乳腺解剖

乳腺是皮下结构，包括乳腺，纤维组织，脂肪组织。在皮肤上覆盖乳晕以及乳头。Adiposetissue(fat)脂肪Nipple乳头Areola乳晕乳腺Milkglands结缔组织FibroustissueTheportionofthebreastthatextendstowardorintotheunderarmoraxillaisreferredtoastheaxillarytailofthebreastorthetailofSpence.乳房延伸至腋下部分称为腋尾。Axillarytail(TailofSpence)有一层结缔组织称为乳腺浅筋膜,它覆盖乳腺实体组织.乳房位于胸腔前表面,被下面的肋骨和肌肉支撑.在乳腺的下方是胸小肌.胸小肌是较小,位置较深的肌肉.在乳房的旁侧和后侧的较宽的胸大肌.Alayerofconnectivetissuecalledthesuperficialfasciaofthebreastsurroundstheparenchymaofthebreast.Thebreastliesontheanteriorsurfaceofthethoraciccagesupportedbytheunderlyingribsandmuscles.Immediatelydeeptothebreastarethepectoralismuscles.Thepectoralisminorisasmallermoredeeplysituatedmuscle.Thepectoralismajormuscleisabroadmusclethatliesadjacentandimmediatelyposteriortothebreast.胸大肌背阔肌锯前肌指状突起腹外斜肌Thepectoralismajorandminormusclesarebothsurroundedbyalayeroffasciareferredtoasdeepfascia.Thesuperficiallayerofthedeepfasciaofthepectoralismajormuscleisincontactwiththedeeplayerofthesuperficialfasciathatsurroundsthebreast.Thesetwosurfacesnormallyglideoveroneanotherallowingawoman‘sbreasttomove.Ifanythingweretooccurthatpreventedthistypeofnormalmotionthebreastbecomesimmobileandisreferredtoas“fixed”.Specifically,thissituationmayoccurifacancergrowsfromthebreastintotheselayers.胸大肌和胸小肌被深筋膜包裹。胸大肌深筋膜的表面接触到包裹乳腺的浅筋膜的深层。Pectoralismajorfascia胸大肌筋膜PectoralismajorMuscle胸大肌Superficialfascia(deeplayer)深层浅筋膜Superficialfascia(superficiallayer)表层浅筋膜Retromammaryspace乳后间隙Thearterialbloodsupplytothebreastoriginatesfrombranchesoftheaxillary,internalthoracicandsubclavianarteries.Thevenousdrainageofthebreastemptiesintobranchesoftheinternalthoracic,axillaryandintercostalveins.乳腺血供来自腋窝、胸内和锁骨下动脉。静脉引流自胸内、腋窝和肋间静脉。锁骨下动静脉腋静脉腋动脉胸内动静脉分支Lymphisafluidthatfiltersbetweenthecellsoftissueandthendrainsintoitsownsetoftransportchannels.Lymphfluidmaycarryinfectiousorganisms,toxinsorcancerouscells.Thechannelsthatcarrythelymphfluidarereferredtoaslymphatics.Theselymphaticsusuallytravelnearorwiththevascularsupplyofatissue.Smalllymphaticsdrainintolargerlymphaticsandeventuallyallthelymphaticfluidemptiesintooneofthelargeveinsinthethoraciccavity.Alongthecourseoftheselymphaticchannelsaresofttissuestructurescalledlymphglandsornodes.Thelymphglandsactasfilterstoremoveharmfulsubstancesfromthelymphfluid.淋巴是在组织间进行过滤的液体,它流入自己的输送渠道.淋巴液载送感染性有机物,毒素和癌细胞.载送淋巴液的渠道称为淋巴管。这些淋巴管通常在组织周围流动并且将组织维管联结。小的淋巴管流入大的淋巴管，并且最终所有的淋巴液流入胸腔的某个大血管。在这些淋巴管道的路程中有一些软组织称为淋巴腺或淋巴结。这些淋巴结象过滤器一样过滤淋巴液中的有害物质。LymphnodesLymphaticsThemajorityofthelymphaticfluidfromabreastdrainstotheipsilateralaxilla.Theaxillaisrichinbothlymphaticchannelsandlymphnodes.Asmallportionofthelymphaticdrainagefromtheinferomedialbreastparenchymawilldraintothelymphaticsystemassociatedwiththeinternalthoracicvessels.乳腺的大部分淋巴液流入腋窝淋巴。腋窝富含淋巴管和淋巴结。小部分乳腺内下侧淋巴液引流入胸内脉管的淋巴系统。Parasternal(internalthoracic)nodesSubclavian(apicalaxillary)nodesInterpectoral(Rotter’s)nodesCentralaxillarynodesBrachial(lateralaxillary)nodesSubscapular(posterioraxillary)nodesPectoral(anterioraxillary)nodesForconventiontheaxillarylymphnodesaredividedintothreegroups:1.Pectoralorlevel1(inferiortopectoralisminorattachment)第一站淋巴结（胸小肌下）2.Centralorlevel2(posteriortopectoralisminorattachment)第二站淋巴结（胸小肌后）3.Apicalorlevel3(superiortopectoralisminorattachment)第三站淋巴结（胸小肌上）Itisbelievedthatthemajorityofthelymphdrainagefromthebreasttowardtheaxillatravelstothelevel1axillarynodesthentothelevel2axillarynodesandthentothelevel3axillarynodes.普遍认为大部分的乳腺的腋窝淋巴引流都是从第一站到第二站到第三站。Theglandsofthebreastarearrangedintocollectionscalledlobules.Thesecretionsoftheglandsofeachlobuledrainintoatubecalledalobularduct.乳房的腺体结合成小叶.小叶腺体的分泌物流入小叶管LobuleLobularductManylobulestogetherformalobeofthebreast.Theductthatcarriesthesecretionsfromallthelobulesinalobeisreferredtoasalobarduct.许多个小叶汇聚成乳叶.小叶分泌物汇聚流入乳管.LobarductLactiferoussinus(ampulla)LobeAbreastcontains15-18lobesandtherefore15-18lobarducts.Thelobarductsarealsoreferredtoaslactiferousducts.Eachlactiferousducthasanopeningonthesurfaceofthenipple.Thereisadilatedregionineachlactiferousductjustdeeptothesurfaceofthenipple.Thisdilatedareaisreferredtoastheampulla.一个乳房有15-18个乳叶和15-18个乳管.乳管也称为乳汁输送管.每个乳汁输送管在其乳头处有一个开口.在乳头深处,每个乳汁输送管都有一个膨胀部位,称为壶腹.LobularductLobarduct(Lactiferousduct)LobuleAmpullaNippleOvertime,duetofactorsscientistpoorlyunderstand,thecellsinthebreastlobulesandductsmayundergochanges.Someofthesechangesincreaseawoman’sriskofdevelopingbreastcancerwhileotherchangesarecancerous.Tounderstandthesechangeslet’slookataductincrosssection.Thisviewiswhatitwouldbeseenifapieceofbreasttissuewereremovedfromthebreastandthenexaminedunderamicroscope.随着时间推移,由于某些无法解释的原因,乳腺小叶和乳管会发生变化.有些变化会增加妇女罹患乳腺癌的风险.而有些变化本身就是癌变.要了解这些变化,让我们来看一看乳腺的横截面.Inanormalductthecellsliningtheductwillbeoneortwolayersthick.Thesecellswillhavesimilarsizeandshape.正常的乳管有1－2层细胞。这些细胞有相似的大小和形状Insomewomen,extracellswillgrowintheduct.Thelatintermforexcessishyperandthetermforgrowthisplasia,soaconditionwithexcessgrowthisreferredtoashyperplasia.InthiscasethespecifictermwouldbeductalhyperplasiaThisconditionconfersnoincreaseriskfordevelopingbreastcancer.有些妇女，乳管内生长了额外的细胞。这称为增生，乳管内增生。乳管内增生Sometimesthe