生理學(xué)報(bào)告 走近闌尾

1、生理學(xué)報(bào)告 走近闌尾外科醫(yī)生躺在一張臨時(shí)搭出來(lái)的竹床上，他的妻子坐在旁邊的藤椅里，他們的兩個(gè)孩子，我哥哥和我，并肩坐在一條長(zhǎng)凳上，聽(tīng)我們的父親在說(shuō)每個(gè)人肚子里都有的那一條闌尾，他說(shuō)他每天最少也要割掉二十來(lái)?xiàng)l闌尾，最快的一次他只用了十五分鐘，十五分鐘就完成了一次闌尾手術(shù)，將病人的闌尾唰地一下割掉了。我們問(wèn)，割掉以后怎么辦呢？ “割掉以后？”我父親揮揮手說(shuō)，“割掉以后就扔掉?！?“為什么扔掉呢？” 我父親說(shuō)：“闌尾一點(diǎn)屁用都沒(méi)有?！蔽腋赣H看了我一會(huì)，說(shuō)：“你說(shuō)得也對(duì)，你們說(shuō)得都對(duì)，肺，胃，心臟，還有十二指腸，結(jié)腸，大腸，直腸什么的都有用，就是這闌尾，這盲腸末端上的闌尾你們知道闌尾有什么用？” 我哥

2、哥搶先學(xué)父親的話說(shuō)了，他說(shuō)：“闌尾一點(diǎn)屁用都沒(méi)有?！盩he appendix (or vermiform appendix; also cecal or caecal appendix; vermix; or vermiform process) is a blind-ended tube（盲管） connected to the cecum（盲腸）, from which it develops embryologically. The cecum is a pouchlike structure（囊袋狀結(jié)構(gòu)） of the colon（結(jié)腸）, located at the junctio

3、n of the small and the large intestines（大腸和小腸）.The term vermiform （蠕蟲(chóng)狀的）comes from Latin and means worm-shaped.The appendix was first depicted in Western medicine by Leonardo Da Vinci in his dissection sketches in 1492.A valve for the cecum?所處位置 locationThe appendix is usually located in the lower r

4、ight quadrant of the abdomen（下腹）, near the right hip bone（髖骨）. The base of the appendix is located 2cm beneath the ileocecal valve（回盲瓣） that separates the large intestine from the small intestine. Its position within the abdomen corresponds to a point on the surface known as McBurneys point（麥?zhǔn)宵c(diǎn)）.umb

5、ilicus臍 anterior superior iliac spine髂前上棘While the base of the appendix is at a fairly constant location2cm below the ileocecal valve, the tip of the appendix can be variably locatedin the pelvis（骨盆）, outside the peritoneum（腹膜） or behind the cecum. The human appendix averages 9cm in length but can r

6、ange from 2 to 20cm. The diameter of the appendix is usually between 7 and 8mm. 結(jié)構(gòu) structure“酒壇子”到了晚上睡覺(jué)的時(shí)候，我們經(jīng)常聽(tīng)到他埋怨我們的母親，他說(shuō)： “說(shuō)起來(lái)你給我生了兩個(gè)兒子，其實(shí)你是生了兩條闌尾，平日里一點(diǎn)用都沒(méi)有，到了緊要關(guān)頭害得我差點(diǎn)丟了命。” Although it has been long accepted that the immune tissue surrounding the appendix and elsewhere in the gutcalled gut asso

7、ciated lymphoid tissue（腸道相關(guān)淋巴組織）carries out a number of important functions, explanations were lacking for the distinctive shape of the appendix and its apparent lack of specific importance and function as judged by an absence of side effects following its removal. Therefore, the notion that the app

8、endix is only vestigial（退化的，殘余的） became widely held. Maintaining gut flora 腸道菌群的避難所 William Parker, Randy Bollinger, and colleagues at Duke University proposed in 2007 that the appendix serves as a haven for useful bacteria when illness flushes those bacteria from the rest of the intestines. This pr

9、oposal is based on a new understanding of how the immune system supports the growth of beneficial intestinal bacteria, in combination with many well-known features of the appendix, including its architecture, its location just below the normal one-way flow of food and germs in the large intestine, a

10、nd its association with copious amounts of immune tissue. Research performed at Winthrop University-Hospital showed that individuals without an appendix were four times more likely to have a recurrence of Clostridium difficile colitis(梭菌結(jié)腸炎),The appendix, therefore, may act as a “safe house” for com

11、mensal (“good”) bacteria. This reservoir of gut flora could then serve to repopulate the digestive system following a bout of dysentery（痢疾，腹瀉） or cholera（霍亂）.The appendix has more recently been identified as an important component of mammalian mucosal immune function（哺乳動(dòng)物的黏膜免疫功能）, particularly B-lym

12、phocyte-mediated（由B淋巴細(xì)胞介導(dǎo)的） immune responses and extrathymically derived T-lymphocytes（胸腺外起源的T淋巴細(xì)胞）. This structure helps in the proper movement and removal of waste matter in the digestive system, contains lymphatic vessels（淋巴管） that regulate pathogens（病原體）, and lastly, might even produce early def

13、ences that prevent deadly diseases. Additionally, it is thought that this may provide more immune defences from invading pathogens and getting the lymphatic systems B and T-cells to fight the viruses and bacteria that infect that portion of the bowel（腸） and training them, so that immune responses ar

14、e targeted and more able to reliably and less dangerously fight off pathogens.Lymphatic system 免疫系統(tǒng)的一部分常見(jiàn)闌尾疾病急性闌尾炎臨床表現(xiàn)常見(jiàn)病因并發(fā)癥目前主要治療方法1、急性闌尾炎臨床表現(xiàn)腹痛：典型的急性闌尾炎早期階段為中上腹和臍周疼痛，疼痛感較彌散，常常不能確切定位，但數(shù)小時(shí)后腹痛轉(zhuǎn)移并固定于右下腹。胃腸道癥狀：在早期可能由于反射性胃痙攣而有惡心、嘔吐等癥狀。多數(shù)病人白細(xì)胞和嗜中性粒細(xì)胞計(jì)數(shù)增高。（細(xì)菌感染）1.梗阻闌尾為一細(xì)長(zhǎng)的盲管，梗阻會(huì)使管腔內(nèi)壓增高，壓迫闌尾壁阻礙血液向遠(yuǎn)端運(yùn)輸，致使闌

15、尾粘膜受損。在此基礎(chǔ)上管腔內(nèi)細(xì)菌侵入受損部位，引發(fā)感染。2.感染闌尾腔因與盲腸相通，因此具有較多的大腸桿菌和厭氧菌。若闌尾黏膜稍有損傷，細(xì)菌侵入管壁，引起不同程度的感染。2、急性闌尾炎常見(jiàn)病因（1）3.胃腸功能障礙胃腸道功能障礙引起內(nèi)臟神經(jīng)反射，導(dǎo)致闌尾肌肉和血管痙攣，若超過(guò)正常強(qiáng)度，可以產(chǎn)生闌尾管腔狹窄、血供障礙、黏膜受損，細(xì)菌入侵而致急性炎癥。4、其他因素飲食習(xí)慣、遺傳因素等2、急性闌尾炎常見(jiàn)病因（2）3、急性闌尾炎并發(fā)癥1.腹膜炎 （21%）在機(jī)體有一定的防御能力時(shí)，穿孔附近的腸系膜等可迅速黏附穿孔處，使穿孔受到局限。若病人缺乏這種能力，闌尾穿孔所致的感染可彌漫及全腹腔，例如嬰幼兒因?yàn)橄的み^(guò)短，發(fā)病的幾率很大。2.膿毒血癥：當(dāng)嚴(yán)重感染時(shí)，細(xì)菌等經(jīng)闌尾靜脈侵入門(mén)靜脈，導(dǎo)致化膿性門(mén)靜脈炎或肝膿腫，有極高的死亡率。4、急性闌尾炎目前主