甲状腺疾病PPT课件.pptVIP

甲状腺疾病 三、甲状腺功能亢进症 一、甲状腺的解剖和生理概要 I区：颏下双颌下淋巴结, 颏下区和颌下三角。II区：颈内静脉上区淋巴结。颅底至舌骨水平，前界为胸骨舌骨肌侧缘颈内静脉段,后界为胸锁乳突肌后缘。III区：颈内静脉中区淋巴结。即舌骨水平至肩胛舌骨肌与颈内静脉交界处, 颈内静脉段周围。IV区：颈内静脉下区淋巴结。即肩胛舌骨肌与颈内静脉交界处到锁骨上, 颈内静脉段周围。V区：颈后三角内(副神经周围,枕后三角,锁骨上)淋巴结: 前界为胸锁乳突肌后缘, 后界为斜方肌前缘, 下界为锁骨(为第二站).VI区：颈前区淋巴结: 气管周围、喉前、Delphin 及甲状腺周围, 上至舌骨下至胸骨上凹, 侧方为颈总动脉。 图2－切除腺叶后找到兰染淋巴结 图4－注射染料后显示蓝染淋巴管  图5－循蓝染淋巴管发现前哨淋巴结  图6－前哨淋巴结 图8－术中γ-探测仪探测术野 * 甲状腺的位置 甲状腺是人体内最大的内分泌腺。 甲状腺是因为位于第2~4气管甲状软骨环前下方而得名。 甲状腺的功能是： 生产、储存和分泌甲状腺激素； 调控人体的新陈代谢，维持组织器官的正常生理活动。 甲状腺解剖生理 甲状腺呈蝴蝶型, 由左叶+右叶+峡部组成。 一般成年人的甲状腺的重量约为15~25克。 甲状腺平时是摸不到的，但出现病变时，甲状腺多数情况下会出现弥漫性或结节性肿大。 甲状腺是人体血液供应最丰富的器官，甲状腺功能亢进时通过甲状腺的血流量可增加100倍。 右叶 左叶 峡部 甲状腺解剖 左叶 甲状腺: 蝴蝶型，位于颈部的甲状软骨下面 (亚当的苹果) 甲状腺背面视图 Lobus pyramidalis 甲状旁腺 气管 甲状腺 Superior thyroid artery Larynx Inferior thyroid artery 峡部 Common carotid artery The Thyroid and Parathyroids 甲状腺扪诊 对甲状腺的体积、结节、活动性及疼痛感的评估 在患者前方或后方触诊 ‘Have the patient lean his head back and swallow, while you look for enlargements on either side of the Adam’s apple. Place your thumbs on both sides of the Adam’s apple and palpate in a slow and firm up-and-down motion, feeling for an enlargement’ 甲状腺细针穿刺 (FNAB) 在B超引导下用细针刺破甲状腺结节或囊肿 鉴别诊断恶性甲状腺结节（甲状腺癌） 核医学扫描 (=Scintigraphy) Injection of radioactive technetium pertechnate (Tc-99m) or radioactive iodine (I-123) Scan for over- and underactive (hot/cold) areas Indication: nodular goitre 颈部淋巴结分区示意图 图1－注射亚甲蓝 * * * The thyroid is a endocrine (= hormonal) gland located in the neck in front of the windpipe (trachea) below the thyroid cartilage (in men also known as ‘Adam‘s apple’). It is a butterfly-shaped organ composed of two lobes: right lobe (lat. lobus dexter) and left lobe (lat. lobus sinister), connected via the isthmus. Some people also have a small 3rd lobe called pyramidal lobe (lat. lobus pyramidalis). On the posterior side of the lobes there are two small parathyroid glands on each side. They produce parathyroid hormone (PTH), which is important for calcium balance. The normal volume of the thyroid gland is