咽部的解剖Anatomy of pharynxWord文档下载推荐.docx
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咽部的解剖Anatomy of pharynxWord文档下载推荐.docx
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会厌epiglottis,勺会厌襞aritenoepiglotticfold,勺区arytenoidarea,假声带falsevocalcord声门区glotticportion:
声带vocalcord声门裂fissureofglottis前联合anteriorcommisure声门下区infraglotticportion:
声门旁区glotticportion:
•3.喉的血管bloodvesseloflarynx喉上动脉superiorlaryngealartery环甲动脉cricothyroidartery喉下动脉inferiorlaryngealartery
•4.淋巴lymphaticsoflarynx
•声门上区supraglotticportion:
淋巴管丰富lymphaticductsareabundant,引流至颈深淋巴结上群drainagetouppergroupofdeepcervicallymphnodes
•声门下区infraglotticportion:
淋巴管不丰富lymphaticductsarenotabundant,引流至颈深淋巴结下群drainagetolowergroupofdeepcervicallymphnodes
•声门区glotticportion:
基本无淋巴管fewlymphaticducts
•5.神经nerves:
迷走神经vagusnerve喉上神经superiorlaryngealnerve内支innerbeanches外支outerbranches支配环甲肌cricothyroidmuscle喉返神经recurrentlaryngealnerve除环甲肌以外喉肌laryngealmusclesexceptforcricothyroidmuscle
喉的生理physiologyoflarynx
•1.呼吸respiration
•2.发音phonation
•3.保护protection
•4.屏气holdingbreath
急性化脓性扁桃体炎Acutesuppurativetonsillitis
•1.病因etiology
•外部因素externalfactors:
溶血性链球菌hemolyticstreptococcus,其它细菌othersbacteria,腺病毒adenoidvirus
•内因internalfactors:
抵抗力下降resistencedecreasing
•2.流行病epidemiology:
传染性infectivity
•3.临床表现clinicalmanifestationa.急性卡他性扁桃体炎acutecatarraltonsillitisb.急性化脓性扁桃体炎acutesuppurativetonsillitis
•4.诊断和鉴别诊断Diagnosisanddifferencialdiagnsis
•a.诊断diagnosis:
症状和体症symptomsandsigns
•b.鉴别诊断differencialdiagnsis:
咽白喉diphteriafauci,奋森氏咽峡炎Vicentangina(ulceromembranousangina),粒细胞减少性咽峡炎hypoleukocyticangina,猩红热scarletfever
•5.并发症Complication:
a.局部并发症localcomplication:
扁桃体周围脓肿peritonsillarabscessb.全身并发症generalcomplication:
风湿热rheumaticfever,急性关节炎acutearthritis,心肌炎cardiomyosis,急性肾炎acutenephritis
•6.预防prevention
•7.治疗treatment
•慢性扁桃体炎Chronictonsillitis
•1.病因etiology
•2.病理pathology
•3.症状symptoms
•4.检查examination
•5.并发症complication:
thesameasacutetonsillitis
•6.诊断diagnosis
腺样体肥大adenoidvegetation
•1.临床表现clinicalmanifestation
•a.局部症状localsymptoms:
1.耳ear2.鼻nose3.咽喉和下呼吸道pharynxlarynxandlowerrespiratorytract4.腺样体面容Adenoidexpression
•b.全身症状generalsymptoms
•2.检查examination:
1.腺样体面容adenoidexpression2.口咽检查oropharygealexamination3.前鼻镜检查anteriornasoscope4.纤维鼻咽镜Nasopharygo-fibroscope5.触诊palpation6.X-ray
•3.治疗treatment
鼻咽癌Nasopharyngealcarcinoma
•1.病因etiology:
a:
遗传因素geneticfactorsb.病毒因素virusfactorsc.环境因素environmentalfactors
•2.临床表现clinicalmanifestation
•早期症状earlysymptoms:
•1.出血bleeding
•2.鼻堵塞nose:
obstruction
•3.耳部症状earsymptoms
•4.颈淋巴结肿大enlargementofcervicallymphnodes
•晚期症状latesymptoms:
•
(1).头痛headache
•
(2).颅神经症状Symptomsofcranialnerve
•3.检查Examination
(1)鼻咽镜nasopharyngeal-scope
(2)CT(3)X-ray
•4.诊断diagnosisa.活检biopsyb.细胞涂片slidingofcellsc.EB病毒抗体antibodyofEBvirusd.误诊率高misseddiagnosisishighe.鉴别诊断
•5.治疗treatment
(1)放疗radiation:
importantmethod
(2)化疗chemotherapy(3)手术surgery
喉癌Laryngealcarcinoma
•1.病因etiologya.吸烟smokingb.饮酒drinkingc.空气污染airpollutiond.病毒感染virusinfectione.癌前病变precancerouslesionsf.激素hormone
•2.病理pathology
(1)鳞癌占90%squamouscellcarcinoma:
90%
(2)分型types:
3型3types声门上癌supraglotticcarcinoma声门癌glotticcarcinoma声门下癌infraglotticcarcinoma(3)原位癌carcinomainsitu(4)继发癌secondarycarcinoma
•3.临床表现clinicalmanifestation
•
(1)音哑hoarseness
•
(2)喉痛sorethroat
•(3)异物感sensationofforeignbody
•(4)呼吸困难dyspnea
•(5)吞咽困难dysphagia
•(6)血痰bloodspitting
•声门上癌supraglotticcarcinoma:
early:
异物感sensationofforeignbody,喉痛sorethroat,吞咽困难dysphagia,血痰bloodspitting
•声门癌glotticcarcinoma:
音哑hoarseness,呼吸困难dyspnea
•声门下癌infraglotticcarcinoma:
早期无症状,咳嗽,血痰earlynosymptoms,cough,bloodspitting晚期呼吸困难,侵犯环甲膜,甲状腺late:
dyspnea,invasionofcricothyroidmembrane,thyroidgland
•4.扩散和转移spreadandmetastasis:
3types
(1)直接扩散directspreading
(2)淋巴转移lymphaticmetastasis(3)血行转移bloodmetastasis
•5.检查examination
(1)体格检查physicalexamination:
喉体膨大,会厌前间隙饱满enlargementoflarynx,fullnessofpre-epiglotticspace
(2)间接喉镜,纤维喉镜,喉动态镜indirectlaryngoscope,fibro-laryngoscope,laryngostroboscopy
•6.诊断diagnosis
(1)病史:
40岁以上,音哑4周以上history:
above40yearsold,hoarseness,above4weeks
(2)活检biopsy(3)X-ray,CT
•鉴别诊断differentialdiagnosis
(1)喉结核laryngealtuberculosis
(2)喉梅毒laryngealsyphilis(3)喉乳头状瘤laryngealpapilloma
•7.治疗treatment
(1)放疗radiation:
a.1期病变stage1lesionb.不适合手术notsuitabletooperation
(2)手术surgury:
全喉切除术totallaryngectomy,喉部分切除术partiallaryngectomy,颈廓清neckresection(3)激光laser:
KTP
喉阻塞Laryngealobstruction
•1.病因etiologya.感染Infectionb.外伤injuryc.异物foreignbodyd.水肿edemae.肿瘤tumorsf.畸形deformityg.声带麻痹vocalcordparalysis
临床表现Clinicalmanifestation
•a.吸气期呼吸困难inspiratorydyspnea
•b.吸气期喉鸣inspirarorylaryngealstridor
•c.吸气期软组织凹陷inspiratoryrecessofsofttissue
•d.音哑hoarseness
•f.紫绀cyanosis
检查examination:
4度
•1度.平静时无症状,运动和哭闹时轻度症状rest:
nosymptoms,motionandcrying:
mildsymptoms
•2度.平静时轻度症状,运动和哭闹时加重rest:
mildsymptoms,motion:
agggravating
•3度.严重吸气期呼吸困难severeinspirarorydyspnea
•4度.极度吸气期呼吸困难moresevereinspiratorydyspnea
诊断和鉴别诊断diagnosisanddifferentialdiagnosis
•
(1)病史,症状,体征history,symptoms,signs
•
(2)根据程度决定是否取材去除病因accordingtothedegree,reasonsshouldbedetectedornot
•鉴别诊断differentialdiagnosis
治疗treatment
•10.保守治疗conservativetreatment
•40.立即气管切开或环甲膜切开immediatetracheostomyorintercricothyrotomy
•20-30.根据条件和病因accordingtotheconditionsandetiologya.炎症inflammation:
先保守,不好转气管切开conservation,tracheostomy
b.异物,手术foreignbody:
operation
咽后脓肿:
切开,引流retropharyngealabscess:
incisionanddrainage
c.肿瘤,双侧喉返神经麻痹,喉外伤不能立即去除病因,应气管切开tumor,bilateralrecurrentnerveparalysis,,injuryoflarynx,cannotberesolvedimmediatelytracheotomy
气管切开术Tracheotomy
•anatomy解剖1.气管trachea2.软组织softtissue3.血管bloodvessel4.甲状腺峡部isthmusofthyroidgland
适应症indication
•1.喉阻塞laryngealobstruction
•2.下呼吸道阻塞和肺水肿Obstructionoflowerrespiratorytractandischeotomy
•3.预防性气管切开preventivetracheotomy
步骤procedures
•1.体位posture
•2.消毒disinfection
•3.麻醉anesthesia
•4.切口incision
•5.分离软组织separationofsofttissue
•6.暴露气管exposingoftrachea
•7.气管切开tracheotomy
•8.插入套管insertionofcannula
•9.缝合和固定sutureandfixation
术后护理postoperativenursing
•1.保持内套管通畅keepinnercannulaunobstructed
•2.保持下呼吸道通畅keeplowerrespiratorytractunobstructed
•3.切口消毒antiseptionofincision
•4.预防脱管preventseperationofcannula
•5.拔管decannulation:
堵管48小时后48hourslaterafterobstruction
并发症Complication
•1.皮下气肿subcutaneousemphysema
•2.纵隔气肿mediastinalemphysema
•3.气胸pneumatothorax
•4.出血bleeding
•5.拔管困难Difficultyindecannulation
环甲膜切开Intercricothyrotomy
耳部EAR
•解剖anatomy
•外耳theexternalear
(1)耳廓auricle
(2)外耳道externalacousticmeatus外耳道软骨部externalcartilaginousmeatus外耳道骨部externalbonymeatus外耳的血液和神经bloodandnervesupplyoftheexternalear
中耳middleear
•鼓室tympaniccavity上,中,下鼓室epitympanummesotypanumhypotympanum
•6个壁6walls
外壁outerwall
•由鼓膜和上鼓室骨部外侧形成formedchieflybythetympanicmembraneandtheouterbonywalloftheepitympanum
•鼓膜分为紧张部和松弛部tympanicmembrane:
parstensaandparsflaccida
•鼓膜由三层组织构成tympanicmembraneconsistsofthreelayers外层为上皮层anouterepithelium中间为弹力组织amiddleelastictissue内层为粘膜层aninnermucousmembrane
•标志marksofthedrumoftheear脐部umbo,锤骨短突shortprocessofmalleus,锤前皱襞anteriormelleolarfold,锤后皱襞posteriormalleolarfold,光锥coneoflight,锤骨柄handleofmalleus
•内壁innerwall鼓岬promontory,前庭窗vestibularwindow(ovalwindows),蜗窗cochlearwindow(roundwindow),水平半规管horizontalsemicircularcanal
•前壁anteriorwall咽鼓管开口openingoftheEustachianTube鼓膜张肌canalofthetensortympanimuscle
•后壁posteriorwall
•上壁upperwall鼓室盖tegmentympani
•下壁lowerwall
•中耳含3块听小骨middleearcontainsthreeossicles锤骨malleus,砧骨incus,镫骨stapes
•中耳肌肉包括鼓膜张肌和镫骨肌muscleofthemiddleear:
thetensortympanicmuscle,stapediusmuscles
•中耳的血液和神经支配bloodandnervesupplyofthemiddleearbloodsupply鼓室丛tympanicplexus,鼓索神经chordatympanicnerve
•咽鼓管pharyngotympanictube
•鼓窦typanicantrum
•乳突mastoidprocess:
气化型pneumatictype板障型diploetictype硬化型sclerotictype混合型mixedtype
内耳theinnerear
•迷路innerear(labyrinth)骨迷路osseouslabyrinth膜迷路membranouslabyrinth:
内淋巴endolymph外淋巴perilymph
•骨迷路osseouslabyrinth:
前庭vestibule,骨半规管osseoussemicircularcanals,蜗管cochlea
•膜迷路membranouslabyrinth:
椭圆囊utricle,球囊saccule,膜半规管membranoussemicircularca
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