7 颈部疾病课件.pptVIP

Neck Disease;颈部疾病;1. Position Deep to sternothyroid and sternohyoid m. Superior terminal is at the level of the midpoint of thyroid cartilage. Inferior terminal is at the level of 6th tracheal ring. Isthmus of the thyroid passes transversely through the anterior to the 2nd-4th tracheal rings.;2. Relations anteriorly— skin, superficial fascia, enveloping fascia, infrahyoid mm. pretracheal fascia, posteromedially- larynx, trachea, pharynx, esophagus and recurrent laryngeal n. posterolaterally—carotid sheath and contents in the sheath;3. Feature right and left lobes isthmus pyramidal lobe 4. Covers Capsule of the thyroid gland (fibrous-capsule,covering the outer surface of the gland ) Thyroid sheath(belonging to pretracheal fascia, suspensory lig. attached to the thyroid cartilage, cricoid cartilage and tracheal cartilage rings) The blood vessels, nn. and parathyroid glands in the space between the covers of the gland;5. Blood vessels 1) arteries (1).superior thyroid a. from external carotid a. (2). inferior thyroid a. from thyrocervical trunk ** lowest thyroid a. 2) veins (1). superior thyroid v. (2). middle thyroid v. (shorter and larger) Above vv. drain the blood into the internal jugular v. (3). inferior thyroid v.drains the blood of inferior poles into the left brachiocephalic v.;Thyroid anatomy-vagus;甲状腺生理概要;病 因 1 摄入碘缺乏：地方性~ 2 甲状腺激素需要量增加：生理性~ 3 甲状腺激素生物合成和分泌障碍 病因分类 1 地方性~endemicity 2 生理性~physiogenic 3 先天性~congenital;发病机理 pathogenesy 1 地方性：缺碘→ T3、T4合成↓→TSH ↑→甲状腺增生、 T3、T4 ↑ 2 3 生理性： T3、T4合成相对↓ →TSH ↑ 4 先天性： T3、T4合成↓ →TSH ↑ ; 病理生理 Pathophysiology 甲状腺增生→ 结节形成→自主功能形成（继发性甲亢）→癌变;诊断 1 病史：高原山区、缺碘 2 甲状腺肿 3 核素显像：大小不等功能不一的结节 4 B超：体积↑、结节（实质、囊性、混合性） 5 X线：胸骨后甲状腺肿，气管受压 6 细针穿刺（FNAC）;预防 去除病因：加碘盐;手术适应证 1 巨大甲状腺肿影响外观及生活 2 出现压迫症状：气管、食管、血管、神经 3 胸骨后甲状腺肿 4 继发甲亢 5 可疑恶变 ;病因分型 1 原发性甲亢：Graves病，突眼性甲状腺肿exophthalmic