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2015八年制局解讨论内容汇总

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 adverse 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。

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. Case Discussion

A 35-year-old woman complains of a 2-month history of hoarseness of her voice and some choking while drinking liquids. She denies viral illnesses. She underwent surgery for a cold nodule of the thyroid gland 9 weeks ago. Her only medication is acetaminophen with codeine. ( Cold nodule: A region of the thyroid gland that does not take up hot iodine radioisotope (as visualized with thyroid scintigraphy) because 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.

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 course of the different branches of the vagus nerve (cranial nerve [CN] X) that innervate the larynx.

5) Be able to describe the consequences of injury to the recurrent laryngeal nerve and contrast with the consequences 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 hoarseness of his voice for about 3 weeks and had attributed these symptoms to an upper respiratory infection. He denies the use 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 cause?

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 presents 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 , pulse 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 second wound is located 4 cm left of the umbilicus. There is no active bleeding from either wound site. The breath sounds are present and equal bilaterally. The abdomen is tender only in the vicinity of the injuries. The patient claims that the knife used in the attack was approximately 12.7 cm in length.

Question:

1)What are the potential injuries?

2)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?

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。

3.A 50-year-old female who has borne five children complains that she has noticed vaginal spotting of blood after intercourse for approximately the past 6 months. More recently, she has had a foul smelling vaginal discharge and indicates that her left leg seems 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 those 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.

Question:

1)What is the most likely diagnosis?

2)What is the applied clinical anatomy for this condition?

Objectives

1)Be able to describe the anatomy of the ovaries, uterine tubes, uterus, and upper vagina, including changes in their epithelial lining.

2)Be able to describe the anatomy of the lateral uterine support structures and related organs. 3)Be able to draw the lymphatic drainage of the uterus and upper vagina.

上肢讨论内容:

1.试分析臂丛及其分支易发生损伤的部位及受损后可能出现的症状。

2. 结合腋窝淋巴结分布及引流关系,讨论其与乳腺癌淋巴转移的关系,并分析乳腺癌腋窝淋巴结清扫时如何寻找相应淋巴结,邻近哪些结构容易受损,受损后症状。

3. 指蹼间隙感染可能的蔓延部位。

下肢讨论内容:

1.结合下肢的解剖特点,分析下肢容易发生周围血管病变的可能原因。(基础知识:血管病变?下肢的血管配布,下肢血管的血流动力学特点)

2.结合髋关节周围的结构配布,试分析临床对髋关节病变患者行髋关节镜或其它侵入性操作时可选择哪些入路,分别经过哪些层次?并讨论各自的优缺点。(基础知识:髋关节组成及结构特点,髋关节与周围结构的毗邻关系,经髋关节的断层解剖学知识)

3.结合下肢的功能与解剖,讨论为何下肢发生周围神经损伤的机率较上肢的小,并进一步分析若支配下肢的神经发生损伤,其可能的原因及相应的损伤后症状。(基础知识:下肢神经的来源、分支、行程、毗邻和支配关系;下肢肌的功能)

4.腘窝内感染扩散的可能途径。(基础知识:下肢的筋膜间隙及连通关系。此题课后讨论。)

脊柱区讨论内容

1.讨论颈肩痛和腰腿痛与脊柱区相关结构的可能联系。

2. A 54-year-old man complains of lower back pain that radiates down the back of his right leg. He states that the pain is worsened by coughing or lifting but relieved by lying down. He denies trauma to his back. On examination, the strength and sensation of his lower extremities are normal. During the examination, while the patient is lying on his back (supine), the patient complains of severe pain when his right leg is raised by the clinician.

Question:

1)What is the most likely diagnosis?

2)What is the anatomical mechanism for this condition?

Objectives

1)Be able to identify the features of a typical vertebra and the intervertebral joints.

2)Be able to label the components of the spinal nerve from spinal roots to primary rami.

3)Be able to locate sites where components of the spinal nerve can be compressed.

4)Be familiar with the dermatomes and the landmarks of the lower extremity.

3. 结合脊柱区的解剖特点,讨论肾手术时腰部斜切口的层次及手术时的注意事项。