The Lymphatic System 淋巴系统 山东大学医学院 解剖教研室 李振华

The Lymphatic System 淋巴系统

The Lymphatic System 淋巴系统 Heart Vein Lymphatic duct Artery Lymphatic trunk Capillaries Lymphatic node Cell Tissue fluid Lymphatic capillary Lymphatic vessel

The Lymphatic System 淋巴系统 Composition Lymphatic vessel 淋巴管 Lymphatic capillary 毛细淋巴管 Lymphatic vessels: 淋巴管 two sets, superficial and deep Lymphatic trunks （nine）: 淋巴干（九条） Lymphatic ducts: thoracic duct 胸导管 right lymphatic duck 右淋巴导管 Lymphatic tissue 淋巴组织 Lymphatic organ 淋巴器官 Lymphatic nodes 淋巴结 Spleen 脾 thymus 胸腺 Tonsil 扁桃体

The Lymphatic System 淋巴系统 Lymphatic capillary 毛细淋巴管 Begin blindly The wall is composed of a single layer of overlapping endothelial cells They are numerous and form complex networks The brain, spinal cord, bone marrow, parenchyma of spleen and eyeball lack lymphatic capillaries

The Lymphatic System 淋巴系统 Lymphatic vessel Have valves that give them a beaded appearance Two sets: superficial (lie in the superficial fascia ) and deep (run with blood vessels and nerves) Passes through at least one lymph node and often several

The Lymphatic System 淋巴系统 Right lymphatic duck Thoracic duct

The Lymphatic System 淋巴系统 lymph node 淋巴结 (Small oval or bean-shaped bodes Afferent vessels enter the node on its convex surface, and afferent vessels leave the node at its concave surface－the hilum Arranged in groups, along the blood vessels Regional nodes

The lymphatic drainage of head Lymph nodes of head Located at junction of head and neck Consist of Occipital lymph nodes 枕淋巴结 Mastoid lymph nodes 乳突淋巴结 Parotid lymph nodes 腮腺淋巴结 ★ Submandibular lymph nodes 下颌下淋巴结 lies near the submandibular gland, receive lymphatic vessels from the face, nose and mouth submental lymph nodes 颏下淋巴结 Drain into deep cervical lymph nodes

Lymph nodes of the neck Anterior cervical ln. 颈前淋巴结 Superficial anterior cervical lymph nodes Deep anterior cervical lymph nodes Lateral cervical ln. 颈外侧淋巴结 ★ Superficial lateral cervical ln. 颈外侧浅淋巴结－lie along the external jugular vein ★ Deep lateral cervical ln. 颈外侧深淋巴结－extend along the internal jugular vein

Lymph nodes of the neck ★ Deep lateral cervical ln. 颈外侧深淋巴结 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 Left jugular trunk joins the thoracic duct Right jugular trunk joints the right lymphatic duct

Lymph nodes of the neck Superior deep lateral cervical ln. 颈外侧上深淋巴结 Jugulodigastric ln. 颈内静脉二腹肌淋巴结 Lies at the junction of posterior belly of digastric and internal jugular vein Drain the nasopharynx, palatine tonsil and root of tougue Inferior deep lateral cervical ln. 颈外侧下深淋巴结 Juguloomohyoid ln. 颈内静脉肩胛舌骨肌淋巴结 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. 颈外侧下深淋巴结 Supraclavicular lymph nodes 锁骨上淋巴结 Lie along transverse cervical a. & v. Retrophrangeal ln. 咽后淋巴结 Lying vertically behind the pharynx

Lymph nodes of upper limb Cubital lymph node 肘淋巴结 lies above medial epicondyle of humerus Infraclavicular nodes 锁骨下淋巴结 Axillary lymph node 腋淋巴结 arranged in five groups

Axillary lymph nodes Axillary lymph nodes vary in size from a pin-head to a large bean. They are arranged in five groups.

Axillary lymph nodes Pectoral lymph nodes 胸肌淋巴结 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 外侧淋巴结 Along medial side distal part axillary vein Receives lymph from upper limb

Axillary lymph nodes Subscapular lymph node 肩胛下淋巴结 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 above three groups pass to central lymph node

Axillary lymph nodes Central lymph node 中央淋巴结 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 尖淋巴结 Lying at the apex of the axilla at the lateral border of the fist rib Receive lymph 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 joints the right lymphatic duct; left usually drains directly into thoracic duct Apical ln. Subclavian trunk Central ln. Pectoral ln. Lateral ln. Subscapular ln.

Lymphatic drainage of thorax The lymphatic drainage of thoracic wall To axillary lymph nodes To parasternal lymph nodes (along internal thoracic vessels) To intercostals lymph nodes from deeper structures

lymph nodes of the thorax Pulmonary ln. 肺淋巴结 lie in the angles of bifurcation of branching lobar bronchi Bronchopulmonary hilar ln. 支气管肺门淋巴结－lie in the hilus of the lung Tracheobronchial ln. 气管支气管淋巴结－situated above or below the bifurcation of trachea Paratracheal ln. 气管旁淋巴结 －along each side of the trachea

lymph nodes of the thorax Anterior mediastinal lymph node 纵隔前淋巴结 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 支气管纵隔干 The left bronchomediastinal trunk terminates in thoracic duct, and right in the right lymphtic duct Posterior mediastinal lymph nodes 纵隔后淋巴结 lie along the esophagus and thoracic aorta

Thoracic duct 胸导管 Begins in front of lower border of T12 as a dilated sac, the cisterna chyli 乳糜池, 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 Travels upward, veering to the left at the level of T5

Thoracic duct 胸导管 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 Drains lymph from lower limbs, pelvic cavity, abdominal cavity, left side of thorax, and left side of the head, neck and left upper limb

Right lymphatic duct 右淋巴导管 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

Lymph nodes of lower limb Popliteal ln. 腘淋巴结 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 tibial a. Efferents pass to the deep inguinal ln.

Lymph nodes of lower limb Superficial inguinal lymph nodes 腹股沟浅淋巴结 Superior group: Lies just distal to the inguinal ligament Receive lymph vessels from anterior abdominal wall below umbilicus, gluteal region, perineal region, external genital organs Inferior group: Lies vertical along the terminal great saphenous v. Receives all superficial lymph vessels of lower limb, except for those from the posterolateral part of calf Efferent vessels drain into the deep inguinal ln. or external iliac ln.

Lymph nodes of lower limb Deep inguinal lymph nodes 腹股沟深淋巴结 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.

Lymphangiogram showing the inguinal lymph vessels and nodes.

Lymph nodes of pelvis Internal iliac lymph node Surround internal iliac vessels Receive afferents from pelvic viscera, perineum, buttock and back of thigh External iliac lymph nodes Lie along external iliac artery Receive afferents from lower limb and some parts of pelvic viscera Sacral lymph node Common iliac lymph node Lie along common iliac artery Receive afferents from all the above nodes Efferent pass to lumbar lymph node

Lymph nodes of abdomen Lymphatic drainage of abdominal wall 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 Lumbar lymph nodes 腰淋巴结 Lie on posterior abdominal wall, along the abdominal aorta and inferior vena cava Receive lymph from kidneys, suprarenal glands, testes, ovaries, fundus of uterus, ovary, 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 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 腹腔淋巴结 －situated around the celiac trunk

Lymph nodes of abdomen Superior mesenteric lymph node 肠系膜上淋巴结 －situated around superior mesenteric a. Inferior mesenteric lymph node 肠系膜下淋巴结 －situated around inferior mesenteric a. Intestinal trunk 肠干 －formed by efferent vessel of celiac, superior and inferior lymph nodes

Lymphangiogram showing the lateral aortic and proximal iliac lymph nodes. The radiograph was taken approximately 24 hours after the injection of contrast medium into the lymphatics of the dorsum of the foot. Intravenous contrast opacifies the renal collecting system.

左 头颈 颈外侧深淋巴结 颈干 ＜ 右 右淋巴导管 左 上肢 尖淋巴结 锁骨下干 ＜ 右 右静脉角 气管旁淋巴结 纵隔前淋巴结 胸骨旁淋巴结 左 胸部 支气管纵隔干 ＜ 静脉 右 左静脉角 腹腔淋巴结 肠系膜上淋巴结 肠系膜下淋巴结 腹部不成对脏器 肠干 乳糜池 胸导管 左 右 腹部成对脏器 腰淋巴结 腰干 盆 髂内淋巴结 髂总淋巴结 下肢 髂外淋巴结

Spleen 脾 Shape Location: The largest single mass of lymphoid tissue in the body Reddish in color Location: 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 脾 Two surfaces Two extremities Two border Diaphragmatic: smooth, convex Visceral: concave, hilum of spleen Two extremities Anterior－wider Posterior－rounder Two border Superior－has 2-3 splenic notch 脾切迹, which serve as a landmark on palpation when it is enlarge; normally it is not palpable Inferior－rounder

Peritoneal connections of the spleen seen on CT scan Peritoneal connections of the spleen seen on CT scan. The peritoneal ligaments contain low attenuation fat on CT. The posterior connection is the splenorenal ligament