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

Artery

Capillaries

Vein

Cell Tissue fluid Lymphatic capillary Lymphatic vessel

Lymphatic node

Lymphatic trunk

Lymphatic duct

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 bo

des 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 n

odes 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 int

ernal 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 du

ct

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 digastr

ic 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 arra

nged in five groups

Axillary lymph nodes

Axillary lymph nodes vary in si

ze from a pin-head to a large

bean.

They are arranged in five gro

ups.

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

Lateral ln.

Pectoral ln.

Subscapular ln.

Central ln.

Apical ln.

Efferents form subclavian trunk, the right subclavian trunk joints the right lymphatic duct; left usually drains directly into thoracic duct

Subclavian trunk

Lymphatic drainage of thorax

The lymphatic drainage of thoracic wall

To axillary lymph nodes To parasternal lymph nodes (along inter

nal thoracic vessels) To intercostals lymph nodes from deep

er 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 th

oracic cavity and pericardium The efferents unite with those of paratrache

al 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, nec

k, thorax and right upper limb

Lymph nodes of lower limb

Popliteal ln. 腘淋巴结 Embedded in the fatty connective tissu

e of popliteal fossa Receive superficial lymphatic vessels f

rom 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 abdomi

nal wall below umbilicus, gluteal region, perineal region, external genital organs

Inferior group: Lies vertical along the terminal great saphen

ous v. Receives all superficial lymph vessels of low

er 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 low

er 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 u

mbilicus To superficial inguinal lymph node from reg

ion below umbilicus To lumbar lymph node from post wall of ab

domen

Lymph nodes of abdomenLymphatic drainage of abdom

inal 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.

上肢 尖淋巴结 锁骨下干

头颈 颈外侧深淋巴结 颈干

胸部气管旁淋巴结纵隔前淋巴结胸骨旁淋巴结

支气管纵隔干

＜左右

＜

＜

左右

左右

腹部不成对脏器腹腔淋巴结肠系膜上淋巴结肠系膜下淋巴结

肠干

腹部成对脏器 腰淋巴结 腰干

乳糜池 胸导管

右淋巴导管

左静脉角

右静脉角

静脉

盆 髂内淋巴结 髂总淋巴结

下肢 髂外淋巴结

左右

Spleen 脾 Shape

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

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. The peritoneal ligaments contain low attenuation fat on CT. The posterior connection is the splenorenal ligament