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1、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。,Adipose tissue (fat)脂肪,Nipple乳头,Areola乳晕,乳腺Milk glands,结缔组织Fibrous tissue,1,t课件,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称为腋尾。,Axillary tail(Tail
2、 of Spence),2,t课件,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.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.,3,t课件,The pectoralis major and minor m
4、uscles 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 allowing a wom
5、ans 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触到包裹乳腺的浅筋膜的深层。,4,t课件,The arterial blo
6、od supply to the breast originates from branches of the axillary, internal thoracic and subclavian arteries. The venous drainage of the breast empties into branches of the internal thoracic, axillary and intercostal veins.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。,5,t课件,Lymph is a fluid that filters between
7、 the cells of tissue and then drains into its own set of transport channels. Lymph fluid may carry infectious 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. Sma
8、ll lymphatics drain into larger lymphatics and eventually all the lymphatic fluid empties into one of the 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 substa
9、nces from the lymph fluid. 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。,6,t课件,The majority of the lymphatic fluid from a breast drains to the ipsilateral axilla. The ax
10、illa is rich in both lymphatic channels and lymph nodes. A small portion of the 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。,7,t课件,For convention the
11、axillary lymph nodes are divided into three groups:,1.Pectoral or level 1(inferior to pectoralis minor attachment)第一站淋巴结（胸小肌下）,2. Central or level 2(posterior to pectoralis minor attachment)第二站淋巴结（胸小肌后）,3. Apical or level 3(superior to pectoralis minor attachment)第三站淋巴结（胸小肌上）,8,t课件,It is believed th
12、at 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 then to the level 3 axillary nodes. 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。,9,t课件,The glands of the breast are arranged into collections called lobules. The s
13、ecretions of the glands of each lobule drain into a tube called a lobular duct.乳房的腺体结合成小叶. 小叶腺体的分泌物流入小叶管,Lobule,Lobular duct,10,t课件,Many lobules together form a lobe of the breast. The duct that carries the secretions from all the lobules in a lobe is referred to as a lobar duct. 许多个小叶汇聚成乳叶. 小叶分泌物汇聚
14、流入乳管.,Lobar duct,Lactiferous sinus(ampulla),Lobe,11,t课件,A breast contains 15-18 lobes and therefore 15-18 lobar ducts. The lobar ducts are also referred to as lactiferous ducts. Each lactiferous duct has an opening on the surface of the nipple. There is a dilated region in each lactiferous duct just
15、 deep to the surface of the nipple. This dilated area is referred to as the ampulla.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.,Lobular duct,Lobar duct(Lactiferous duct),Lobule,Ampulla,Nipple,12,t课件,Over time, due to factors scientist poorly understand, the c
16、ells 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 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
17、removed from the breast and then examined under a microscope.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.,13,t课件,In a normal duct 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层细胞。这些细胞有相似的
18、大小和形状,14,t课件,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 to as hyperplasia. In this case the specific term would be ductal hyperplasia This condition confers no increase risk fo
19、r developing breast cancer.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,15,t课件,Sometimes the excess growth within the duct includes some very abnormal or atypical cells. This condition is referred atypical ductal hyperplasia or ADH. The presence of this condition in a womans breast increases her risk of deve
20、loping 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 cell. 有时，额外的细胞包括不正常或不典型的细胞。这些细胞增加了妇女得乳腺癌的风险。单个来说，这些不典型细胞类似癌细胞。,不典型增生,16,t课件,If there are many atypical cells the enti
21、re 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 cells are only located within the duct and have not spread out of the affected duct. Some physicians refer to
22、 this condition as a “pre-cancer”. This is incorrect, this is indeed a localized breast cancer.如果乳管内有许多不典型细胞，直至整个乳管都充满了不正常不典型的细胞。这其实是早期的乳腺癌。称为乳管内原位癌。,乳管内原位癌 DCIS,17,t课件,If DCIS is not treated the cancer cells will eventually break out of the duct and invade the breast tissue. This is referred to as
23、invasive ductal carcinoma. 如果原位癌没有得到治疗，癌细胞会最终突破乳管，侵犯乳腺组织。称为浸润性乳管癌。,浸润性乳管癌,18,t课件,If excess growth occurs in the lobules the condition is referred to as lobular hyperplasia. Atypical lobular hyperplasia may also develop. If Atypical lobular hyperplasia progresses in severity a condition referred to a
24、s lobular carcinoma in situ or LCIS may develop. This condition is very different from DCIS.也会发生小叶增生以及不典型小叶增生。小叶增生发展到严重程度称为小叶内原位癌。,Lobular hyperplasia,Atypical lobular hyperplasia,19,t课件,BIRADS*乳腺影像报告数据系统(Breast Imaging Reporting Data System),Standard descriptors to identify findings of辨别影像发现的标准描述Masses 肿块Calcifications钙化Abnormalities 不正常影像发现Impression and assessment印象和评估Categories: 0-5,20,t课件,012345,Category,Assessment,Recommendations,BIRADS,21,t课件,乳腺癌的外科治疗,Lumpectomy肿块切除术,Quadrantectomy象限切除术,Modified RadicalMastectomy乳房改良根治术,Radical Mastectomy乳房根治术,22,t课件,
