乳腺解剖实用.pptx

《乳腺解剖实用.pptx》由会员分享，可在线阅读，更多相关《乳腺解剖实用.pptx（23页珍藏版）》请在淘文阁 - 分享文档赚钱的网站上搜索。

1、乳腺解剖实用乳腺解剖实用The portion of the breast that extends toward or into the underarm The portion of the breast that extends toward or into the underarm or axilla is referred to as the or axilla is referred to as the axillary tailaxillary tail of the breast or the of the breast or the tail of tail of Spenc

2、eSpence.乳房延伸至腋下部分称为腋尾。乳房延伸至腋下部分称为腋尾。Axillary tail(Tail of Spence)第1页/共22页有一层结缔组织称为乳腺浅筋有一层结缔组织称为乳腺浅筋膜膜,它覆盖乳腺实体组织它覆盖乳腺实体组织.乳乳房位于胸腔前表面房位于胸腔前表面,被下面的被下面的肋骨和肌肉支撑肋骨和肌肉支撑.在乳腺的下在乳腺的下方是胸小肌方是胸小肌.胸小肌是较小胸小肌是较小,位置较深的肌肉位置较深的肌肉.在乳房的旁在乳房的旁侧和后侧的较宽的胸大肌侧和后侧的较宽的胸大肌.A layer of connective tissue called A layer of connecti

3、ve tissue called the the superficial fasciasuperficial fascia of the breast of the breast surrounds the surrounds the parenchymaparenchyma of the of the breast.The breast lies on the breast.The breast lies on the anterior surface of the thoracic anterior surface of the thoracic cage supported by the

4、 underlying cage supported by the underlying ribs and muscles.Immediately ribs and muscles.Immediately deep to the breast are the deep to the breast are the pectoralispectoralis muscles.The muscles.The pectoralis pectoralis minorminor is a smaller more deeply is a smaller more deeply situated muscle

5、.The situated muscle.The pectoralis pectoralis majormajor muscle is a broad muscle muscle is a broad muscle that lies adjacent and immediately that lies adjacent and immediately posterior to the breast.posterior to the breast.胸大肌背阔肌锯前肌指状突起腹外斜肌第2页/共22页The pectoralis major and minor The pectoralis maj

6、or and minor muscles are both surrounded by a muscles are both surrounded by a layer of fascia referred to as layer of fascia referred to as deep deep fasciafascia.The superficial layer of the.The superficial layer of the deep fascia of the pectoralis major deep fascia of the pectoralis major muscle

7、 is in contact with the deep muscle is in contact with the deep layer of the superficial fascia that layer of the superficial fascia that surrounds the breast.These two surrounds the breast.These two surfaces normally glide over one surfaces normally glide over one another allowing a womans breast a

8、nother allowing a womans breast to move.If anything were to occur to move.If anything were to occur that prevented this type of normal that prevented this type of normal motion the breast becomes motion the breast becomes immobile and is referred to as immobile and is referred to as“fixedfixed”.Spec

9、ifically,this situation”.Specifically,this situation may occur if a cancer grows from may occur if a cancer grows from the breast into these layers.the breast into these layers.胸大肌和胸小肌被深筋膜包裹。胸大肌和胸小肌被深筋膜包裹。胸大肌深筋膜的表面接触到包裹胸大肌深筋膜的表面接触到包裹乳腺的浅筋膜的深层。乳腺的浅筋膜的深层。Pectoralis major fascia胸大肌筋膜Pectoralis majorMus

10、cle胸大肌Superficial fascia(deep layer)深层浅筋膜Superficial fascia(superficial layer)表层浅筋膜Retromammary space乳后间隙第3页/共22页The arterial blood supply to the The arterial blood supply to the breast originates from breast originates from branches of the branches of the axillary,axillary,internal thoracicinternal

11、 thoracic and and subclavian arteriessubclavian arteries.The.The venous drainage of the breast venous drainage of the breast empties into branches of the empties into branches of the internal thoracicinternal thoracic,axillaryaxillary and and intercostal veinsintercostal veins.乳腺血供来自腋窝、胸内和锁乳腺血供来自腋窝、

12、胸内和锁骨下动脉。静脉引流自胸内、骨下动脉。静脉引流自胸内、腋窝和肋间静脉。腋窝和肋间静脉。锁骨下动静脉腋静脉腋动脉胸内动静脉分支第4页/共22页LymphLymph is a fluid that filters between the cells is a fluid that filters between the cells of tissue and then drains into its own set of of tissue and then drains into its own set of transport channels.Lymph fluid may carry

13、 transport channels.Lymph fluid may carry infectious organisms,toxins or cancerous infectious organisms,toxins or cancerous cells.The channels that carry the lymph cells.The channels that carry the lymph fluid are referred to as fluid are referred to as lymphaticslymphatics.These.These lymphatics us

14、ually travel near or with the lymphatics usually travel near or with the vascular supply of a tissue.Small vascular supply of a tissue.Small lymphatics drain into larger lymphatics and lymphatics drain into larger lymphatics and eventually all the lymphatic fluid empties eventually all the lymphatic

15、 fluid empties into one of the large veins in the thoracic into one of the large veins in the thoracic cavity.Along the course of these lymphatic cavity.Along the course of these lymphatic channels are soft tissue structures called channels are soft tissue structures called lymph glandslymph glands

16、or or nodesnodes.The lymph glands.The lymph glands act as filters to remove harmful substances act as filters to remove harmful substances from the lymph fluid.from the lymph fluid.淋巴是在组织间进行过滤的液体淋巴是在组织间进行过滤的液体,它流入自它流入自己的输送渠道己的输送渠道.淋巴液载送感染性有机物淋巴液载送感染性有机物,毒素和癌细胞毒素和癌细胞.载送淋巴液的渠道称为淋巴载送淋巴液的渠道称为淋巴管。管。这些淋巴管

17、通常在组织周围流动并且将这些淋巴管通常在组织周围流动并且将组织维管联结。组织维管联结。小的淋巴管流入大的淋巴管，小的淋巴管流入大的淋巴管，并且最终所有的淋巴液流入胸腔的某个大血并且最终所有的淋巴液流入胸腔的某个大血管。管。在这些淋巴管道的路程中有一些软组织在这些淋巴管道的路程中有一些软组织称为淋巴腺或淋巴结。称为淋巴腺或淋巴结。这些淋巴结象过滤这些淋巴结象过滤器一样过滤淋巴液中的有害物质。器一样过滤淋巴液中的有害物质。Lymph nodesLymphatics第5页/共22页The majority of the lymphatic fluid The majority of the lymp

18、hatic fluid from a breast drains to the from a breast drains to the ipsilateral axillaipsilateral axilla.The axilla is rich.The axilla is rich in both lymphatic channels and in both lymphatic channels and lymph nodes.A small portion of lymph nodes.A small portion of the lymphatic drainage from the t

19、he lymphatic drainage from the inferomedial breast parenchyma inferomedial breast parenchyma will drain to the lymphatic system will drain to the lymphatic system associated with the associated with the internal internal thoracic vesselsthoracic vessels.乳腺的大部分淋巴液流入腋窝淋巴。乳腺的大部分淋巴液流入腋窝淋巴。腋窝富含淋巴管和淋巴结。小部

20、分腋窝富含淋巴管和淋巴结。小部分乳腺内下侧淋巴液引流入胸内脉管乳腺内下侧淋巴液引流入胸内脉管的淋巴系统。的淋巴系统。Parasternal(internal thoracic)nodesSubclavian(apical axillary)nodesInterpectoral(Rotters)nodesCentral axillarynodesBrachial(lateral axillary)nodesSubscapular(posterior axillary)nodesPectoral(anterior axillary)nodes第6页/共22页For convention the a

21、xillary lymph nodes are divided into three For convention the axillary lymph nodes are divided into three groups:groups:1.Pectoral or level 1(inferior to pectoralis minor attachment)第一站淋巴结（胸小肌下）2.Central or level 2(posterior to pectoralis minor attachment)第二站淋巴结（胸小肌后）3.Apical or level 3(superior to

22、pectoralis minor attachment)第三站淋巴结（胸小肌上）第7页/共22页It is believed that the majority of the It is believed that the majority of the lymph drainage from the breast toward lymph drainage from the breast toward the axilla travels to the level 1 axillary the axilla travels to the level 1 axillary nodes then

23、 to the level 2 axillary nodes nodes then to the level 2 axillary nodes and then to the level 3 axillary nodes.and then to the level 3 axillary nodes.普遍认为大部分的乳腺的腋窝淋巴引流普遍认为大部分的乳腺的腋窝淋巴引流都是从第一站到第二站到第三站。都是从第一站到第二站到第三站。第8页/共22页The glands of the breast are arranged into collections called The glands of th

24、e breast are arranged into collections called lobuleslobules.The secretions of the glands of each lobule drain into a.The secretions of the glands of each lobule drain into a tube called a tube called a lobular ductlobular duct.乳房的腺体结合成小叶乳房的腺体结合成小叶.小叶腺体的分泌物流入小叶管小叶腺体的分泌物流入小叶管LobuleLobular duct第9页/共22

25、页Many lobules together form a Many lobules together form a lobelobe of the of the breast.The duct that carries the secretions breast.The duct that carries the secretions from all the lobules in a lobe is referred to as from all the lobules in a lobe is referred to as a a lobar ductlobar duct.许多个小叶汇聚

26、成乳叶许多个小叶汇聚成乳叶.小叶分泌物汇聚流小叶分泌物汇聚流入乳管入乳管.Lobar ductLactiferous sinus(ampulla)Lobe第10页/共22页A breast contains 15-18 lobes and therefore 15-18 lobar ducts.The lobar A breast contains 15-18 lobes and therefore 15-18 lobar ducts.The lobar ducts are also referred to as ducts are also referred to as lactiferou

27、s ductslactiferous ducts.Each lactiferous duct has.Each lactiferous duct has an opening on the surface of the nipple.There is a dilated region in each an opening on the surface of the nipple.There is a dilated region in each lactiferous duct just deep to the surface of the nipple.This dilated area i

28、s lactiferous duct just deep to the surface of the nipple.This dilated area is referred to as the ampulla.referred to as the ampulla.一个乳房有一个乳房有15-1815-18个乳叶和个乳叶和15-1815-18个乳管个乳管.乳管也称为乳汁输送管乳管也称为乳汁输送管.每个乳汁输送管在其乳头处有一个开口每个乳汁输送管在其乳头处有一个开口.在乳头深处在乳头深处,每个乳汁输每个乳汁输送管都有一个膨胀部位送管都有一个膨胀部位,称为壶腹称为壶腹.Lobular ductLob

29、ar duct(Lactiferous duct)LobuleAmpullaNipple第11页/共22页Over time,due to factors scientist poorly understand,the cells in the Over time,due to factors scientist poorly understand,the cells in the breast lobules and ducts may undergo changes.Some of these changes breast lobules and ducts may undergo cha

30、nges.Some of these changes increase a womans risk of developing breast cancer while other changes increase a womans risk of developing breast cancer while other changes are cancerous.To understand these changes lets look at a duct in cross are cancerous.To understand these changes lets look at a duc

31、t in cross section.This view is what it would be seen if a piece of breast tissue were section.This view is what it would be seen if a piece of breast tissue were removed from the breast and then examined under a microscope.removed from the breast and then examined under a microscope.随着时间推移随着时间推移,由于

32、某些无法解释的原因由于某些无法解释的原因,乳腺小叶和乳管会发生变化乳腺小叶和乳管会发生变化.有些变化会增加妇女罹患乳腺癌的风险有些变化会增加妇女罹患乳腺癌的风险.而有些变化本身就是癌变而有些变化本身就是癌变.要了要了解这些变化解这些变化,让我们来看一看乳腺的横截面让我们来看一看乳腺的横截面.第12页/共22页 In a normal duct the cells lining the duct will be one or two layers thick.These cells will In a normal duct the cells lining the duct will be o

33、ne or two layers thick.These cells will have similar size and shape.have similar size and shape.正常的乳管有正常的乳管有1 12 2层细胞。这些细胞有相似的大小和形状层细胞。这些细胞有相似的大小和形状第13页/共22页In some women,extra cells will grow in the duct.The latin term for excess is In some women,extra cells will grow in the duct.The latin term for

34、 excess is hyperhyper and the and the term for growth is term for growth is plasiaplasia,so a condition with excess growth is referred to as ,so a condition with excess growth is referred to as hyperplasiahyperplasia.In In this case the specific term would be this case the specific term would be duc

35、tal hyperplasiaductal hyperplasia This condition confers no increase risk This condition confers no increase risk for developing breast cancer.for developing breast cancer.有些妇女，乳管内生长了额外的细胞。这称为增生，乳管内增生。有些妇女，乳管内生长了额外的细胞。这称为增生，乳管内增生。乳管内增生第14页/共22页Sometimes the excess growth within the duct includes som

36、e very Sometimes the excess growth within the duct includes some very abnormal or abnormal or atypicalatypical cells.This condition is referred cells.This condition is referred atypical ductal atypical ductal hyperplasiahyperplasia or or ADHADH.The presence of this condition in a womans breast.The p

37、resence of this condition in a womans breast increases her risk of developing a breast cancer in her lifetime.increases her risk of developing a breast cancer in her lifetime.Individually,these atypical cells may resemble cancer cells.The more Individually,these atypical cells may resemble cancer ce

38、lls.The more abnormal and atypical an individual cell the more it resembles a cancer abnormal and atypical an individual cell the more it resembles a cancer cell.cell.有时，额外的细胞包括不正常或不典型的细胞。这些细胞增加了妇女得乳有时，额外的细胞包括不正常或不典型的细胞。这些细胞增加了妇女得乳腺癌的风险。单个来说，这些不典型细胞类似癌细胞。腺癌的风险。单个来说，这些不典型细胞类似癌细胞。不典型增生第15页/共22页If ther

39、e are many atypical cells the entire duct may be filled with these abnormal,atypical cells.This If there are many atypical cells the entire duct may be filled with these abnormal,atypical cells.This condition is actually an early breast cancer.It is referred to as condition is actually an early brea

40、st cancer.It is referred to as ductal carcinoma in situductal carcinoma in situ or or DCISDCIS.Theoretically,the cancer cells are only located within the duct and have not spread out of the affected Theoretically,the cancer cells are only located within the duct and have not spread out of the affect

41、ed duct.Some physicians refer to this condition as a“pre-cancer”.This is incorrect,this is indeed a localized duct.Some physicians refer to this condition as a“pre-cancer”.This is incorrect,this is indeed a localized breast cancer.breast cancer.如果乳管内有许多不典型细胞，直至整个乳管都充满了不正常不典型的细胞。这其实是早期的乳如果乳管内有许多不典型细胞

42、，直至整个乳管都充满了不正常不典型的细胞。这其实是早期的乳腺癌。称为乳管内原位癌。腺癌。称为乳管内原位癌。乳管内原位癌 DCIS第16页/共22页If DCIS is not treated the cancer cells will eventually break out of the duct and invade the If DCIS is not treated the cancer cells will eventually break out of the duct and invade the breast tissue.This is referred to as brea

43、st tissue.This is referred to as invasive ductal carcinomainvasive ductal carcinoma.如果原位癌没有得到治疗，癌细胞会最终突破乳管，侵犯乳腺组织。称为浸润性乳管癌。如果原位癌没有得到治疗，癌细胞会最终突破乳管，侵犯乳腺组织。称为浸润性乳管癌。浸润性乳管癌第17页/共22页If If excessexcess growth occurs in the lobules the condition is referred to as growth occurs in the lobules the condition

44、is referred to as lobular hyperplasialobular hyperplasia.Atypical lobular Atypical lobular hyperplasiahyperplasia may also develop.If Atypical lobular hyperplasia progresses in severity a condition referred may also develop.If Atypical lobular hyperplasia progresses in severity a condition referred

45、to as to as lobular carcinoma in situlobular carcinoma in situ or or LCISLCIS may develop.This condition is very different from DCIS.may develop.This condition is very different from DCIS.也会发生小叶增生以及不典型小叶增生。小叶增生发展到严重程度也会发生小叶增生以及不典型小叶增生。小叶增生发展到严重程度称为小叶内原位癌。称为小叶内原位癌。Lobular hyperplasiaAtypical lobular

46、hyperplasia第18页/共22页BIRADS*BIRADS*乳腺影像报告数据系统乳腺影像报告数据系统乳腺影像报告数据系统乳腺影像报告数据系统(Breast Imaging Reporting Data System)Breast Imaging Reporting Data System)Standard descriptors to identify findings Standard descriptors to identify findings ofof辨别影像发现的标准描述辨别影像发现的标准描述辨别影像发现的标准描述辨别影像发现的标准描述Masses Masses 肿块肿块肿

47、块肿块CalcificationsCalcifications钙化钙化钙化钙化Abnormalities Abnormalities 不正常影像发现不正常影像发现不正常影像发现不正常影像发现Impression and assessmentImpression and assessment印象和评估印象和评估印象和评估印象和评估Categories:0-5Categories:0-5第19页/共22页012345评估不足评估不足 阴性阴性良性良性可能良性可能良性怀疑恶性怀疑恶性高度怀疑恶性高度怀疑恶性更多的诊断方法更多的诊断方法常规摄片常规摄片常规摄片常规摄片短期随访短期随访立即活检立即活检采取相应行动采取相应行动CategoryAssessmentRecommendationsBIRADS第20页/共22页乳腺癌的外科治疗乳腺癌的外科治疗Lumpectomy肿块切除术肿块切除术Quadrantectomy象限切除术象限切除术Modified RadicalMastectomy乳房改良根治术乳房改良根治术Radical Mastectomy乳房根治术乳房根治术第21页/共22页感谢您的观看。感谢您的观看。第22页/共22页