生理學報告2走近闌尾剖析

1、闌尾,周二11組 許涵濛 易澍,外科醫(yī)生躺在一張臨時搭出來的竹床上，他的妻子坐在旁邊的藤椅里，他們的兩個孩子，我哥哥和我，并肩坐在一條長凳上，聽我們的父親在說每個人肚子里都有的那一條闌尾，他說他每天最少也要割掉二十來條闌尾，最快的一次他只用了十五分鐘，十五分鐘就完成了一次闌尾手術(shù)，將病人的闌尾唰地一下割掉了。我們問，割掉以后怎么辦呢？ “割掉以后？”我父親揮揮手說，“割掉以后就扔掉?！?“為什么扔掉呢？” 我父親說：“闌尾一點屁

2、用都沒有。”……我父親看了我一會，說：“你說得也對，你們說得都對，肺，胃，心臟，還有十二指腸，結(jié)腸，大腸，直腸什么的都有用，就是這闌尾，這盲腸末端上的闌尾……你們知道闌尾有什么用？” 我哥哥搶先學父親的話說了，他說：“闌尾一點屁用都沒有?！?The appendix (or vermiform appendix; also cecal [or caecal] appendix; vermix; or vermiform proce

3、ss) is a blind-ended tube（盲管） connected to the cecum（盲腸）, from which it develops embryologically. The cecum is a pouchlike structure（囊袋狀結(jié)構(gòu)） of the colon（結(jié)腸）, located at the junction of the small and the large intestines

4、（大腸和小腸）.The term "vermiform" （蠕蟲狀的）comes from Latin and means "worm-shaped".,The appendix was first depicted in Western medicine by Leonardo Da Vinci in his dissection sketches in 1492.A valve for t

5、he cecum?,所處位置 location,The appendix is usually located in the lower right quadrant of the abdomen（下腹）, near the right hip bone（髖骨）. The base of the appendix is located 2 cm beneath the ileocecal valve（回盲瓣） that sep

6、arates the large intestine from the small intestine. Its position within the abdomen corresponds to a point on the surface known as McBurney's point（麥氏點）.,umbilicus臍 anterior superior iliac spine髂前上棘,While the base

7、of the appendix is at a fairly constant location—2 cm below the ileocecal valve, the tip of the appendix can be variably located—in the pelvis（骨盆）, outside the peritoneum（腹膜） or behind the cecum.,The human appendix

8、averages 9 cm in length but can range from 2 to 20 cm. The diameter of the appendix is usually between 7 and 8 mm.,結(jié)構(gòu) structure——“酒壇子”,到了晚上睡覺的時候，我們經(jīng)常聽到他埋怨我們的母親，他說： “說起來你給我生了兩個兒子，其實你是生了兩條闌尾，平日里一點用都沒有，到了緊要關(guān)

9、頭害得我差點丟了命?！?Although it has been long accepted that the immune tissue surrounding the appendix and elsewhere in the gut—called gut associated lymphoid tissue（腸道相關(guān)淋巴組織）—carries out a number of important functions, explana

10、tions were lacking for the distinctive shape of the appendix and its apparent lack of specific importance and function as judged by an absence of side effects following its removal. Therefore, the notion that the append

11、ix is only vestigial（退化的，殘余的） became widely held.,Maintaining gut flora 腸道菌群的避難所,William Parker, Randy Bollinger, and colleagues at Duke University proposed in 2007 that the appendix serves as a haven for useful bacteria

12、 when illness flushes those bacteria from the rest of the intestines. This proposal is based on a new understanding of how the immune system supports the growth of beneficial intestinal bacteria, in combination with man

13、y well-known features of the appendix, including its architecture, its location just below the normal one-way flow of food and germs in the large intestine, and its association with copious amounts of immune tissue. Res

14、earch performed at Winthrop University-Hospital showed that individuals without an appendix were four times more likely to have a recurrence of Clostridium difficile colitis(梭菌結(jié)腸炎),The appendix, therefore, may act as a “

15、safe house” for commensal (“good”) bacteria. This reservoir of gut flora could then serve to repopulate the digestive system following a bout of dysentery（痢疾，腹瀉） or cholera（霍亂）.,The appendix has more recently been identi

16、fied as an important component of mammalian mucosal immune function（哺乳動物的黏膜免疫功能）, particularly B-lymphocyte-mediated（由B淋巴細胞介導的） immune responses and extrathymically derived T-lymphocytes（胸腺外起源的T淋巴細胞）. This structure hel

17、ps in the proper movement and removal of waste matter in the digestive system, contains lymphatic vessels（淋巴管） that regulate pathogens（病原體）, and lastly, might even produce early defences that prevent deadly diseases. Add

18、itionally, it is thought that this may provide more immune defences from invading pathogens and getting the lymphatic system's B and T-cells to fight the viruses and bacteria that infect that portion of the bowel（腸）

19、and training them, so that immune responses are targeted and more able to reliably and less dangerously fight off pathogens.,Lymphatic system 免疫系統(tǒng)的一部分,常見闌尾疾病——急性闌尾炎,臨床表現(xiàn)常見病因并發(fā)癥目前主要治療方法,1、急性闌尾炎——臨床表現(xiàn),①腹痛：典型的急性闌尾炎早期階段為中

20、上腹和臍周疼痛，疼痛感較彌散，常常不能確切定位，但數(shù)小時后腹痛轉(zhuǎn)移并固定于右下腹。②胃腸道癥狀：在早期可能由于反射性胃痙攣而有惡心、嘔吐等癥狀。③多數(shù)病人白細胞和嗜中性粒細胞計數(shù)增高。（細菌感染）,1.梗阻闌尾為一細長的盲管，梗阻會使管腔內(nèi)壓增高，壓迫闌尾壁阻礙血液向遠端運輸，致使闌尾粘膜受損。在此基礎(chǔ)上管腔內(nèi)細菌侵入受損部位，引發(fā)感染。2.感染闌尾腔因與盲腸相通，因此具有較多的大腸桿菌和厭氧菌。若闌尾黏膜稍有損傷，細菌侵入

21、管壁，引起不同程度的感染。,2、急性闌尾炎——常見病因（1）,3.胃腸功能障礙胃腸道功能障礙引起內(nèi)臟神經(jīng)反射，導致闌尾肌肉和血管痙攣，若超過正常強度，可以產(chǎn)生闌尾管腔狹窄、血供障礙、黏膜受損，細菌入侵而致急性炎癥。4、其他因素飲食習慣、遺傳因素等,2、急性闌尾炎——常見病因（2）,3、急性闌尾炎——并發(fā)癥,1.腹膜炎  （21%）在機體有一定的防御能力時，穿孔附近的腸系膜等可迅速黏附穿孔處，使穿孔受到局限。若病人缺乏這種