纵隔七要点解说

The mediastinum is a critical anatomical region of the human body. However, this is not an organ. Therefore, let’s start by summarizing the five key facts about the mediastinum before deep-diving into the details of this body part. 

1. 纵隔不是器官,而是胸腔中的一个隔室,包含许多器官、血管、神经和其他结构。 

2. 纵隔是人体最重要的器官:心脏。 

3. The mediastinum is virtually divided into anterior, middle, posterior, and superior regions. This division is mainly used for clinical purposes.

4. 纵隔是身体中具有不同边界的区域之一:前部(由 胸骨)、后部(由胸椎定义)、上(由上胸椎开口或出口定义)、下(由横膈膜定义)和外侧(由肺和每个胸膜腔定义)。 

5. The anatomical division of the mediastinum has been largely debated in the past. While radiologists used to define this space based on the landmarks observed in the radiological images, surgeons were relying on the intraoperative margins. A CT scan-based division is now the most common and consistent approach across different medical specialties. 

6. The primary function of the mediastinum is to provide these structures with a protected pathway.

7. The mediastinum is also clinically significant due to many pathologies occurring in it. One of the most invasive and difficult to treat is a mediastinal tumor. A mediastinal mass can be found in the anterior, posterior, or middle mediastinum, and depending on their location they can apply pressure on vital organs such as the lungs, esophagus, spine, or trachea, leading to serious consequences. If a mediastinal tumor is suspected, the practitioner will recommend different tests, including a biopsy of the mediastinal mass in the thoracic cavity, a ct scan, or other imaging procedures and functional tests. Depending on the size and positioning of the tumor, surgical resection can be an option and it can be combined with pharmacological intervention to reduce the size of the mass and limit the risk of metastasis. 

现在让我们在下面的部分中探讨纵隔的解剖结构和功能。

胸腔前视图显示纵隔,这是肺和图表之间的区域。图片来源 Blausen Medical 2014 医学画廊

使用下面的交互式模型在 3D、AR 和 VR 中探索纵隔及其器官。

结构

The mediastinum is the space between the two lungs that extends the whole length of the thoracic cavity. From the top to the lowest point, the mediastinum extends from the thoracic inlet to the upper lining of the diaphragm. Though there is no distinct physical partition of the mediastinum, it is divided into the superior and inferior.

The inferior mediastinum is further divided into anterior, middle, and posterior compartments. Hence, there is a total of four compartments of the mediastinum. The Mediastinum houses vital body structures, such as the heart, esophagus, trachea great vessels, and several nerves. 

上纵隔

边界

The uppermost margin of the superior mediastinum is the thoracic inlet, and the inferior boundary is the thoracic plane or sternal angle. The pleural sacs bound the superior mediastinum laterally. The anterior border is the dorsal surface of the sternum, while the posterior boundary is the central aspect of the first four thoracic vertebrae.

内容

上纵隔容纳器官、血管和神经。上纵隔的器官包括胸腺、食道和气管。上纵隔的血管包括 主动脉弓, 头臂干,以及左锁骨下动脉和左颈动脉。上纵隔静脉包括 SVC、 头臂静脉, and azygous vein. It also contains some parts of the thoracic lymphatic duct. The nervous content o the superior mediastinum consists of both vagus nerves, phrenic nerves, recurrent laryngeal nerves, and cardiac nerves.

下纵隔

下纵隔从上纵隔的下边界延伸到横膈膜的上表面。它分为前部、中部和后部。

前纵隔

前纵隔的内容物包括胸腺、胸内血管分支和胸骨旁淋巴结。

中纵隔

中纵隔包含心脏、主要血管,即主动脉、肺干、上腔静脉和 肺静脉.迷走神经、膈神经和交感神经的一部分也穿过中纵隔。

后纵隔

The contents of the posterior mediastinum include the esophagus and descending thoracic aorta. It also contains part of the thoracic duct, azygous and hemizygous veins. It also has part of the vagus, splanchnic, and sympathetic chain nerves.

纵隔及其内容的插图。图片来源 OpenStax 学院

功能

纵隔的主要功能是为穿过胸腔的不同结构提供安全通道,并容纳胸腔的重要器官。

上纵隔的主要功能是为从头颈部到胸腔的不同结构创建管道或通道。前纵隔的主要功能是保护位于其后面的结构。它具有结缔组织和脂肪,可作为外部推力的缓冲垫。 

中纵隔将心脏和大血管隐藏在前纵隔盾的后面。后纵隔被认为是上纵隔的延续。后纵隔是从胸腔到腹腔的结构的管道。

神经血管供应

不同纵隔隔室的血液供应、静脉引流和神经供应来自各个隔室的神经血管内容物。纵隔的内脏器官也由其各自隔室的神经和血管供应。

临床相关性和相关疾病

纵隔在临床方面是身体的重要空间。它有几个心肺结构。纵隔内脏内容物的病理和异常与纵隔的不同隔室相关。以下部分简要介绍了纵隔的临床重要性。

纵隔在临床方面是身体的重要空间。它有几个心肺结构。纵隔内脏内容物的病理和异常与纵隔的不同隔室相关。以下部分简要介绍了纵隔的临床重要性。

上纵隔

上纵隔充当许多血管和神经的管道。胸部上部的穿通伤容易损伤上纵隔的血管和神经。上纵隔包含主动脉弓,这是主动脉瘤的潜在部位。如果主动脉弓的动脉瘤未被诊断出来,它可能会导致死亡。

上纵隔还包含食道和气管的一部分。食道和气管的阻塞导致严重的后果。气管阻塞导致呼吸损害和随后的死亡。

前纵隔

前纵隔的主要临床意义与甲状腺疾病有关,甲状腺位于其上部。前纵隔也容易受到胸部挤压伤。这些挤压伤可能导致前纵隔脂肪坏死和出血。

中纵隔

中纵隔是临床上最重要的纵隔隔室。它包含大血管的心脏和根部。心肌梗塞、心包填塞、心肌病等心脏病均与中纵隔有关。心脏和大血管的先天性异常也与中纵隔有关。

后纵隔

后纵隔是许多结构的上行通道。中纵隔的病变可导致全身功能障碍。胸降主动脉瘤、胸导管梗阻和 食管发育不良 是与后纵隔相关的臭名昭著的临床疾病,很容易演变成危及生命的疾病。

外卖信息

The posterior mediastinum is an ascending route for a lot of structures. The pathologies The mediastinum is the space or cavity that extends between the pleura of two lungs. From superior to inferior, the mediastinum extends from the thoracic inlet to the superior surface of the diaphragm. The mediastinum extends between the sternum’s dorsal surface and the vertebral column’s ventral surface from the anterior to the posterior. The mediastinum is arbitrarily divided into four components; superior, anterior, middle, and posterior compartments. Each compartment contains different visceral organs, blood vessels, nerves, and lymphatics. The neurovascular of the mediastinum is from its content blood vessels and nerves. The mediastinum is clinically significant due to the visceral structure and blood vessels it contains. The middle mediastinum is clinically most important due to the presence of the heart in it.

参考

1. Stoddard N,Heil JR,Lowery DR。解剖学,胸腔,纵隔。 [2020 年 7 月 31 日更新]。在:StatPearls [互联网]。金银岛(佛罗里达州):StatPearls Publishing; 2021年1月-。可从: https://www.ncbi.nlm.nih.gov/books/NBK539819/

2. Priola, SM, Priola, AM, Cardinale, L., Perotto, F., & Fava, C. (2006)。前纵隔:解剖和成像程序。 医学放射学111(3), 295–311。 https://doi.org/10.1007/s11547-006-0031-6

3. Rizvi, S., Wehrle, CJ, & Law, MA (2020)。解剖学、胸腔、上纵隔和大血管。在 统计珍珠. StatPearls 出版。 https://pubmed.ncbi.nlm.nih.gov/30137860/

4. Stoddard, N., Heil, JR 和 Lowery, DR (2020)。解剖学,胸腔,纵隔。在 统计珍珠. StatPearls 出版。 https://pubmed.ncbi.nlm.nih.gov/30969641/

5. Mast, WR 和 Jafek, BW (1975)。纵隔镜医师的纵隔解剖。 耳鼻喉科档案(伊利诺伊州芝加哥:1960)101(10), 596–599。 https://doi.org/10.1001/archotol.1975.00780390010003

Health Literacy Hub 网站上共享的内容仅供参考,并不旨在取代您所在州或国家/地区的合格医疗专业人员提供的建议、诊断或治疗。鼓励读者确认其他来源提供的信息,并就他们可能对自己的健康有任何疑问寻求合格医生的建议。健康素养中心不对因应用所提供材料而产生的任何直接或间接后果负责。

分享你的意见
Chinese (China)