乳腺解剖講課

1、乳腺是皮下結(jié)構(gòu)，包括乳腺，纖維組織，脂肪組織。在皮膚上覆蓋乳暈以及 乳頭。 Adipose tissue (fat) 脂肪 Nipple 乳頭 Areola 乳暈 乳腺M(fèi)ilk glands 結(jié)締組織 Fibrous tissue The portion of the breast that extends toward or into the underarm or axilla is referred to as the axillary tail of the breast or the tail of Spence. 乳房延伸至腋下部分稱為腋尾。 Axillary tail (Tail

2、 of Spence) 有一層結(jié)締組織稱為乳腺淺筋 膜, 它覆蓋乳腺實(shí)體組織. 乳 房位于胸腔前表面, 被下面的 肋骨和肌肉支撐.在乳腺的下 方是胸小肌. 胸小肌是較小, 位置較深的肌肉. 在乳房的旁 側(cè)和后側(cè)的較寬的胸大肌. A layer of connective tissue called the superficial fascia of the breast surrounds the parenchyma of the breast. The breast lies on the anterior surface of the thoracic cage supported by

3、 the underlying ribs and muscles. Immediately deep to the breast are the pectoralis muscles. The pectoralis minor is a smaller more deeply situated muscle. The pectoralis major muscle is a broad muscle that lies adjacent and immediately posterior to the breast. 胸大肌 背闊肌 鋸前肌指狀突起 腹外斜肌 The pectoralis ma

4、jor and minor muscles are both surrounded by a layer of fascia referred to as deep fascia. The superficial layer of the deep fascia of the pectoralis major muscle is in contact with the deep layer of the superficial fascia that surrounds the breast. These two surfaces normally glide over one another

5、 allowing a womans breast to move. If anything were to occur that prevented this type of normal motion the breast becomes immobile and is referred to as “fixed”. Specifically, this situation may occur if a cancer grows from the breast into these layers. 胸大肌和胸小肌被深筋膜包裹。 胸大肌深筋膜的表面接觸到包裹 乳腺的淺筋膜的深層。 Pecto

6、ralis major fascia 胸大肌筋膜 Pectoralis major Muscle 胸大肌 Superficial fascia (deep layer) 深層淺筋膜 Superficial fascia (superficial layer) 表層淺筋膜 Retromammary space 乳后間隙 The arterial blood supply to the breast originates from branches of the axillary, internal thoracic and subclavian arteries. The venous drai

7、nage of the breast empties into branches of the internal thoracic, axillary and intercostal veins. 乳腺血供來自腋窩、胸內(nèi)和鎖骨 下動(dòng)脈。靜脈引流自胸內(nèi)、腋窩 和肋間靜脈。 鎖骨下動(dòng)靜脈 腋靜脈 腋動(dòng)脈 胸內(nèi)動(dòng)靜脈分支 Lymph is a fluid that filters between the cells of tissue and then drains into its own set of transport channels. Lymph fluid may carry infec

8、tious organisms, toxins or cancerous cells. The channels that carry the lymph fluid are referred to as lymphatics. These lymphatics usually travel near or with the vascular supply of a tissue. Small lymphatics drain into larger lymphatics and eventually all the lymphatic fluid empties into one of th

9、e large veins in the thoracic cavity. Along the course of these lymphatic channels are soft tissue structures called lymph glands or nodes. The lymph glands act as filters to remove harmful substances from the lymph fluid. 淋巴是在組織間進(jìn)行過濾的液體, 它流入自 己的輸送渠道. 淋巴液載送感染性有機(jī)物, 毒素和癌細(xì)胞. 載送淋巴液的渠道稱為淋巴 管。 這些淋巴管通常在組織周

10、圍流動(dòng)并且將 組織維管聯(lián)結(jié)。 小的淋巴管流入大的淋巴管 ， 并且最終所有的淋巴液流入胸腔的某個(gè)大 血管。 在這些淋巴管道的路程中有一些軟組 織稱為淋巴腺或淋巴結(jié)。 這些淋巴結(jié)象過 濾器一樣過濾淋巴液中的有害物質(zhì)。 Lymph nodes Lymphatics The majority of the lymphatic fluid from a breast drains to the ipsilateral axilla. The axilla is rich in both lymphatic channels and lymph nodes. A small portion of the

11、lymphatic drainage from the inferomedial breast parenchyma will drain to the lymphatic system associated with the internal thoracic vessels. 乳腺的大部分淋巴液流入腋窩淋巴 。 腋窩富含淋巴管和淋巴結(jié)。小部 分乳腺內(nèi)下側(cè)淋巴液引流入胸內(nèi)脈 管的淋巴系統(tǒng)。 Parasternal (internal thoracic) nodes Subclavian (apical axillary) nodes Interpectoral (Rotters) nodes

12、 Central axillary nodes Brachial (lateral axillary) nodes Subscapular (posterior axillary) nodes Pectoral (anterior axillary) nodes For convention the axillary lymph nodes are divided into three groups: 1.Pectoral or level 1 (inferior to pectoralis minor attachment) 第一站淋巴結(jié)（胸小肌下） 2. Central or level

13、2 (posterior to pectoralis minor attachment) 第二站淋巴結(jié)（胸小肌后） 3. Apical or level 3 (superior to pectoralis minor attachment) 第三站淋巴結(jié)（胸小肌上） It is believed that the majority of the lymph drainage from the breast toward the axilla travels to the level 1 axillary nodes then to the level 2 axillary nodes and

14、then to the level 3 axillary nodes. 普遍認(rèn)為大部分的乳腺的腋窩淋巴引流 都是從第一站到第二站到第三站。 The glands of the breast are arranged into collections called lobules. The secretions of the glands of each lobule drain into a tube called a lobular duct. 乳房的腺體結(jié)合成小葉. 小葉腺體的分泌物流入小葉管 Lobule Lobular duct Many lobules together form a

15、 lobe of the breast. The duct that carries the secretions from all the lobules in a lobe is referred to as a lobar duct. 許多個(gè)小葉匯聚成乳葉. 小葉分泌物匯聚流 入乳管. Lobar duct Lactiferous sinus (ampulla) Lobe A breast contains 15-18 lobes and therefore 15-18 lobar ducts. The lobar ducts are also referred to as lactif

16、erous ducts. Each lactiferous duct has 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 is referred to as the ampulla. 一個(gè)乳房有15-18個(gè)乳葉和15-18個(gè)乳管. 乳管也稱為乳汁輸送管. 每個(gè)乳汁輸送管在其乳頭處有一個(gè)開口. 在乳頭深處, 每個(gè)乳汁輸 送管都有一個(gè)膨脹部位,

17、稱為壺腹. Lobular duct Lobar duct (Lactiferous duct) Lobule Ampulla Nipple Over time, due to factors scientist poorly understand, the cells in the breast lobules and ducts may undergo changes. Some of these changes increase a womans risk of developing breast cancer while other changes are cancerous. To

18、understand these changes lets look at a duct in cross 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. 隨著時(shí)間推移, 由于某些無法解釋的原因, 乳腺小葉和乳管會(huì)發(fā)生變化. 有 些變化會(huì)增加?jì)D女罹患乳腺癌的風(fēng)險(xiǎn). 而有些變化本身就是癌變. 要了解 這些變化, 讓我們來看一看乳腺的橫截面. In a normal du

19、ct the cells lining the duct will be one or two layers thick. These cells will have similar size and shape. 正常的乳管有12層細(xì)胞。這些細(xì)胞有相似的大小和形狀 In some women, extra cells will grow in the duct. The latin term for excess is hyper and the term for growth is plasia , so a condition with excess growth is referred

20、 to as hyperplasia. In this case the specific term would be ductal hyperplasia This condition confers no increase risk for developing breast cancer. 有些婦女，乳管內(nèi)生長了額外的細(xì)胞。這稱為增生，乳管內(nèi)增生。 乳管內(nèi)增生 Sometimes the excess growth within the duct includes some very abnormal or atypical cells. This condition is referr

21、ed atypical ductal hyperplasia or ADH. The presence of this condition in a womans breast increases her risk of developing a breast cancer in her lifetime. Individually, these atypical cells may resemble cancer cells. The more abnormal and atypical an individual cell the more it resembles a cancer ce

22、ll. 有時(shí)，額外的細(xì)胞包括不正常或不典型的細(xì)胞。這些細(xì)胞增加了婦女得乳腺 癌的風(fēng)險(xiǎn)。單個(gè)來說，這些不典型細(xì)胞類似癌細(xì)胞。 不典型增生 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 ductal carcinoma in situ or DCIS. Theoretically, the cancer

23、cells are only located within the duct and have not spread out of the affected duct. Some physicians refer to this condition as a “pre-cancer”. This is incorrect, this is indeed a localized breast cancer. 如果乳管內(nèi)有許多不典型細(xì)胞，直至整個(gè)乳管都充滿了不正常不典 型的細(xì)胞。這其實(shí)是早期的乳腺癌。稱為乳管內(nèi)原位癌。 乳管內(nèi)原位癌 DCIS If DCIS is not treated the

24、cancer cells will eventually break out of the duct and invade the breast tissue. This is referred to as invasive ductal carcinoma. 如果原位癌沒有得到治療，癌細(xì)胞會(huì)最終突破乳管，侵犯乳腺組織 。稱為浸潤性乳管癌。 浸潤性乳管癌 If excess growth occurs in the lobules the condition is referred to as lobular hyperplasia. Atypical lobular hyperplasia may also develop. If Atypical