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12015下学期局部解剖学讨论内容头面部讨论内容1．腮腺深部肿瘤手术切除时可经口内径路到达病灶，结合腮腺的解剖讨论此径路的优点及手术中要注意保护的结构。（基础知识：腮腺的形态、分部；腮腺的毗邻；穿经腮腺的结构；腮腺床；颞下窝与咽旁间隙的关系）目的：理解局部器官的毗邻关系对临床应用的重要指导意义；增加咽旁间隙的内容（教材上没有述及）。2．垂体肿瘤手术治疗的入路问题（基础知识：垂体的位置、毗邻，颅外不同部位至垂体的层次、经过的结构。可结合不同断层进行讨论）目的：理解并掌握如何利用断层解剖的知识学习重要器官的毗邻关系。3．关于颅脑外伤，你能想到些什么？（基础知识：颅脑基本结构，颅外至颅内的层次，头面部软组织的特点及其临床联系，颅骨薄弱部位，脑的被膜及相关间隙，颅腔的分区及内容物）目的：1）了解外伤（Trauma）的基本概念：Traumaisthestudyofmedicalproblemsassociatedwithphysicalinjury.Theinjuryistheadverseeffectofaphysicalforceuponaperson.Thereareavarietyofforcesthatcanleadtoinjury,includingthermal,ionisingradiationandchemical.However,theforceinvolvedinmostinjuriesismechanical.Thesubjectoftraumathereforecentresuponthedeleteriouseffectsofkineticenergyonthehumanframe.2）颅脑外伤为日常生活常见情况，根据头部的基本结构及功能，了解颅脑外伤可能产生的特征性症状，增强理论联系实际的意识。颈部讨论内容：1.请结合颈部局部解剖知识，分析颈部不同部位锐器伤（刺伤或切割伤）可能损伤哪些结构？导致什么后果？（目的：掌握颈部不同平面器官结构的毗邻关系。建议结合颈部横断解剖分析。）2.CaseDiscussionA35-year-oldwomancomplainsofa2-monthhistoryofhoarsenessofhervoiceandsomechokingwhiledrinkingliquids.Shedeniesviralillnesses.Sheunderwentsurgeryforacoldnoduleofthethyroidgland9weeksago.Heronlymedicationisacetaminophenwithcodeine.(Coldnodule:Aregionofthethyroidglandthatdoesnottakeuphotiodineradioisotope(asvisualizedwiththyroidscintigraphy)becausethetissuedoesnotcontainfollicularthyroidcells.)Question:1)Whatisthemostlikelydiagnosis?2)Whatistheanatomicalexplanationforhersymptoms?Object:1)Beabletoidentifythepartsofthethyroidgland.22)Beabletodrawbranchesofthearteriesandveinsthatsupplythethyroidgland.3)Beabletoidentifythemainfeaturesofthelarynxandlistfeaturesthatassistinrespiration(phonation)orprotectthelaryngealinletduringswallowing.4)Beabletoidentifythecourseofthedifferentbranchesofthevagusnerve(cranialnerve[CN]X)thatinnervatethelarynx.5)Beabletodescribetheconsequencesofinjurytotherecurrentlaryngealnerveandcontrastwiththeconsequencesofinjurytothesuperiorlaryngealnerve.3.气管切开术（traceotomy），系切开颈段气管，放入金属气管套管，以解除喉源性呼吸困难、呼吸机能失常或下呼吸道分泌物潴留所致呼吸困难的一种常见手术。结合所学知识，讨论经皮气管切口术适合的切口部位，经过的层次及可能的处理程序和注意事项。胸部讨论内容：1．结合胸部的解剖特点，分析肋骨骨折后可能损伤哪些结构？导致什么后果？。2．A48-year-oldmancomplainsofswellingoftheneckandshortnessofbreathof1-weekduration.Hehasnoticedsomenasalstuffinesswithhoarsenessofhisvoiceforabout3weeksandhadattributedthesesymptomstoanupperrespiratoryinfection.Hedeniestheuseofalcoholbuthassmokedtwopacksofcigarettesperdayfor30years.Lately,hefeelsasthoughsomethingispushingagainsthisthroat.Onphysicalexamination,thepatient’sfaceappearsruddyandswollen.Thejugularveinsaredistended.Question:1)Whatisthemostlikelydiagnosis?2)Whatisthemostlikelycause?3)Whataretheanatomicalstructuresinvolved?Objectives1)Beabletodescribethedivisionsofthemediastinumandthecontentsofeach.2)Beabletodescribethelymphaticdrainageofthethoracicorgans.3.根据食管的位置、毗邻，讨论如何暴露食管各段。（基础知识：颈、胸、腹段食管的毗邻关系）腹部讨论内容：1.肝、胆、胰、脾、阑尾手术及剖腹探查手术可能选择的腹前外侧壁切口，并分析各切口所经层次及优缺点。（基础知识：腹前外侧壁层次及各层次的特点、手术切口选择的基本原则、腹部分区及腹腔脏器体表投影、腹部体表标志）2.体内脏器或组织离开其正常解剖部位，通过先天或后天形成的薄弱点、缺损或孔隙进入另一部位，称为疝。疝多发生于腹部，以腹外疝为多见。腹外疝是由腹腔内的脏器或组织连同腹膜壁层，经腹壁薄弱点或孔隙，向体表突出而致。腹内疝是由脏器或组织进腹腔内间隙囊内而形成，如网膜孔疝。请结合腹部的解剖特点，分析腹部哪些部位容易发生疝，为什么？3.A22-year-oldmanpresentstothehospital1houraftersustainingtwostabwoundsduringanaltercation.Onexamination,thepatientappearsintoxicatedandgrimacesduringmanipulationofthewounds.Histemperatureis36.8°C,pulserate86beats/min,bloodpressure128/80mmHg,andrespiratoryrate22breaths/min.Athoroughphysicalexaminationrevealstwostabwounds.3Onewoundislocatedattheanterioraxillaryline,1cmabovetheleftcostalmargin;thesecondwoundislocated4cmleftoftheumbilicus.Thereisnoactivebleedingfromeitherwoundsite.Thebreathsoundsarepresentandequalbilaterally.Theabdomenistenderonlyinthevicinityoftheinjuries.Thepatientclaimsthattheknifeusedintheattackwasapproximately12.7cminlength.Question:1）Whatarethepotentialinjuries?2）Whatisyournextstep?第二节课1.根据肝内管道配布及组织学特点，讨论为满足临床工作需求，应如何对肝进行分叶分段？2.胃十二指肠溃疡非手术治疗无效或并发穿孔、出血、幽门梗阻、癌变时拟行胃大部分切除术。结合胃的解剖学特点，请讨论：1)术中哪些血管及相关腹膜结构需处理？2)若患者已发生癌变，术中可能要对哪些淋巴节进行清理？3)胃大部分切除后（胃远段和十二指肠近段切除），要重建消化道连续性，请讨论残胃端可能与哪段肠管进行吻合，如何吻合？3.结合脾的位置、毗邻及血供，试讨论临床行脾切除时可能的操作步骤。盆部、会阴讨论容：1.盆筋膜及其间隙与腹壁层次的关系。2.对盆腔脏器起承托作用的结构有哪些？各有何功能？若这些结构受到破坏或功能异常可能导致什么疾病。3．A50-year-oldfemalewhohasbornefivechildrencomplainsthatshehasnoticedvaginalspottingofbloodafterintercourseforapproximatelythepast6months.Morerecently,shehashadafoulsmellingvaginaldischargeandindicatesthatherleftlegseemslargerthanherrightone.Shepreviouslyhadsyphilis.Shehassmokedonepackofcigarettesperdayfor20years.Examinationofherbackshowsleftflanktenderness.Thecircumferencesofherleftthighandcalfarelargerthanthoseoftheright.Pelvicexaminationshowsnormalfemaleexternalgenitaliaanda3-cmgrowthonthesurfaceontheleftlipoftheuterinecervix.Question:1）Whatisthemostlikelydiagnosis?2）Whatistheappliedclinicalanatomyforthiscondition?Objectives1）Beabletodescribetheanatomyoftheovaries,uterinetubes,uterus,anduppervagina,includingchangesintheirepitheliallining.2）Beabletodescribetheanatomyofthelateraluterinesupportstructuresandrelatedorgans.3）Beabletodrawthelymphaticdrainageoftheuterusanduppervagina.4上肢讨论内容：1．试分析臂丛及其分支易发生损伤的部位及受损后可能出现的症状。2.结合腋窝淋巴结分布及引流关系，讨论其与乳腺癌淋巴转移的关系，并分析乳腺癌腋