiac
ln.
Celiac lymph nodes
－situated around the
celiac trunk
Lymph nodes of abdomen
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Superior mesenteric
lymph node －situated
around superior
mesenteric a.
Inferior mesenteric
lymph node －situated
around inferior
mesenteric a.
Intestinal trunk －
formed by efferent
vessel of celiac,
superior and inferior
lymph nodes
四、脾和胸腺
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脾spleen
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形态
位置
功能
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Shape
Spleen
The largest single mass of
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lymphoid tissue in the body
Reddish in color
Location:
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lies in the left hypochondriac
region (between stomach and
diaphragm) deep to the 9th to
11th rib
its long axis corresponds roughly
to the 10th rib
Its lower pole extends forward
only as far as the midline and
cannot be palpated on clinical
examination
Spleen
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Two surfaces
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Two extremities
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Diaphragmatic: smooth, convex
Visceral: concave, hilum of spleen
Anterior－wider
Posterior－rounder
Two border
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Superior－has 2-3 splenic notch, which
serve as a landmark on palpation when
it is enlarge; normally it is not palpable
Inferior－rounder
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胸腺 thymus
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形态
位置
功能
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Thymus
The thymus is partly in the neck
and partly in the thorax. It
comprises one to three lobes,
each of which consists of
numerous lobules containing
lymphocytes, which are important
in the development and
maintenance of the immune
system. The cervical part of the
thymus lies on the anterior and
lateral sides of the trachea,
whereas the thoracic part lies
posterior to the superior portion
of the sternum. The organ has a
profuse blood supply and
lymphatic drainage. The thymus
reaches its greatest size at puberty
and then begins to regress. Much
of its substance is replaced by fat
and fibrous tissue, but thymic
tissue never disappears
completely. Function:to
develop lymph cell
Spleen
 Function
Erythrocyte storage
Phagocytosis
Cytopoiesis
Immune responses