2015下学期局部解剖学讨论内容
头面部讨论内容
1．腮腺深部肿瘤手术切除时可经口内径路到达病灶，结合腮腺的解剖讨论此径路的优点及手术中要注意保护的结构。
（基础知识：腮腺的形态、分部；腮腺的毗邻；穿经腮腺的结构；腮腺床；颞下窝与咽旁间隙的关系）
目的：理解局部器官的毗邻关系对临床应用的重要指导意义；增加咽旁间隙的内容（教材上没有述及）。
2．垂体肿瘤手术治疗的入路问题
（基础知识：垂体的位置、毗邻，颅外不同部位至垂体的层次、经过的结构。可结合不同断层进行讨论）
目的：理解并掌握如何利用断层解剖的知识学习重要器官的毗邻关系。
3．关于颅脑外伤，你能想到些什么？
（基础知识：颅脑基本结构，颅外至颅内的层次，头面部软组织的特点及其临床联系，颅骨薄弱部位，脑的被膜及相关间隙，颅腔的分区及内容物）
目的：
1）了解外伤（Trauma）的基本概念：Trauma is the study of medical problems associated with physical injury. The injury is the adver effect of a physical force upon a person. There are a variety of forces that can lead to injury, including thermal, ionising radiation and chemical. However, the force involved in most injuries is mechanical. The subject of trauma therefore centres upon the deleterious effects of kinetic energy on the human frame.
2）颅脑外伤为日常生活常见情况，根据头部的基本结构及功能，了解颅脑外伤可能产生的特征性症状，增强理论联系实际的意识。
门丽颈部讨论内容：
1. 请结合颈部局部解剖知识，分析颈部不同部位锐器伤（刺伤或切割伤）可能损伤哪些结构？导致什么后果？（目的：掌握颈部不同平面器官结构的毗邻关系。建议结合颈部横断解剖分析。）
2. Ca Discussion
A 35-year-old woman complains of a 2-month history of hoarness of her voice and some choking while drinking liquids. She denies viral illness. She underwent surgery for a cold nodule of the thyroid gland 9 weeks ago. Her only medication is acetaminophen with codeine.交通扣分 ( Cold nodule: A region of the thyroid gland that does not take up hot iodine radioisotope (as visualized with thyroid scintigraphy) becau the tissue does not contain follicular thyroid cells.)
Question:
1) What is the most likely diagnosis?
2) What is the anatomical explanation for her symptoms?
Object:
1) Be able to identify the parts of the thyroid gland.
作业没写完>烧鱿鱼的做法
2) Be able to draw branches of the arteries and veins that supply the thyroid gland.
3) Be able to identify the main features of the larynx and list features that assist in respiration (phonation) or protect the laryngeal inlet during swallowing.
4) Be able to identify the cour of the different branches of the vagus nerve (cranial nerve [CN] X) that innervate the larynx.
5) Be able to describe the conquences of injury to the recurrent laryngeal nerve and contrast with the conquences of injury to the superior laryngeal nerve.
3. 气管切开术（traceotomy），系切开颈段气管，放入金属气管套管，以解除喉源性呼吸困难、呼吸机能失常或下呼吸道分泌物潴留所致呼吸困难的一种常见手术。结合所学知识，讨论经皮气管切口术适合的切口部位，经过的层次及可能的处理程序和注意事项。
胸部讨论内容：
1．结合胸部的解剖特点，分析肋骨骨折后可能损伤哪些结构？导致什么后果？。
2．A 48-year-old man complains of swelling of the neck and shortness of breath of 1-week duration. He has noticed some nasal stuffiness with hoarness of his voice for about 3 weeks and had attributed the symptoms to an upper respiratory infection. He denies the u of alcohol but has smoked two packs of cigarettes per day for 30 years. Lately, he feels as though something is pushing against his throat. On physical examination, the patient’s face appears ruddy and swollen. The jugular veins are distended.
Question:
1) What is the most likely diagnosis?
2) What is the most likely cau?
点亮小灯泡3) What are the anatomical structures involved?
Objectives
1) Be able to describe the divisions of the mediastinum and the contents of each.
2) Be able to describe the lymphatic drainage of the thoracic organs.
3. 根据食管的位置、毗邻，讨论如何暴露食管各段。（基础知识：颈、胸、腹段食管的毗邻关系）
腹部讨论内容：
1.肝、胆、胰、脾、阑尾手术及剖腹探查手术可能选择的腹前外侧壁切口，并分析各切口所经层次及优缺点。（基础知识：腹前外侧壁层次及各层次的特点、手术切口选择的基本原则、腹部分区及腹腔脏器体表投影、腹部体表标志）
2.体内脏器或组织离开其正常解剖部位，通过先天或后天形成的薄弱点、缺损或孔隙进入另一部位，称为疝。疝多发生于腹部，以腹外疝为多见。腹外疝是由腹腔内的脏器或组织连同腹膜壁层，经腹壁薄弱点或孔隙，向体表突出而致。腹内疝是由脏器或组织进腹腔内
间隙囊内而形成，如网膜孔疝。请结合腹部的解剖特点，分析腹部哪些部位容易发生疝，为什么？
3. A 22-year-old man prents to the hospital 1 hour after sustaining two stab wounds during an altercation. On examination, the patient appears intoxicated and grimaces during manipulation of the wounds. His temperature is 36.8°C , pul rate 86 beats/min, blood pressure 128/80 mm Hg, and respiratory rate 22 breaths/min. A thorough physical examination reveals two stab wounds. One wound is located at the anterior axillary line, 1 cm above the left costal margin; the cond wound is located 4 cm left of the umbilicus. There is no active bleeding from either wound site. The breath sounds are prent and equal bilaterally. The abdomen is tender only in the vicinity of the injuries. The patient claims that the knife ud in the attack was approximately 12.7 cm in length.
Question:
1）What are the potential injuries?
2）稻香歌曲What is your next step?
第二节课
1.根据肝内管道配布及组织学特点，讨论为满足临床工作需求，应如何对肝进行分叶分段？
2.胃十二指肠溃疡非手术治疗无效或并发穿孔、出血、幽门梗阻、癌变时拟行胃大部分切除术。结合胃的解剖学特点，请讨论：
1) 术中哪些血管及相关腹膜结构需处理？
2) 若患者已发生癌变，术中可能要对哪些淋巴节进行清理？
宝山石头城3) 胃大部分切除后（胃远段和十二指肠近段切除），要重建消化道连续性，请讨论残胃端可能与哪段肠管进行吻合，如何吻合？
3.结合脾的位置、毗邻及血供，试讨论临床行脾切除时可能的操作步骤。
盆部、会阴讨论容：
1. 盆筋膜及其间隙与腹壁层次的关系。
2. 对盆腔脏器起承托作用的结构有哪些？各有何功能？若这些结构受到破坏或功能异常可能导致什么疾病。
驴肉火烧热量
3．A 50-year-old female who has borne five children complains that she has noticed vaginal spotting of blood after intercour for approximately the past 6 months. More recently, she has had a foul smelling vaginal discharge and indicates that her left leg ems larger than her right one. She previously had syphilis. She has smoked one pack of cigarettes per day for 20 years. Examination of her back shows left flank tenderness. The circumferences of her left thigh and calf are larger than tho of the right. Pelvic examination shows normal female external genitalia and a 3-cm growth on the surface on the left lip of the uterine cervix.
