DAI HOC Y DOC THANH PHO HO CHI MINH

BO MON GIAI PHAU HOC

BAI GIANG
47
-

BIAI PHAU JJ Cc
Chu bien: NGUYEN QUANG QUYEN

\it NHA XUAT BAN Y HQC

 DAI HOC Y DOC THANH PHO HO CHI MINH
HO MON GIAI PHAU HOC

rid t4t e7n.

BAI GIANG

GIAI PHAU HOC

TA P 2

THAN MINH - NGUC BUNG - THAN KINH TRUNG UONG

PHAU HOC DAI CUONG
In 1An thtmu fi btin
Co be sung va seta chaa

NHA XUAT BAN Y HQC

Chi nhanh Thanh ph6 H6 Chi Minh
2012 1-7 - 0 (c./ - coo
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 CIIU BIEN
NGUYEN QUANG WYE N

BAN BIEN SOAN

LE VAN CIJdNG D!kJNG VAN HAI

VO VAN HAI NGUYEN THIN HUNG
TRAN HUNG NGO TRI HUNG
PHAN BAO KHANH NGUYEN QUANG QUYEN
NGUYEN HOANG VAN LUVNG THI BACH VAN
NGUYEN TRUNG VINH
 Lai not clan
(Ldn xudt bdn thd nam)

Cudn 13ai gifing giai phltu hQc" dupe soon rot tinh gian theo chuang
trinh hoc czia sinh vien he dai han ccic Twang Dai hoc Y Khoa a Viet Nam.
Stich dttor stip xep lam hai tap. Tap I gdm ccic chuang chi tren, chi ditai va
detu mat co. Tap II Om ccic chuang ngdc, bung, thein kink trung uong va giai
phdu hoc dai cuang. Phdn dai cuong trinh bay lai he theing cdc ca quan de bd
sung cho nhdng phdn truck &tor trinh bay theo wing.
Cdc danh tit vet not dung cdc dank tit claw set dung ham town theo
ban dank tit gidi phau qudc to Nomina Anatomica (N4) vet dich chzi yeu
theo cudn Tit dien gidi phau hoc (4 thd tieng : La tinh, Anh, Phdp, Viet)
ctia Nguyen Quang Quyen (Nhet Xudt &in Y hoc, 1983) co stia ddi dOi chzit
khi cdn thiet cho sat nghia han voi nguyen &in tieng La tinh. Ben canh
mai to tieng Viet deu c6 dui thich trong ngoac don tit La tinh tucmg
Cudi mot tap scich co kin chi ddrz tra cdu tieng Viet vet tieng La tinh.
Sau lczn tdi bdn thd ba, theo y hien czia nhieu ddng nghiep vet ban
doc, ngoeti viec sda chz7a nhang ch5 in sai, cluing toi dei them phdn muc
tiett trung gian ctia mon gidi pilau hoc vet muc tieu chuyen biet ctia tang
bdi gicing vcio phdn ddu ctia mji bed va a cudi m6i bai, c6 cdc can It&
tree nghiem theo clang cau tra lai chon hca (MCQ) de sinh vien co the tz/
hoc vet ttt ddnh gid dttqc. Ngoai ra de cudn scich horn chlnh han chting
tOi del cho in trztac m6i beti mot hinh mew tong hap chup tren xdc (cha
yeu lay theo Rouviere) vet ccic s6 lieu gidi pluiu tren netai Viet Nam
nham muc dich tham khdo.
Trong ldn tdi bdn thd W vet dui nam nay, B I S Ngo Tri Hung dei
g6p sac trong viec chzi thich cdc hinh mau vet PTS Le Van Chung da cho
cdc s6 lieu net& Viet Nam trich trong cudn luan an PTS diet minh. BS
Pham Dang Dieu vet BS Nguy'gn Van Ddc (BO mon Gidi phau hoc
TTDTBDCBYT theinh phd Hd Chi Minh) dei bd sung them nhieu cau
trdc nghiem MCQ vet g6p y szta nhang sai sot czia Mn in truck. Xin hoan
nghenh vet than thank cam an nhang clang gop quY bdu dd.
Cluing tai cling bay to long biet an Nhet Xudt bdn Y Hoc del cho tdi
bdn Mn thd nam cudn sack nay.
Thetnh pito Hd Chi Minh, tilting 911995
Nguygn Quang QUygn
 Ltd not din
(Xuat ban Mn tha mu'ai ba)

BO sach Bai giang Gidi Phdu Hoc do co- Pho Gicio su Nguyen Quang Quyen cha
bien vai su tham gia bi'en sown caa cac nha gicti phda giau kinh nghiem va su
gOp sac caa tap the can 130 nhan vien BO mon Gidi Phu Hoc Dai hoc Y Daac
Thanh phor Hd Chi Minh. BO sach du'ac xuat ban Mn ddu tien vao ncim 1985,
qua 12 ldn tai ban, bO sach la sach gicio khoa gid i phdu caa Dai hoc Y Du'ac
Thanh phd Hd Chi Minh vet la mot tai lieu gidi phclu quan trong, clacc sa dung
tham khdo tai cac tru'ang dgi hoc y khoa trong mak.
BO sach Bai gidng Gidi Phau Hoc co 2 tap cho ddi tu'ang sinh vien clai hoc g 'dm
cac chuyen nganh bac si y khoa, bac si rang ham mat, bac si nganh y hoc co
truy'en, y to tong Ong va duet si. Ngoai ra bO sach con phut vu ciao tgo he ca
nhan cac chuyen nganh y hoc va cac chuyen nganh khcic lien quan den khoa hoc
sac khoe.
Qua nhieu lan tai ban BO sach da duac be sung saw chaa de ngay tang hoan
thien hon. Dac biet trong . Mn tai ban nay, tap the Ccin 190 gidng BO mon Gidi
Pau Hoc, trong do c6 nhiu can bO gidng tre da tham gia tech cu'c trong tong
tac saa chaa cac loi va thie'u sot, co bo9 sung, chinh saa mot so bai gicing cho
hoan chinh hon va ve lgi mot so hinh chaa ra, chu'a dep del lam tang ch'dt ktorng
caa cac bai gidng nhu bai yang ben, trung that, runt non, runt gia,... Scip xe'p lgi
tha tu, phan nh6m mot so bai gicing cho pha hap hon nhu' cac phdn khdi xu'ang
so, khoi xu'ang mat.
Vdi sy phcit trien caa khoa hoc, mot cuo'n sach can phdi du'ac be sung, saa chaa
lien tuc de" cap nhat kie'n that mai. Do do, chang toi xin quY thdy co, quY ddng
nghiep, cac hoc vien va cac em sinh vien dong g6p y /din de BO mon Gidi Phdu
Hoc saa chaa, bo9 sung cho tap sach ngay tang hoan thien hon trong lan tai bcin
sau. Chang toi xin cam on sy (long g6p quy bciu do. Chang Eiji cling rat cam on
Nha xuat bcin Y hoc, chi nhcinh Thanh phd .1--pd Chi Minh, la nai da giap hie‘u
dinh va saa chaa qua nhi'Ju lan xuat
Thanh phd Hd Chi Minh, ngay 16 thcing 5 nam 2011
Chu nhiem 1130 mon

PGS.TS. Le' Van Cutting

5
 MUC LUC
Trang
Lari not detu 7

PHAN IV - THAN MINH

28 Xtiong va khdp cila than (3 ti6t) 9

29 Ca ctia than, ca hoanh (4 ti6t) 28
30 Ong ben (1 ti6t) 50

PHAN V - NGIJC

31 Ph6i (2 ti6t) 60
32 Tim (3 ti6t) 75
33 Trung that (1 ti6t) 93

PHAN VI - BUNG

34 Da day (2 ti6t) 102

35 Lach (1 ti6t) 114
36 Ta tang va tuy (3 ti6t) 119
37 Gan (4 ti6t) 133
38 RuOt non (2 ti6t) 154
39 Ruat gia (3 ti6t) 168
40 Than va tuy6n thuong than (2 ti6t) 183
41 Nie‘u quan, bang quang, nieu dao (3 ti6t) 201
42 Ca quan sinh due nit (3 ti6t) 222
43 Ca quan sinh duc nam (2 ti6t) 242
44 Day chat! (1 ti6t) 256
45 Phtic mac phan khu 6 bung (4 ti6t) 270

PHAN VII - THAN KINH TRUNG tiCiNG

46 Tay gai (2 ti6t) 301

47 Tram nao va trung nao (3 ti6t) 312
48 Gian nao (2 ti6t) 325
49 Doan nao (4 ti6t) 334
50 He than kinh tu chi" (2 ti6t) 355
51 Mang nao tuy (2 ti6t) 363
52 Mach nao tuy (2 ti6t) 376

7
 PHAN VIII - GIAI PHAU DAI CUCING

53 Thy gai (1 tie-t) 387

54 Tram nao va trung nao (1 tie-t) 402
55 Gian nao (1 tigt) 412
56 Doan nao (2 tie-t) 419
57 He than kinh tit chil (1 tie-t) 438
58 Mang nao thy (1 tie-t) 446
59 Mach nao thy (1 tie-t) 452
60 He than kinh tit chii (1 tigt) 460
61 Mang nao thy (1 tigt) 465
62 Mach nao tily (1 tie-t) 485
Phu luc 492
Bang tra kii cac cau trAc nghWm 532
Bang chi dAn tra cdu tigng VWt 542
Bang chi dan tra exit' tie-ng Latinh 568

8
 PHAN IV THAN MINH

28 CAC XUONG VA KHOP CCJA THAN

MIX TIEU BAI GIANG

A. MUC TIEU LY THUYET
1. MO to dac di6m chung caa cac d6t song va dac di6m rieng cua cac clot song a tang doan
c6, ngac, that lung, cung nha cua mot vai d6t s6ng dac biOt.
2. Phan bit &roc d6t s6ng co, d6t s6ng ngac va d6t s6ng that lung.
3. MO to cac doan cong cua OA song de giai thich sa phat tridn cac doan cong do thich
nghi vdi tit the dung th'ang cua ngudi.
4. Neu cac dac di6m caa tang d6t s6ng va tang doan d6t song thich nghi vdi chile nang
cua clning.
5. MO to sit lien k6t giCia than cac d6t s6ng.
6. M6 to vi tri, dac di6m caa xuang uc, wong sun, sun satin.
7. K6 ten cac ,khdp cua king ngac.
B. MUC TIEU THVC TAP
1. Chi du'oc tren xu'ong, phim X quang cac dac di6m chung cua cac d6t s6ng.
2. Nhan bigt du'oc d6t s6ng d tang doan cot song cang nha nhung d6t s6ng dac bi6t.
3. Chi daoc tren xu'ong cac chi tiel giai phAu cna xaong de.
4. Dat cac xu'ong satin dung vi tri cua no va chi du'oc cac chi ti6t giai phau quan trong.
5. Chi du'oc hinh anh binh thudng caa cot sting va khdp giva cac than d6t song tren phim X quang.
6. Xac minh mom gai cua d6t song c6 VII va tang xu'ong satin tren ngu'di s6ng.

Xacrng caa than ngurdi gom c6 : cot s6ng nha mot cai true chinh der than minh. )(acing de
va cac xu'ong sadn hop vdi cac d6t s6ng ngac tao thanh long ngac. Ngoai ra can c6 2 xuang
chau (da hoc a phgn xu'ong chi dadi) hop vdi xu'ong cling thanh khung chau. Cac xuang do khdp
vdi nhau thanh cac khdp.

9
 COT SONG

C5t song (columna vertebralis) la mot cot xutrng dai uon 6o tit mat &red xuting cham den
hgt xuong cut. C5t s6ng bao boc va bao ve tuy gai.
Nhin nghieng cot song co 4 doan. cong : doat c6 161 ra trudc, doan ngut 15i ra sau, doan
that lung 15i ra trudc va doan cangl5i. ra sau (H.28.1). Cali trite 4 doan cong nay thich nghi vdi
to the dung thang cua nguari, trong khi d d5ng vat 4 char' thi chi co in5t, doan cong xu6ng dudi.
Crit song có tit 33 deli 35 d6t s6ng (vertebra) x6p ch5ng len nhau.
Doan t hgt lung

o („z

A. NHiN SAU B. NHIN BEN C. NHiN TRU6C

Hinh 28 1 : COt song
10
 24 d6t tren thi nhau tao thanh 7 d6t song c6, 12 d6t song nguc va 5 d6t s6ng thdt
lung, 5 d6t tiep dudi dinh lai lam mot tao thanh xuung cung va 4 hoac 6 d6t cu6i cung rat nho
va can c6i cf.-mg dinh tai lam mot tao thanh xucrng cut.

1. CAU TAO CHUNG CtA MOT DOT SONG

MOt d6t song not chung co nhang thanh phan sau day (H.28.2)
1.1. THAN DOT SONG (corpus vertebrae) hinh tru, co 2 mat : tren va durdi, hal lam d gifia
va mot vanh xuang dac d xung quanh.

Manh cung cf6t song

MO khdp Iran

Mom ngang Cu6ng cung

d6t s6ng

Than d6t s6ng

A. NHIN TREN

Mc3m khdp tren

H6 Wan ngang

Mom gai

H6 sddn du'di
Khuyet seing du'ai
Mom khdp du'di
B. NHIN BEN
Hinh 28.2 : Dot song ngzic
11
 1.2. CUNG DOT SONG (arcus vertebrae) ding vdi than d6t song tao thanh 16 d6t s6ng
(foramen vertebralis). Cung d6t s6ng g8m 2 manh cung d6t song (lamina arcus vertebrae) va 2
cu6ng cung d6t song (pediculus arcus vertebrae). Hai b6 tren va dUdi cUa m6i cu6ng c6 khuye't
s6ng tren (incisura vertebralis superior) va khuye't song du'ai (incisura vertebralis inferior). Khi
2 d6t song khdp nhau thi cac khuygt do tao thanh 16 gian d6t s6ng (foramen intervertebrale) de'
cho day than kinh gai s6ng chui ra.
1.3. CAC MOM. TU cung d6t sting ch6i ra cac mom nhu' sau :
1.3.1. MOm gai (processus spinosus) tit giaa mat sau cda cung d6t song chay ra sau va
xu6ng duari.
1.3.2. MOm ngang (processus transversus) tit ch8 n6i giga cu6ng va manh di ngang ra
phia ngoai.
1.3.3. MOrn khdp. M6i d6t song c6 4 mom : 2 mom khdp tren (processus articularis
superior) va 2 mom khdp duai (processus articularis inferior).
Cac mom nay cung moc ra tit ch6 not gifita cu6ng va manh cua cung d6t song. M6i mom c6
mot dien khdp de' khdp yeti d6t s6ng lie- can.
1.4. LO DOT SONG (foramen vertebral& duvc gidi han phia tru6c beii than d6t s6ng, d hai
ben va phia sau bdi cung d6t song. Khi cac d6t song ghep1ai thanh cot s6ng thi cac 16 d6t song
tao thanh 6ng song (canalis vertebralis).

2. DAC DIEM RIENG CIJA TUNG LOAI DOT SONG.

Thy theo chile nang cua tUng doan cua cot song ma cac d6t song co nhiing dac didm rieng.
2.1. CAC DOT SONG CO (vertebrae cervicales) (H.28.3).

Dian khdp dudi M6m gai

L6- do-tseing

C6 mom ngang
CO sau
dot song c6

CO trcidc Than d6t s6ng

dot song co

Hinh 28.3: Dolt song co

2.1.1. Bac diem chung cua cac clot song ce.
Than det be ngang, day phia tru'dc hem phia sau.
Cu6ng torch ra tit phan sau clia/ mat ben than d6t s6ng va khuye't song tren va du'ai deu
sau bang nhau.

12
 Manh hinh vuong va rOng hun cao.
Dinh ciia mom gai tach lam hai CO.
Mom ngang dinh vao than va cu6ng bai 2 re" gidi han nen met to goi la 18 ngang (foramen
transversarium) dg cho mach d6t s6ng chui qua. Dinh dia mom ngang tach lam 2 cu : cii track
d6t s6ng c6 (tuberculum anterius vertebrarum cervicalium) va ea sau d6t song c6 (tub erculum
posterius vertebrarum cervicalium). Mat tren cua mom ngang c6 ranh than kinh gai song
(sulcus n. spinalis).
MOm khdp co dien khdp phang nam ngang. Dien tren nhin len tren va ra sau. Dien dual
nhin xidng &Jai va ra trade.
LO d6t s6ng hinh tam gibe va rung horn a cac 10 d6t song ngac va that lung de cht.la doan
phinh c6 caa tay gai va thich Ling vdi bien de di Ong ldn cud doan s6ng c6.
NOi tom lai, ddc trttng quan trong nhat dg xdc dinh met d6t s6ng c6 la co to ngang.
2.1.2. Bac diem rieng cua mOt vai clot sang
B6n d6t song c6 c6 met vai ddc tru'ng rieng la d6t sting c6 I, d6t s6ng c6 II, d6t s6ng c6 VI
va d6t s6ng c6 VII.
2.1.2.1. D6t song co I con goi let ct6t song ctOi (atlat) (H.28.4) c6 ddc diem la khong co than,
nen c6 hinh nha met cal veng vdi 2 kh6i ben (massa lateralis) c6 h6 khdp tren (fovea
articularis superior) cid khdp vdi loi cau xuung cham va co h6 khdp daai (fovea articularis
inferior) de khdp vdi d6t song c6 II.
Hai ben dtrcic not nhau a phia trade bdi cung trildc (arcus anterior) va a phia sau bai cung
sau (arcus posterior). Phia tru'dc cung trade 10i ra thanh cu trade (tuberculum anterius) va phia
sau lOm thanh h6 rang (fovea dentis) de khdp vdi rang (dentis) cua d6t c6 II. C1 phia sau cung
sau 10i ra thanh cu sau (tub erculum posterius) va phia tren sat vdi kh6i ben c6 ranh Tang mach
d6t s6ng (sulcus arteriae vertebralis).

H6 rang Ranh ddng mach

dal song

H6 khdp tren Khoi ben

Hinh 28.4 : D6t sang co I (dO't song dOi)

13
 2.1.2.2. &it song cd II con goi là ddt song trig (axis) (H.28.5) la clot sang day va khOe
nhat trong cac clot sang co. 134c digm caa cl6t nay là co mat mom moc len tren than &St sang
goi la rang (dentis). Rang ducic coi nhu than dm clot dOi dinh vao dot true de lam true cho deft
dOi quay. O phia tru'6c rang co dien kilt) tru'erc (facies articularis anterior) dg khdp voi h6 rang
ciia dot dai va CO mat dien khdp sau (facies articularis posterior) dg khdp vdi day chang ngang
caa dot dal.
2.1.2.3. Ddt song co VI co dac digm la mom ngang 16i to ra thanh ca canh (tuberculuin
caroticum vertebrae cervicalis VI). Ca nay ngu to qua c6 the ellen vao Tang mach canh chung. N6
cling la moc gap go' caa dung mach canh chung vdi dOng mach giap dudi va dang mach dot

DiOn khdp trudc Rang

DiOn khdp tren

DiOn khop dudi

Hinh 28.5 : Deft song co II (dot song true).

2.1.2.4. .136/t song co VII c6 dac digm là mom gai khang the doi va dal han ra, soy ngay
thay clu'ac dudi da nen can goi la dot song 16i (vertebra prominens). L6 ngang rat nhO, co khi
'thong co. Deft song c6 VII nam a ranh gidi giaa doan sang c6 va doan sang ngu:c nen co nhidu
dac digm chuygn tiep gida dal sang c6 va dot song nguc.
2.2 CAC DOT SONG NGIIC (vertebrae thoraciae).
2.2.1. Dac diem chung caa cac dot sang ngurc Cac dot song nguc khdp vdi xu'ung atoll
va qua xuang su'an vdi xu'ang etc dg tao nen 16ng nglic do do mat dac digm quan trong caa d6t
sang ngiic là a m6i ben than dot song c6 2 ho- kii') là 116 satin tren (fovea costalis superior) va
h6 wan dudi (fovea costalis inferior) de kilo') vdi dau xuang
Nhang dac digm khac caa dot song nguc la than day hurl cac dot sang co, khuygt sang
du'ai sau hon khuygt sang tren (H.28.2).
Mom gai dai va chile xuang Judi vi doan sang ngu-c Ichang cu clang nhidu.
MOrn ngang c6 mat dien khdp goi la ha- wan ngang (fovea costalis tranversalis) de' khop
vdi ca mung wan.
Minn Ich6p co cac dien khop dung ngang nhin ra phia trade hoac phia sau.
L6 dot sang hinh an tran
Tom lai dac trung quan trong nhat dg xac dinh mat d6t song ngu:c la c6 h6 satin a mat
ben than dot sang.

14
 2.2.2. Dac diem rieng cua mOt so clot sang nglic.
—Dgt sting nguc I la cl6t chuygn tigp tit doan c6 sang doan nate nen có nhigu dac digm
giOng dgt c6 VII. Ngoai ra có cdc dac digm rieng la h6 stem tren là mOt, h6 tron ven dd khdp
vdi chOm xuong sudn I trong khi h6 stem 'lath chi la mOt, nt a h6 cid khdp vdi mOt, phan ch6m
xuang stem II.
—D6t sting nate X khOng có 116 sudn dudi.
—D6t song narc XI va XII chi co mot h6 stem dg khdp toan 130 vdi cdc xuang sworn Wang
dug. Cdc mom ngang kitting có h6 sworn ngang.

2.3. CAC DOT SONG THAT LUNG (vertebrae lumbales).

2.3.1. Bac diem chung ctia cac dot sang thdt 'ling (H.28.6). Do phai chgng del than
than va can chuygn thing nhigu nen the d6t song that lung co cd.c dac digm sau day :
Than rgt, ldn va Ong b6 ngang.
Cu6ng day va khuygt song Judi cung sau him khuygt song tren.
Mom gai co hinh chit nhat va hudng ngang ra sau.
MOm ngang dai dudc coi nhu mOt, xtiong stern thodi h6a nen goi là mOm sworn (processus
costarius). CI phia sau ch6 mom stem dinh vao cung d6t song co mOm phu (processus
accessorius).
MOm khdp tren det chigu ngang, co din khdp lam d mat trong va co mom num vu
(processus mamillaris) d mat ngoai. Mom khdp Judi co digit khdp 16i hinh try dg thich ung vdi
din khdp tha mom khdp tren.
L6 dgt song hinh tam gidc nhO lion 16 dgt song c6 va ldn han 16 &it song nguc. Tom lai, vi
d6t song that lung khong khdp vdi xtiong stem va khong có dOng mach &it sting chui qua 16
ngang nen dac trong dg xdc dinh mot dgt song that lung la khOng c6 h6 stein d ben than va
khong co 16 o mom ngang.
2.3.2. Dac diem rieng cua m(lt se; det sang thdt lung
—Dgt song that lung I co mOm satin kern phat tri6n han cdc dgt khdc.
—Dgt song that lung V thi co than day or phia trudc han phia sau, 2 mom khdp &rad each
xa nhau him d nhang dgt that lung khdc, mOm gai nhO nhat trong s6 cdc d6t, that lung.

2.4. XLICING CLING

Xuang cung (os sacrum) do 5 dgt song ding (vertebrae sacrales) dinh lai ma thanh.
Xuang ding khdp d tren vdi d6t sting that lung thil nam tao thanh mot goc 16i ra phia
trudc goi la u nho (promontorium). Hai ben khdp vdi xudng chau tao thanh chau hong. Xuang
ding hinh thap 4 mat, det trudc sau, nen quay len tren, dinh xugng dudi, có 2 mat là mat chau
hOng va mat lung, mot nen, mot dinh va hai phan ben (H.28.7 va H.28.8).

15
 Mom khdp tren

MOm khdp Judi

Mom sudn

La ddt seing

Than d6t song

A. NH/N TREN

Mom khdp tren

KhuyErt song tren

Khuye't song dudi

B. WIN BEN

Hinh 28.6: Dot song that lung

2.4.1. M4t ch4u hong (facies pelvina). mg nay quay ra phia trade (nen con goi la mat
tru'dc) nhin vac chdu hong vb. ltim. Co 4 &Ong ngang (lineae transversae) la vet tich ranh gidi
gitira cdc d6t song ding. O hal ben ddu cdc dating ngang la 16 ding chdu Wing (foramina sacralia
pelvina) de cho cdc nhanh track cua cdc day than kinh gal song cling chui ra.
2.4.2. A/W king (facies dorsalis) rat 16i va g6 ghe. Doc &ging giita la mao ding gifra (crista
sacralis mediana). Mao nay la do cdc mom gai cud. 4 d6t song ding tren tao nen. 0 ddu dual

16
mao tre dot tao thanh 2 sang cling (cornu sacrale). Giaa 2 sang là mot khe ha goi la 18 ding
(hiatus sacralis) thong vdi 6ng ding (canalis sacralis). CI hal ben mao ding gide( la mao cling
trung gian (crista sacralis intermedia). Mao nay do cac mom khdp cUa cac clot s6ng ding tao
nen. Phia ngoai mao la cac 16 ding lung (foramina sacralia dorsalia) de cho nganh sau cUa cac
day than kinh gai s6ng ding chui ra. Ngoai cac 16 cung lung la mao clang ben (crista sacralis
lateralis) do cac mom ngang cUa cac d6t song ding tao nen.

Nan xudng sang Mom khdp tren

Phan sau
k5-1kigiii:00gr dddng tan sting

L6 cOng Dudng ngang

chau hong

Hinh 28.7 : Xudng cling (nhin trlidc)

Gina mao ding giaa va hai mao ding trung gian la hal ranh ding do cac manh caa cac dek
ding dinh
2.4.3. Nen micing cung (basis ossis sacri) (H.28.9) Wong 1mg vdi mat tren cua dot s6ng
ding the nhat. Gina nen la ddu tren cUa 6ng ding.
Hai ben la mom khdp tren (processus articularis superior) de khdp vdi mom khdp (lath cila
d6t s6ng that lung that nam. Doting gdc trim lien tie-p giaa nen veil mat chau h6ng cUa xuang
ding tao nen phan sau ctia dung cung (linea arcuata) can xnang ch4u, ranh gidi giaa chau ldn
va chau nha.
2.3.4. PhAn ben (pars lateralis) hinh tam gidc ma an a tren va dinh d dudi. O phan
trudc nen co dien tai hay dien nhi (facies auricularis) de khdp vdi dien tutting 1mg cUa xuccng
chau. Phla sau dien nhi là ldi ca cling (tuberositas sacralis) (H.28.10).
17
 Mom khdp tren Ong cung

Mao cung ben

Mao cung trung gian
Mao cOng giCia

Ranh cung

L6 cOng

Sung cut )(acing cut

Hinh 28.8 : Xu'ung cling (nhin sau)

Ong cOng Mao cling giCia

Mc3m khdp trot?

Phan sau clueing tan cung

Hinh 28.9 : Nen xuong cung

2.4.5. Dinh 3c-tieing cung (apex ossis sacri) tie.p khdp vai nen xtiong cut bang mot din khap
hinh soan có dudng kinh ngang ldn. O nhang ngirdi ldn tu6i, khdp nay cling lai bang mo xuong.
2.4.6. Ong cling (canalis sacralis) lien tie-p vdi 6ng song va chda cac nhanh cua dual
ngua. Ong 'ding cid ti6t din hinh tam giac va thong vai cac 16 cung chau hong va ding lung bdi
4 16 gian d6t so-rig (foramina intervertebralia).

18
 Goo nh6

DiOn nhi

Mao cung giCia

L6 el:mg

Hinh 28.10 : Xuang cang (nhin ben)

2.5. XIIONG CUT

Xiang cut (os coccygis) durcic tao nen bai 4 den 6 cl6t song cut hic ddu rai nhau, sau dinh
lai lam mot (H.28.7 va H.28.8). Cac d6t sang cut nay rat can coi va dude coi nhu la di tich cda
cai duoi a cac load vat. Xizang cut cdng hinh thap 4 mat : mat chau hong, mat lung, hai mat
ben, mot nen va mot dinh.
Mat chau hong 16m, mat lung 16i, nen quay len troll va khdp vdi dinh xu'ung ding. Co hai
sting cut (cornu coccygeum) n6i vdi hai sting cling bai mot day chang.

)(YONG NGIJC
Nguc (thorax) dudc tao bai mot khung xuang g6m 12 dot song nguc, cac xudng stun va
xuang dc, khung nay quay lay mot khoang goi la 16ng ngtic (cavum thoracis) de chda cac tang
quan trong nhu' tim va pho'i (H.28.11).

19
 L6 fren long ngcc

Xudng Cc

Khoang
gian sudn

Ranh phdi
Cung su'o'n

Goc dudi Cc

Mom
mui kigm

LO duel lOng ngcc

Hinh 28.11 : ang ngcc

L6ng nguc giong nhu melt thung r6ng phinh a giaa. Khac vdi do, ng vat 4 chan ma 16ng
ngyc có du6ng kinh ngang be horn dieing kinh tru'ac sau, 16ng nguc u ngutii co du'6ng kinh
ngang ldn horn thing kinh trudc sau de thich nghi Arai ttt thg dCng thong. L6 tren 16ng nguc
(apertura thoracis superior) &roc gidi han bdi d6t song nguc tint nhat, miang subn the nhgt va
b6 tren can xuang Cfc. L6 dudi 16ng nguc (apertura thoracis inferior) ldn han, duqe gidi han Val
d6t song ngu:c thd mudi hai va xuang sutn thd mtto i hai u phia sau, sun sun thd bay not vdi
xuang Cc u phia trudc. Cl day hai sun su6n thil bay to thanh goc dual Cc (angulus
infrasternalis). Hai ben 16ng nate la cung su'6n (arcus costalis). Gida hai xuang sutin la khoang
gian akin (spatium intercostale). Trong 16ng nguc doc hai ben cot song la ranh ph6i (sulcus
pulmonalis) de chda phan sau cua ph6i.
I. XIANG WON. Cac xuang su6n (costae) g6m 12 doi là nhilng xuang demi, det, cong, a hai
ben 16ng nguc. Bay doi tren n6i true tie-p vdi Wang Cc bang sun rieng goi la xuang su6n that
(costae verae). Nam doi cu6i g6m 3 doi VIII, IX, X n6i vdi xuong tic nh6 sun satin thd bay va
hai doi XI, XII khong có sun n6i vdi xuang Cc. Nam doi cu6i nay ditqc goi la xuang sLiCfn gia
(costae spuriae).

20
 1.1. DAC DIEM CHUNG CUA CAC XU'ONG SCION. M6i xu'o'ng wan c6 mOt ddu, mOt co
va mkt than (H.28.12).
1.1.1. Ddu gain (caput costae) có mot din khdp (facies articularis capitis costae) Om hai
mat chech ngan each nhau bed mOt mao goi la mao ddu akin (crista capitis costae). Dien nay
tiep khdp yai h6 suan a mat ben than hai d6t song ke nhau.

Ranh stun

Than su'an

Dau
sudn
B. MAT NGOAI
Dau su'an

CO' seen

Goc su'ein Than saan

A. MAT TRONG

Hirai 28.12 : Xuang Stan

1.1.2. Co surdn (collum costae) la phdn thdt lai n6i tit &du subn tai cu akin. Boy tren co xia
xi goi la mao c6 su'an (crista colli costae) de cho day cha'ng suftn ngang tren barn.
1.1.3. Cu stidn (tuberculum costae) num a phdn sau ch8 not giiia co Ira than. C1 phia
trong cUa cu &fan c6 mOt dien khdp (facies articularis tuberculi costae). Dien nay 18i, hinh soan
ti'ep khdp vdi h6 wan ngang cua mom ngang d6t song.

21
 1.1.4. Than Wein (corpus costae) dai, det ya rat cong. Phan n6i giiia doan sau va doan
ben nho gap 141 tao thanh g6c &fan (angulus costae). TO' ch6 g6c nay than 'axing soan nho bi
van lam cho cac mat caa than xutng a phia sau hutng theo 2 mat phang nom ngang va a phia
trodc hoeing theo hai mat phang chgch.
Mat ngoai xu'ong stein thi nha'n va c6 co barn, con mat trong thi lam va doc theo phia bti
dudi co mot ranh goi la ranh wan (sulcus costae) trong c6 mach gian stern sau va nhanh trade
&la than kinh gian stern.
1.2. DAC DIEM RING CUA MOT VAI XIANG SIMIN DAC BIET.
1.2.1. Xtidng stein I : ROng nhat va nggn nhat, khong bi xoAn van va c6 hai mat tren va
dudi (H.28.13).
mat tren c6 hai ranh : ranh trade goi la ranh tinh mach dudi don (sulcus v. subclaviae)
va ranh sau goi la ranh dOng mach dudi don (sulcus a. subclaviae). Gifia 2 ranh la cu co bac
thang truck (tuberculum m. scaleni anterioris) O phia sau ranh dung mach dual dem la ch6 barn
cua co bac thang giita va car rang troac.
Mat dual khong c6 ranh so On

Cu soon

Xtfong soon II

Xuang soon I
Ranh dung mach dual clOn

Loi cu
cci rang truec Cu cc bac thang

Ranh tit-1h mach

dudi don

Hinh 28.13: Xudng Wan I vci II

22
 1.2.2. Kticing svidn II : CO hai mat ch6ch tren ngoai va dudi trong. O phan gifia mat tren
ngoai co lei cu co rang trudc (tuberositas m. serrati anterioris) de cho co ding ten barn vao
(H.28.13).
1.2.3. Xtking stain XI va XII : Dau soon chi có met mat khdp. Khong co co soon, cu su'an
va gOc wan. Xiiong saran much hai CO de dai rat thay del
1.3. SUN SIION. Sun attn. (cartilago costalis) tie-p not vdi than su'O'n 6 phia trutc de khdp
vdi xuang tic. CO hai mat trade va sau. Bay sun tren thi bam truc ti6p vao xtiong tic con ba sun
&ran VIII, IX va X thi barn vao xiiong tic gian ti6p qua sun soon VII. Hai )(dung soon XI va XII
kh6ng co sun ma lo lting nen con diroc goi la xuang soon cut.
Cac sun soon barn vao xuong tic d cac khuygt, soon.
Sun wan I barn vao xutng tic a can tic. Sun soon II a cho not gliita can va than tic va sun
suOn VII 6 ch6 not gicia than va mom mui kie-m.

Khuygt dOn
Khuye't clan

Dign khap vdi

sun sudn I
Can tic
Khuygt
tinh mach canh DiOn khap vdi
sun akin II

Cac khuyg&Ia
\n Dian khdp vdi
Than d'a sun &fan III,
IV, V

CIO khdp vdi

sun sudn VI, VII

MOm mOi kigm

Mom mOi kie'm

Hinh 28.14 : Xdang tic (nhin trade) Hinh 28.15 : Xu'ang tic (nhin ben)

23
2. WONG tIC Xu'dng tic (sternum) (H.28.14) là mot xticrng det nam a thanh trudc cua long
ngtic va g6m ba phdn : can tic (manubrium sterni), than tic (corpus sterni) va mom mai kie-m
(processus xiphoideus). Can tic va than tic hop nhau thanh g6c tic (angulus sterni) 16i ra phia
tilt& (11.28.15).
Xuong dc có hai mat : trudc va sau, hai bet ben va hai ddu : ddu troll hay day va ddu dudi
hay dinh.
Mat trudc hdi cong 16i ra trudc, có nhiing mao ngang là vet tich cita ch6 n6i 2 clot dc vdi
nhau.
Mat sau nhdn va cong lOm ra sau.
BO ben có bay khuyet akin (incisurae costalis) de khdp vdi bay sun strain.
Nen co khuyet tinh mach canh (incisura jugularis) o gitita va khuyet don (incisura
clavicularis) o hai ben de khdp vdi dau dc cUa xuang don.
Dinh mang va nhon nhu mot mai kiam nen goi IA mom mai kiam. Doi khi co thUng mot
16 goi là 10 mid kie-m. Thuting duoc eau tao bang sun.

CAC KHdP CCJA THAN

Cac xuang than duOc lien kat vdi nhau bai cac khdp. Cac dot sang lien ket vdi nhau bang
cac khdp gida than clot sang va cac khdp gida cac mom khdp dot sang. Cac 'co:mg suein lien ket
vdi cac dot sang bang cac khdp suan clot song (articulationes costovertebrales) va khdp sudn
ngang (articulatio costotransversaria). Cac xuong swain khdp vdi xuong dc bang cac khdp sic
(articulationes sternocostales). Xuong chau lien kat vdi nhau bang khdp ban dOng mu
(symphysis pubica) va vdi wiring cling bang khdp ding chau (articulatio sacroiliaca). Trong
pham vi gidi han ctia cuan sach, Chung to chi xet qua v6 khdp gida than cac dot song la khdp
quan tong va có nhieu y nghia hon ca.

KHOP GICIA THAN CAC DOT SONG

DO là mot khdp ban Ong sun

1. DIEN KHOP là mat tren va mat ducli ciia than hai dot sang kg nhau. Vi hai mat nay lOm
nen gitia hai mat khdp co dia gian d6t, sang.

2.Da GIAN DOT SONG (disci intervertebrales) cat' tao bang so sun có hinh than kinh hai
mat 16i. Co tat ca 23 dia nam then gida than cac dot sang W Tat c6 thu nhat tdi xuong ding.
Can cac dia gida cac Mt sang ding va dot sang cut thi da hoa )(acing va dinh lien lai thanh
mot xuong ding va mot xuong cut... Rienggida xuang ding va xuang cut thi van ton tai mot
khdp goi lA khdp cong cut (junctura sacrococcygea), thuang là mot khdp sun hoac mot khdp
hoat dich (khdp do, ng).
M6i dia g6m có hai phdn : phdn chu vi goi la yang sgi (anulus fibrosus) duoc cau tao bai
24
cac vong so sun d6ng tam rat dan h6i va phan trung tam goi la nhan dry (nucleus pulposus)
(H.28.16). Nhan thy ducrc cau tao bai mOt, chat rat dan hai va ca thg di chuygn trong yang sqi thy
theo vi tri eaa cac dgt sting. Thudng thi nhan nam gan boy sau hon. ba trade cUa dia gian d6t, nen
khi gap marsh than ngutri ra truac ca thg gay thoat vi dia ra sau day 16i vao trong gng sang.

Day chang yang Day chang

doc sau

Day chang
tren gai Dia gian d6t song
(nhan tay)

Day chang VOng soi

gian gai

Day chang
doc track
Khdp lien
mom khdp

Dien khdp cua L6 gian cl6t song

mom khdp dddi

Hinh 28.16 : Khdp giila than cac dot song

Dia gian dot song day va lan nhat a doan that lung. O doan c6 va doan that hung dia day
a phia truac hon phia sau Ira ngu'oc lai a doan nguc, vi vay doan co va that hung 16i ra trade va
ngu'oc 14i doan nguc 14i 16i ra sau.
3. DAY CHANG DOC TRIJOC (lig. longitudinale anterius) barn tit nen )(acing cham tai tan
)(dung ding, hep d tren, rOng d doan song nguc roi lai thu hep dan a doan that lung de sau
cUng li8n tip vdi cat mac cila clot song ding II. Day chang dinh vao than dgt sang va dia gian
clot song (H.28.16).
4. DAY CHANG DOC SAU (lig. longitudinale posterius) barn tit xdang cham tai tan )(acing cut
mkt sau than cac dgt sang tdc la thanh truac ang song.

CAU HOI TRAC NGHIEM

Chon cau tra lai dung nhat

323. Xacrng nao du'ai day KHONG thu6c xriong than minh :
25
 a) D6t s6ng nguc. d) Xifung ding va xu'ong cut.
b) Xuang de. e) Tat ca dgu sai.
c) Xuang don.
324. D6t s6ng that lung khac vdi dot s6ng c6 do THigU :
a) Mom gai. d) Mom khdp.
b) MOm ngang. e) Khong c6 col barn.
c) LO ngang.
325. MOt d6t song ma mom ngang KHONG co 16 ngang va h6 sudn ngang c6 thg xac dinh dirge la :
a) DOI s6ng that lung. d) D6t song nguc 12.
b) D6t song c6 7. e) Tat ca dgu thing.
c) D6t song nguc 11.
326. Tieu chuan chu ygu dg phan bit mot d6t song that lung vdi cac d6t song co va ngyc la :
a) Than to va rOng chigu ngang. d) Mom ngang dai va hep.
b) LO song hinh tam gide. e) MOm gai hinh chit nhat;
c) Khong c6 16 ngang va h6 swan. ngang va khong
327. Xu'ung sin c6 dac digm sau :
—Dau soon chi co mot mat khdp,
—Khong c6 c6 sudn, cu swan va goc warn la :
a) Xunng satin 1. d) a, b, c dung.
b) Xudng sudn 11. e) b va c thing.
c) Xu'ang swan 12.
Dung hinh ve de tra ldi can 328, 329.

Xttong scan 1 nhin tit tren

26
328. Chi tigt (1) là :
a) Dau sutrn.
b) Cu canh.
c) Cu co rang track.
d) Cu car bac thang trade.
e) Cu satin.

329. Chi tigt (2) la. :

a) Ranh DM (lath don. d) Khuyet satin.
b) Ranh TM dadi don. e) KhUye-t canh.
c) Ranh sun.
330. Chon cau thing. Xildng tic :

a) C6 3 phan : can, than va mom mai

b) C6 bay khuyet a 136 ben de khdp vdi cac skin satin.
c) CO khuygt canh.
d) a, b thing.
e) a, b, c thing.

Dung cho cac cau 331, 332. Chon

a) Neu (A) thing, (B) thing, (A), (B) ca lien quan nhan qua.
b) Ngu (A) dung, (B) thing, (A), (B) khong lien quan nhan qua.
c) Neu (A) dung, (B) sai.
d) Neu (A) sai, (B) thing.
e) Neu (A) sai, (B) sai.
331. (A) Dd thich nghi vdi tti th6 diing thing a ngiki, can c6 trong tam cilia co the rdi thing vao
than de gala hai ban than NEN.
(B) COt song ngutri c6 b6n doan cong kho.c vdi cot song ar &Ong vat chi c6 mot doan cong.
332. (A) Doan Ong ngkfc can c6 dinh, it di clang de to thanh Fang ngktc NEN.
(B) Mom gai d6t sting ngkic chdc xu6ng hcln d6t song that lung WI c6.

27
 29 CO THAN MiNH - CO HOANH

MUC TIEU BAI GIANG

A. MUC TIEU LY THUYET

1. K6 ten cac ca theo tUng lap a yang nguc, lung va thdt lung.
2. MO to nguyen ay barn tan va huang the co caa cac ca rung bung, tic dung va chi ph6i
than kinh cua cac ca do.
3. Neu cac phan ca hoanh va than kinh mach mail chi phol no.
4. Neu cac mo-c d6i chie-u caa ca hoanh len thanh ngkic va bung trade.
5. Ve so d6 ngang a tren run va duai run cho thay sit khac nhau v6 cgu tao caa bao co
thing bung.
B. MUC TIEU THTIC TAP
1. Chi tren xac va mo hinh cac co va than kinh chi ph6i cac ca ciia Wing ngtfc, lung, thdt
lung va thanh bung trade ben.
2. CM tren xac, mo hinh va phim X quang cac phan ca hohnh va cac nai barn vao thanh ngu:c.

Ca a than g6m cac co a thanh ngiic, thanh bung, cac co a lung va yang day chau. Ca
hoanh ngan each 16ng ngiic vai 6 bung. Trong bai nay, khong d6 cap tai cac ca a vUng day chau
vi se du'o'c trinh bay a mot bai rieng.

co ei THAN
G6m cha ye-u là cac co a thanh nguc, thanh bung va cac co a lung (H.29.1) (H.29.2).

1. CAC CO THANH NGIjC (musculi thoracis).

Cac co a thanh ngu'c cluvc sap xe-p thanh 3 lap. d nguc, lap ngoai là ca gian afan ngoai,
lap gide. là ca gian scan trong, lap trong là cc; gian wan trong ding, co du'oi suOn, ca ngang
nguc va co nang wan.

28
Cd thang
Cd Delta

Ca duel gai

Cd tram Cd trOn to

Cd Icing rdng

Cd die° bong ngoai

Tam giac that king

Hinh 29.1 : Cdc ca a than (nhin to phia sau)

Ca ngo'c to

Cd rang tru'dc

Ca cheo bung ngoai

Tam giac that king

Hinh 29.2 : Ccic ca a than (nhin tit' phia ben).

29
 MOt s6 co' khac ding gap phan to nen thanh ngt.ic gum cac ca lien quan dgn chi tren
nhu : ca flop to, ngu'c be, dual don, rang truck da dime trinh bay trong phan chi tren.
1.1. CAC CO GIAN SI56N NGOAI (mm. intercostales externi) (H.29.3).
Nguyen dy, ctu'ang di : tit bar cludi tha 11 xtrang sutin tren, cac sgi ca chay doc xu6ng dudi
va ra tru'ac.
Barn tan :136 tren tha cac xuang sworn ngay dual.
Trong mai khoang gian suttn, cc gian sworn ngoai di tit di xacing sutin a phia sau tai gan
khdp sun - stein a phia trade, tit day, cac cv du'ac n6i tiep bai mang gian wan ngoai (membrana
intercostalis externa).
Thein kinh van dOng : la cac than kinh gian sworn Wang (mg.
DOng tdc : nang cac xacing scorn, do do có tac dung hit vao.
1.2. CAC CO GIAN SU'ON TRONG (mm. intercostales interni).
Nguyen dy, cheang di : tit bar duai cua cac xu'ang satin, sun scrum va day cac ranh wan, cac
soi ca chay doc xu6ng dual va ra sau.
Barn tan : bur tren tha xu'crng sworn ke can phia dual.
Ca gian satin trong trai tit dau ire tha khoang gian sutin a phia trade tai goc xuang scorn a
phia sau : tit day, ca duac tigp n6i bai mang gian satin trong (membrana intercostalis interna)
(H.29.5).
Thdn kinh van dOng : la cac than kinh gian su'an tu'crng tIng.
DOng tdc : 4-5 ca gian sworn phia tren CO tae dung hit vao (nang scorn), cac ca gian scorn
dutli co tae dung that ra (ha sworn).
1.3. CO GIAN STJON TRONG CLING (mm. intercostales intimi).
Ca nay throe xem nhu la mot phan cua ca gian wan trong, ngan each vdi ca gian wan
trong bai bó mach thin kinh gian wan. Ca it phat tridn va co the kheng có a cac khoang gian
sutin tren.
Nguyen ily, clueing di : ca xuat phat a ranh akin cila cac xuang sworn tren.

Cac the di song song vdi cac the cua ea gian swan trong.
Barn tan : a bet tren xttang sworn du'ai (H.29.4).
Thein kinh van dung : la cac than kinh gian sworn.
DOng tdc : chaa rO.

30
 Cd gian swan trong

Ca gian suan ngoai

Hinh 29.3 : Ccic cd gian wan (nhin tic phia tru'ac).

T M.
Cd gian su'dn ngoai D.M B6 mach
thgn kinh gian sudn

Cd gian sudn trong

Co gian sudn trong ceing

Hinh 29.4 : Ccic ca gian scan (thiet cid cdt ding ngang qua mot khodng gian Wan)

31
 1.4. CAC CO DVOI WON (mm. subcostales) (H.29.6).
S6 ca thay d6i. Thirang phat trign a phdn dual ngkic.
Nguyen fly : tit ba dttai cac )(dung akin.
Bdm tan : bar trail dm xuvng soh' that hai hoac thd ba phia
Thdn kinh van crdng : la cac thdn kinh gian
Ddng tdc : trc gidp cho Ong tac hit vao (nang su'an).

Ddng mach gian suer;

Than kinh gian mien
Mang gian &kin trong

Co gian sten ngoai Co gian Diing mach crib

suen
trong cling

Mac (can) not ngtfc

Ca gian swan trong
Ddng mach ngvc trong

Mang gian suer) ngaji

Hinh 29.5 : Cdc ca gian scan

Hinh 29.6: Co. dvdi scan

32
 1.5. CO NGANG NG-L/C (m. transversus thoracis) (H.29.7)
Nguyen tiy : 1/2 dcal mat sau xuting circ va mom mui kigm.
Barn tan : mat sau cdc sun scan tit sun scan tha hai (hoac this ba) tai sun scan thu sau.
Than kinh van dd'ng : là cdc than kinh gian scan.
DOng tdc : chca ra.

Co ngang ngtfc

Hinh 29.7: Co' ngang ngifc

1.6. CO NANG SU'ON (mm. levatores costarum) (H.29.8)

Cc nay that ra thuOc nham co lung, nhung v6 chat nang thl Wang tai nhu cdc cc gian scan.
Nguyen'ay : tit mom ngang cac clot song nguc tii ngirc VU (N7) tai ngu'c XI (Nn).
Barn tan : vac mat ngoai cdc )(dung Ice- can phia dual, a phan giaa cu scan va g6c scorn.
Thein kinh van ddng : la nhanh sau cua cdc than kinh gai ging tit c6 VIII den nglic XI
Deing tdc : cc nay dace xem nhu ding lap voi cc gian scan ngoai va c6 tdc dung nang
xtiOng scan hic hit vao.

2. CAC CO THANH BUNG (musculi abdominis).

2.1. THANH BUNG TRIIOC BEN. Cdc cc a thanh bung trade ben Om c6 cc thong bung,
cc thdp a phia track va cdc cc cheo bung ngoai, cheo bung trong va ngang bung xe-p thanh 3
lap tit 'long vao sau a hai ben.

33
 Co nang sUdn

Hinh 29.8 : Ca ncing scan

2.1.1. Cd cheo bung ngoai (m. obliquus externus abdominis) (H.29.9).

Day la cc; 6 lap nong nha-t.
Nguyen ay, &tang di : xuat phat bai tam tre ca barn vao mat ngoai &la tam xuang akin
Cac tre ca nay dan Lan vao giCta cac tre cua ca rang truck va ca lung rang (ba tre
Cac did ca chay chgch tit tren xuang dual va vao trong. Khi tai khoang 3cm tren gai chau trate
tren thi phan ca duct not tiep bai mOt la can rOng.
Bdm tan : Can ca cheo bung ngoai tie-p tuc huang di chay ra phia trade, g6p phan to
nen la trade bao ca thong bung, truce khi den barn tan vao duang trang (linea alba) tit
xuang sic tai xuang mu. Phan &Ali dia can tit loan trust mao chau tai than xucing mu barn
bang hai tru : ngoai (crus laterale ), trong (crus medial& Ira mOt day chang phan chigu (lig.
reflexum) chay quat len tit tru ngoai de tao nen 16 ben nong (anulus inguinalis
superficialis). Bar tit do a phia ditai clia la can nay; di tit gai chau trade tren tai al mu la
day chang ben (lig. inguinale). Con cac tha cad phan dual hau nhu chay thong xu'ang den
barn vao mep ngoai mao chau. Tai day, ba sau co cheo bung ngoai hop vai ba ngoai ca lung
rang va mao chau thanh mat tam gide goi la tam giac that lung (trigonum lumbale) (11.29.2) la
nai co the xay ra thoat vi thanh bung.
Thdn kinh van dOng : G6m cac nhanh cua sau than kinh gian wan dual, than kinh cluai
scorn (n.subcostalis) va doi khi ca than kinh chau - ha vi (n. iliohypogastricus).

2.1.2. Cd cheo bung trong (m. obliquus internus abdominis) (H.29.10).

Là lap ca nom sau dual ca cheo bung ngoai.
Nguyen dy, cluang di : Tit can nguc that lung (fascia thoracolumbalis), 2/3 truck mep gtiia
mao chau va 1/2 ngoai day chang ben. Tii ch6 xuat phat, cac thd ca t6a ra trucac nhu hinh nan
quat.

34
 Cd ch6o bung ngoai

Day chang ben

Hinh 29.9 : Ca cheo bung ngoai

Can ngtic that lung

Liam ben
(gan ke't hop)

Cd biu

_Wirth 29.10 : Ca cheo bung trong

Barn tan : - Cdc the tren t6a che-ch len tren va ra trade barn van ba xuang surcrn cu6i. Cac
the gifia chay ngang ra tru'ac, gdn tai ba ngoai ca thang bung thi tiep not bai mot can, can nay
tai barn tan va dan Ian vdi can ben dol dien a duang trong. CI 2/3 tren, can tach thanh hai la,

35
mot Id trade, mot Id sau co thing bung de tao thanh la tru'ac va la sau caa bao co thing bung.
C1 1/3 dudi, can chay hoan than trade co nen chi tao ra la trade bao co (H.29.13).
- Cdc thd dudi torch tit day chang ben, am a phia tren va phia sau thang tinh (hoac day
chang tran). Cdc the nay hop vdi cac the caa co ngang bung de tao nen lien' ben (falx
inguinalis) hay On ket hop (tendo conjunctivus) va barn tan vao mao lu'oc xtiong mu. 0 nam
gidi, cac the (Judi cong cua ca bt tinh hoar' keo xu6ng dudi tdi tan biu tao nen co biu (m.
cremaster) (H.29.10).
Than kinh van thing : gam hai than kinh gian scan dudi, than kinh dudi snarl, than kinh
chau ha vi va doi khi ca than kinh chau-ben (n. ilioinguinalis).
2.1.3. Cd ngang bung (m. transversus abdominis) (H.29.11)
Nam sau dudi co cheo bung trong.
Nguyen uy, doing di : ta 1/3 ngoai day chang ben, mep trong mao chau, can ngkrc - that
lung va mat trong sau )(acing akin va sun scorn cu6i; tai day cac tre &la co ngang bung dan Ian
vdi cac tre caa co hoanh. TIE( cac chi xua't phdt, cac the' co chay yang ra trnac.
Barn tan : gan tdi ba ngoai co thing bung co &roc tigp not bai mat can.
ai 2/3 tren, can chay phia sau co thing bung, cang can co cheo bung trong tao nen la sau
bao co. 0 1/3 dudi, can chay ra trcdc co, tao nen IA trade bao co. Cac the co clued clang dinh vao
cac the' &la co cheo bung trong tao nen hem ben nhu' dor ma to d teen.

Bao ca thing bung

(la sau)
Can ngifc that king
Cd thing bung

Bao ca thing bung

(la tniac)

Ligm ben

Hinh 29.11 : Ca ngang bung

36
 Sau hon co ngang bung la mac ngang, lclp ma ngoai phdc mac r6i den phLic mac.
Than kinh van dOng : am 5 hay 6 nhanh than kinh gian scan cu6i, than kinh dudi
than kinh chau - ha vi va than kinh chau - ben.
2.1.4. Cd thang bung (m. rectus abdominis) (H.29.12) la mot co dai
Nguyen ay, chterng di : tit mom mui kigm xu'ong tic va cac sun wan thu 5,6,7 a tren, cac
the co chay doc thong xu6ng dual.
Barn tan : vao than )(ming mu. Thu ang co tit 3-5 tre gan ngang (intersectiones tendinae)
chia co lam nhigu doan. Co duqc bao boc bdi mot bao co cau tao Om can cila cac co cheo va co
ngang bung (H.29.13).
Bao co thong bung (vagina m. recti abdominis) cau tao khac nhau gi€ia 2/3 tren va 1/3
dudi. 0 2/3 tren, la truac (lamina anterior) bao co cluoc tao thanh bdi la -bra& can co cheo bung
trong va mot phan can co cheo bung ngoai, la sau (lamina posterior) bao co Om la sau can co
cheo bung trong va can co ngang bung. 0 1/3 du'ai, la trade bao co Om cac can ngang bung,
can co cheo bung trong va mot phan can co cheo bung ngoai. La sau bao co chi Om co mac
ngang (fascia transversalis). Vi vay, la sau cda bao co, not glad han glib. 3/4 tren va 1/4 dual, do
sit chuye'n ra phia trade cua cac can co cheo bung trong va ngang bung tao thanh mot duang
cong hoi lom xu6ng duidi la &Ong cung (linea arcuata).
Than kinh van clang : GOm 5-6 than kinh gian scion cu6i va than kinh dudi sun.

Co thAng bung
La Mick1Bao co
thang bung
La sau
Co did() bung ngoai
Co' thdng bung
Mqc ngang
Co die() bung trongi

Co ngang bung La tru'dc} Bao co

thgng bung
La sau

a' oho° bung ngoai Co thgng bung

Co thap Cd cheo bung trong Mac ngang
Cd ngang bung

Hinh 29.12 : Co thdng bung va thdp Hinh 29.13 : Bao co. thdng
A - 6 3/4 tren
B - 114 dudi

37
 2.1.5. Cd thap (m. pyramidalis) (H.29.12).
Khong quan trong va thuOng khong c6
Nguyen dy, du'ang di : xuat phat tit than xtrung mu, cac thd cc chay hui che-ch len tren va
vao trong.
Barn tan : vao du'Ong trang a 1/3 dudi ke tit du'dri rein.
Tibet' n kinh van dOng : la than kinh dudi stun.
2.1.6. Tac dung cua cac cd thanh bung trdorc ben.
Do can true cua cac co gom nhiing did clan cheo lan nhau, cac cc( thanh bung c6 chile nan.g
gilt va bao ve cho cac tang trong bung khong sa ra ngodi. Chilc nang chinh cua co thang bung
la gap than. Cac co cheo bung ngoai, cheo bung trong, ngang bung va cu hoanh khi cling hoat
clOng se gay ra mot sit gia tang rat 16'n dp lire trong 6 bung, vi vay tac dOng caa cac cc nay rat
quan trong trong hic dai tien, ti6u tien, of mita va sanh de. Cac cc cua thanh bung tru'dc ben,
khong hoat dOng luc ho hap binh thu'Ong ma chi giiip der ho hap khi the ra gang sac. Cac cc
nay con tra gitip cac cc canh song trong cac dOng tac xoay than the va giit viing tii the.
2.2. THANH BUNG SAU
Thanh bung sau duuc tao nen bdi than cac d6t song va cac dia gian d6t song that lung,
cac cc that lung to, that lung be, cc chau, cc vuong that lung. Cac cu canh song va cac co ldp
Ming se dune mo to chung trong phan co vOng lung va that lung. COn cac cc that lung chau da
dirge to trong phan chi &raj.
Cd vuong thAt ldng (m. quadratus lumborum).
Là mOt co det hinh bon. canh
Nguyen dy, du'ang di : xuat phat tit phan sau mep trong man chau, cac tha chay thang len
tren.

X. sudn 12

Cd that Icing be Ca vuong that lung

Co that king to

Co chau

Co that king ch0

Ca that lung chau
(cat)

Hinh 29.14 : Cdc ca thanh bung sau

38
 &int tan : BO clued xu'ong sudn 12 Ira mom ngang cac d6t song that lung (H.29.14).
frcing tdc : gap than sang ben. Khi hai co ding co co tdc dung du6i cat song. Co can cd
chile nang co dinh xuong sun12.

3. CAC CC; O LUNG (musculi dorsi).

Cdc co a lung g6m cac co thanh sau ngu'c va that lung &roc xep thanh 2 lap : ldp nong va
ldp sau.
Cdc co lap sau gam cac co a canh cat song thu'Ong lien ti6p nhau tao nen nhang dai co trai
dai tit xticrng chain tdi =mg clung. Cdc co a gdy da &toe mo to trong bai co dau mat c6 nen
khOng d6 cap tdi a day.

3.1. CAC CO NONG

Cdc co nong duoc x6p thanh ba lap tit nong den sau nhu sau :
- Ldp thd nhat : co thang, co lung rang.
- Ldp thd hai : co nang vai, co tram.
- Lap thd ba : co rang sau tren va
3.1.1. Cd thang (m. trapezius) (11.29.1) (H.29.2).
La mat co rang, hinh tam gide, det va mOng
. du'ang di : xua-t, phat a dieing gdy tren, u cham ngoai, mom gai cac deit song tit
Nguyen dy,
co I den nguc XII va day chang gian gai a doan nay, cac did co di ra ngoai va khep dan vao
phan gala.
Barn tan 1/3 ngoai bd sau xitong don, bo trong va mat tren mom cimg vai, mep tren bd
sau gai vai.
Thdn kinh van dOng : gam than kinh phu (n. accessorius) va mat nhanh cila ddm r6i than
kinh c6 (C3).
DOng tdc : xoay xutong vai vat) gan cat song, nang va khep xitong vai.
3.1.2. Cd Ming rung (m. latissimus dorsi) (H.29.1) (H.29.2).
Là mat co rang, det, phil gdn het phan clu'ai lung
Nguyen ziy, duang di : barn nhie'u ncri, g6m :
+ MOm gai cac d6t song tit nguc VI Mn xitong ciing va day chang gian gai a snot doan
nay. Co barn vao day Jodi mat tam gan det.
+ 1/3 sau mao chau.
+ Bon xuang su'On cuooi ding
Noi ti6p vdi ban gan nguyen Uy, cac thd co di ch6ch len tren va ra ngoai, van clan tit sau
ra trade, tdi xliOng canh tay.
39
 Barn tan : ranh gian cu (sulcus intertubercularis) xacmg canh tay.
Thdn kinh van dOng : là than kinh nyc-lung (n. thoracodorsalis) thuOc dam r6i thdn kinh
canh tay.
Eking tdc : du6i, khep va xoay trong xuang canh tay.
3.1.3. Cd nang vai (m. levator scapulae) (H.29.15).
Nguyen uy : mom ngang cac d6t song tit c6 I clan c6 IV.
Barn tan : b6 trong xuang vai (phia tren gai vai).

Ca nang vai

CO tram Co rang sau tren

Co rang sau duel

Hinh 29.15: Ccic ca a lung

40
 Thdn kinh van clang : than kinh lung vai (n. dorsalis scapulae).
Dong tcic : nang va xoay xu'ung vai, nghieng co (khi xuang vai co dinh).

3.1.4. Cd tram (m. rhomboideus) (H.24.15).

Nguyen ay : mom gai cac dot song tit c6 VII den nguc V, day chang gian gai a doan nay va
day chang gay (lig. nuchae).
Barn tan : cac thd di xueng dudi va ra ngoai. Co met boo phia tren tach rieng ra gai 1a cu
tram be (m. rhombodeus minor), phan can lai la cu tram to (m. rhombodeus major). Cac thd co
bam tan o bar trong xuong vai (phia du'ai gai vai).
nein kinh van clang : than kinh lung vai.
Dong tac : nang va keo xitung vai vao trong.

3.1.5. Cd rang sau tren (m. serratus posterior superior) (H.29.15)

Nguyen uy : day chang gay, mom gai cac del song tit c6 VI dgn nguc II va day chang gian
Joan nay.
Bain tan : mat ngoai b6n xuung soon tren.
Than kinh van clang : b6n than kinh gian soon tren.
Bang tac nang cac 'Wong soon hic hit vao.

3.1.6. Cd rang sau &dal serratus posterior inferior).

Nguyen ay : mom gai cac d6t song tit nguc XI d6n that lung III va day chang gian gai
Wong Ling.
Barn tan : mat ngoai b6n xu'ung soon cu6i.
Than kinh van clang : b6n than kinh gian soon cu6i.
Dong tac : ha cac xuang soon.

3.2. CAC Ci CANH COT SONG

Cac co canh cot song g6m nhieu cu dinh vao nhau tao nen met kh6i cu chung pink tap.
Cac cu nay cang sap xep theo 3 ldp tit nang den sau flint sau :
Lap tlyt? nhgt (H.29.16) IA cd ding sang (m. erector spinae) g6m cac co chau soon
(m. iliocostalis), cu dai (m. longissimus) va co gai (m. spinalis). VI cac ca nay chay doc tit
xucing cham tai xitung cang, nen a mai doan, cac cu can doge gai ten là : c(5 ch4u Warn that
lung, chau akin nguc, chau soon c6, dai nguc, dai c6, dai dau, gai nguc, gai c6, gai Cac
cu a ldp sau hun ding chive gai ten theo each Wong b.f.
Chitc nang chu ye'u cua co dung song la dai cot song va nghieng cot song (khi mat
ben co).

41
 Cc dal clau

cc- u
Co chau Co dai co
&kin co Co chau
sodn c6

Co dal ngtic

Co chau Co dai nguc

sua n ngvc
Co gai Co chau
soon nguc
Co gai

Co chau su'an
that lung Cd chOu
su'an that king

Hinh 29.16 : Ca canh song (lap nong).

Lap that hai (H.29.17) la cd ngang gai (m. transversospinalis). Co bam tit mean ngang
sang morn gai cua cac d6t song. Co nay gam cac co ban gai semispinalis), co nhi6u chan (m.
multifidus) va co xoay (mm. rotatores).
Chdc nang cua cac co nay cha ygu IA xoay cot
Lap tha ba g6m cac cd gian gai (mm. interspinales) barn gida cac mOrn gai va cac co
gian ngang (mm. intertransversarii) barn gitia cac mom ngang.
Co gian gai có tac dung du6i cot sang. Co gian ngang co tac dung du6i va nghieng
cot song.
Than kinh van dOng cho tat cd cac co canh song IA cac nhanh sau cua cac than kinh
gai

42
 Co ban gai co

N1

dai
Co xoay
ngiin
Co ban gai ngac

N10
CO XOAY

CO BAN GAI C2

Co gian ngang
Ni

Co nang su'an

N10

Co nhigu chan

Co gian ngang

Hinh 29.17 : Ca canh song (lap sau)

CO HOANH

Co hoanh (diaphragma)l.a. mot co det, Ong, ngan each gidal6ng ngdc va 6 bung. Co hinh
vam, mat lom hating v6 phia bung. Co hoanh g6m phan ca a xung quanh va ph4n gan 6 gida
nen du'ac coi nhii do nhi6u 'ca hai bung hap 14i. Co hoanh co nhi6u 16 d6 cho cac tang, mach

43
mau va than kinh di tit long ngtic xu6ng bung hay nguqc lai tit 6 bung len nguc. Co hohnh la co
van quan trong vi gilt vai tro cha ye-ti trong su ho 13.6p.

Khe ac skin

Than kinh hoanh trai

Trnh mach chi' duel
va thin kinh hoanh phai Than kinh tang thang trai
Thac quan
Than kinh tang thang phai
Than kinh tang len DOng mach chi.)

Thin kinh tang be

Tit-1h mach ban den

Be (irking chap

Chu& giao cam

Hinh 29.18 : Co' hoanh (nhin tit phia dual)

Tinh mach cha du'ai

Xuting ac
Thac quan
Co hoanh -
N10
Eking mach chii

That tang 1

Hinh 29.19 : Ca hodnh (thie't d6 cdt clang doc).

1. NGUYEN UY (H.29.18).

Ca hohnh barn bdi cac b6 car vao thanh nguc a xdang sic, xu'o'ng stidn, sun stun va cot song
that lung.
1.1. PHAN ec (pars sternalis). Cac did co barn vao mat sau mom mai kie-m xu'ung sic tao
thanh met bo hay hai bo nhO. Bo nay ding vdi bo saran (phdn scan) gidi han met khe goi la
khe tic-scion hay tam gide tic soon, qua do co bo mach thus ng vi tren di qua. Khe nay la nal co
the xay ra thoat vi cd hoanh.

44
 1.2. PHAN SliON (pars costalis). Co hoanh barn vao sau xucing Wen cuoni bdi cac tre co.
MOt s6 tre barn vao sun sudn va xu'ong sudn VII, VIII, IX. MOt s6 tre barn vao )(dung warn X,
XI, XII. Cac tre nay clan fan vai cac tre caa co ngang bung.
1.3. PHAN THAT LUNG (pars lumbalis) (H.29.20). Co hohnh barn vao cot s6ng that lung
bai cac try co va day chang.
- Tru phai (crus dextrum) : barn vao than cua ba (hay bon) d6t song that lung tren va cac
dia gian song Wong ang.
- Try trai (ceus sinistrum) : thu'dng barn cao hon tru phai mot d6t s6ng, a than va cac dia
gian s6ng cua hai (hay ba) d6t song that lung tren. 0 boy trong caa moi tru cO mot dai sod goi la
day chang cung gida (lig. arcuatum medianum).
- Day chang cung trong (lig. arcuatum mediale) bac ngang truck co that lung. That ra
day la ch6 day len dm le, can Ora phia trade co that lung tai ch6 co hoar-1h yang ngang qua.
Day chang nay barn tit than d6t s6ng that lung I hay that lung II tai morn ngang Wong dug.
- Day chang cung ngoai (lig. arcuatum laterale) bac ngang truce co vuong that lung,
cung la ch6 day len cila co vuong that lung, barn td mom ngang d6t s6ng that lung I (hay that
lung II) tai xu'ong such XII.

Day chang cung trong

Lo thVc quan
Tam giac that lung satin

Day chang cung ngoai • ,

L6' D.M. chi)

Tru trai

Day chang cung giCia

Try phai

Co vuong that king

Co that king -

Hinh 29.20 : Cdc cot trip va day chang eV' a ca hoanh

2. CAU TRUC VA BAM TAN

Tit nguyen ay, cac did co chay hating len tren roi yang ngang thanh vOm de cung tap
trung ve mot tam gan a gida co goi là trung tam gan (centrum tendinum). Gan nay dude coi
nhv not barn tan cria ca hoanh.
45
 Trung tam có hinh ba la : la trust, la phdi, la trai. La trade thu'dng hai lach sang trai va
rang ngang, hai la phdi va trai thi dai va hai chgch ra sau. Tim va mang tim nam de len trung
tam gan nay nen vam hoanh a giaa hai lam xuang tao nen hai \Tom hoanh phdi va trai a hai
ben.
Rieng phan ca thi ca hohnh la mat ca van. Phan ac cila co' hoanh là phan ngan nhat so
vdi cac phan khac. Cac sai ca xuat phat tit day chang cung ngoai dal khi khong co, tao nen mat
khoang hinh tam gide (tam gidc thcit lung - van) chi có mo lien ket the phil. Do do, day ph6i
va mang ph6i a tren gam nhu lien quan trite tiep vdi than va tuygn thuang than a cludi.
3. CAC LO CCi HOANH

Ca hoanh có ba 16 chinh (H.29.20).

3.1. LO TINH MACH CHU (foramen venae cavae). Nam a trung tam gan, giCia la phdi va
la trade. Loa ngang mac dia gian sang giaa Mt song nguc VIII va nguc IX. Qua 16 co tinh
mach chit dudi di 6 bung len nguc de vao tam nhi phdi. Doi khi than kinh hoanh phdi cang
qua 16 nay, a phia trade ngoai tinh mach.
3.2. LO BONG MACH CHU (hiatus aorticus).
Nam ngay tradc cot song, ngang mac Mt ngiic XII. L6 do hai cat tru phai va trai hap lai
tao nen. Qua 16 nay co clang mach chit tit ngkfc xu6ng bung va 6ng narc, a phia sau do, ng mach
tit 6 bung len nguc. Doi khi can thay co mat nhanh cua tinh mach clan a ben phdi hoac nhanh
ctia tinh mach ban clan a ben trai. CO khi than kinh tang cling qua 16 nay.
3.3. LO THI1C QUAN (hiatus esophageus).
Nam a phan ca, do cac ca xuat phat tii hai cat tru phdi va trai hop thanh, co khi do cac
the; co' tit cat tru phdi yang quanh thuc qudn tao nen. L6 thuc quan ngang Mt song nguc
X. Qua 16 co thuc van va hai than than kinh lang thang phdi va trai tit ngu:c xu6ng. Than trai
a trade thuc quail, than phdi a sau thuc qudn. Ngoai ra can c6 nhanh n6i cua dung mach hoanh
tren va dudi, cac nhanh n6i giaa he tinh mach ciia va tinh mach clad.
3.4. CAC KHE CO HOANH.
M6i tru phai va trai cua ca hoanh thuang tach thanh ba phan nh6 bai hai khe doe. Qua
khe phia trong c6 than kinh tang ldn (n. splanchnicus major) va than kinh tang be (n.
splanchnicus minor). Qua khe phia ngoai có chu6i hach giao cam va tinh mach dun (ben phdi)
ho4c tinh mach ban dein (ben trdi).
Qua khe Lie - &I an of) 136 mach thuang vi

4. Doi CHIEU HOANH LEN THANH NGUC - BUNG

Vi tri dia vam hoanh thay d61 theo sit het hap va ttt the. ei tu the thing va giaa kST ho
hap binh thuang (khong gang sure), yam hoanh phdi Wang Ling a trudc vdi khodng gian
sudn 4 va a sau vdi khodng gian suan 9; vain hoanh trai Wang Ling a tnrdc vdi khodng gian
wan 5 va a sau vdi khodng gian slidn 10. Trung tam hoanh a ngang mdc vdi ba trail mom
kiem xu'ung tic.

46
5. MACH VA THAN KINH
5.1. MACH MAU. Co hohnh du'oc nuoi daang bdi ba ngu6n mach chinh :
- acing mach hoanh tren (a. phrenica superior) xuat phat tit dOng mach cha nguc.
- DOng mach hohnh dudi (a. phrenica inferior) xuat phat tit Ong mach cha bung.
- Cac nhanh xuat phat tit trung that sau.
- DOng mach co hoanh (a. musculophrenica) xuat phat tit Ong mach nguc trong.
5.2. THAN KINH. Than kinh van dung chinh la than kinh hohnh, nhanh dia dam rol
than kinh c6. Them van do la nhanh caa sau than kinh gian wan cu6i. M6i naa co hohnh ducic
chi phoi bai mot thdn kinh hoanh. Than kinh hoanh d6n co hoanh a 131;t ngoai trung tam gan,
sau do xuyen qua co r6i chia cac nhanh van dung cho co hohnh a mat dudi. Ngoai ra than kinh
hoanh con c6 cac soi cam gide va giao cam. Cac soi cam giac chi ph6i cam gide cho mang ngoai
tim, mang ph6i trung that va phtic mac pha phan dudi co hoanh. Cac sqi giao cam g6m cac sqi
van mach.

6. BONG TAC

- Co hoanh la co quan trong nhat cua su ho 11.6p. Khi co co, yam hoanh ha xu6ng lam cho
16ng nguc dan to theo chi6u doc, ap luc trong Ring nguc giarn, gidp khOng khi tit ben ngoai vao
ph6i.
- De ep van gan, lam tang ap luc trong 6 bung day man tit cac tinh mach trong gan, trong
6 bung troy ve tim de dang.
- G6p phan cang cac co thanh bung lam tang ap luc trong 6 bung khi ran 11.1c dai tien,
sinh de v.v...
- Co hoanh (phan a 18 thuc quan) con c6 tac dung nhu' mot co that thuc quan.
Khi co hoanh co manh clOt ngOt thi gay non, nac. Thodt vi co hohnh la trung hop cac
tang trong 6 bung chui len nguc qua cac 18 va khe co hoanh. Track day, ngutri. to CO the lam liet
1/2 co hoanh de dieu tri lao ph6i ben de.

CAU HoI TRAC NGHIEM

Chon cau tra loci cititig nhgt

333. Co dung song g6m :

a) Co chau su'an, co dai, co gai.

b) Co chau satin, co dai, co lien gai.
c) Co nang such, co dal, co ban gai.
d) Co chau sildn, co dai, co xoay.
e) Co chau su6n, co gai, co xoay.
47
 334. Tam giac that lung duqc gith han bai :
a) Mao chau, ca cheo bung trong, co lung to.
b) Mao chau, ca cheo bung ngoai, co lung to.
c) Mao ding giaa, co cheo bung ngoai, ca lung to.
d) Mao ding giaa, ca cheo bung trong, ca thang.
e) Mao cling gida, ca cheo bung ngoai, car thang.

335. Day phoi va mang phOi c6 thO lien quan true tigp vai than va tuyen thtrang than qua :
a) Khe trong co hoanh. d) Tam gide that lung suan.
b) Khe ngoai co hoanh. e) Tam gide that lung.
c) Khe ac wan.
336. Than kinh van clang cho ca cheo bung ngoai là :

a) Sau than kinh gian swan cuol.

b) TK dudi sworn.
c) TK chau ben.
d) a, b, c
e) a, b ding.

337. Cau nao cuing :

a) Ca hoanh c6 nguyen ay barn vao xtrang tic, cac sun akin va xuang swam ta 7 - 12, barn
tan a cat song that lung.
b) TK van clang co hoanh la TK hoanh va mat s6 nhanh cria than kinh TL1, TL2, TL3.
c) L6 hay khe thuc quan a ngang d6t song N10.
d) L6 hay khe thuc quan, 16 DM chi' va 16 TM cha nom trong pilau co dia co hoanh.
e) Tat ca deu ding.
Ghep cac thanh phan sau day vao cac 16 hay khe cria cc hoanh twang img ma no di qua (Mat
chi tie't c6 the ding nhieu Ian) :
a) L6 TM chi'. d) Khe trong.
b) L6 DM chi. e) Khe ngoai.
c) L6 thu'c quan.
338. Ong nguc.
339. TK lang thang.
340. TK tang lan.
341. Chu6i hach giao cam

48
342. TM don.
Dung hinh ye d tra loci cau 343, 344.

CU thdng bong

343. Thigt d6 tren la thie-t do cat ngang thanh bung tru'c1c qua :
a) 1/3 tren bung.
b) Du'di dublig cung.
c) 1/2 gida bung.
d) Ngang ro-n.
e) Tgt ca d6u sai.

344. Chi tie't (1) trong hinh ye la :

a) La sau mac co ngang bung.

b) Can ccl ngang bung.
c) Mac ngang.
d) Philc mac.
e) Mac sau c6 thang bung.

49
 30 ONG BEN

MIX TIEU BAI GIANG

A. MUC TIEU LY THUYET

1.MO to cac 16, cac h6 va cac thanh 6ng ben.
2. Ke ten cac thanh phan trong 6ng ben va lien quan cua cac thanh phan do vdi nhau.
3. Ve hinh chieu 6ng ben len thanh bung.
4. Ve hai su de 6ng ben (cdt song song vai cung ddi vd clang doc qua giaa (frig ben).
5. Giai thich tai sao 6ng ben la diem yeu cua thanh bung Ira ca the cac loai thoat vi ben.

B. MUC TIEU THI1C TAP

1. Chi tren xac va cac pinking tien thuc tap khac nhu mO hinh vai, thach cao cac thanh
6ng ben va cac thanh phan di qua 6ng ben.
2. Xac dinh &I've tren car the nguOri song m6c d6i chieu tren da cua 6ng ben.
3. Xac dinh ducic 16 ben ngoai tren co the ngu6i song.

I. DAI CU'CliNG
Ong ben (canalis inguinalis) la met khe nam giffa cac ldp can ca cua thanh bung, di tit 16
ben sau tdi 16 ben nong, dai khoang 4-6 cm. Ong nam chech tit tren xu6ng doh, vao trong va
ra trudc, gan nhu song song vai rala trong cua nep ben. Ong ben la met didm ydu cua thanh
bung nen thu'6ng hay xay ra thoat vi ben dac biet la a nam gidi.
O nam, 6ng. ben la du6ng di cUa tinh hoan tit 6 bung xu6ng biu trong hie phei thai. Khi
tinh hoan da xu6ng biu, 6ng ben se chda thUng tinh. CI nit, trong 6ng ben có day chang

2. CAU TAO
Ong ben duvc cdu tao bed : b6n thanh : trudc, sau, tren, du'di va hai dau la 16 ben sau
va 16 ben nong.

50
 2.1. THANH TRIMC ONG BEN (H.30.1) (H.30.2)
Phan ldn thanh trudc 6ng bend phia trong doge tao nen bdi can co cheo bung ngoai (m.
obliquus externus abdominis) va mot phdn nho phia ngoai bdi co cheo bung trong (m. obliquus
internus abdominis) a ch6 co nay barn vao day chang ben.
—Can co cheo bung ngoai cd phan barn vao xu'crng mu bdi hai dai can goi là hai cot try :
—COt try ngoai (crus laterale) : barn vao ea mu.
—COt tru trong (crus mediale) : chay qua trade co thang bung va co thap tdi barn vao than
xuong mu va doOng trdng (linea alba).
Ngoai ra con co mot dal can doi khi rat ro, di tit ch8 bam caa cot try ngoai, quat nguoc len
tren va vao trong d phia sau cot tru trong r6i dan lan vdi can co choir) bung ngoai ben clea dien.
Dai can nay duoc goi la day chang phan chigu (lig. reflexum). Gitia hai cot try ngoai va trong
cOn co nhiing thd soi not lien hai cot tru va dole goi la soi gian try (fibrae intercruralis)

Can co cheo byng ngoai

COt try ngoai

COI try trong
L6 ben nong
Sqi gian tru

Day chang bQn

phan chigu

Day chang lu'oc

Day ch,ing khuygt

Hinh 30.1 : Ong ben (thank track)

2.2. THANH DWI ONG BEN (11.30.2)

Thanh Judi 6ng ben doge tao nen bdi day chang ben (lig. inguinale)
Day chang ben chang qua chi la ch6 day len ciia ber cloth can co cheo bung ngoai, di tit gai
chdu trudc — tren tdi ca mu. O doan trong, tit day chang ben, ngoai nhang soi tdi bam vao ca

51
mu can co nhting thd soi chay yang ra phia sau de-n barn vao &rang bloc cua )(acing mu goi la
day chang khuyet (lig lacunare). Day chang lchuygt tiep tuc di ra phia ngoai tdi 16i chu mu, a
day no hba ldn vdi can ca ktqc va ldp chu cot mac dm micrng mu tao nen mot day chang rat
chac goi la day chang htqc (lig. pectineale) (H.30.1) (H.30.3).
2.3. THANH TREN ONG BEN (H.30.2)
Thanh tren 6ng ben la ba dudi cilia ca cheo bung trong va co ngang bung (m. transversus
abdominis). Khi ba dadi cua hai ca nay dinh vao nhau thi tao nen met au true goi là hem ben
(falx inguinalis) hay gan kgt hoop (tendo conjunctivus) (gap trong 5% cac tru'ang hop).
Cac sqi ca a ba dodi hai ca cheo bung trong va ngang bung a phia ngoai bam vao day
chang ben. Ca ngang bung bam a 1/3 ngoai, ca cheo bung trong barn a 1/2 ngoai; do do ma có
met phan ca cheo bung trong tao nen thanh trade 6ng ben. 0 gifia 6ng ben, ba du'di hai ca nay
yang len tren Om lay thUng tinh va dinh vao nhau tao nen lie'm ben. O phia trong, ligm ben di
sau thimg tinh va cu6i cang bam vao &fang lime xuang mu.

Co cheo byng trong Cc ngang bung

Can co cheo
bung ngoai
Thang tinh
Day chAng ban Day ching gian h6

DOng mach thu'vng vi duet

Day ching luOc
Tinh mach dui
Cc ILioc
Mac ngang
Ligm ban (gan ke't hop)
Theing tinh
Day cith"ng ban Philc mac

Day chilng hicic

Cot tru trong

L6 ban nong Liam ben
Thang tinh

C6t tru ngoai Day chang ben

phan chiau
Day chang khuygt

Hinh 30.2 : Ong ben, ba thie't do cdt dang doc qua Ong ben.
CI 15 ben sau — 0 gida Ong ben, — 0' lo ben ?Ming.

52
 L6 tTnh mach chi; dc/di
Trung tam On

DEng mach chi;

Day chAng cung trong

Tru tr.&
Day chAng cung ngoai

161.4111116.

Cd vuong that ldng Tru phai

Cd that Icing

AnhXXV : Co holinh (nhin dadi len)

53
 Cd cheo bung ngoai

d rang trUoc

Can cd cheo bung ngoai

Can that Icing

Cd cheo bung trong

Cd cheo bung trong
Cd &do bung ngoai
Cd ngang bung

Cd chi.° bung trong

Cd (bó ngok)

Anh XXVI : Cae co bung yet yang ong ben.

54
 2.4. THANH SAU (H.30.3) (H.30.4) (H.30.5)
ThAnh sau 6ng ben dtidc tao nen chd ygu bai mac ngang (fascia transversalis). Day là ldp
mac bao phd khap 6 bung va nam ngay dual ca ngang bung. Midi mac ngang 1a lap ma ngoai
phtic mac r6i d6n phdc mac va cac tang trong 6 bung. VI dtfo'c ca.0 tao-chil ye-u bdi mac ngang
nen thAnh sau 6ng ben rat ye-u, do do cac thodt vi thAnh bung thaang xay ra a viing ben vA
cludc goi la thodt vi ben.
Co rat nhigu quan diem khdc nhau trong viQc ma to mot s6 cat.' trait trd Idc cho mac
ngang a vang ben. Do là cac day chang hodc nhm ding ldp vdi mac ngang hoc d cac ldp k6
can dinh vac) mac ngang de lAm cho mac ngang a thAnh sau 6ng ben them yang chat. Tuy
vay, tdc dung cda cac day chang nay khong clang ke. 0 day chi dg cap tdi m0t s6 cat' trite da
dude nhi6u ngtiai chap nhan, do là:
Day chang gian ho (lig. interfoveolare): day chang nay là mot ch6 day len caa mac
ngang a ba trong 16 ben sau. CI tren, day chang nay dinh vAo mat sau ca ngang bung va a dddi
vAo day chang ben. Day chang gian ha/ khong phai ldc naa cung ro rang, dOi khi no co chda
mot s6 sqi car xuat Oat tit ca ngang bung.
Ngutri to can mo to mot khoang tam gidc, goi là tam gidc ben (trigonum inguinale) a
thAnh sau 6ng ben vh coi do la ch6 yeu nhat cua thAnh bung ben. Tam gide nay dttqc gidi han
phia ngoAi bai dQng mach thuung vi dual (a. epigastrica inferior), phia trong IA ba ngoAi cd
thang bung, phia dtidi IA day chang ben. Tam gidc nay là nal xay ra cac thoat vi ben tryc

Cu thing bung o ngang bang

Outing cung

Day chang gian h6

Ong mach thlicing vi dUdi

CO ben sau

Lim ben
Thanh sau 6ng bon Bo mach tinh hoan
(mac ngang)

Day chgng khuye't

Day chang lupe

Ong clan tinh

Hinh 30.3: Thetnh sau 6ng ben (nhin tit phia sau, pluic mac del chtqc ldy

55
 Sau mac ngang la 16'p me ma ngoai pinic mac. Trong lap nay, a yang ben, c6 mat clang
mach va hai tiding soi di qua, tit ngodi vao trong la:
- Bang mach thuung vi la mat nhanh ctia dOng mach chau ngoai. Luc cldu, clang
mach chay xu6ng va vao trong, song song vont day chhng ben. Sau khi di xu6ng &roc
khoang 1 cm thi yang quanh bar trong 18 ben sau de qudt len tren. Khi dang mach tai bar ngoai
co' thang bung, a tren xdung mu do 5cm thi chay vao bao ca va cu6i ding not vdi clang mach
thuung vi tren (a. epigastrica superior) a gdn r6n.
- Day chang r6n trong (lig. umbilicale mediale): la dOng mach ran trong thai ky phOi
thai, bi tAc lai sau khi sanh.
- Day chang r6n giaa (lig. umbilicale medianum): con goi la day treo bang quang
(urachus), là di tich cua 6ng nieu mac trong thai ky phoi thai.
Ph6c mac khi phu len cac thling soi nay tao nen cac ch8 not ga len goi la cac nep. 'Ling
vdi clang mach thdong vi doh va hai thdng soi ke tren, tit ngoai vao trong c6 cac nep r6n
ngoai (plica umbilicalis lateralis), nep r6n trong (plica umbilicalis medialis) va nep r6n giaa
(plica umbilicalis mediana). Gina cac nep, pink mac lam thanh ba h6 goi la:
- H6 ben ngoai (fossa inguinalis lateralis): a phia ngoai clang mach thdong vi dual, day
la nui xay ra thoat vi ben gian tidp.
- H6 ben trong (fossa inguinalis medialis): nam giita nep r6n ngoai va nep r6n trong.
Day la not ydu nhdt cua thanh bung, thdang xay ra thoat vi ben tract tidp.
- H6 tren bang quang (fossa supravesicalis): nam gala nep r6n trong va nep r6n giiia,
it xay ra thoat
2.5. LO BEN SAU (anulus ingunalis profundus) (H.30.3) (H.30.4) (H.30.5).
Doi chidu len thanh bung tru'ac, 18 ben sau nam ar phia tren trung didm cua nep ben
khoang 1,5cm - 2cm. L6 ben sau nam tren mac ngang, nhin ben ngoai khOng rti rang nhu'ng

Co cheo bung ngoai

Co cheo bung trong

Co' ngang bung

Liem bon
Mac ngang
LO' bon sau

L6 bon nong
Theing tinh

Can cci cheo bung ngoai

Hinh 30.4: Cdc to ben vet thank sau 6ng ben nhin tit phia tritelc.

56
nhin tit ben trong, 16 ben sau c6 giai han re horn a bu trong ba'ri day chang gian h6. Ngay phia
trong 16 ben sau la be mach thiong vi duai. Qua 16 ben sau, cac thanh phan tao nen thong
tinh se quy to lai de chui vao 6ng ben.
Trong triang hop thoat vi ben gian ti6p, kh6i thoat vi sa ra ngoai to h6 ben ra ngodi, qua
16 ben sau va nam trong 6ng ben.
2.6. LO BEN NONG (anulus inguinalis superficialis) (H.30.1) (H.30.4).
Cot tru ngoai va cot tru trong cila can co cheo bung ngodi giai han met khe hinh tam
gide. Khe nay du'oc cac soi gian try va day chang ben phan chi6u giai han lai thanh met 16
trim horn goi la 16 ben nong. L6 ben Tieing nam ngay phia tren di mu. Qua 16 ben Ming, c6
thing tinh di to 6ng ben xu6ng biu.

3. CAC Cd QUAN DI TRONG ONG BEN

Di trong 6ng ben la thing tinh (a nam) hoac day chang trong nu.). Kern then thing tinh
(hodc ddy chdng trong) con c6 nhanh cad, cac than kinh chau ben (n. ilioinguinalis) a trade
thing tinh va nhanh sinh dye caa than kinh sinh due - dui (n. genitofemoralis) a phia sau
thing tinh.
Thing tinh g6m có:
- Ong clan tinh, dOng mach, tinh mach va dam r6i than kinh cua 6ng dan tinh, deng
mach co biu.
- DO'ng mach tinh hoan (a. testicularis), nhanh cua Ong mach chi bung, xung quanh co
dam r6i tinh mach hinh day leo.
- Cac to chile t6 bao va di tich cua 6ng pink - tinh mac (mom boc).
Tren day là met s6 ma to có tinh each kinh then ve giai phdu hoc 6ng ben va viing ben.
That ra giai phau hoc viing ben 'dad phdc tap vi co nhieu quan diem mo to khac nhau v4 Orli
true ding nhi danh
Ptnic mac
L6 bon sat/

Day chang gian h6

/Ddrtg mach thtlyng vi dUdi

Day chhng rein trong

Co thang byng

/ Day chang ran giaa

(day treo bang quang)
H6 bon quan.
nao.i r.
0- 7A1

"41,2027h7,017.4,
Ca Chap
Mac ngang Liam bon
Ca ngang bong
Co cheo bong trong Day chang bon phan chieu
Can co cher) bung ngoai Cdt try trong
(cat try ngoai) Thong tinh
Co biu

Hinh 30.5: Thie't d nam ngang qua true o'ng ben.

57
 4. CAC CHO YgU VU
s NG BEN DUI

TT-Ong tinh
Cac khoang yeu Mach mthu thuOng vi &kW
wing bon deli ung gan co ngang bung
Day chang bon
L6 bon sau
(h6 bon ngothi) Day chang khuy6t
H6 bon trong
VOng dui

Hinh 30.6: Lo ca lilac

L6 cc luqc dole ma to hal Fruchaud, trong 16 nay co day du 3 diem yeu gay nen thoat vi
la h6 ben ngoai, h6 ben trong va vong

Baa co thhng bung

Duang cung
DOng mach thuOng vi du'Oi

Ló bon sau

H6 bon trong
c3ng dhn tinh
VOng dOi

Day chang khuyet

Day chang bon

Hinh 30.7: Ccic diem yeu vang ben dal

Co 3 diem yeti that su u vUng ben dui la h6 ben ngoai -Wong vdi 16 ben sau la nal xay
ra thoat vi ben gian ti6p. H6 ben trong, nui thieu 2 ldp co cheo bung trong va co ngang bung,
la nui xay ra thoat vi ben truc tiep. Ong din thOng ra ngoai vai mac sang, la not xay ra thoat
vi

58
 CAU 1161 TRAC NGHIEM
Chen cau tra loci dung nhat

345. Liem ben (hay gin ket hap) la:

a) Bar dual can ca cheo bung ngoai.
b) Ba duai can ca cheo bung trong.
c) Bd duai can ca ngang bung.
d) Bar ngoai bao co' thing thing.
e) Tat ca deu sai.
346. Tam giac ben cluac gidi han bdi:
a) DM thoong vi tren, bar ngoai co thing bung, day chang ben.
b) DM thitang vi dadi, bar ngoai car thing bung, day chang
c) DM thuicing vi tren, bar ngoai car cheo bung ngoai, day chang ben.
d) DM thuang vi clued, bar ngoai co thing bung, day chang ben.
e) DM thuang vi duai, bar ngoai Ca cheo bung trong, day chang khuy6t.
347. Cau nao thing:
a) Thanh dadi 6ng ben là day chang ben va day chang
b) Thanh tren 6ng ben la bd daai cc cheo bung ngoai va ca ngang bung.
c) L6 ben nong dutac gidi han bdi day chang khuyet va day chang phan
d) L6 ben sau nam d mac ngang, phia tren day chang ben khoang 1,5cm - 2cm.
e) Tat ca deu sai.
Cau 348, 349, 350. Chou:
a) Neu (A) thing, (B) dung. (A), (B) co lien quan nhan qua.
b) Neu (A) dung, (B) dung. (A), (B) khong lien quan nhan qua.
c) Ngu (A) dung, (B) sai.
d) Neu (A) sai, (B) thing.
e) Neu (A) sai, (B) sai.
348. (A) Thoat vi ben tryc tie'p xay ra glib. DM thaang vi dual va thiing DM r6n VI
(B) Cl h6 ben ngoai thanh bung ye'u do co di tich caa 6ng phdc tinh mac.
349. (A) Thoat vi ben it xay rad nu VI (B) O nit khong có thong tinh nen khong co 6ng ben.
350. (A) Ong ben la didrn ye-u cua thanh bung VI
(B) Ci do thie'u hai lap ca: cc cheo be va ca ngang bung.
Dung hinh ye ben dg tra ldi cau 351 va 352: (A) Can co cheo_
byng ngoai
351. Chi tie't (1) là:
a) Phdc mac. (B) Liam bgn
b) Mac ngang.
c) Can co ngang bung. (C) Ong ciAn tinh —
d) Can ca cheo bung trong.
e) Tinh mac. (D) Day chang bgn -

352. Chu thich nao tren hinh SAI: (E) Day (-Mang khoyel
a) B. d) B va E.
b) D. e) B, C va E.
c) B va C.

59
 PHAN V - NGLiC

31 PHOI

MUC TIEU BAI GIANG

A. MUC TIEU LY THUYET

1. M6 to vi tri, chdc nang va cac mat ctia. phoi.
2. Ve cay phg Ivan dg kg ten cac phan they ph6i.
3. MO to cac thanh phan cua cu6ng ph6i va su lien quan cua cac thanh phan do vai nhau.
4. MO to mang ph6i, 6 mang ph6i, cac ngach mang ph6i va met s6 Ling dung lam. sang.
5. Ve hinh chigu phoi, 'Jiang ph6i len long nguc.
6. Ve so de hinh anh X quang cua ph6i (nhin tru'ac).
B. MUC TIEU THVC TAP
1. Chi &foe tren xac, mO hinh cac chi tigt giai phAu d cac mat ph6i, cac thanh phan trong
r6n ph6i.
2. Chi dooc tren xac, mo hinh, phim X quang hinh anh cua ph6i, mang ph6i tang, mang
ph6i thanh, 6 mang ph6i va ngach stun hoanh.
3. Xem soi X quang tim ph6i tren ngu'ai s6ng.
4. Xem ph6i va mang ph6i tren ch6 s6ng. So sanh \rai ph6i nguai.

Ph6i (pulmo) la ca quan chu ygu cua he ho hap, là nai trao d6i khi gala mau va khon.g khi.
Hai ph6i nam trong Ring ngkre duqc ngan each nhau bdi met khoang goi la trung that. M6i ph6i
du'oc boc trong met bao thanh mac, g6m hai la goi la mang ph6i (pleura) Wang tit nho mang
ngoai tim hoac mang bung.
1. HiNH THE NGOAI CI7JA PHOI
M6i ph6i duoc vi nhu' met nth hinh non g6m met day, met dinh, hai mat va hai ba.
1.1. DAY PHOI (basis pulmonis) co mat hoanh (facies diaphragmatica) d phia duai nam dp
sat len vam hoanh va qua vain hoanh vai cac tang cua 6 bung dac biet vdi gan. Met dp xe
mat tren gan c6 thg von qua ca hoanh len ph6i gay dp xe ph6i.

60
 1.2. DINH PHOI (apex pulmonis) a phia tren, nho len khoi miring sun I qua 18 tren cua
16ng nguc (apertura thoracis superior) va narn ngay a nen c6 (H.31.1. va. 31.2.).
Dinh ph8i ngang mdc d'Au sau )(tieing soon I, con phia trade thi o tren phAn trong xuzing
don khoang 3cm.

Khe ngang

Khe chePh
• ThOy girla
641
Thew dui

Hinh 31.1: Ph& phcii (mat swan).

Thuy tren

Khe chePh

Thuy dui

Ludi ph6i trai

Hinh 31.2: Ph& trdi (mat su'an).

61
 1.3. MAT SU'ON (facies costalis) là mat 16i ap sat vao thanh trong 16ng nate a phia ngoai
va phia sau. Co vet an len cila cac xudng akin va có khe chgch (fissura oblique). Rieng a ph6i
phai con có them khe ngang (fissura horizontalis) (H. 31.1. va 31.2.) chia phcii phai lam 3
they: thug tren (lobus superior), they gida (lobus medius) va thuy dudi (lobus inferior). Khe
chgch chigu len thanh ngttc O'' Tau sau ngang mac dau sau khoang gian sudn 3 can khe ngang
tach tit khe ch6ch ngang mutt khoang gian sudn 4 a during nach gicia va dau truck ngang mite
sun satin 4 (H. 31.12.). Ch8 cac mat they ph6i ap sat nhau goi la mat gian thily (facies
interlobares). 0 ph6i trai vi 'thong CO khe ngang nen chi có hai thOty tren va thiiy du di,
nhitng lai co mot mdu ph6i 16i ra phia trade dirdi trong nhu* mot cai hied nen goi la luibri ph6i
trai.

1.4. MAT TRONG (facies medialis) hoi lOm va quay vao phia trong, g6m hai phan: phan
sau lien quan cot sting goi la phan cot song (pars vertebralis) Ara phan track quay lay cac
thanh phan trong trung that sau goi la phan trung that (pars mediastinalis), phia truck doh
có mot ch8 lOm lien quan vdi tim goi la an tim (impressio cardiaca) (H. 31.3. va H 31.4.). Vi
tim nam lOch sang trai, an tim ben trai rat sau cho nen con goi la h6 tim.

Ranh tinh mach

canh tay dau phai
An tinh mach don
Ranh (Ring mach
duet don
Phg quan chinh phai
Eking _mach
pheii phai
Hach bach huygt
Tinh mach
phdi phai tren
Khe ngang Tinh mach
An tim phdi phai dudi

An thric quan
Khe chgch

•
.\
zt, ■ -%\s's Day chang phdi

Hinh 31.3: Phdi phcii (meft trong)

62
 (II mat trong c6 ro-n ph6i (hilus pulmonis). RO-n ph6i c6 hinh mot chigc vot, bong ban la noi
c6 cdc thanh phan caa cu6ng ph6i (radix pulmonis) di qua nhu : phg qudn chinh (bronchus
principalis), Ong mach ph6i (arteria pulmonalis) d phia truck (ddi vdi phdi phdi) hoac tren phg
quan chinh (ddi vdi phdi trdi), hai tinh mach ph6i (venae pulmonales) nam throe va dudi phg
qudn chinh. Ngoai ra can c6 cdc thanh phan nhO nhu Ong mach va tinh mach phg quan (aa. et
vv. bronchiales), cdc day than kinh va hach bath huygt. Cdc thanh phan nay du'oc bao quanh
bai mot lap vO mo lien kgt.
Cl mat trong, ngoai rein ph6i con co ranh Ong mach cha' phdi trai) va ranh tinh mach
don (a phdi phdi). Phia tren rein ph6i co ranh clOng mach dudi don va ranh than tinh mach
canh tay dau (H.31.3 Ira 31.4).
Ph6i va mang ph6i a day tigp mic vdi cdc thanh phan kg tren qua 6 mang ph6i (cavum
pleurae) va mang ph6i trung that (pleura mediastinalis). Phia sau, mat trong ph6i lien tigp vdi
mat suarn khOng tao thanh mot ba rO ret do do ph6i khOng. co sau nhu mot s6 sach mo

Ranh than tinh mach

canh tay d5u trai

R5nh thing mach

dtidi dOn

Ranh ddng mach chet

Ddng mach
Ph5 quan chinh trai phdi trai

Hach bath huy6t Tinh mach phdi

trai tren
Ranh clOng mach chit'

H6 tim
Khe chePh
Tinh mach ph6i
trai dadi Khuye't tim

Day chang phol

NNN, , ,‘.___-..,,....—
;s'--,:—.----
— .--
.•.;,..-.,,,, ____,-----

Hinh 31.4 : Phdi trai (mdt trong)

1.5. BO TRUOC (margo anterior) la ranh gidi &a mat sUan va mat trong. Ba nay chigu
len thanh ngu'c ngay sat &fang keo dai dinh ph6i tai dam trong sun su'an VI.0 ben
trdi, be, trade bi khuygt a dudi thanh khuygt tim cua ph6i trai (incisura cardiaca pulmonis
63
Than kinh hohnh trai
DOng mach ngdc trong
Than kinh quit ngUpc trai
Than kinh lang Hach trung that
thang trai Bong mach rinqc trong
Cung dOng mach chO

Hach h.ung that

Than- kinh hoanh phai
Quai tint; mach ddn
Tinh mach nach
Mang phol

Than Aunt, lang thang phai

Pho;
Thuc quan
Ong ngdc

Anh XXVII : Thiet do ngang lOng nguc qua dot ngdc IV

64
sinistri), vi vay dung chieu cua bar track d ben trdi tai dau trong sun saan IV thi yang ra phia
ngoai (H.31.12).
1.6. BO DU'dI (mango inferior) quay lay mat hoanh va g6m 2 doan : doan thang ngan each
mat hohnh with mat trong va doan cong ngan each mat hoanh vori mat saan. Doan cong nay
mong va sac lath vao ngach su'an hoanh (recessus costodiaphragmaticus) cua mang ph6i. Doan
nay chieu len thanh narc theo met ding tit dau trong sun saan VI qua khoang gian akin VII
a &fang nach va tai sat cet song a dau sau xu'ung saan XI.
Tren be mat ph6i có cac dien hinh da gidc to nho khdc nhau. DO là day cac tidu they ph6i.

2. HINH THE TRONG CUA PHOI

. Ph6i duac eau tao do cac thanh phan qua r6n ph6i toa nho dan trong ph6i. Do là cay phe
quan, thing mach va tinh mach ph6i, mach pile quan, cac bath mach, cac sal than kinh caa
dam r6i ph6i Ira cac mo lien ket a xung quanh.
PHAN CHIA CUA CAY PHE QUAN
M6i phe quan chinh (bronchus principalis) sau khi chuff vao r6n ph6i se chia thanh cac phe
quan they (bronchi lobares). M6i phe quan they dan kin cho met thay ph6i va lai chia thanh cac
phe quan phan they (bronchi segmentales) dan khi cho met phan they ph6i (H.31.5). M6i phe quan
phan they lai chia thanh cac phe pan ha phan they. Cac phe quan ha phan they lai chia nhieu
Ian nita cho tai tan pile quan tidu they dan khi cho met tigu they ph6i. Day &la cac tidu they hien
len thanh nhiing hinh da gide a cac mat ph6i. Tieu they ph6i là met dan vi ca sd caa ph6i g6m cac
tik phd quan ho hap (bronchioli respiratorii) dan khi vao 6ng phe nang (ductuli alveolares) rdi vao
tuff phe nang (sacculi alveolares) va sau cang la phe nang (alveoli pulmonis) (H.31.6). Mat phe nang
có cac mao mach ph6i de trao d6i khi gida mau va khong khi.
Ve ca.0 tao, phe quan g6m met lap scri sun (lap nay khong có a nhang tieu phel qudn ho
hap), met lap ca mOng (khi co theit dot ngot gay khd tha trong b'enh hen) va trong ding la met
lap niem mac.
Sau day la bang torn tat sit phan chia cua cay phe quan cho tai eac phe quan phan thay
(H.31.7 va 31.8).
PHOI PHAI PHOI TRAI
A. Thity teen (lobus superior) A. Thiry tren (lob us superior)
1. Phan they dinh (segmentum apicale) 1-2. Phan they dinh - sau (segmentum
2. Phan they sau (segmentum posterius) apicoposterius)

3. Phan thay track (segmentum anterius) 3. Phan they trade (segmentum anterius)

B. Thiry ghla (lob us tnedius)

4. Phan they ben (segmentum lateral& 4. Phan they 1ttSri tren (s. lingulare superius)
5. Phan thay giaa (segmentum mediale) 5. Phan thay Kral dual (s. lingulare inferius)
65
 Sun gigp

Sun nhin

Khi quan
llllllll 141

Phg gain chinh trgi

Phg qugn chinh phai
1 ft", ,,,,,,,,, "" 1
2
Phg quart thOy trgn
phai 3
Phg guan they dc/di Phg (wan they tren trai
phgi 6
Phg quan they gicia
phai
Phg qugn they duel trgi

9 10
Hinh 31.5 : Cdy phe qudn (ccic s5 chi ccic phe qudn phdn thity)

Phg nang

Tui phg nang Tui phg nang

Ong phg nang

Phg nang

DO:fig mach phgi

Tigu phg guar, Tinh mach ph gi
h6 hgp

Hinh 31.6 : Sa coo mot phein heti they phdi cho thety mgi lien quan gizZa mach va tai khi

66
 C. Thiry chiral (lobus inferior) B. Tire.ly (Weil

6. Phan thay dinh (segmentum apicale) 6. Phan they dinh (s. apicale)
6'. Phan they ditai dinh (segmentum subapicale) 6'. Phan they ditch dinh (s. subapicale)

7. Phan they day giita (segmentum basale mediale) 7. Phan thay day gida (s. basale medial&

8. Phan thay day trade (segmentum basale anterius) 8. Phan thay day truck (s. basale anterius)

9. Phan they day ben (segmentum basale laterale) 9'. Phan they day ben (s. basale laterale)

10.Phan they day sau segmentum basale posterius) 10. Phan they day sau (s. basale posterius)

Phan thOy dinh

Phan they trudc

Phan they dinh

(they dtidi)

Phan they ben

Phan thOy day giCia

Phan the'
day sau
Phan thay Phan thOy giCia
day ben

Phan they
day truck

Hinh 31.7 : Ccic phan thay ph& phcii (nhin ngoai)

Bac di6m ph6i a ngliai Viet Nam la :
—2,2% c6 khe Ming ngan each phan thOy 7 v6i cac phan they day con lai.
—12% c6 mot khe khong hoan than ngan each phan thay 6 vdi cac phan thay day can lai.
—34% ph6i phai a ngikri Viet Nam phan they 6 c6 them phan they du'ai dinh.
—54% ph6i trai a ngoori Viet Nam phan they 6 c6 them phan they duth dinh.
2.2. SII PHAN CHIA CUA BONG MACH PH6I
DOng mach ph6i phai va dOng mach phoi trai de'u tach ra tit than Ong mach ph6i.
67
 Phan they dinh

Phan they twee

Phan they sau

Phan they dinh

Phan they /trod tren (thuy dUdi)

Phan thu'y duel

Phan they day sau

Phan they day twee

Phan they day ben

Hinh 31.8: Ccic phcin thdy phdi trcii (nhin ngodi)

2.2.1. Than dOng mach ph6i (truncus pulmonalis) bat Tau di tit 16 ging mach ph6i cua
tam thdt phai chay len tren va ra sau tdi bd sau cua quai dung mach chil thi chia thanh ding
mach ph6i phai va deng mach ph6i trai.

2.2.2. Dung mach phOI phai (a. pulmonalis dextra) di ngang td trai sang phai chui vao
run phol phai d dual phg quern they tren di tru'dc phe quern r6i ra phia ngoai va cu6i tong a sau
ph6 quern. Deng mach xoaii chung quanh than phe- quern nhu met con ran quern quanh cet
(H.31.9). DOng mach ph6i phai cho cac nhanh ben c6 ten goi Wang dng vdi cac thUy hoac phan
thuy ma 116 cap huye-t: Cac nhanh ben d6 la : nhanh dinh (ramus apicalis), nhanh sau xue-ng
(ramus posterior descendens), nhanh trudc xu6ng (ramus anterior descendens) nhanh trudc len
(ramus anterior ascendens), nhanh sau len (ramus posterior ascendens) (a ngu'di Viet Nam s6
ding mach vao they tren : c6 hai Ong mach chiem 67%, ba dung mach c6 27% va bon deng
mach c6 6%), nhanh they gala (ramus lobi medii), nhanh nay lai chia lam hai nhanh la nhanh
ben (ramus lateralis) va nhanh gida (ramus medialis) ngu'di Viet Nam c6 hai Ong mach di
vao thUy gitia IA 75%, c6 met cling mach vao thily gida là 21% va cod ba Ong mach vao they
gida la 4%), nhanh dinh cUa thUy du'ai (ramus apicalis lobi inferioris). Sau khi tach ra nhanh
nay dung mach ph6i duoc goi IA phan day (pars basalis) va chia ra cac nhanh vao cac phan
they day nhu nhanh dtidi dinh (r. subapicalis), nhanh day gida (r. basalis medialis), nhanh day
trade (r. basalis anterior), nhanh day ben (r. basalis lateralis) va nhanh day sau (r. basalis
posterior) (H.31.9).

68
 Nhanh sau xu6ng
DOng mach ph6i phai

Nhanh dinh
DOng mach ph6i trai

Nhanh dinh
Nhanh tru'dc
Nhanh sau
Nhanh sau len

Phan day Nhanh trudc

xueing
Nhanh they git7a
Nhanh Nal

Phgn day
Nhanh day Nhanh day git7a
tradc Nhanh day
taidc
Nhanh day ben

Hinh 31.9: DOng mach cda pheci

2.2.3. Dung mach phi trait (a. pulmonalis sinistra) ngan va nha ham Ong mach ph6i
phai di che-ch sang ben trai va len tren bat die° mat truck phd quan chinh trai r6i chuff vao
rein ph6i phia tren Ord quan thUy ben trai (khdc \raj. Ong mach ph6i phai). Tiff day trot di dung
mach di giehig ben phai nghia la a phia ngoai r6i phia sau than phd quan.
DOng mach ph6i trai cling cho cdc nhanh ben tuang tiff nhu Ong mach ph6i phai trii
nhanh sau cua they tren, thay vi c6 hai thi chi c6 mot. Ngoai ra nhanh thily giita thi duqc goi
la nhanh (ramus lingularis) va chia ra hai nhanh nha là nhdnh tren (r. lingularis
superior) va nhanh laesi dual (r. lingularis inferior).
2.3. SIj PHAN CHIA CUA TINH MACH PHOI
Cde lctdi mao mach phd nang se d6 vao cdc tinh mach quanh tidu thUy r6i tip tuc thanh
cdc than lam dan cho tai cdc tinh mach gian hoac dtffc7i phan they (v. intersegmentalis) hoac
tinh mach trong phan they (v. intrasegmentalis) hoac cdc tinh mach thUy va cual ding tap hap
thanh hai tinh mach phoi a m6i ph6i de d6 vao tam nhi trai. Nhin chung, tinh mach ph6i phai
tren (v. pulmonalis superior dextra) va tinh mach ph6i trai tren (v. pulmonalis superior
sinistra) nhan khoang bon hoac nam tinh mach dm thily tren va thUy gala (du /(1 phdi phdi)
can tinh mach ph6i phai du'ai (v. pulmonalis inferior dextra) va tinh mach ph6i trai du'esi (v.
pulmonalis inferior sinistra) thi nhan cdc tinh mach cUa toan be) they &raj. (H.31.10).

69
 DOng mach phdi phai 77nh mach phdi phai tren
DOng mach phdi trai
Tinh mach phdi
trai tren
Nhanh tTnh
mach dinh sau

TInh mach
they tren Nhanh tru'dc

Nhanh
Tinh mach
they giCla

Tinh mach ph6i yr

d
4P#4 dinh Nhanh Irldi

Tinh mach phdi

phji duel 69 Tinh mach day trai drldi
duel

t. I Tinh mach day trOn

Hinh 31.10 : Tinh mach czia phdi

So phan b6 cua cac tinh mach ph6i nhi/ vay khong hoar' toan giong d6ng mach. Ngoai cac
tinh mach di trong cac dun vi ph6i nho d6ng mach, con co cac tinh mach di a chu vi hoac ranh
gidi Oda cac don vi ph6i. VI vay cac tinh mach dttac coi la not di vao cac gidi han cua phan
they trong phau thuat cat ba phan they (H. 31.7. va 31.8.).
2.4. DONG MACH VA TINH MACH PHE QUAN (a. et v. bronchialis) la thanh phan dinh
dung cua ph6i. D6ng mach ph6 quan rat nhO thodng tach ra a d6ng mach chu d6i vdi ben
trai Ara tit d6ng mach gian soon sau thO3 doi vdi ben phai, cac d6ng mach nay di tritdc hoac
sau 016 quan chinh con tinh mach ph.6 quan thi d6 vao cac tinh mach dun. M6t s6 nhanh nhO
d6 v6 tinh mach phoi.

2.5. BACH HUYET CUA PHOI : G6m nhieu mach bach huy6t, chay trong nhu In6 ph6i va
d6 vao cac hach bach huy6t ph6i (nodi lymphatici pulmonalis) thodng nam d ch6 chia doi dm
cac ph6 quan. Cac hach nay lai d6 vao cac hach ph6 quan ph6i (nodi lymphatici
bronchopulmonales) nam a r6n ph6i de cu6i ding d6 vao cac hach Ichi phe quan tren (nodi
lymphatici tracheobronchiales superiores) N/a cac hach Ichi ph6 quan dudi (nodi
tracheobronchiales inferiores) nam a ch6 chia doi cda kin quan (H.31.11).
2.6. THAN KINH CUA PHOI. Do dam r6i ph& (plexus pulmonalis) tao nen bdi cac soi
than kinh giao cam va cac nhanh ctia day than kinh lang thang. Dam r6i ph6i chia thanh
mot mang cac nhanh clan a xung quanh phd quan chinh r6i chui vao r6n ph6i dd phan
nhanh trong ph6i.

70
 Khi qua'n
Chu& hach khi
phg quan tren Chuai hach khi
phe'quan
Quai tinh mach tren
don On
Quai ddng
mach chd
Chu6i hach
khi phe
quan du'di Hach bach
huygt phdi

Hinh 31.11 : Sa do cac dam hach bach huyet ctia phoi

3. MANG PHOI (pleura). GiCing nhu mang tim va 'pang bung, mang ph6i la met thanh mac
g6m hai la : mang ph6i thanh va mang ph6i tang. Gina hai la la 6 mang phOi.
3.1. MANG PHOI TANG (pleura pulmonalis) boc sat va dinh chat vac) nhu mo ph6i, lach
ca vao cac khe gian thily ph6i. O r6n ph6i, mang ph6i tang qu'a't ra de lien tiep vdi mang ph6i
thanh. Duang quat co hinh met cai vot b6ng ban ma can quay xu6ng nai hai la mang
ph6i sat vao nhau de tao nen day chang ph6i (ligamentum pulmonale) (H.31.3) va (H.31.4).
3.2. MANG PHOI THANH (pleura parietalis) dp sat phia ngoai mang ph6i tang, g6m co :
mang ph6i trung that (pleura mediastinalis) dp sat phan trung that &la mang phoi tang, mang
phoi wan (pleura costalis) dp sat vao mat trong 16ng nguc va ngan each vdi 16ng ngtic baimOt
Idp me lien ket mOng goi la mac not nguc (fascia endothoracica), mang phcii hoanh (pleura
diaphragmatica) dinh sat vao mat tren ca hoanh. Phan mac not nguc a day ngan each mang
ph6i vdi ca hoanh goi la mac hohnh - mang ph6i (fascia phrenicopleuralis). Dinh mang ph6i
(cupula pleurae) la phan mang ph6i thanh Wang ging vdi dinh ph6i. Dinh mang ph6i duoc giii
tai ch6 bai cac day chang treo dinh mang ph6i barn tit cac xuting song, xuang wan lan can tdi
dinh mang ph6i. Phan mac not nguc a day dirge goi la mang teen mang ph6i (membrana
suprapleuralis).
Goc nhi dien hyp bai hai phan mang ph6i thanh goi la ngach mang ph6i (recessus pleurales).
CO hai ngach mang ph6i : ngach suan hoanh (recessus costodiaphragmaticus) do mang ph6i
suan gap mang ph6i hoanh. Ngach nay chieu len thanh nate thap han bar dudi ph6i cu the là
ngang mac xuang scan 10 a clueing nach giaa, xuung swan 11 a each duang giaa sau 10cm

71
va tan hgt a khoang gian d6t song ngitc 12 va thdt lung 1 (H.31.12); ngach thtt hai la ngach
wan trung that (recessus costomediastinalis) do mang ph6i satin gdp mang ph6i trung that.
Ngach nay chieu len thanh ngkic giffing bar trade ph6i till a phdn cloth ben trai thi gan &tang
gala hOm khuye't tim caa bar tru'ac ph6i trai (H.31.12).

Ngach sudn
trung that Dinh mang ph&

Ba trddc Dinh ph&

phdi phai
Bd tru'dc
Khe ngang ph& trai

Khe chgch Khuygt tim coa

ph& trai
Bo dudi
ph& pligi Khe chgch

Ngach &Ian Ba duel

hoanh phai ph& trai
Ngach sudn
Mom mui kigm hoanh trai

D6t sting ngLic XII

Mang pho7 hoanh •

Hinh 31.12 : Doi chi& czla phdi va mang phdi len ldng nguc (nhin phia trade)
During dam let giai han caa phdi;
Duang chdm chdm la gioi han mang

3.3. 6 MANG PHOI (cavum pleurae). Gioeng nho 6 mang tim va 6 pink mac, 6 mang ph6i
la mot khoang do, nam giaa mang phol tang va mang ph6i. thanh. Hai mang dp sat vao nhau
va c6 the truVt len nhau lam a clang cho ph6i na ra hodc be lai lac hit vao hodc the ra. M8i
phcli c6 mot 6 mang ph6i rieng khong thong not nhau. Khi mang ph6i bi viem, trong 6 mang
ph6i c6 the chtia dich hodc mau, mu, do la tran dich mang phOi. Khi mang ph6i bi thOng,
khong khi tran vao 6 mang ph6i gay trail khi mang ph6i.
4. DOI CHIEU CUA PHOI VA MANG PHOI LEN THANH NGVC
Cac m6c gidi han d6i chi6u cua ph6i la dinh, bar trudc, bar dirai va cac khe gian thOy; con
&la mang ph6i la dinh, ngach wan trung that va ngach satin hoanh da docic mo to a cac phan
Wang ung (H.31.12). Cac m6c nay thay d6i, tuy lac the/ ra hay hit vao va thy dang bing ngoc
rOng hay hep v.v...

72
 CAU HoI TRAC NGHIEM
Chon cau tra 16i dung nha-t
353. Thong thutng thby gida ph6i (P) co :
a) MOt phan thug. d) B6n phan they.
b) Hai phan they. e) Nam phan
c) Ba phan thUy.
354. Nhu me ph6i duoc nuoi dung beri :
a) DM ph6i. d) Cau a va c.
b) TM ph6i. e) Cau b va c.
c) DM pile- quan.
355. C1 dutng nach giCia, bO duti ph6i va mang ph6i Mn luot a ngang mutt cac xutng sutn :
a) 6 va 8. d) 9 va 11.
b) 10 va 12. e) 8 va 10.
c) 7 va 9.
356. Don vi co sot cua ph6i la :
a) Tidu they ph6i. d) Tdi phg nang.
b) Phan thy phoi. e) Ong phe nang va phe- nang.
c) Phe nang.
357. Dinh ph6i :
a) ei ngang mire bo tren xuang don.
b) O ngang mdc bO &Ai xuang don.
c) C1 ngang mitt dau tic xutng don.
d) C1 ngang mutt bor tren xucing suOn 1.
e) C1 tren Tau de )(acing don khoang 3cm.
Cau 358 va 359. ChQn
a) Neu 1, 2, 3 dung. d) Neu chi có 4 dung.
b) Ndu 1, 3 dung. e) Neu 1, 2, 3, 4 cle'ti dung.
c) Neu 2, 4 dung.
358. 1. Ph6i (P) co ba thuy va ph6i (T) co hai thUy.
2. Ph6i la mot tang nam trong trung th6t.
3.6 ph6 mac hai phoi khong thOng nhau.
4. BO dudi ph6i nam ngang mutt khoang gian suOn IX tren dutrng sat cot song.
73
359. 1. Ph6 mac tang bao phU toan 1315 be mat cila ph6i va len vao tan cac khe gian thUy.
2. Ludi ph6i trai dude gidi han bdi khe ch6ch va khe ngang.
3. Mat trong ph6i phai khong có an tim.
4. Ph6 mac thanh va tang lien ti6p nhau O" r6n ph6i.
Dung hinh ye dddi day de tra ldi cau 360, 361, 362.

1
Eking mach phei
Phe qua n

360. Hinh ve tren là hinh mat trong cua ph6i

361. Chi tiet (1) trong hinh là :
362. Chi ti6t (2) trong hinh la :

74
 32 TIM

MUC TIEU BAI GIANG

MUC TIEU Ijs2. THUYET
1. M6 to vi tri, clulc nang va lien quan cac mat cua tim.
2. M6 to hinh thd trong va eau tao caa tim.
3. MO to Ira ye so d6 mach mall va than kinh caa tim.
4. Ve hinh d6i chidu tim va cac 16 van tim len 16ng nguc.
B. MUC TIEU THIIC TAP
1. Dat clang vi tri caa tim trong 16ng nguc xuong.
2. CM duoc cac chi ti6t giai phdu y6 hinh thd ngoai, trong cua tim tren xac, m0 hinh, tieu ban.
3. Chi du'oc tren xac va m6 hinh cac mach mau va than kinh cua tim, cac 16p mang tim.
4. CM cac chi tidt giai phan cua tim tren phim X quang.
5. Xem tim va mang tim tren cho song.

1. DAI CLING

Tim (cor) la mot co quan g6m m6t, khol ca dac biet, bao boc lay mot khoang r o- ng c6 bon
bu6ng. Tim c6 tac dung nhur mot cai born vita but vim day mau. Tim nam trong trung that .gida.
caa. 16ng ngkic, tren co hohnh va sau xuong tic, gala hai ph6i, hai Lech sang ben trai. Can nang
trung binh a nguai twang thanh la. 270gr d nam va 260gr 6 nil Thd tich to bang nam tay
ngu'6i ldn. True Mn tif day tai dinh khoang 12cm va be ngang khoang 8cm.

2. HINH THE NGOAI VA LIEN QUAN

Tim gi6ng nhu mot hinh thap ba mat, mot day va mOt, dinh. Dinh quay ra truck va hai sang
trai, day ra sau va hai sang phai. Truck:41 di tit sau ra tru6c hai chdch xu6ng duai va sang trai.
2.1. DAY TIM (basis cordis) quay ra phia sau ang vai mat sau cua hai tam nhi. Gifla hai
tam nhi c6 mot ranh doc goi là ranh gian nhi. Ben phai ranh là tam nhi phai hoi quay sang phai

75
lien quan vent mang ph6i phai va day than kinh hoanh phai. Cl phia tren co tinh mach chi' tren
(v. cava superior) va a clued c6 tinh mach chili duai (v. cava inferior). Co met ranh nong not 136
phai tinh mach chi' tren va chu duai a mat sau tam nhi phai goi là ranh tan ding (sulcus
terminalis) (H.32.1). Phan tam nhi phai nai co tinh mach cha tren va chti dual 06 vao hart
phlnh ra a phia sau tao nen xoang tinh mach chil (sinus venarum cavavum). Ben trai ranh
gian nhi la tam nhi trai hoan toan quay ra phia sau, c6 tinh mach ph6i 06 vao va lien quan vai
thuc quan. Trong benh suy tim ngu tam nhi trai phinh to co thg de vao that quan.

2.2. MAT I-IC StidN (facies sternocostalis) (H.32.2) con goi la mat trade. Co ranh vanh
(sulcus coronarius) chay ngang ngan each phan tam nhi a tren va phan tam that a dual. Phan
tam nhi bi cdc thing mach lan tit tim ra the lap nhu than &Ong mach ph6i a ben trai va Ong
mach chil,0 ben phai. Hai ben clung mach c6 tidu nhi phai va trai (auricula dextra et
sinistra). Ci phan tam that co ranh gian that truck (sulcus interventricularis anterior) chay doc
tit sau ra phia ben phai dinh tim ngan dui hal tam that. Trong ranh c6 nhanh gian that trade
cila do, ng mach vanh trai (a. coronaris sinistra) va tinh mach tim lan (v. cordis magna).

Cung clOng mach chi)

Tinh mach cht) tren

DOng mach ph6i

Tam nhi phai

(xoang tinh mach ch())

Tinh mach phei phai

Ranh tan cung
Tinh mach chi; duel
Tam nhi hal

Tam that phai

Ranh gian that sau

Tam thgt trai

Hinh 32.1 : Tim (nhin phia sau)

Mat Lk swan caa tim lien quan a truck \red mat sau xu'o'ng tic va cdc skin strait tit thd III tai
thd VI. ei tre em thuting c6 tuygn Cfc (thymus) nam then giita tim va thanh nguc.

Mat dc suan caa tim chigu len thanh nguc theo met hinh tOr gide ma bon g6c là : g6c tren
trai a khoang gian satin 2 canh bar trai xuang dc, g6c teen phai a khoang gian swan 2 canh bur
phai xuang etc, g6c ducli trdi a khoang gian atini V, ngay ducli num vu trai khoang 1 cm va g6c
dual phai a khoang gian suan V canh bar phai xu'ang tic (11.32.3).
76
 2.3. MAT HOANH (facies diaphragnzatica) (H.32.1) con goi la mat dtrdri, lien quan vdi co
hohnh Ira qua ca hoanh vdi thily trai cua gan va day cua da day. Mat hoanh ming co ranh
vanh lien ti6p vdi ranh vanh d mat dc sa6n va chia tim thanh hai phan: phan sau hep là tam
nhi va phan trade la tam that,. 0 phan nay co ranh gian that sau (sulcus interventricularis
posterior) di tit sau ra trudc va n6i vdi ranh gian that trudc o phia ben phai dinh tim. Trong
ranh co nhanh gian th6t, sau cUa. &Ong mach vanh phai (a. coronaris dextra) va tinh mach tim
gi€ia (v. cordis media).

2.4. MAT PHOI (facies pulmonalis) con goi là mat trai, lien quan Wdi ph6i va mang phi trai.

2.5. DINH TIM (apex cordis) con goi la mom tim nam che-ch sang trai o ngay sau 16ng
natc. CO the nhin thay mom tim dap d khoang gian warn V ngay dadi num v6 trai. 0 ben phai
dinh tim là khuy6t dinh tim (incisura apicis cordis), nai hai ranh gian that tru'dc va sau gap
nhau (H.32.2).

D¢ng mach canh g6c trai

- DOng mach dudi riOn trai
Than dOng mach
canh tay dau
Day chang ddng mach

Tinh mach crib tren

Than cldng mach ph6i
Nganh len coa
ddng mach cha
Than chung cUa
ding mach vanh trai

Ddng mach Tinh mach tim

vanh phai

Ranh gian that track

Cac tinh mach va nhanh gian that trudc
tim trudc ct:ia Ong mach vanh trai

Than Ong
mach phdi

Dinh tim

Hinh 32.2: Mat dc su'an vet mach vanh cua tim

77
 Diem nghe Goa
to Ong mach
ch5 DOng mach ch5

Diem nghe Than Ong

c5a Id than mach pheii
dOng mach L6 than de.mg
phdi mach pheii
L6 than dOng L6 dOng mach chO
mach phdi
Lo Ong
mach ch5 L6 nhT thdt trai
Li nhTthgt
trai L6 nhT that phai
Diem nghe
c5a k5 nhi thgt trai
Diem nghe
cOa to nhT thgt phai Lo nhT thgt phai

Hinh 32.3: Ddi chi& etia tim vet cdc to van tim len long ngVc.

3. HINH THE TRONG

Tim &lac chia lam b6n bung : hai tam nhi va hai tam that ngan cach nhau bai cac vach
sau day :
+ Vach nhi thgt (septum atrioventriculare) là met mang mOng ngan each tam nhi phai va
tam that trai. Set di co vach nay la vi phan mang cda vach gian that dinh l'ech sang phai (H.32.4).
+ Vach gian nhi (septum interatrial) dinh vao thanh trong tam nhi irng vdi ranh gian nhi
d mat ngoai. Vach du.ac cau tao tit he phoi thai bai hai vach dec lap nhau va khong kin hoan
toan. Tuy nhien hai vach trong qua trinh phat tridn dp sat vao nhau va ngan cach hoan than
hai tam nhi, vi vay a ngirdi twang thanh can di tich a mat phai cua vach met lem goi la 116
bau dye (fossa ovalis). Truang hap hai vach khong gap nhau thi de lai met 16 goi là to bau doe
(foramen ovale) tao nen tat thong lien nhi. Phia trade tren cda h6 là met gd goi la vier' h6 bdu
doc (limbus fossae ovalis) (11.32.5). Di tich 116 bail dye a mat trai cua vach gian nhi la van 16
bdu doc (valvula foraminis ovalis) can goi la hem vach (falx septi) (11.32.6).
+ Vach gian thSt (septum interventriculare) ngan cach hai tam that, barn a thanh trong
tam that Ling vdi hai ranh gian that trade va sau a ben ngoai. Vach CO met phan nhO, rat mOng
a On 16 nhi that goi la phan mang (pars membranacea) va dai be phan con lai rat day goi la
phan ca (pars muscularis) (H.32.4). Vach tong 18i sang ben phai nen tarn that trai ldn Ilan tam
that phai. Neu phan mang cda vach gian that bi khigm khuyet thi tao nen tat thong lien that.
Tom lai ba vach nhi that, gian nhi va gian that chia tim thanh b6n bu8ng : tam nhi phai,
tam nhi trai, tam that phai va tam that trai.

78
 Tam nhT phai Tam nhT trai

Phan ming vach gian that

Vach gian nhT

Vach nhT that Van nhT that trai

Van nhT thdt phai Tam that trai

Tam that phai Thing gin

Vach gian that

Hinh 32.4 : So d6 hinh the trong oda tim

3.1. TAM NHL Noi chung, hal tam nhi na'm d phan day tim phia sau, cc') nhang dac didin
chung sajday :
— Thanh mong hun tam that vi chi lam nhi."0-n vu but mau ve tim.
— CO cac tinh mach d6 vao.

Tinh mach chi trail Ddng mach ch5

Vidn ho Pau ddc

Than dOng mach ph6i

Cac cc ILTdc
Ho Pau ddc

Van tinh mach

ch5 duet L6 xoang tinh mach vanh

Mao tan cang

Tinh mach chu dual

Hintz 32.5 : Tam nhi phdi

79
 77nh mach phai

DOng mach cht)

77nh mach chi' tren

Mach vanh
77nh mach phei phai

Van 10 b'au duc

77nh mach phei trai

L0 de vao tim ca a
tinh mach phei trai

Mach vanh
Van nig that trai
Thanh tam thgt trai

Hinh 32.6: Tam nhi trdi

- Thong vdi mot tai nh6 a phia tradc goi là tidu
- Thong vdi tam that ding ben bai 16 nhi that c6 van day kin.
3.1.1. Tam nhi phai (atrium dextrum) (11.32.5). Thanh trong cua tam nhi phai la mat
phai cua vach gian nhi, c6 116 Mu due va vien h6 bau due nha da to a tren. Phia trade c6 16 nhi
that phdi (ostium atrioventriculare dextrum) thong tam nhi phai vdi tam that phai. Phia tren
16 la tidu nhi phai (auricula dextra). Phia sau dudi la 16 tinh mach chd dual (ostium venae cavae
inferioris) c6 van tinh mach chd dadi (valvula venae cavae inferioris). Gan 16 nhi that c6 16
xoang tinh mach vanh duc day mot phan bai van xoang tinh mach vanh (valvula sinus
coronarii). Phia tren c6 16 tinh mach chi' tren (ostium venae cavae superior) khong c6 van. Co
mot goi n6i phia bor phai caa hai tinh mach clui tren va chd dual goi la mao tan cang (crista
terminalis) uing vdi ranh tan ding a ben ngoai. Phia ben phai ranh tan ding, mat tam nhi sdn
sui not len thanh nhiIng gd tao nen cdc co' lu'dc (mm. pectinati). Phia du'di thanh sau cda tam
nhi phai doi khi not len mot cu nh6 goi la cu gian tinh mach (tuberculum intervenosum). D6
vao tam nhi phai con co rat nhigu 16 tinh mach nha (foramina venarum minimarum) din mot
phan nha mat' tinh mach ta thanh tim vao.
3.1.2. Tam nhi trai (atrium sinistrum) (11.32.6). Thanh trong tam nhi trai c6 van 16 Mu
duc nhu da to d phan vdch gian nhi. Ngoai ra phia tntdc c6 16 nhi that trai (ostium
atrioventriculare sinistrum) thong tam nhi trai vdi tam that trai. Phia tren, tam nhi trai thong
80
vdi tidu nhi trai (auricula sinistra). CO ban 16 tinh mach ph6i (ostia venarum pulmonalium) d6
vao tam nhi trai.
3.2. CAC TAM THAT. Dac di6m chung cua hai tam that la co thanh rat day, dac biet la d
tam that trai de lam nhiem vu co bOp day mau tit tim di. Trong thanh rat san sui vi co nhieu
ca n6i len. Tit tam that co cac clang mach Ian di ra, co van day rat kin.
3.2.1. Tam thk phai (ventriculus dexter) (H.32.7) Hinh thap ba mat (track, sau, trong) mat nen
quay ra phia sau va mat dinh phia trade, co the tich nhO hctn va thanh mong Ilan tam that trai.

Than clang mach ph6i -

Van than clang

mach pho'i

Tido nhi phai

Van nhi thdt phai

Co nhti

Tam thdt trai

Hinh 32.7 : Tam thett phcii

nen có 16 nhi that phai (ostium atrioventriculare dextrum) thong tam nhi phai vdi tam
that phai. L6 dnac day bdi van nhi that phai (valva atrioventricularis dextra) con goi la van ba
la (valva tricuspidalis) vi co ba la 1a : la tali& (cuspis anterior), la sau (cuspis posterior) va la
vach (cuspis septalis) cOn goi la la trong vi dinh vao vach a phia trong. Nhu vay m6i la. Ling vdi
mat thanh cila tam that (H.32.9).
Phia truO'c tren 16 nhi that phai la 16 than dong mach phoi (ostium trunci pulmonalis) co
van than dong mach ph6i (valva trunci pulmonalis) day kin. Van gam ba van nh6 hap lai la :
van ban nguy't trade (valvula semilunaris anterior), van ban nguyet phai (valvula semilunaris
dextra) va van ban nguyet trai (valvula semilunaris sinistra). Cl gida bCt tai do cilia m6i van n'61
len mat cue nh6 goi là cue van ban nguyet (noduli valvularium semilunarium). Phan tam that
phai On 16 than dong mach ph6i bi hep lai thanh non clang mach (conus arteriosus) cOn goi là
ph'eu (infundibulum). Gina non dong mach va phan con lai cila tam that n6i len mat get goi la
mao tren tam that (crista supraventricularis).
81
 D'Ong mach chi

Van clOng mach chi

DOng mach pho'i

Van nhi that trai

Thanh tam that trai

Co nhu

Hinh 32.8 : Tam that trdi.

trong tam that phai, iing vdi ba thanh cif) cac co nha trade (musculus papillaris
anterior), co nha sau (muscularis papillaris posterior) va cac car nhti vach (musculi papillares
septales). dem 4( do dm cac co nhti có cac thong gan (chordae tendineae) not co veil cac la caa
van ba là (H.32.7).
Doi khi có mot go co n6i len goi la be vach vin (trabecula septomarginalis) n6i to thanh
vach ciia tam that phai tdi car nha truck. Trong be co try phai &la bó nhi that.
3.2.2. Tam that trait (ventriculus sinister) (H.32.8) co thanh rat day vi phai bop mdu qua
dOng mach chit vao veng tun hoan lern di kith co the. CO hinh non det, v6rt hai thanh trai
(ngoai) va phai (trong), mot nen va mot dinh.
Nen co 16 nhi that trai (ostium atrioventriculare sinistrum) direct dAy bai van nhi thgt trai
(valva atrioventricularis sinistra) hay van tang mao (mu ni) (valva mitralis). Van co hai la nha
mOt, mu ni frog vai hai thanh ctia tam that là la triidc (cuspis anterior) hay là ngoai va la sau
(cuspis posterior) hay la trong. L6 dOng mach chii (ostium aortae) nam a phia phai 16 nhi th‘t
trai clu'oc dAy bed van dOng mach chti (valva aortae).
Gio-ng van than Ong mach ph6i, van Ong mach cha cung g6m ba van nho hqp lai la van
ban nguy4 sau (valvula semilunaris posterior), van ban nguyet phai (valvula semilunaris dextra) va
van ban nguyet trai (valvula semilunaris sinistra). O m6i van ding co cue van ban nguyet
(H.32.9). Cac 16 van tim chie-u len thanh ngkic a nhitng didm minh hoa tren hinh 32.3 (H.32.3).
CO hai car nhti la co nhti trot & (m. papillaris anterior) va co nhti sau (m. papillaris posterior)

82
vb. ding c6 cdc thang gan dinh tit dinh ea tai cdc la van tang mao. Cac 18 nhi thdt phai va trai,
cac 18 than d6ng mach phoi va to dOng mach chU duac chie-u len thanh ngoc theo hinh 32.3
(H.32.3).

Van than clOng mach phdi

Van clOng mach ch

Van nhi that trai

Van nhi that phai

Hintz 32.9 : Sa (16 cdc van tim

4. CAU TAO CtA TIM

Thanh cua tim duac cau tao bed ba lap : ngoai tam mac, ca tim va not tam mac.
4.1. NGOAI TAM MAC (pericardium) con goi la mang ngoai tim la mot till kin Om hai
bao : bao sai a ngoai goi la ngoai tam mac sai va bao thanh mac d trong goi la ngoai tam mac
thanh mac.
4.1.1. Ngoai tam mac scii (pericardium fibrosum) bao boc phia ngoai tim va co cdc the
sai dinh \Teti bac ca quan tan can nhu co hohnh, cot song, xuang sic, khi quart, phd quan va thkrc
quan. Cdc tha sai bam vao xuang atc bit h6a rO ret thanh cdc day chhng uIc ngoai tam mac
(ligg. sternopericardiaca) (H.32.10).
4.1.2. Ngoai tam mac thanh mac (pericardium serosum) gio-ng nha mang phOi hoac
pink mac, ngoai tam mac thanh mac co hai thanh (lamina parietalis) va la. tang (lamina
visceralis). Ghia hai ld là mot khoang ao goi là 6 ngoai tarn mac (cavum pericardii). Khi viem
ngoai tarn mac, trong 6 co chda nhieu chat dich.
Ld tang va la thanh lien tiep nhau d cdc mach mdu 16n a day tim. Do do co hai bao mach
: bao Ong mach d phia truac boc ldy dOng mach cha va than Ong mach phOi va bao tinh mach
a phia sau boc cdc tinh mach ph8i va tinh mach chi.' tren. Gina hai bao là xoang ngang ngoai
tam mac (sinus transversus pericardii).
83
 Thoc ngon tay qua xoang ngang to se 1u6n duoc tay phia sau cac Ong mach va phia tracic
cac tinh mach (H.32.10).

Eking mach ph6i phai DOng mach chd

Xoang ngang Bao soi

Mang ngoai tim

Tinh mach ph6i (la thanh)

Mang ngoai tim

(la tong)

Tam nhi trai

Co' tim

Hinh 32.10 : Sa do cdu tao czia cdc lop mang ngodi tim

Gina hai tinh mach phOi phai va hai tinh mach phoi trai a mat sau tam nhi trai co mOt
h6 nong lom nhu' mOt tai ding goi la xoang chech ngoai tam mac (sinus obliquus pericardii)
(H.32.1).
4.2. CO TIM (myocardium) tao nen mOt lap day mong tuy ch6, mang a tam nhi va rat day
a tam that dac biOt la tam that trai. Dai b0 phan la cac soi co co b6p, ngoai ra con mOt phan
nho la cac soi ca kern biOt hOa mang tinh chat than kinh goi la "h0 thong clan truyk cua tim".
4.2.1. Cac sdi cat co bop (H.32.13) Cac co tim bam vao mOt hO thong vOng soi (anuli
fibrosi) chive coi nhtt cai cat cua tim. CO bon vOng soi quay quanh bon 16 lin cua tim : Hai 16
nhi that va hai 16 thing mach chti va than dOng mach ph6i. Phan sai giap giii gida 16 Ong
mach clul vii hai 16 nhi that dac biOt day va chac duac goi la cac tam gide soi (trigona fibrosa).
Cac did ca bam vao cac vOng soi g6m hai loai : loai rieng cho tang tam nhi hoac tiing tam that
va loai chung cho hai tam nhi hoac hai tam that (H.32.12).
4.2.2. 14 thong &An truyen eita tim là cac sqi co kem biOt hoa nam lan trong cac soi co
bop va có nhiOm vu duy tri so co bOp tit Ong cua tim.
84
 L5 nhi" thit phai ,oullirILEASOUblt 400PLUNIVINK
_ L5 nhi thgt trai
41111601W Aural
14/113 Irgijkii ii"Os'
4„,.. rr igg ammo \
• 01%
IN Too

4m.
V.4*
• 43
i thatre,
401
Lei dOng mach chef Nati L5 dung mach ph6i

Hinh 32.11 : Sa do cac sqi ca rieng cua tim

L5 nhi that phai Lo nig thgt trai

Lo dung mach chi) L5 dOng mach ph6i

Cac thd co qua

dinh tim
Cac thd co kh6ng
qua dinh tim

Hinh 32.12 : Sa do cac sqi ca chung cda tim.

He thong bao g6m met s6 nut va cac b6 sqi (H.32.13).

— Ntit xoang nhi (nodus sinuatrialis) nam a thanh phdi caa tam nhi phai phia ngoai 16
tinh mach chit tren.
— Nut nhi that (nodus atrioventricularis) nam trong thAnh dia tam nhi phdi gida Id trong
caa van ba ld va 16 xoang tinh mach vanh.
Tit nut nhi that tach ra b6 nhi that (fasciculus atrioventricularis) nam a mat phdi ctia
vach nhi that, khi di h6t phan mang cua vach gian that thi Chia lam hai try try phdi (crus
dextrum) phan nhanh trong thAnh tam that phdi nam trong be vach vien N/A tan cung ar than
cac co' nhti, try trai (crus sinistrum) chui qua vach taa vao thanh tam that trai va cung tan
cung a than cac co- nhti.
4.3. NOI TAM MAC (endocardium) hay mang trong tim IA met mAng Tat mang phu va
dinh chat len tat ca mat trong cac bu6ng tim va lien ti6p vdi nei mac dia cac mach mdu tii tim
ra hoac vao. Khi viem nei tam mac c6 thd gay cac hep hoac hu cac van tim hoac gay cac
cyc huy6t khoi lam tdc Ong mach.
85
 Tinh mach chi tren

Tinh mach ph6i

Nut xoang nhi

Nut nhitha't

Bo nhi thgt

Tam thgt trai

Try trai
Try phai

Tam that phai

Tinh mach chu dcroi

Hinh 32.13 : Sc, do he thong dein truyen cua tim

5. MACH VA THAN KWH C19.JA TIM
5.1. BONG MACH. Tim du'ac nuoi dung bai hai citing mach vanh phdi va trai.
5.1.1. DOng mach vanh phai (a. coronaria dextra) tach tit cung dOng mach chei ngay phia
tren van dung mach chu, chui ra mat truac tim qua khe gala than do, ng mach ph6i va ti6u nhi
phdi r6i yang sang phai di trong ranh vanh xu6ng mat hoanh cua tim vao ranh gian that sau
va tan ding a dinh tim. Tren du'ang di, citing mach cho cdc nhanh nuoi tim trong do c6 nhanh
16'n nha't la nhanh gian that sau (ramus interventricularis posterior).
BOng mach vanh phdi a ngurai Viet Nam c6 dung kinh 3,7 mm. C1 ngtrai Phdp &tang kinh
la 4,0 - 4,5mm,. dung di cila Ong mach chay ngoan ngheo trong ranh gian nhi that phdi, cung
cap mdu cho doan dau dOng mach chU, Ong mach ph6i, toan 130 tam nhi phdi, vach gian nhi,
tam that phdi, mat sau tam thA trai va naa sau vdch gian that.
5.1.2. DOng mach vanh trai (a.coronaria sinistra) cung tdch tir cung Ong mach chil,
ngay tren van &Ong mach chu chui ra mat truck tim qua khe giCta than dOng mach ph6i va tieu
nhi trai r6i chia lam hai nhanh chinh : nhanh gian that tru'ac (ramus interventricularis
anterior) di trong ranh gian that trade - t6i dinh tim yang ra phia sau de n6i \Teri Ong mach
vanh phdi. Can nhdnh mu (ramus circumflexus) thi yang ra trai trong ranh vanh di xu6ng mat
hoanh va not hoac khong not vai do", ng mach vanh phdi (H.32.2).

86
 Cung dOng mach do
Day chang ctOng mach

TInh mach chit tren

DOng mach phdi

Tinh mach chit du'eti

TIM mach tim On

*Mb mach chgch

cila tam nhi trai
Xoang tinh mach vanh

Tinh mach sau

coa tam thit trai DOng mach vanh phai

Tinh mach tim giaa

Hinh 32.14 : Mach vanh ciia tim (nhin phia sau)

5.2. TINH MACH CUA TIM. Tinh mach cad tim gam. c6 :
- Tinh mach tim 16n (v. cordis magna) chay trong ranh gian that triidc yang sang trai vao
ranh vanh u mat hoanh caa tim va n6i vdi xoang tinh mach vanh (H.32.2).
- Tinh mach tim giaa (v. cordis media) chay trong ranh gian that sau r6i cling d6 vao
xoang tinh .mach vanh (H.32.14).
- Tinh mach sau caa tam that trai (v. posterior ventriculi sinistri) nam a thanh sau ben
caa tam that trai va cang d6 frac ti6p vao xoang tinh mach vanh (H.32.14).
- Cac tinh mach tim trudc (vv. cordis anteriores) gam rat nhigu nhanh nh6 a mat tra6c
tam that phdi va thaang d6 frac ti6p vao tam nhi phi (H.32.2).
- Tinh mach tim nh6 (v. cordis parva) nhan mau ta tam nhi phdi va tam that phdi chay
trong ranh vanh a mat hoanh &la tim va d6 vao xoang tinh mach vanh.
- Tinh mach ch6ch cua tam nhi trai (v. obliqua atrii sinistri) di cheo tii thanh ben tam nhi
trai va d6 vao xoang tinh mach vanh (H.32.14).
Cac tinh mach tim clic nha (vv. cordis minima& la cac tinh mach cila thanh tim d6 trac
ti6p vao cac tam nhi va tam that bang cac 16 tinh mach cac nha.
87
 - Xoang tinh mach vanh (sinus coronarius) la phan tan cung caa hau het cdc tinh mach
cUa tim, track 'chi do vao tam nhi phai a 16 xoang tinh mach vanh. Xoang tinh mach vanh dai
khoang 2,5 cm phinh to ra va nam trong ranh vanh a mat hoanh &la tim (H.32.14).

5.3. BACH MACH CUA TIM chay theo hal dong chinh song song vdi hai dOng mach vanh.
- Deng trai chay theo dung mach vanh trai nhan bach huyet a phan tim trai r6i d6 vao
cdc hach Ulf phe quan.
- Dang phai chay theo Ong mach vanh phai nhan bach huyet a phan phai caa tim r6i d6
vao chu6i hach trung that track.

5.4. THAN KINH CUA TIM

Ngoai phan he th6ng dan truy6n cua tim da mo to a phan ca tim, tim dude chi phol bai
than kinh thuOc he tit chi g6m cdc sal giao cam ti cac hach co va hach ngu'c tren va cdc sai
d6i giao cam tit day than kinh lang thang. Cdc sai tao thanh dam rea tim (plexus cardiacus)
qua hach tim (ganglia cardiaca) nam a dual cung &Ong mach cha de vao tim (Xem them bai He
thein kinh to cha).

CAU HO! TRAC NGHIEM

Chon cau tra loci clang nhgt

363. Ranh tan clang :

a) di day tim la ranh gidi caa tam nhi (P) va (T).
b) Noi bar phai tinh mach cha tren va (lath.
c) ben trai vdch lien-nhi.
d) Tudng ling vdi be) nhi that.
e) Tat ca deu sal.
364. Phan mang cua vach nhi that ngan each :
a) Tam nhi trai vdi tam nhi phai
b) Tam that phai vdi tam that trai.
c) Tam nhi phai vdi tam that phai.
d) Tam nhi phai vdi tam that trai.
e) Tam nhi trai vdi tam that phai
365. Tam nhi trai lien quan phia sau cha ye-u yeti :
a) Thqc quan.
b) Phe quan chInh trai.
c) DM cha xueing phan ngu:c.
d) COt song ngu'e va chu6i hach giao cam ben (T), doan ngtic.
e) Ph6i va mang ph6i.

88
TTnh mach chei tron

Cung cffing mach. chef

Tieu nhT ph& — bong mach phdi

Tieu nhT trai
DOng mach vanh phai
Dong mach vanh trai

Anh XXVIII : Tint (nhin phia truck)

89
366. Ho bdu dye :
a) La mot l6 thOng tit giai doan phoi thai thu6c thanh trong tam nhi (P).
b) Vita thu6c tam nhi (P) vita thuOc tam nhi (T).
c) CO vien h6 bdu due giai han a phia trade va tren h6.
d) CO van caa h6 Mu duc la phan keo dai cila van TM chi' du'ai.
e) Tat ca deu sai.
367. Van ban nguyet ngan each :

a) L6 DM ph6i va tam that phai.

b) L6 DM chil Ira tam that trai.
c) L6 xoang TM vanh va tam nhi phai.
d) a va b dung.
e) a, b, c deli" thing.

368. Xoang ngang mang ngoai tim là ngach :

a) Nam giaa DM chi' len a phia trade va than DM ph6i a phia sau.
b) Nam giaa DM cha len, than DM ph6i a phia tru'ac va TM cha tren, cac TM ph6i 6 phia sau.
c) Nam giaa TM chii tren, DM chii len a phia tru'ac va than sau DM ph6i, cac TM ph6i 6 phia
sau.
d) Nam giaa 2 TM ph6i trai va 2 TM ph6i phai.
e) Tat ca deu sai.

369. Cau nao sau day SAI :

a) Tim g6m CO ba mat : etc - wan, hoanh, phoi.

b) Tim thu6c trung that giaa.
c) Day tim nam tren car hoanh.
d) Tim co bap dui sa chi ph6i ciia he th6ng ddn truye'n cua tim (mit xoang, nut nhi that,
134:5 nhi that) va &fed sa dieu khien ctia. he TK tai chti.
e) Thac quail na'm ngay sau tam nhi trai.

370. Cac DM vanh Ira TM tim :

a) Nam tren be mat bao xci mang ngoai tim.
b) Nam dual bao xo mang ngoai tim.
c) Nam trong khoang mang ngoai tim.
d) Nam giaa la tang bao thanh mac mang ngoai tim va be mat ca tim.
e) Nam trong co tim.

90
371. Di trong ranh gian that truac c6 :
a) Nhanh gian thg trurac cila DM vanh trai.
b) Nhanh gian that truck &la DM vanh phai.
c) TM gian that try ac.
d) a va c dung.
e) b va c
Dung hinh ye sau de tra ldi cau 372, 373.

372. D6i chieu ciia 16 van DM chil len thanh ngqc a vi tri C..).
373. D6i chie-u 16 van hai la len thanh ngkic a (...) (Xem them beti 56).
Dung hinh ye sau de tra idi cau 374, 375.

Tim nhin tit' truck Tim nhin tit sau

91
374. TM tim be a vi tri :
a) 1. d) 5.
b) 2. e) 6.
c) 4.
375. TM mang s6 (6) la :
a) TM tim
b) TM gian that sau.
c) TM tim gifra.
d) TM sau tam that (T).
e) Tat ca d'eu sai.

92
 33 TRUNG THAT

MUC TIEU BAI GIANG

A. MUC TIEU LY THUYgT
1.Dinh nghia va xac dinh gidi han cac trung that.
2. M6 ta si lien quan cua cac thanh phan trong timg trung that, dac biet la trung that sau.
3. Ve thi6t d6 cat ngang 16ng nguc qua d6t s6ng ngkic IV.
4. Giai thich cac trieu chung caa h6i cluing trung that sau.
B. MUC TIEU THVC TAP
1. Chi tren xac, mo hinh, tranh ye va phim X quang gidi han cac trung that.
2. Chi tren xac, xuungl6ng nguc va m6 hinh cac thanh phan trong cac trung that.

mang phoi (cavum

Trung that (mediastinum) là mot khoang trong 16ng nguc nam giga 2 6
pleurae). Trung that là not chtla hau h6t cac thanh phan quan trong clial6ng ngkfc trif hai ph6i.

1. GIdI HAN VA PHAN KHU

1.1. GIdI HAN. Trung that &rue gidi han phia tru'dc bai mat sau xuung dc (sternum) va
cac sun sudn, phia sau bai mat truck cot s6ng nguc. Phia tren là 16 tren cua 16ng nguc, nui
trung that thong vdi nen c6. Phia diidi IA co hohnh (diaphragms), not cif) cac thanh phan di tit
(pleura mediastinalis)
16ng nguc xu6ng 6 bung va nguuc lai. Hai ben là mang ph6i trung that
(H.33.1).
1.2. PHAN KHU. Theo quy tide, d6 a m6 ta ngu'ai ta phan chia trung that thanh nhieu
khu. CO hai each phan chia khac nhau :
1.2.1. Quan niOni co then. Ngticli ta chia trung that thanh hai phan : trung that truac va
trung that sau. M6t mat phang thing ngang di qua khi quan va hai ph6 quan chinh duqc quy
uerc la ranh gidi giiia hai trung that (H.33.2).
93
 Trung that
Xudng iic tren
Trung that
trudc
Trung that Trung that
trade"
Phdi

Trung that sau Trung that gida

Trung that sau
Hinh 33.1: Gidi han Hinh 33.2: Phdn khu Hinh 33.3: Phan khu
cda trung thdt trung that trade vet sau trung theft tren, tru'dc, giila vet sau
1.2.2. Quan niOni dude thong qua d hOi nghi quac to cac nha giai phdu.
Chia trung that thanh b6n khu: trung that tren, trung that trade, trung that gida va trung
that sau.
.Trung that tren (mediastinum superius) nam phia tren mat phang ngang di ngay tren
khoang mang tim ngoai tim talc la ngang mac a phia sau vai khe d6t s6ng c6 4 va 5 va a phia
tru'ac vai gac xao'ng ttc (khap gitia can arc vai than tic) (H.33.3).
Trung that &dot (mediastinum anterius) la mot khoang rat hep nam ngay traac mang tim
va sau xu'o'ng tic.
Trung that gitla (mediastinum medium) la nai chtla tim va mang ngoai tim.
Trung that sau (mediastinum posterius) nam sau tim va mang ngoai tim.
Khi ma 16ng ngu:c tit phia track co th6 thdy ngay cac thanh phan cua trung that trade va mot
s6 cac thanh phan cua trung that tren Ira giita. Con mu6n thay cac thanh phan cua trung that
sau phai lath tay vao mat akin dia ph6i r6i lat vao trong, n6u khong mu6n di tit phia sau tai.
N6u so sanh hai quan niem phan chia, to thay trung that trade theo quan ni6m co dik
bao g6m toan 130 trung that gitia, trung that traac va dai 130 phan phia truck trung that tren,
cbn trung that sau van theo quan ni6m c6 didn bao g6m trung that sau va mot phan nh6 phia
sau trung that tren (H.33.2) va (H.33.3).
1.2.3. Phan chia trung thgt theo Susan Standring
Hi6n nay c6 cach phan chia mai nhat theo Susan Standring dilac trinh bay trong sach
gido khoa Gray's anatomy an ban Fan tha 40. Trung that dart chia thanh trung that tren va
trung that Sau do trung that daai dtrac chia ra thanh trung that fro:3c, trung that gida va
trung that sau. Mat phang chia trung that tren va du'ai, a phia traac di qua khap can va than
xu'o'ng tic (g6c tic), phia sau di qua mat clued dia d6t song ngtic thti 4.
2. TRUNG THAT THEN: nam giita can xuang ac va 4 d6t s6ng ngu:c tren. Giai han &rai caa
no la mat phang ngan cach trung that tren va duai. Giai han tren la mat phang di qua 16 tren
16ng ngtic. Giai han phia ngoai bai mang ph6i trung that. Trung that tren chda dau dual caa
cur tic mOng, ca tic giap va cu dai co; tuy6n tic; dung mach va tinh mach nglic trong, tinh mach
canh tay Tau va nira tren curia tinh mach chii tren; than kinh hoanh va than kinh lang thang
phai trai, than kinh thanh quan quat nguac trai, than kinh tim va phan nong dia dam r6i
tim; khi quan, thtic quan va 6ng ngtic. N6 cling chtia cac hach bach huyet khi 016 quan, hach
bach huy6t canh tay dau, hach bach huy6t canh khi quan.
94
 DOng mach Khr quan
canhchung tra i
De)ng mach
Trung that tren (Judi dem frai
Duong xuong soon 1
Tuyern Oc Cung d'Ong mach chO
Can etc ()Ong mach ph e5i phai

Phe quan chinh trai

Trung thgt trudc

Trung thit giCa

Tinh mach
chO duoi Thu'c quan
Trung that sau
D Ong mach chO

Hinh 33.4: Phan chia trung Omit theo Susan Standring.

3. TRUNG THAT TRII€JC: Nam gida than xuong utc va mang ngoai tim. N6 chda mo lien
keet long leo, day chang itc mang ngoai tim, met vai hach bach huygt va cdc nhanh trung that
cUa Ong mach nguc trong. Doi khi trung that trudc c6 the chda mot phan tuyen
4. TRUNG THAT GItTA: La phan ldn nhat caa trung that du'di. N6 chda mang ngoai
tim va d'Ong mach chil len; phan cludi cua tinh mach chit clued nhan cung tinh mach don o phia
sau; khi quan chia hai va hai phe quan chinh, than Ong mach ph6i va ding mach, tinh mach
ph6i trai Ira phai; than kinh hohnh trai va phai; phan sau cua ddm r6i tim; cdc hach bach
huygt khi 0.6 quan.
5. TRUNG THAT SAU: Trung that sau dugs gieri han phia trudc boi khi quan chia &A, mach
mdu phcii, mang ngoai tim va phan sau cUa mat tren co hoanh. 0 phia sau, no dude gidi han
bdi cot song, td bar dudi cua d6t ging nguc 4 den d6t song that lung nguc 12 va a hai ben là
mang ph6i trung that. NO chda &Ong mach chil nguc doan xuong va tinh mach don, ban don va
bdn don phu; chu6i giao cam phai va trai, cdc day than kinh tang va than kinh hoanh - trai va
phai; thuc quan; ong nguc va cdc hach bach huyat trung that sau.
5.1. CAC THANH PHAN TRONG TRUNG THAT SAU
5.1.1. Thuc quart (esophagus). Thuc quan tigp theo ham it c6, xuong nguc, qua trung that
tren (0 phia sau va hai l'Och sang trai khi quan) xuong trung that sau r6i chui qua 18 thuc quan
dm co hoanh de vao 6 bung n6i vdi da day o 18 tam ATI (cardia).
Thuc quan la mit ong co dai 25cm, det, do cdc thanh dp sat vao nhau trii khi c6 vat dang
nueCt thi thurc quan co hinh Ong. Co ba ch6 hep: mot d dau teen trong c6 ling vdi sun nhan, mot

95
a ngang mac cung dOng mach cha va ph6 quail chinh trai va mot a ddu dUdi ch6 n6i vdi tam vi
(H.33.5). Cac di vat thuang &mg ar ch6 hep Ong mach cha - ph6 quan.
Thuc quan du'ac cau tao bai ba lap. Trong ding la niem mac r6i tai lap du'ai niem mac va
ngoai ding la car (ca doc a Wang, ca yang sau). Ci 1/3 tren, ca hoat diMg theo y mu6n va do
cac sai van dOng theo y mu6n caa day X chi ph6i, dm 2/3 Midi la co' trdn chi ph6i bdi cac sal
d6i giao cam caa day X va cac sai giao cam.
VI \Tay, Ong tac nu6t khong hoan than theo y mu6n (khong thd nu6t tie-p ductc).

DOng mach Tinh mach

chO ngVc ban don phi!

Cac tinh mach

gian suo'n
Tinh mach don

DOng mach Da day

chCi bung
Tinh mach
ban don

Hinh 33.4: Thuc quan yet d'Ong mach chii nguc. Hinh 33.5: M' tinh mach clan

5.1.2. DOng mach chii nguc (aorta thoracica)

Ti6p tut dOng mach cha ngang mac d6t song 4. Mai dau nam sat b6 trai than cac d6t
song, clan clan di vac ga'n duang giCta r6i chui qua 18 Ong mach cha cua co hoanh a ngang mac
ba du'ai d6t song nguc 12 dd not ti6p vdi Ong mach cha bung (aorta abdominalis) (H.33.4).
Cac nhanh dm Ong mach cha nguc thuang rat nho bao
- Cac Ong mach ph6 Tian (a. bronchialis) ca hai Ong mach va thuang di sau ph6 quan.
- Cac Ong mach trung that (a. mediastinalis) cap huyeet cho mang tim.
- Cac dong mach thuc wan (thu'ang có hai hoc mot ngdnh).
- Cac thing mach hoanh tren (aa. phrenicae superiores) cap huy6t cho mat tren phan sau
ca hoanh.
- 9 cap dong mach gian sworn (et. intercostalis) di sat cot song va la thanh phan phia sau
nhat a trung that sau.

96
 O nguai Vi6t Nam cung do, ng mach chit nguc a ngang mac than dot sang nguc V va có
durang kinh trung binh la 19,1mm. Con dung mach cha nguc có diking kinh trung binh là
15,8mm va- tan dung O' mac ngang dot song nguc XII. Eking mach cha nguc cho ra 9 cap dOng
mach gian suan va &tang kinh trung binh cita &Ong mach gian wan là 1,2mm.
5.1.3. HO tinh mach dein (vi khong deli xang hal ben). LA 116 thong tinh mach n6i tinh
mach chit dudi vdi tinh mach chil tren va nhan man chi' y6u a thanh nguc (vi vdy trong hoi
chang trung thdt khi bi then ep, có hien Wang phis kieu ao choang phu plat nen co va
phd n tren ngVc). H6 tinh mach dan Om mot tinh mach chinh la tinh mach dan va cac nganh
phu la tinh mach ban dan, tinh mach ban dan phu va cac tinh mach gian stem v.v...
- Tinh mach dan (v. azyyos) duoc hop bai tinh mach gian stun, tinh mach that lung len
phai va mot nhd.nh tdch ra.ta tinh mach cha dudi (11.33.5) a ngang mac ca hohnh. Tit (16 tinh
mach di len sat ba phai dm than cac d6t song tai ngang mac d6t sang nguc 4 thi cong ra phia
trudc tao thanh mot quai a phia tren cu6ng phiSi phai r6i d6 vao tinh mach cha tren. Tren
&tang di tinh mach dan nhan 9 tinh mach gian suan phai dudi, tinh mach ban dan, tinh mach
ban dan phu va than tinh mach gian sitan phai tren,
- Tinh mach ban don (v. hemiazygos) nguyen Uy ding gi6ng nhu tinh mach dan nghia la
duac hap bai tinh mach gian suan, tinh mach that lung len trai va mot nhanh tach ra tit tinh
mach chit duai hoac tinh mach than trai. Tinh mach bdn dan di tit ca hohnh len sat wan trai
cita cot song ngtfc tdi khoang xuang wan VII till qua't sang phai dd d6 vao tinh mach dan.
Tren ducting di, tinh mach bdn dan nhan 5 hoac 6 tinh mach gian su'an trai cu6i ding.
- Tinh mach ban dan.. phu (v. hemiazygos accessoria) do 6 hoac 7 tinh mach gian suan
trai dau tien hop thanh. Tinh mach ding di a sun trai cot song xuang tdi khoang xuang wan
VI thi ding vat sang phai d6 d6 vao tinh mach dan.
- Tinh mach gian suiin phai tren (v. intercostalis superior dextra) la than chung dia ba
tinh mach gian suan phai tren cung. Than nay cung d6 vao tinh mach dan.
het
5.1.4. Ong ngiic (ductus thoracicus) (11.33.6). La eng bach huy6t lan thu nhan hau
bach huyet cua ca thd tra nas phai cua dau, c6 va nguc. Bat ngu8n tit hai hoac ba than a
ngang mac dot sang ngtic 12 hoac daft that lung 1 ngay tren hoac dudi ca hoanh.
Trong trung hdp bat flgu6n a dudi ca hoanh tac la trong 6 bung, 6n.g ng1tc có the phinh ra
thanh mot bong goi la bd dung trap (cisterna chyli). Tit do ang nguc di len trong trung that
sau qua 16 Ong mach chii cua ca hoanh, tdi nen c6 thi quat sang trai tao thanh mot quai phia
tren dinh phOi va d6 vao 110i lora tinh mach dudi don trai va tinh mach canh trong trai. VI 6ng
ngifc chaa bach huy6t nen khOng có mau hoac mau hai trang do do it duoc nhan bigt khi bi
ton thuang trong cac phau thuat a trung that sau, gay ra do bach huy6t vao 6 mang phOi.
5.1.5. Day than kinh lang thang (n. vagus) (11.33.7). Hai day than kinh lang thang phai va
trai sau khi di sau ph6 quail chinh Wang ang vdi thuc quan thi chia lam nhidu nhanh. Cdc nhanh
a hai ben not vdi nhau chung chit tao thanh dam r6i thgc quan. Tdi gan co hoAnh thi cac
nhanh lai hop lai thanh hai than. Than trai di a mat truck thuc quan con than phai di a mat
sau thuc quan de xu6ng da day. Cdc cong trinh nghien cau On day cua cac tdc gia Vidt Nam
ding xac nhan lai vi tri caa hai day lang thang phai va trai a (Mu dual thuc quan nhu' vita mo ta.

97
 H6i hiu tinh mach
dtidi dOn trai
Khi guar?

Ong noic Than kinh

tang thang trai

Than kinh
lang thang phai

Da day

Hinh 33.6: Ong nguc Hinh 33.7: Hai day than kinh lang thang

5.1.6. Chu& hach giao cam ngtic. G'Om 11 hach not nhau bai cac nhanh gian hach nom
hai ben song nguc ngang dau cac xu'ong suan. VI vay cac phdu thuat cat ba hach giao cam
nguc (Vi du cdt bo hach ngu'c 4) có the thyc hi5n qua &fang nguc phia truck hoac duang canh
song phia sau.
Chu6i hach giao cam nguc cho nhigu nhanh ben vac cac mach vacac tang nInt ph6i, thyc
quail va dac biOt co ba day tang (tang lan, tang be vet tang ditai) di qua ca hoanh xu6ng bung
van cac hach caa dam r6i tang.
5.2. LIEN QUAN CU' A CAC THANH PHAN TRONG TRUNG THAT SAU
Vi trung thdt sau IA mot 6ng hep nen cac thanh phan vita neu or tren lien quan rat mat
thidt vdi nhau (H.33.8). M5t kh6i u a trung that sau rat de chan van cac thanh phan do. Ndu
ldy thkfc quan lam m6c thi phia truac a tren la khi quan va a duVi là tam nhi trai va xoang
chdch mang ngoai tim. (Khi tam nhi trai bi to thi de veto mat tru'oc thitc qudn gay kh6 nuat vci
c6 the ph& hi'On being cc ch chup X quang Zang ngu'c tzi phia ben sau khi cho tang thuac can
quang). Phia sau thyc quan a gida la 6ng nvc, ben trai là d5ng mach cha nguc va cac tinh
mach ban dan, con ben phai là tinh mach dan. Sau niia va a xa hai ben wan cot sang nguc là
chu6i hach giao cam nvc. Hai ben thyc wan là day than kinh X nhung xuang phia du'ai thi
day trai di ra truac can day phai di ra phia sau thqc quan.

98
 Than kinh lang thang phai
TuyeP giap
Hach co gifia — -
Than kinh quat ngtiOc phai \ Than kinh lang thang trai
Tinh mach canh trong
Quai co DOng mach dui dem
DOng mach canh chung
Tinh mach cluei dOn
Than tinh mach Than tinh mach canh tay dau
canh tay dau • Tinh mach giap dildi
.Than kinh quat nguOc
Than Ong mach
canh tay dau

Than kinh lang thang

Than kinh quat nguOc trai
Khi quan
Day chang clOng mach
Quai tinh mach clOn
DOng mach phe' quan trai
Dung mach
phg quan phai
Phe" guar; chinh phai

Phe'' guar; chinh trai

TIM mach cho tren
DOng mach chi) De:mg mach ph&
Hach giao cam ngVc \DOng mach clic)
Than kinh lang thang trai
Tinh mach don ThVc quan

Anh XXIX : Trung that sau

99
 Gan Tuye-n thuqng than
Tinh mach chu duel
Thvc quan

Than

Da day

Ke't trang len

Tin mat

Ke't trang ngang

Anh XXX : Lien quan mat tru'ac da day vai cdc tang khcic.

100
 Tim

Than kinh
lang Mang trai Thyt guar?
Thin kinh fang thang phai
Tinh mach &In
Eking mach chi) ngVc

Chuoi hach
giao cam canh song

Hinh 33.8; Thie't ci6 ngang lang nguc qua deft nguc VII.

Tat ca cac thanh phan tren duoc quay quanh bai met to chtic to bao ma day mong thy ch6,
va cac to chic nay lien ti6p yeti cac to chic to bao a nen c6, a trung that truac va a duai phtic
mac. Cac dp xe a trung that sau co the lan tai cac vOng lan can do. Ngoai ra con có cac hach
bath huy6t nam raj rat trong trung that sau. Hach sung to hoac met Ich6i u trong trung that
có the gay cher' ep vao cac thanh phan di trong trung that sau gay nen hei thong trung that
(kha tha, khd nualt, phis nen co vet phcin tren ngicc v.v...).

CAU H6I TRAC NGHIEM

Chon cau tra loci dung nhat.

376. Trong trung that sau:

a) Ong nguc ar sau DM chii nguc den N10 thi huang sang (T) de de vao TM duai don (T).
b) TK lang thang (P) a sau thkrc quan, TK lang thang (T) a trade thoc quan.
c) Cung TM don bac cau tren cu6ng phei (T). Cung DM cha bac cau teen cueing phei (P).
d) Cau a, b, c thing.
e) Cau a, b, c sai.
Ditng bang tra Idi sau d tra loci cac cau 377, 378, 379.
a) Trung that tren. d) Trung that gicia.
b) Trung that &tad. e) Trung that sau.
c) Trung that tradC.
377. Tuyen ac nam trong trung that nao?
378. TK lang thang (X) phan lan nam trong trung that nao?
379. TK 'vat nguac thanh quan (T) nam trong trung that nao?
380. Chon cau thing nhat. Day than kinh hoanh (P) va (T):
a) Di phia sau cac ph6 quan chinh, nam giiia IA thanh trung that va bao xa mang tim.
b) Chi có nhiem vu van clang co hoanh.
c) Di trade cac phe quan chinh, la day than kinh h6n hop (TK van Tang va cam gide).
d) Cho nhanh n6i vai day than kinh hoanh phy. (n6u co).
e) c va d dking. (Xem them bai 19)
101
 PHAN VI - BUNG

34 DA DAY

MUC TIEU BAI GIANG

A. MUC TIEU 1.,)? THUYET
1.Mo to vi tri chic nang, hinh thd ngoai va lien quan ciia da day.
2. MO to cau tao, mach mau va than kinh cUa da day.
3.. Ve so d6 cac dung mach da day.
4. Ve hinh chidu cua da day len viing thoong vi va cot song.
B. MUC TIEU THVC TAP
1.CM tren xac va cac phuong tien thuc tap khac : vi tri, hinh the ngoai va lien quan cua da day.
2. CM tren xac, mach mau va than kinh &la da day.
3. CM tren phim X quang, hinh anh da day binh thuang.
4. Xem tinh trang va hinh the da day tren cho

Da day (ventriculus) la loan phinh to nhat ctia 6-rig tieu h6a, n6i giCia thuc quail va to
trang, nhm sat du'ai yam hoanh trai, a sau cung sit in ya yang thuong vi trai. Da day rat co
gian, c6 the tich Ur 2 lit den 2,5 lit hoac hon naa, nen khong do hinh clang nhat dinh. Ci xac
nguti phau tich, da day thuang gi6ng cai to va. Can d ngutii song, khi rung, no gi6ng hinh chit
J. Hinh clang da day rat that' GI& thy thuOc luong an vao, ttt thd, kich thadc 16ng ngkc, tu6i,
gidi tinh, sac co bop va thy theo ca hie quan sat : xem true tidp khi m6 6 bung hoac gian tidp
khi chip roi da day co luting thu6c can quang (H.34.2).
1. HINH THE NGOAI (H.34.1)
Da day g6m c6 hai thanh truac va sau, hai ba cong vi lan va nhO va hai dau : tam vi
tren, mon via du'Oi.

102
 Ke tit tren xu6ng, cda day gom co :
1.1. TAM VI (pars cardiaca) la mot \Tung rOng khoang 3 den 4 cm, nam ld can that quan
va bao g6m ca 16 tam vi (ostium cardiacum). L6 nay thong thuc quan vdi da day, khOng co van
thing kin ma chi c6 nep niem mac. O nguari song, 16 tam vi nam sau sun akin 7 trai, till& than
d6t song ngkic X va lech v6 ben trai du'Ong giaa khoang 2,5cm.
1.2. DAY VI (fundus ventriculi) la phan phinh to hinh chain cdu, d ben trai 16 tam vi va
ngan each vdi thyc quan bung bdi mOt, Ithuye-t goi là khuy6t tam vi (incisura cardiaca). Day vi
thuOng chda khong khi chimg 50cc, nen d6 nhin thay tren. phim X quang (H.34.2).
1.3. THAN VI (corpus ventriculi) n6i ti6p phia duoi day vi, hinh 6ng, cau tao bdi hai thanh
va hai ba. Gidi han tren là mat phang ngang qua 16 tam vi va gidi han &raj la mat phang qua
khuyet goc (incisura angularis) cua bar tong vi nh6.
1.4. PHAN MON VI (pars pylorica) gom c6 hai phan :
—Hang mon vi (antrum pyloricum) : ti6p n6i vdi than vi chay sang phai va hoi ra sau.
—Ong mon vi (canalis pyloricus) : thu hep lai trong gi6ng cai ph6u va d6 vao mon vi.

Khuygt t"m vi

— Day vi
TM:1'c quan

L6 tam vi ---
Phan tam vi
Than vi

Khuyat goc

L6 mon vi

Ta trang

Mon vi /
Ong mon vi
Hang Mob vi

Hinh 34.1 : 5a dO cac phan caa da day

1.5. MON VI (pylorus). Mkt ngoai cua Mein vi duqc danh dau bdi tinh mach trade mon vi
(v. prepylorica). SO bang tay bao giO cilng d6 nhan bie't duac mon vi hon là nhln bang mat. O
giCra mon vi la 16 mon vi (ostium pyloricum) thong vdi hanh to trang. L6 nam d ben phai d6t
song that lung 1.
103
 TOi khi

Bei stun trai

A

Ron B

Hinh 34.2 : Hinh dnh X quang cda da clay a tit the clitng sau hhi uoing chdt cdn quang
A. U6ng 50m1 chdt cdn quang.
B. U6ng 200m1 chdt can quang.
C. U6ng 400m1chcit cdn quang.

2. LIEN QUAN CUA DA DAY

Da day de di dOng, nlmng khi da day r6ng va ngiRii nam ngda, thiRing có cac lien quan
nhu sau.
2.1. THANH TRTIOC (paries anterior) lien quan vdi thanh ngtic a tren va thanh bung
clued.
- PhAn thanh ngtic : da day lien quan vdi cac car quan trong 16ng ngu:c qua yam cd.hohnh
trai ph6i va mang ph6i trai, tim va mang ngoai tim. Thay gan trai it nhigu xen vao nam a
mat trade da day (H.34.3A).
- Phdn thanh bung : da day nam sat (kith thanh bung trade, trong mot tam gide gidi
han Uri bd dirdi gan, cung wan trai va mat tren ket trang ngang (H.34.4).
2.2. THANH SAU (paries posterior).
- PhAn day tam vi : nam tren try trai ca hoanh, co day chang vi hoanh gan vao nen it
di &Ong.
- PhAn than vi : la thanh trudc ctia hau cung mac not va qua do da day có lien quan vdi :
• Duoi tuy va cac mach mau cua rtin lath nam trong day chang than lath.
• Than va tuyen thddng than trai (H. 34.3B).
- PhAn Cing mon vi : nam tip len mat tren mac treo ket trang ngang, qua do co lien
104
quan vdi g6c td hang trang va cac quai tieu trang trail, nen cac nho pilau thudt lqi dung ski lien
quan nay de thuc hien thil thudt noi vi h6ng trang qua mac treo kgt trang ngang.
2.3. BO CONG VI NHO (curvatura ventriculi minor) c6 mac noi nho barn vao, ben trong
chda yang dung mach bar cong vi nh6 va chu8i hach bach huyat. Qua hdu cung mac n6i, bar cong
nay c6 lien quan vdi Ong mach chili bung, Ong mach than tang va dam r6i tang.

2.4. BO CONG VI LON (curvatura ventriculi major) chia lam 3 loan :

—Doan day vi : dp sat vam hoanh trai va lien quan vdi 16.ch.
—Doan c6 day chang hay mac n6i vi loch (lig. gastrolienale) chtla cac Ong mach vi nen.
—Doan c6 mac n6i lan chda vong dung mach bit cong vi ldn.
T6m lai, tuy da day di dung, nhung duoc treo tai ch8 nho cac mac cud phtic mac nInt mac
n6i nhO, mac noi lan, cac day chang vi hoanh, vi lath va vi kgt trang. Bei day chang nay ld
thanh phan ciia mac noi ldn.

3. OW TAO CT.J'A DA DAY (H.34.5, H.34.6) gem 5 lap :

3.1. LOP THANE' MAC (tunica serosa) nom ngoai cung, thuOc ld tang dm pink mac va la
su lien tuc ctia mac noi nho phti hai mat thick va sau cua da day. Dgn bac cong vi ldn, chang
lien tuc vdi mac n6i ldn va mac n6i vi lath.

3.2. TAM DWI THANH MAC (tela subserosa) la mot to chile lien kgt rat mong, doc biet
hai mat trudc va sau cua da day, lap thanh mac gan nhu dinh chat vao lap ca fru- a en hal
bar cong vi de 136c tach han vi to chic nay day len nha chda ma va cac b6 mach than kinh.

3.3. LOP CO (tunica muscularis) ke tit ngoai vao trong gem c6 :

- Tang doc (stratum longitudinal& lien tuc vdi cac the co doc ctia that qudn va to trang va
day nhdt doc theo be( cong vi nhO.
- Tang yang (stratum circulae) bao kin toan the da day, doc biet day a mon vi to nen c
that mon vi (m. sphincter pylori) rat chdc.
- Thd cheo (fibrae obliquae) la mot lap khong hoan than, chay yang quanh ddy vi va di
cheo xuang (lath ve phia ba cong ldn.

3.4. TAM DTiOI NIEM MAC (tela submucosa) la to chiIc lien kgt rat long leo nen de bi xe
day. Dieu nay c6 the gdy nham lan la khi cat het lap co Wang là da vao duoc trong long da
day, cho nen chi khi nao thdy dich da day chdy ra mai chac la da cat hat thanh da day.
3.5. LOP NIEM MAC (tunica mucosa) (H.34.5) 16t mat trong ct a. da day.

105
 Than

A. MAT TRUCYC DA DAY B - MAT SAU DA DAY

Hinh 34.3 : Lien quan cila da day

Tim

Pho'i trai

Gan
Da day

Lach

Hinh 34.4 : Deli chi& ciia cla day len thanh tru'ac ca the có so scinh vai phoi, tim, gan, lack.

Lap nay 16i lom nho len xgp thanh cdc ne-p (plicae gctstricae), phan 16rn chay theo chieu
doc, nhgt la doc theo bor tong nh6, cdc ne-p trong deu va lien tuc horn tao thanh ranh goi la Ong

106
vi (canalis ventriculi). Mat oh MOM mac 16n nho'n vi n6i len rat nhi6u num con, m8i num goi là
mot yang da day (areae gastricae) co kith thu'6c thay d6i tit 1 mm dgn 6mm. Tren mat num c6
nhiL h6 da day (foveolae gastricae) ngan cdch nhau bdi cdc ngp mao vi (plicae villosae). H6 I.A. (ling
tigt dm 3 dgn 5 tuygn da dAy (glandulae gastricae). Cdc tuyen nay tigt ra khoang 2 lit dich vi m8i
24 giO. Dich vi g6m ca hai chat axit va ki6m. Rieng cdc tuygn yang mon vi (glandulae pyloricae) chi
tigt, ra chat ki6m. Rai rdc trong niem mac con c6 cdc mo bach huygt va doi khi chung tap trung lai
thanh cdc nang bach huyet da day (folliculi lymphatici gastrici). Tat ca cdc cau talk nay au nhm
tren mot tam an phang, d6 IA Id co niem mac (lamina muscularis mucosoe).

Lap
co
vong

Alefp niem
mgc doc

Hinh 34.5 : Niem mac da dciy Hinh 34.6: Ccic lap do day

4. MACH MAU CUA DA DAY (H.34.7)

Bat ngu6n tit Ong mach than tang (truncus celiacus). Deng mach than tang là nhAnh caa
dOng mach cha bung du6i coy hoAnh, ngang mac dia gian d6t sang nguc 12 va dot sang that
lung L Ngay sau khi xuat phdt Ong mach chia thanh ba nganh là: Ong mach vi trdi, Ong
mach lath va dOng mach gan chung.
4.1. VONG MACH BO .CONG VI BE
4.1.1. BO mach vi pilaf
- Dung mach vi phai (a. gastrica dextra) thudng xual phat tit dOng mach gan rieng. Trong

107
cuong gan, dOng mach a trade va ben trai, den b6 cong nh6 chia lam hai nhanh di len de not
vai hai nhanh cua Ong mach vi trai.
Dac diem (Icing mach vi phdi &la ngu'ti Viet Nam là 95,16% c6 nguyen tit do, ng mach
gan rieng, 3,20% xudt phat tit Ong mach vi to trang, c6 dutng kinh trung binh la 1,62 mm.
- Tinh mach vi phdi (v. gastrica dextra) kern theo Ong mach va d6 vao tinh mach c6a.

4.1.2. Bó mach vi trai.

- Wing mach vi trai (a. gastrica sinistra) xuat pita tit Ong mach than tang, deli len met
nep phtic mac thanh ne-p vi tuy trai (plica gastropancreatica sinistra) den 136 cong nh6 nui 1/3
tren chia thanh hai nhanh : track va sau, be) sat thanh bo cong nho de xu6ng n6i v6i hai
nhdnh cUa Ong mach vi phdi.
74,1% Ong mach vi trai a ngtrti Viet Nam c6 nguyen Uy tit Ong mach than tang; 16,1%
xu'dt phat tryc tie-p tit dOng mach chi' bung, 6,4% c6 than chung vi ldch. Dutng kinh trung binh
cua Ong mach vi trdi la 2,5mm. Ddc biet IA c6 24,19% dung mach vi trai cho nhanh den thiry
trai cua gan.
- Tinh mach vi trai (v. gastrica sinistra) phat sinh gdn tam vi di kern theo dung mach va
d6 vac tinh mach cda (vena portae).

4.2. VONG MACH BO CONG VI LON.

Du'oc tao nen 136'i dOng mach vi mac n6i phdi (a. gastroepiploica dextra) va dOng mach vi
mac n6i trai (a. gastroepiploica sinistra).

4.2.1. Bó mach vi mac not phal.

- DOng mach vi mac n6i phdi (a. gastroepiploica dextra) phat sinh tit dOng mach vi td
trang (a. gastroduodenalis) di trong day chung vi ket trang, r6i song song vai be cong 16n de cho
nhling nhanh len phan ph6i cho mon vi, than da day va nhQng nhanh xu6ng goi IA nhanh mac not
(rami epiploici). Ding kinh cua dOng mach vi mac n6i phdi a nguti Viet Nam 1a 2,1 mm.
- Tinh mach vi mac not phdi (v. gastroepiploica dextra) ban ddu no di kern theo Ong
mach, klii den mon vi u6n len trade ddu tuy de d6 vao tinh mach mac treo trang tren (v.
mesenterica superior).

4.2.2. Bó mach vi mac ilea trai

- acing mach vi mac n6i trai (a. gastroepiploica sinistra) phat sinh tit dOng mach ldch trong
r6n ldch hay tii met nhanh da dung mach vi nail di vao mac n6i vi lath, r6i theo doc b6 cong
lan trong day chung vi kgt trang de cho nhting nhanh ben nhu dOng mach vi mac n6i phdi. Vi
chay trong hai la khdc nhau cua mac not 16n nen 6 cho- tan ding cUa hai dung mach vi mac not
phdi va trai c6 the kitting th6ng not trite tiep vUi nhau.
Diking kinh cua do, ng mach vi mac n6i trai a ngtkci Viet Nam IA 1,5mm.

108
 Nhanh thifc quan Dung mach day vi

Dung mach vi trai

/
/
//
DOng mach th5n tang 1/
// DOng mach vi nggn
'I
Ding mach gan rieng
Deing mach gan chung r
e
DOng mach
DOng mach vi ph5i lach

DOng mach
vi to trang
Eking mach vi
mac n6i trai

Nhanh mac n6i

DOng mach vi —
mac not phai

Nhanh mac not

Hinh 34.7 : So do ciOng mach da clay

— Tinh mach vi mac not trai (v. gastroepiploica sinistra)

Theo dOng mach d6 vao tinh mach lath trong run lath.

4.3. NHUNG BONG MACH VI NGAN (a. gastricae breves) phdt sinh tit Ong mach lath
hay mot "nhanh cua no, chitng 5-6 nhanh qua mac n6i vi lath phan ph6i cho phan tren b i tong
vi ldn.

4.4. BONG MACH VUNG BAY VI VA TAM VI Om co :

— Cac nhanh that quan (rami esophagei) phat sinh tit dung mach vi trai, di nguoc len
phan ph6i cho mat truac va sau vUng tam vi va day
- Bong mach day vi sau bat thuang sinh ra tit dung mach lath di trong day chung
hohnh pilau ph6i cho day vi va mat sau that quan.
- Cac dOng mach hoanh dudi (aa. phrenicae inferiores) trai cho nhanh dgn mat sau tam vi.
Tom lai tat ca cac Ong mach tao thanh mot mang thong n6i a hai mat da day, dac

109
biet la trong niem mac có sit' thong n6i Ong tinh mach.
Trong lap duai niem mac có mot mang Ong mach rat Ian, tit do cho hai loai nhanh phat
sinh : mot quay vd lap co, n14 tan cang trong niem mac.

5. THAN KINH DA DAY

Da day duoc chi ph6i bai hai than than kinh lang thang tru'ac va sau thuQc he doi giao
cam va nhang soi than kinh Ur dam r6i tang thuQc hd giao cam.

5.1. STJ PHAN PHOI CUA DAY THAN KINH LANG THANG O DA DAY.
Hai than than kinh lang thang truck va sau di den gan ba cong nho Chia nhiQu nhanh cho
mat trade (nhcinh vi truck) (rami gastrici anteriores) va mat sau da day (nhanh vi sau) (rami
gastrici posteriores). Ngoai ra :
—Than than kinh lang thang trade can cho nhanh gan di trong phan day cUa mac n6i nho
den tinh mach caa thi cho nhanh mon vi di xu6ng dieu haa hoat dOng vang mon vi, 6ng mon vi
va mot phan to trang.
—Than than kinh lang thang sau con cho cac nhanh tang (rami celiaci) theo than Ong
mach vi trai d6n dam r6i tang (H.34.9).
Kich thich cac day than kinh lang thang thu'ang lam tang hoat Ong tit' (pan cua da day
va cling lam cho sit bai tiet cua cac tuy6n da day tang len nhieu, nen có phau thuat cat day
than kinh lang thang trong dieu tri benh loft da day td trong.
Than kinh lang thang truac a da day cila nguai Viet Nam da s6 nam a mat truac thu'c
quail bung Ira each bar phai thu'c quail 9,4 mm. Mating kinh clia than kinh lang thang truac la
1,4 mm va 52% tru'ang hop có than kinh lang thang phu. Than kinh lang thang sau da s6 nam
a sau va each boy phai thu'c quan bung 1,1 mm, du'ang kinh cua than kinh lang thang sau la
1,8 mm va 37% truang hop c6 than kinh lang thang phu.
Co nha'n.g dang hi6m gap la than kinh lang thang tru'ac c6 dang dam r6i a mat truac
thuc quan (6%). Doi khi than kinh lang thang trade hoac sau khi6m khuyet (reit nhd) va khi
do than kinh lang thang sau hoac truck phat tridn lin va cho nhanh d6n phan khigin
khuy6t d6 thay th6.

5.2. PHAN PHOI CUA CAC SOI DAY THAN KINH GIAO CAM O DA DAY.
Cac soi giao cam xuat phat W cac loan thy nguc 6 d6n 10, qua cac hach than kinh not
tang va hach tang di vao da day doc theo cac huyel 'pan (xem them bai he than kinh tu' chit).
Con cac soi than kinh cam giac thi thuOc nhi'eu loai va di len theo day than kinh lang
thang.

6. HACH BACH HUYET DA DAY

G6m có :

110
 6.1. CHUOI HACH BACH HUYET DA DAY (nodi lymphatici gastrici) doc theo bay cong vi
nho, nhan bach huye't oda 1/2 phai phan thing va 1/2 tren phan ngang da day.
6.2. CHUOI HACH BACH HUYET VI - MAC NOI (nodi lymphatici gastroepiploici) nhan
bach huyet cila 1/2 trai than vi va 1/2 duti phan ngang doc b6 cong ldn.
6.3. CHUOI HACH BACH HUYET TUY-LACH (nodi lymphatici pancreaticolienalis) nhan
bach huye-t cila day vi va 1/2 tren than vi. (H.34.8)
Mang bach mach d4 day Wu thong tit do vdi mang bach mach that quan, nhung it vdi
mang to trang, nen ung that mon vi khong lan tdi to trang ma chi len bd cong nho.

Thgn kinh
Thgn kinh
Ian thang fru&
Chu& tang thang sau
Chu& hgch hach Nhanh tang
da day tuy-lath
Nhanh
mon vi -Nhanh vi tru'oc

-Nhanh vi sau

Chu& hach
vi-mac n&

H.34.8. Cdc yang bach huye't da day H.34.9. S' phan bd ca'a tha'n kinh lang thang a da day

CAU HOI TRAC NGHIEM

Chon cau tra ldi clang nhat

381. Day vi :
a) Phan th'ap nhat cua da day.
b) Phan not than vi vdi hang
c) Phan n6i than vi vdi Ong mon
d) Phan da day nam tren mat phang nam ngang di qua khuyet tam
e) Khong the xac dinh du'oc.
382. Da day có cac dac didm :
a) L6 tam vi có mot van that ski de ngan khOng cho thac an trao ngu'oc tit (14 day len thuc quan.
b) Day vi finking là ncli thiic an hay dich vi dong lai.
c) Khuye-t goc la khuye't gi€ a. phan diing va phan ngang cua bor cong vi nhO.
d) a, b, c thing.
e) a, b, c sai.
111
383. Doi chigu len cot song, tam in va mon vi a ngang mac :
a) N10 \TA. TL1. d) N12 va TL2.
b) N11 vb. TL1. e) N12 va TL3.
c) N11 va TL2.
384. Tang nao sau day KHONG lien quan vdi mat sau da day :
a) Ca hoanh. d) Than (T).
b) Lach. e) Tuy.
c) Gan.
Dung hinh ye va bang tra sau de tra loci cac cau 385, 386, 387 va 388.
a) Gan.
b) Lach.
c) Than trai.
d) Mac treo kgt trAng ngang.
e) Ca hoanh.

Sa do lien quan cda mat sau da day :

385. Wing (1) IA vUng mat sau da clay lien quan vdi •
386. Wing (2) la. \Tung mat sau da dAy lien quan vdi
387. Wing (3) IA vung mat sau da dAy lien quan vai •
388. Viing (4) la. \Tung mat sau da dAy lien quan vdi •
389. Tinh mach vi phai va Tinh mach vi trai d6 vd :
a) TM cda. d) TM gan chung.
b) TM lath. e) TM gan rieng.
c) TM mac treo trAng tren.

112
Mang hinh ye va bang tra ldi dtidi day de tra 1di cac cau 390, 391, 392.
a) DOng mach vi phai.
b) DOng mach vi trai.
c) Ding mach vi to trang.
d) Ding mach vi mac n6i
e) DOng mach vi mac n6i trai.

Sa dd thing mach da dciy

390. Chi tiet s6 (1) la :

391. Chi tiet s6 (2) la. :
392. Chi tiet s6 (3) la :

113
 35 LACH

MUC TIEU BAI GIANG

A. MUC TIEU LY THUYET
1.MO to vi tri, chile nang, hinh the ngoai va lien quan caa la lath.
2. Neu Y nghia ba c6 khia cua lath.
3. MO to mach, than kinh cua lath.
4. Ve hinh doi chigu caa lath len thanh ng1c.

B. MUC TIEU THVC TAP

1. Chi tren xac va mO hinh vi tri, hinh the ngoai va lien quan caa lath.
2. Chi tren xac, mach va than kinh cua lath.
3. Chi tren xucing va nguai song hinh chigu &la lath len thanh ngu'c.

Lach (lien) hay tY la mOt tang huygt, nal san sinh ra to bao lympho va la m6 ellen cac
hang cdu gia. Lach c6 mau nau do va tren xac chgt thi chuygn thanh mau tim tai. Lach la mOt
tang xek-p vi vay khi chgn thuang lath rat de bi va, nhgt la khi lath sung to. Lach dirge boc bdi
mOt lap sai (tunica fibrosa). Lap nay cho cac tre di sau vao me lath thanh cac be lath
(trabeculae lienis). Ngoai ldp sai la ldp thanh mac (tunica serosa). Trong lath c6 tay (pulpa
lienis) c6 cht?a nhieu nang bath huygt (folliculi lymphatici lienales). Thuang chi co mOt lath
nam nap dual Om hohnh trai, phia ben trai caa da day, than va phia troll gOc kgt trang trai.
Nhung doi khi c6 the co nhigu lath phu (lien accessorius). Dating kinh caa lath ch8 lorn nhgt la
12cm Ira nho nhat là 4cm. Can nang khoang 200gram.

1. HiNH THE NGOAI VA LIEN QUAN

Lach co hinh thu Wang to nhu mOt hinh soan dai hoac mOt hinh thap ba mat, mOt dau sau
hay dinh va mOt ddu trade hay day, hai bo tren va duai (H.35.1).

114
 1.1. MAT HOANH (facies diaphragmatica) hay mat n.goai. Mat nay tong 16i theo mat lem
hoanh. Qua ca hoanh, lath lien quan vdi mang ph6i va cac xuang satin IX, X, XI. D6i
chie-u len thanh ngvc, true lan cua lath song song vdi xuang akar X. Bof tren lath ngang mite
vdi ba dual xuang stain VIII, bar (Mai lath ngang mire vdi ba dual xuang su'an XI, dau trade la
ch6 gap nhau giiia xuang svOn X va dating thang n6i khap tic don trai vii dau truac xuang sutrn
XI, Tau sau a tren khoang gian akin X each &rang gai song khoang 5 cm (H.35.2). Co the barn
thu6c can quang chap he tinh mach lath - cira bang each choc kim vao khoang gian wan. IX.

Mat da day

BO tren
Bi du'di
Cac khia

Ron lath

Mat than

BOng mach lath

77nh mach lath

Mat ket trang

Hinh 35.1 : Hinh the ngoai cua ldch (nhin tru'dc trong)

1.2. MAT DA DAY (facies gastrica) hay mat trade, dp van day da day va duqc not vii da
day bdi 2 la phtic mac goi la day chang vi-lath (lig. gastrolienalis) hay mac n6i vi-lath lien tie-p
tit lath sang O nay có r6n lath (hilus lienis). Rein la mat ranh doc co cueing lath
day.mat
bao g6m mach Ira than kinh nam trong day chang hoanh lath (lig. phrenicolienale) can goi la
day chang lath than (lig. lienorenale) hay mac not tuy-lath di tit phia duoi tuy vao r6n lath.
Duoi tuy ne'u dai thi sat vao r6n lath do do cu6ng lath se nggn (trdang hop nay cat 1,6 ldch se
kilo) va nguvc lai duoi tuy nggn thi cu6ng lath dai va cat lath de hon.
1.3. MAT THAN (facies renalis) hay mat sau trong lOm de Ling vii mat tru'dc 16i cila than
trai NIA tuygn thvgng than trai.
1.4. MAT KET TRANG (facies colica) con goi la day hay la dau tru'ac, nam tren mac treo
kgt trang ngang va day clang hoanh ket trang trai nhu nam tren mat cai vOng. Nhieu khi mat
ket trang khong trai thanh mat mat ma nhon len thanh mat dau quay ra phia trade dudi nen
ducrc goi la dau truck (extremitas anterior). Ca ba mat : da day, than va ket trang duce goi
chung là mat tang (facies visceralis).
115
 Bd cluei phdi trai

Ngach suen hoanh

cc.; a mang phdi )(acing suen X

Hinh 35.2 : Fioi chieu ccia lcich len thdnh ngitc

1.5. DAU SAU (extremitas posterior) nhon nen con goi la dinh lach chen vao giia da day
va co hoanh. C1 den nay hai la phlic mac boc lach dinh vao nhau va vao co hoanh tao nen day
chang treo lach. Doi khi hai la xa nhau va deu sau lach dinh sat vao co hoanh lam cho vi0c cat
lach kilo khan hon.
1.6. DAU TRAGIC (extremitas anterior) da mo to a phan 1.4.
1.7. BO TREN (margo superior) can goi la bet trirdc vi ludang ra phia trudc. Ba nay cong 16i
ra tru'dc, sac va c6 nhieu khia phan chia lach thanh cac thug. Cac khia nay lai cang hien rO
khi lach bi sang to c6 the sd they ngay du di da bung lam ta de chen doan phan biet with cac
tang khac.
1.8. BC; DTIOI (margo inferior) thi tha'ng va dp sat vao phan that lung ciia co hoanh.

T6m lai, lach du'oc an nau trong met 6 : dau va lung cong tura vao vom hoanh va thanh
ngtfc trai, day ng6i tren g6c ket trang trai, sitan sau tura vao then va akin trade up vao day vi.
Lach du'oc gilt trong 6 bdi cac mac nha day chang treo lach, day chang vi-lach va day chang
hoanh lach. Do do binh thu'ong khong sa they lach d thanh bung, frit khi lach bi to do benh Ur,
lach mdi vu'ot qua khe gicia day vi va co hoanh de vao 6 bung ldn va ta sor they &roc ngay dual
da bung nhd bar c6 khia cda lach.

116
2. MACH VA THAN KINH CUA LACH

2.1. BONG MACH LACH (a. lienalis).

Wang mach ldch la mat nhdnh cua clang mach than tang (truncus celiacus) chay ngang
sang trdi doc bar tren tuy dgn duai tuy, chay ra mat track duai dg di vao day chang hoanh lath
r6i phan chia vao ran ldch. Tren (hieing di clang mach ldch cho cac nhanh ben dg vao cac tang
16.n can nhv : cac nhdnh tuy (rami pancreatici) cac clang mach vi ngdn (aa. gastricae breves) va
clang mach vi mac nal trdi (a. gastroepiploica sinistra).
Bong mach ldch phan thanh cac nhanh ding de vao ldch goi là cac nhanh lath (rami
lienales) sap xgp theo hang doc nhv bac thang - dg vao r6n ldch (H.35.1).
Bang mach lath d ngvai Viet Nam có chieu dai trung binh là 135mm va &rang kinh la
4,6mm. Dung mach ldch có 74,1% xuat phdt tit clang mach than tang, 16,1% chung than vdi
clang mach gan chung va 6,4% chung than vdi clang mach vi trdi. Wang mach citc tren va o/c
clued cua ldch chigm ti le thap, tit 16,12% - 20,96% nen cat ldch a ngvai Viet Nam a han so
vdi ngvai Au.
2.2. TINH MACH LACH (v. lienalis). Cac nlidnh tinh mach tit r6n ldch ra di theo Tang
mach tdi phia sau c6 tuy thi hqp vdi tinh mach mac treo trang tren thanh tinh mach cita. Tren
dvang di, tinh mach ldch nhan cac nhanh ben nha : cac tinh mach tuy (vv. pancreaticae), cac
tinh mach vi ngdn (vv. gastricae breves), tinh mach vi mac not trdi (v. gastroepiploica sinistra).
Ngoai ra can nhan them mat tinh mach ldn la tinh mach mac treo trang dudi (v. mesenterica
inferior).
2.3. BACH MACH. Bach huygt cua lath d6 vao chu6i hach ldch (nodi lymph. lienales) nam
trong day chang hoanh 'deb. Chu& hach nay lai d6 vao chu6i hach tuy ldch (nodi lymph.
pancreaticolienales) nam doc theo mach ldch c1 bar tren thy.
2.4. THAN KINH : Than kinh cua ldch la ddm rot ldch (plexus lienalis) xuat phat tit phan
giCia va phan trvdc cua ddm roi tang (plexus celiacus) (con goi let dam reci du'orng) di theo clang
mach ldch d6 vao ldch.

CAU Hell TRAC NGHIEM

Chan cau tra lai thing nhat

393. Lach :
a) Là mot tuygn tieu hoa.
b) Co ran loch nam d mat than cila
c) Bct diidi có nhigu khia.
d) Cau a, b thing.
e) Cau a, b, c dgu sai.
117
394. Tang nao KHONG lien quan vdi lach :
a) Da day. d) Than (T).
b) Thny trai cUa gan. e) Goc ket trang trai.
c) Dad. tuy.
395. True lan cua lach song song va a ngang mdc :
a) Xuang wan 8. d) )(dung su'an 11.
b) )(acing wan 9. e) Xuang wan 12.
c) Xuang su'an 10.

Cau 396, 397. Chon :

a) Ngu (A) dung, (B) dung. (A), (B) có lien quan nhan qua.
b) Nati (A) dung, (B) dung. (A), (B) khong có lien quan nhan qua.
c) Ngu (A) dung, (B) sai.
d) Neu (A) sai, (B) dung.
e) Neu (A) sai, (B) sai.
396. (A) Nguai to khong the cat b6 lach. Vi
(B) Bao gia cang chi coo mot lach duy nhat.
397. (A) Lach rat Idni va khi bi chan thuzing VI
(B) Binh thuang lach narn sau duai yam hoanh trai.

118
 36 TA TRANG VA TUY

MUC TIEU BAI GIANG

A. .MUC TIEU L.c7 THUYgT

1. MO tá vi tri, chdc nang, hinh the ngoai, va lien quan cua to trang, tuy tang (chil 3'r den
khol to trang va dau toy).
2. MO to tau tao, hinh the trong caa to trang va tuy tang.
3. MO std mach va than kinh cua to trang, toy tang.

B. MUC TIEU THVC TAP

1. CM tren xac vi tri, hinh the ngoai va lien quan cern td trang, tuy tang.
2. CM tren xac va cac 0-lifting tien thtic tap khdc hinh the trong can to trang va toy tang.
3. CM tren xac va cac phuong tien thqc tap khdc, mach than kinh cua tá trang, tuy tang.
4. Chi tren phim X quang cac phan cua to trang binh finking.
5. So sanh to toy cua ngadi \raj. cua ch6.

TA. trang (duodenum) va toy (pancreas) va hai tang c6 lien he chat the vg mat
sinh 1y, benh 13'r nen thu'6ng duqc mo to chung goi la khoi to toy.

TA TRANG

Ta trang là kink dau cCia tigu trang di Ur mon vi den g6c to hang trang (flexura
duodenojejunalis).
Luc phoi thai to trang di dOng nhd c6 mac treo, nhung sau mac treo dinh vao la pluic mac
thanh th1 tá trang c6 dinh va nha bi bat ra sau ph& mac.
119
 1. VI TRI VA HINH THE NGOAI

Ta trang nam sat thanh bung sau, truck cOt song va cdc mach mdu truck cOt song. Ta
trang c6 hinh giong chit' C va chia lam 4 phan (H.36.1).

Phan tren
Ong met chi)
G6c to trang tren Tyy
Phan xu6ng GOc to hong trang
Phan len
G6c to trang duel HOng trang
Phan ngang

Hinh 36.1 : Hinh chieu cda to trang len thanh king

oa. Duang thing clang qua ro'n; ob. atang ngang qua rein; oc. Ditang phan gicic cda goc vuong aob.
1.1. PHAN TREN (pars superior) tidp n6i mon vi, 2/3 dau phinh to thanh hanh to trang.
Phan tren nam ngang ho'i chgch len ra sau va sang phai ngang mdc d6t song that htng I, ngay
dual gan.
1.2. PHAN XUONG (pars descendens) chay thing xu6ng doc ba phai d6t song that htng I
den d6t song that kmg III, nam troac than phai. Gitia phan tren va phan xu6ng la g6c td trang
tren (fleura duodeni superior).
1.3. PHAN NGANG (pars horizontalis) vat ngang qua cOt song that long, tit phai sang
trai, ngang mac sun gian d6t song that lung III va IV, de len dOng mach cha bung va tinh
mach cha dcith. Phia track c6 Ong mach mac treo trang tren. Vi vat ngang qua cOt sang nen
phan nay de bi ton thuong khi va cha.m a bung.
Ghia phan xu6ng va phan ngang là g6c td trang (flexura duodeni inferior).
1.4. PHAN LEN (pars ascendens) chay len tren hai ch6ch sang trai de tai g6c to hang
trang (flexura duodenojejunalis) nam ben trai cot song, canh dOng mach cha. Mac treo tidu
trang barn vao g6c to hang trang. Khi khong ban thing g6c nay thi to trang bi rut ngan lai
hay dai ra (nem ne-u barn kin ve phdn tren td trang, dai netu barn Ian zie hong trang).

120
 Data vao ski di Ong hay c6 dinh ngudi to chia to trang ra lam hai doan :
— Doan di Ong : g6m 2/3 clau (hanh td trang) &la phan tren.
— Doan c6 dinh : g6m 1/3 diidi cua phan tren, phan xueing, phan ngang va phan
Cdc phan nay cung (tau tuy dinh vao thAnh bung sau bai mac dinh to tuy,
Rieng g6c to hang trang dinh vao thanh bung sau bdi co treo to trang (musculus
suspensorius duodeni) di tit tru phdi cat hohnh tdi goc to hang trang.

2. KICH THIIOC
Ta trang dAi 25 cm, diking kinh 3-4 cm. Phan dam phinh to thAnh hanh to trang, phan
xu6ng hep a giita ndi c6 num runt, phan ngang ding hep dr ch6 dOng mach mac treo trang tren
chay qua.
Chieu dAi trung binh cUa to trang a ngu'di Viet Nam do tren xdc tudi lA 25,62 cm vA duang
kinh &la phan xu6ng to trang lA 3,46 cm.

3. HINH ANH X QUANG

X quang co thu6c can quang thi &rang vin to trang khong thong ma hdi 16i lam c6 tua
nInt mot yang hoa. Con hanh to trang co hinh tam gide, ddy quay vd mon vi va dinh sang phdi
va chgch len tren (H.36.2).
Trong benh loet hanh to trang thi hA.nh to trang bign clang khong can hinh tam gide.
Trong benh u Tau tuy khung to trang gian to ra.

4. CAU TAO VA HINH THE THONG

Cung nint cdc doan cua 6ng tieu h6a, to trang c6 nom ldp tit ngoai vao trong g6m :
— Lap thanh mac : IA pinic mac tang bao boc td trang. O doan di dOng c6 pinic mac the
phil du hai mat to trang. CI doan c6 dinh thi mat sau pinic mac dinh vao la thAnh bung sau va
troy thanh mac dinh to tuy.
Mon vi

Ranh to trang

Ph6n xu6ng to trang Hang 1.4

Hang trang

Hinh 36.2 : Sa dd hinh dnh X quang cda td trang (co tieing thudc can quang).

121
 —Tam ditai thanh mac : IA to chile ngan each gida lap thanh mac va lap car.
—Lap cd : CO hai lap : lap thd car doc : a nong, lap thd car yang : a sau
—Tam dudi niem mac : la to chile lien kat m6ng va nhao chila nhieu mach mdu va than kinh.
— Lap niem mac : mau hang min gem co :
+ Mao trang (villi intestinales) la niem mac dai ra nhu cac sdi long nhii phit len long td. trang.
+ Nap yang (plicae circulares) la cac nap ngang a niem mac, CO a phan ditch nhd to lan de
lam tang dien tich hap thu.
+ Nap doc (plica longitudinalis duodeni) là nhfing nap niem mac thay a thanh sau phan
xuang td trang va tan het a nhd to lan.
+ Cac tuyen to trang (glandulae duodeni) CO nhieu o tren nhd to lan, fiat ra dich to trang.
— Nhu td. lan (papilla duodeni major) hinh non d mat trong phan xuang, 50% nhti to lon,
r6ng o gitia goi la bong gan tuy (ampulla hepatopancreatica), d6 vac) bong co ang mat chit va
ang tuy chinh.
— Nhil ta. be (papilla duodeni minor) na.'m phia tren nhu td Ian 3 cm. Dinh nhii to be co l6
thOng cita 6ng tuy phu (H.36.3)

Tyy

Ong tyy phy

NhO to be

Ong met chit

Ong tyy chInh

NhO to Ion

vong

Ta treng

Hinh 36.3 : Hinh the trong cila tci trang.

Tv 1(

'Puy (pancreas) IA tuyen thuOc 130 may tieu Ma vita not fiat vita ngoai fiat :
— Ngoai tiet : tiet ra cac men de tieu boa cac chat duang, dam, mar.
— Ni
O tiet : tiet vao mdu chat insulin de chuyen hoa during trong car the.
122
1. VI TRi VA HINH THE NGOAI
Tuy di tit phan xu6ng td trang dgn cuffing ldch, nam vat ngang trade cot song that lung,
che-ch len tren sang trai, phan 16n tuy o tang tren mac treo ke't trang ngang, mot phan nh6
du6i mac treo nay.
Tuy c6 hinh gi6ng mot cdi bda va c6 ba phan : dau, than va duoi (H.36.4).

CO truec
Ranh to trang
CO mgc n6i
Than tuy
Duoi tuy
o04111 War
At At 04144 1-,;.
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46.adme olakT
4
11&

uto■ ■*A' ■11 i.

Day
tuy

var
16.4*1"
lOattO
Khuygt tvy

Mat
tradc
Bei tren

Mat sau

Mdm mac
Bei Thick Be( ditai
Mat duel

Hinh 36.4: Hlnh the ngodi tuyen tuy

1.1. DAU TUY (caput pancreatis).

Det, gan hinh vuong, co td trang vay quanh, dau dudi tdch ra mot mom goi IA mom mot
(processus uncinatus). Gala dau tuy va than tuy c6 khuygt tuy (incisura pancreatis)
1.2. THAN TUY (corpus pancreatis).
Tit khuyet tuy (do dong mach mac treo trang tren en len ma thanh) che'ch len tren sang
trai c6 hai chiL cong 16m ra sau om cot song, cong lOm ra trueic om da day.
Than tuy co ba mat va ba b6 :
—Mat trade (fades anterior) : lOm dp mat sau da dAy, dive phu bai pink mac thAnh sau
cua hau cung mac n6i.
—Mat sau (facies posterior) : phang, dinh vao la thanh sau cua phtic mac, di tit phai sang
trai bat cheo Ong mach chU bung. DOng mach ldch chay a b6 tren cila mat sau.

123
 -M4 t dadi (facies inferior) : hep, a phia sau mac treo ke't trang ngang.
- Ba tren (margo superior) : giai han mat trade vai mat sau lien quan with &Ong mach loch.
- Ba duoi (margo inferior): giai han mat sau va mat dual..
- Bu trade (margo anterior) : gidi han mat track va mat clued, c6 mac treo ket trang ngang
dinh vao.
1.3. DUOI TUY (cauda pancreatis) : nha mOt lutdi tiep n6i theo than tuy. Duoi co thd dai
hay ngdn, trim hay det, phia tren va trade duoi CO dung mach loch chay qua. Dual tuy di dOng
trong mac not tuy-lath (day chcing hodnh ldch)

2. KICH THIJdC VA MAU SAC

Kich thadc tuy thay d6i, trung binh dai 15 cm, cao 6cm, day 3cm va nang 80g. T6 chile dia
tuy mem va c6 mau trang h6ng.

3. PHU.CiNG TIEN CO DINH TUY

- Dau tuy va than tuy dinh chat vao thanh bung sau bai mac dinh to tuy.
- Dau tuy c6 to trang quay quanh, 6ng mat chili va cac mach mau di vao tuy va to trang
nen dau va than tuy c6 dinh. Chi co duoi tuy la di dung.
4. CAC ONG TIET CUA TUY
Tuy la mOt tuye-n vita nOi tigt vita ngoai tigt.
- Phan nOi tigt : tit ra insulin di thong vao mau qua cac mao mach trong tuydn.
- Phan ngoai ti6t : cac 6ng tigt lien tidu thity d6 vao cac 6ng tidt ldn. CO hai 6ng la :
4.1. ONG TUY (ductus pancreaticus)
Con goi la 6ng tuy chinh chay tii duoi qua than tuy theo true caa tuy.

Ny tyy king

Ta trang
gan

Ong tyy phy

Ong mat chi;

Tyy lung
Ong tyy chinh Tyy byng

Hinh 36.5: Sa dd phdt trien phoi thai cua tuy.

124
 Gan

Anh XXXI : Hinh chie"u caa lcich va mot s6 tang khcic len thanh bung va thanh ngvc.

125
 Co tCli mat

DOng ,mach gan rieng

Tui mat Ong mat chti
Gan Ong tuy chinh
Than tuy
Ong tui mat
Phan tren to trang
mach 14 to trang
DOng mach
to tuy tren sau Ong tuy chinh
DOng mach mac
Nhu to be
treo trang tren
Ong tuy phy Trnh mach mac
Nha to lOn treo trang tren
Ong mat chef

Phan len to trang

Phan ngang to trang

G6c ke't trang phai

Anh XXXII : Td trang vet tuy

126
 TIN Ichuydt tuy thi be tong xuang dual qua Tau tuy d6 tdi nha td lan r6i cling eing mat chin
d6 vao bong gan tuy (ampulla hepatopancreatica). Ong tuy nhan cdc nhaith ben nen toan ba
6ng tiat trong nha hinh mat gan cua. la cay.
4.2. ONG TUY PHU (ductus pancreaticus accessorius) torch a ang tuy chinh ra, di chich
len tren tdi nhti td be a phan xu6n.g cua td trang.
Mu6n hidu ngueln g6c cua hai 6ng tuy chinh va phu, thong to can xem scc d6 phdt trien
phoi thai cUa tuy (H.36.5).
5. LIEN QUAN CiTA TA TRANG VA TUY
5.1. LIEN QUAN GILDA TA TRANG VA TUY
Chi có Tau tuy la lien quan mat thigt vai to trang dm than va dual tuy chay tan sang ben
trai 6 bung nen d rat xa to trang.
Ta trang quay quanh dau tuy.
— Phan tren td. trang : doan di clang va mon vi norm tilt& tuy, doan c6 dinh cua phan tren
xe Tau tuy thanh mat ranh, truac ranh la di track va sau ranh la di mac not (tuber omentale)
norm phia sau mac n6i nh6.
—Phan xu6ng : xe vao bar phdi dam tuy mat ranh doc, khLic nay dinh chat vao dau tuy bai
cdc 6ng tuy chinh va phu tii tuy d6 vao td. trang.
—Phan ngang : 6m lay mom mew nhang khong dinh vao nhau.
— Phan len : xa dan Tau tuy.

Tihh mach chit duet

Tuye'n thriong than phai

Lach

S.1■
isrev,01
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ot
„,, 4■411_ Tgy
Than phai wii4111101".

Goc trai ke't trang

Goc phai
ket trang

Fa mac treo ke't trang ngang

Niau quan phai Wing trang

Hinh 36.6: Lien quan czia tci trang vet tuy

127
 5.2. LIEN QUAN CUA KHOI TA TRANG-DAU TUY.
Doan to trang c6 dinh va dau tuy dinh lien vdi nhau duoc boc chung trong 2 la cUa mac
treo to tuy. Mac treo nay ve sau dinh vao thanh bung sau goi la mac dinh to tuy.
Ta tuy la mot khol c6 ding lien quan yeti phtic mac va cdc tang chung quanh (H.36.6).
5.2.1. Lien quan yeti phtic mac.
—Mat sau : mat sau to tuy dinh vao thanh bung sau bai mac dinh td. tuy (mac Treitz).
—Mat truac : khol to tuy a mat truck c6 re" mac treo 101, trang ngang barn vao, re mac treo
nay chay chech len tren sang trai r6i di doc ba duai than tuy. Vay khol to tuy mot phan
tren, mot phan a duai mac treo kgt trang ngang, con than va dad tuy d tren mac treo nay.
—Mac treo tidu trang thdang dinh khong dung vao g6c to h6ng trang ma dinh Fan sang
h6ng trang nen gidi han vdi ph& mac a phia sau mot ngdch goi la ngach to trang sau (recessus
retroduodenalis). Ngoai ra con ngach td tren (recessus duodenalis superior), ngdch to dtt6i
(recessus duodenalis inferior) va ngach canh to trang (recessus paraduodenalis).

5.2.2. Lien quan vdi cac tang.

—Mat sau : qua mac dinh to tuy, kheil to tuy lien quan vdi tuyen thuong than phai, nun
than phai, cu6ng than phai, tinh mach chit dad. Phan ngang cUa td trang di bang qua cot sang
that lung va Ong mach chit' bung. Phia sau khol to tuy con c6 Ong mat chu va cdc mach mdu
cua to tuy. Co the tim Ong mat chit' bang cach b6c mac dinh to tuy.
—Mat tru'ac : lien quan vdi kh6i to tuy a tang tren mac treo ket trang ngang la gan va
mon vi cUa da day. O tang dual mac treo ket trang ngang, kh6i to tuy lien quan vdi cdc quai
runt non. Dung mach mac treo trang tren an vao mat duai-tuy thanh khuyet tuy.

5.3. LIEN QUAN CUA KHUYET WY, THAN VA Dub' TUY.

5.3.1. Lien quan cua lEhuygt tuy.

Sau khuyet tuy c6 do, ng mach chii bung va tinh mach ciia.
Tren khuyet tuy c6 dOng mach than tang.
Dudi khuyet tuy co dOng mach mac treo trang tren.
Nhu vay ba dOng mach tren vay quanh Wing not giOn dau va than tuy.
5.3.2. Lien quan clia than tuy.
Than tuy nam trong hal Id mac treo vi sau ma phan ben phai dinh vao thanh bung sau, do
do phan ben phai cilia than tuy nai not \rai dau tuy duoc c6 dinh.
— Truac than tuy lien quan vdi mat sau da day.
— Sau than tuy lien quan vdi than, tuyen thing than trdi.

128
 —Dual than tuy c6 re mac treo ket trang ngang barn vao.
—Tren than tuy co dung mach lath di qua.

2.3.2. Lien quan cua duel tuy.

Duoi toy là pilaf' di Ong cua bay cung yeti mach lath n'am trong hai la dm mac n6i toy
lath. Duoi try Infong ve rein lath, neu duoi toy dai thi cu6ng lath ngan va ngucic lai ne-u duoi
tuy ngAn thi cuo-ng lath dai (del not a bed Lach).

6. MACH VA THAN KINH CUA TA TRANG VA TVY (Hinh 36.7)

6.1. MACH MAU.
6.1.1. Deng mach. DOng mach cung cap cho to trang va toy g6m cc!, 2 nguem :
6.1.1.1. Tit ding mach than tang (truncus celiacus) : &Ong mach than tang cap mau cho td trang
va toy do 2 nhanh ben caa dOng mach than tang la d6ng mach vi to trang va dOng mach lath.
— Deng mach vi to trang (aa. gastroduodenalis) d6n to trang va toy bdi 2 nhanh :
+ Dung mach to tuy tren sau (a. pancreaticoduodenalis superior posterior) se cung cap cac
nhanh tyy va nhanh to trang cho mat trnac va sau kh6i to toy.
+ D6ng mach to toy tren trade (a. pancreaticoduodenalis superior anterior) cung cap cac
nhanh cho mat trade to trang.
+ Cac dOng mach sau to trang (aa. retroduodenales) cho cac nhanh nho vao mat sau td trang.
— Deng mach lath cho cac nhanh sau day den toy :
+ Wing mach tuy lung (a. pancreatica dorsalis).
+ DOng mach try clued (a. pancreatica inferior).
+ DOng mach duOi tuy (a. caudae pancreatis).
+ DOng mach toy lan (a. pancreatica magna).
6.1.1.2. Tit ciOng mach mac treo trang tren den td trang va tuy bai cac Ong mach to toy
duoi (aa. pancreaticoduodenales inferiores). Wing mach nay cho nhanh to try track dadi va to
try sau cloth de-n nu6i mat trudc va mat sau caa phan dctai kh6i to toy.
DOng mach than tang a ngutd Viet Nam có nguyen ay da s6 a ngang mac d6t sting that
lung 1, co dung kinh la 5,7 mm va chie'u dai trung binh la 7,5 mm. Skt phan chia nhanh ben
rat thay dOi (có 7 clang).
DOng mach vi to trang la nhanh caa Ong mach gan chung có dung kinh la 3,4mm.
6.1.2. Tinh mach. Tinh mach to trang va tuy dgu trtic ti6p hay gian ti6p d6 vao tinh
mach cora. DO la :
Tinh mach tren to trang, tinh mach sau to trang d6 trite ti6p v6 tinh mach can.
— 'Dinh mach tuy dual d6 vao tinh mach mac treo trang tren.
— Tinh mach than va du6i toy d6 v6 tinh mach lath.
129
 Ddng mach than tang
Tinh mach ciia Dang mach lach
DO:ng mach tyy lung
DOng mach vi to trang
dir
t
Ddng mach to tuy tren sau

Ddng mach vi Ddng mach dudi tyy

mac not phai
A
'4111 0k
Dang mach tuy Ian
DOng mach to tyy /,
/
tren trudc /- DOng mach tyy duel

Tinh mach mac treo trang dudi

Ong mat chi!'

EN:mg mach mac treo trang tren

D'Ong mach to tyy du'di

Dang much to tyy sau
Dang mach to tyy du'di trudc

Hinh 36.7 : Sri de; dOng mach clia td trdng vd tuy

6.2. BACH HUYET.
G6m b6n nhom : track sau, phai, trai. Ca b6n nham nay hap thanh chu6i hach tuy lach
(nodi pancreaticoliennales).
6.3. THAN KINH.
Than kinh tur chu cda to trang va tuy tach tit dam r6i tang (plexus celiacus) va dam r6i
mac treo trang tren (plexus mesentericus superior).

CAU HOI TRAC NGHIE,M

Chon cau tra lai clang nhat

398. Ta trang :
a) HInh chit C, nam hoax' toan ben phai cot song.
b) G6m b6n phan la phan ngang, phan xu6ng, phan duai va phan len.
c) Khong ca lap thanh mac bao boc ben ngoai vi bi dinh vao thanh bung sau va coi
nam sau pinic mac.
d) Cau a, b, c dung.
e) Cau a, b, c sai.

130
399. Ta trang :
a) La phan dau cita runt non
b) Dai khoang 25 cm.
c) Co &king kinh 16n lion hang trang va hoi trang.
d) Co mot loan di thing khong dinh vao thanh bung sau.
e) Tat ca d'eu dung.
400. G6c ta-hang trang dinh vao thanh bung sau bdi :
a) Re" mac treo k6t trang ngang. d) Mac not 16n.
b) Ca treo ta trang. e) Mac dinh ta-tuy.
c) Mac n6i nh6.
401. Phan nao ctia ta trang dinh chat nhat vac, dau tuy :
a) Phan tren. d) Phan len.
b) Phan xu6ng. e) G6c to trang tren va goc ta trang du'6i.
c) Phan ngang.
402. Lien quan phia sau vai phan tren cua to trang la :
a) DM vi to trang. d) a, b, c thing.
b) Ong gan chung. e) a, b, c deu sai.
c) TM cua.
403. Mat sau khol ta tuy KHONG lien quan v6i
a) TM chit diidi. d) Re mac treo k6t trang ngang.
b) Ong mat chit. e) Mac dinh ta tuy.
c) Than (P).
Cali 404, 405. ChQn :
a) N6u (A) thing, (B) thing, (A), (B) c6 lien quan nhan qua.
b) N6u (A) dting, (B) dung, (A), (B) khong lien quan nhan qua.
c) N6u (A) thing, (B) sai.
d) Neu (A) sai, (B) thing.
e) N6u (A) sai, (B) sai.
404. (A) O ngutri, to trang khong duvc xem la mot phan caa runt non. VI
(B) Ta trang bi mat mac treo do dinh vao thanh bung sau.

405. (A) Ngutti ta c6 the chup X quang khung to trang c6 thu& can quang de than down u dau tuy VI
(B) U dau tuy se di can va tao nen cac u cua to trang.

131
 406. DOng mach den nuoi tuy nao da6i day la nhanh ctia DM mac treo trang tren :
a) DM lung tuy. d) DM sau to trang.
b) DM tuy 16n. e) DM to tuy duc3i.
c) DM tuy

407. Cac tinh mach d'an luau tit td trang va tuy d6 van :

a) Tinh mach 'd) Ca a, b, c deu dung.

b) TM mac treo trang tren. e) Chi b va c thing.
c) TM lach.

132
 37 GAN

MUC TIEU BAI GIANG

A. MUC TIEU LY THUYET

1. MO to vi tri, cluic nang, hinh the ngoai, hinh the trong, lien quan cua gan va cac
phuung tien gilt gan tai ch6.
2. M8 to lien quan &la cac thanh phan caa cuang gan.
3. MO to su phan b6 dai cuong cua clueing mach mat trong gan.
4. Ke ten cac phan thity cua gan.
5. Neu duuc lien quan cua cac diking clan mat ngoai gan.
6. Ve" soy d6 he th6ng not dia-chti de giai thich cac y nghia cila no.

B. MUC TIEU THTJC TAP

1. CM tren xac, mo hinh, tieu ban vi tri, hinh the va lien quan ctia gan, cac phu'ung tien
gift gan tai ch6.
2. Chi tren xac va cac pinking tien thuc tap khac cac thanh phan ctia cu6ng gan va lien
quan cua du'Ong dan mat ngoai gan.
3. D6i chie-u gan len thanh bung nguc va xac dinh diem tui mat tren ngutri song.
4. So sanh gan nguari yeti gan cho.

Gan (hepar) la tang to nhat trong cc the, nam trong 6 bung nhung lien quan nhieu yeti
thanh nguc. Ve sinh lY gan la mot tuyen vim ngoai tiat (tie't ra m4t) vita nOi ti6t tham du' nhieu
chile phan dieu hoa dit6ng huyet, ch6ng nhie'm dOc.
+ Gan có mau do nau, trun bong. Mat dO hal chac nhu'ng de bi nghien nat va de vo trong
chgn thuung va kht von, chay mau rat nhieu.
133
 + ngu'di chgt gan na.ng 1500g. di ngiferi song gan nang khoang 2.300g do có chaa nhieu mau.
+ Kich thuac : gan có be ngang trung binh 28 cm, be trade - sau trung binh 18 cm va be
cao trung binh 8 cm.
1.VI TIti
Gan a tang tren mac treo ket trung ngang, trong o &tad hoanh phai nhimg lan sang 6
thu'ong vi va o diidi hoanh trai.
Gan trong dlic theo khuon vam hoanh. Ngu dal chigu len thanh nvc thi gan len tan
khoang gian wan IV tren dirang vii phai, bir duai gan chay doc bar wan phai.
2. Hilsal THE NGOAI VA LIEN QUAN
Gan cal hinh dang nhu' qua dila hau cat chgch tii trai sang phai theo mat binh dien nhin
len tren ra truac va sang phai. Do do gan có hai mat la mat hoanh 16i a tren dp sat vao co
hoanh va mat tang phang, a diidi tigp xuc vdi cac tang trong 6 bung. Gan chi co mat bar duy
nhat là bar diidi (H.37.1).
2.1. MAT HOANH (facies diaphragmatica).
Mat hoanh dtioc chia lam bOn phan :
2.1.1. PhAn teen (pars superior) 16i, tron, lang, nap dirdi co hoanh va co vet an tim
(impressio cardiaca). Qua co hohnh pilau tren lien quan vdi day phoi phai, mang tim, mang
ph6i va day ph6i trai.

Day chang
tam giac phai
La trues } Day chang vanh
a sau
Day chang
Vying tran tam giac trai
An tim
An thut quan
Tinh mach
ch' duel

ay chang iiem
Ba duet
Day chang tran
Day tOi mat
Hinh 37.1 : Sa d6 mat hoanh ctia gan (nhin tru'oc).
134
 Ong gan trai
DOng mach till mat
Ong tai mat
Ong gan chung
Ong gan phi DOng mach 0 trai
Co till mat °Ong mach gan chung
Ttii mat

DOng mach gan

DOng mach vi ph5i Vuoi tyy
Ong mat chi' .- DOng mach lach
DOng mach to tyy been tn/dc Than ivy
DOng mach 0 to trang • TIM mach dia
DOng mach 0 mac not phai Moc tyy
DOng mach mac treo trang
DOng mach to tuy !Yen sau
TInh mach mac treo trang tren
Dau tuy

Anh XXXIII : Cuing Gan

135
 DOng mach day vi sau •
DOng mach day vi tru'dc
Eking mach than tang
Eking mach MI mat -- - DOng mach vi trai
Dong mach gan rieng DOng mach lath
Elting mach vi phai DOng mach vi mac n6i trai
DOng mach gan rieng DOng mach mac treo tram tren
DOng mach 14 to trang Tihh mach than trai
DOng mach to tyy
tren sau Tinh mach mac treo trang dudi
DOng mach vi mac DOng mach tyy dudi
n6i phai Cung dong mach kat trang ngang
DOng mach kat trang trai
Tihh mach lath DOng mach mac treo trang tren
Eking mach ./ Cung mach
ke.t1rang phai
DOng mach to tyy dudi
DOng mach hal
,Tihh mach mac treo trang tren
ke't trang
DOng mach ke't trang xueing
DOng mach
h6i ;at trang DOng mach mac treo trang dudi
DOng mach runt theta
DOng mach
manh trang trudc Cac dOng mach SIGMA
DOng mach DOng mach SIGMA tren
manh trang sau
DOng mach SIGMA git7a
Cung mach hai
- kat trang
DOng mach SIGMA dudi
DOng mach tryd trang tren

Anh =IV : DOng mach than tang vet cac dOng mach mac treo

136
 2.1.2. Phan trade (pars anterior) tiep xtic \rai co hoanh va thanh bung trade. Ca phan
tren va phan duti dgu duoc chia doi bai day chang liem (lig. falciforme hepatis). Day la mep
phan chia 6 clued hoanh phai thanh hai ngan ben phai va ben trai caa day chang
2.1.3. PhAn phai (pars dextra) do la phan nhin sang phai lien tip vdi phan. tren Ira phan
trade dies mat hohnh, la yang ma mat hohnh dea din vai cac cung sutn this VII dgn XI ben phai.
Phan phai each cac xutng sin bai co hohnh, mang ph6i va mot ba mang caa day ph6i phai.
2.1.4. PhAn sau (pars posterior) là phan nh6 nhat dm mat hoanh, hinh tam giac, c6 vUng
tran (area nuda) là yang gan khong c6 phiic mac the phi va thay duoi (lobus caudatus)
(H.37.2). Phan sau Ong a ben phai, hep a ben trai va dinh vao co hoanh. Ben phai caa they
dual c6 ranh tinh mach cha (sulcus venae cavae), ben trai c6 khe day chang tinh mach (fissures
lig. venosi).
Mat hohnh caa gan qua co hoanh lien quan \raj phoi, mang phoi, tim, mang tim, do do mot
dp xe gan khi vet c6 thg lan len ph6i.
2.2. MAT TANG (facies visceralis) la mat caa gan nhin xu6ng duai va ra sau. Mat tang
lOm khong dgu do cac vet cua cac tang trong 6 bung an vao. Dac bit c6 nhfing vet an sau tao
thanh hai ranh doc va mot ranh ngang c6 hinh chit H a mat tang va phan sau cua mat hoanh.

Day chang liorn

Ranh tinh mach chu

La trade
Day chang tranh
La sau

Day chang
tam giac trai

Thiry duo! Day chang

tarn giac phai

Vung tran

Hinh 37.2 : Sa dó phdn sau ctict mat hodnh gan.

137
 2.2.1. Ranh doc phai tao bdi phia trade la h6 tai met (fossa vesicae felleae), phia sau la
ranh tinh mach cha (sulcus vena cavae), gala hai ranh có mom duoi (processus caudatus) cda
thuy duoi.
2.2.2. Ranh doc trai hop va sau each ranh doc phdi khodng 6 cm. Phia trade la khuyet day
chang trim (incisura lig. teretis), day nay la di tich cda tinh mach r6n bi the lai. C1 phan sau cua
mat hoanh la khe day chang tinh mach (fissura lig. venosi). Day cheng tinh mach la di tich &la
Ong tinh mach (ductus venosus) n6i tinh mach cd'a vao tinh mach cha dutri luc phoi thai.
2.2.3. Ranh ngang la cda gan (porta hepatis) nem lech ve phia sau hon phia tru'dc, dal
6 cm chay tit phdi sang trai. Mach, than kinh va Ong &an met chay tit gan ra ngoai hay tit
ngoai vao gan d'eu qua cda gan.
Hai ranh doe va mot ranh ngang tao thanh hinh chit H chia mat tang va phan sau cilia
mat hoanh ra lam b6n thUy. Thuy phai (Zebus hepatis dexter) a ben phdi ranh doc phai. Thay
trai (Zebus hepatis sinister) d ben trai ranh doc trai. Gina hai ranh, trade ca'a gan la thuy vuong
(Zebus quadratus), sau cita gan la thUy duoi (Zebus caudatus).
Mat tang a thuy phdi có ba vet an cua ba tang la an ket trang (impressio colica) a phia trutic,
en then (impressio renalis) phdi a phia sau va an to trang (impressio duodenalis) a phia trong.

Day chgng Thiry dual

tam giac trai Day chang
Day chgng tinh mach
cher du'di tam giac phai

Tinh mach
chei du'di
Day chhng vi gan
ranh day chang
tinh mach An than phai

An da day
Mom dual
DO:hg much Mom nhci
Ceia gan gan rieng
Tinh mach ale
[ Ong gan 1 An ket trang

Khe day chgng trOn

to tiang
They vuong
Day chgng trOn Till mat

Day chang horn

Hinh 37.3 : So. a melt tang clia gan

138
 Mat tang a they trai c6 mot lOm lan la an da day (impressio gastrica).
Mat tang a thity vuong up len da day, mon vi va ta. trang.
Thity duoi a sau cita gan có mot phan thuOc v6 phan sau cua mat hoanh.
Thity duoi co hai mom cdch nhau bai mot lom do tinh mach cil'a an len, mom ben trai trOn
la mom nhti (processus papillaris), ben phdi la mom du6i. (processus caudatus) vi co dang mot
cdi duoi nhon nam gifia h6 tOi mat va ranh tinh mach chti (H.37.3).

2.3. BO. Gan chi co mot bti la b6 dual (margo inferior). BO nay rO va sac tao bai ranh gidi
giita phan truac cilia mat hoanh va mat tang, chay tit phdi sang trai. Khi gan lan to co the s?
&roc 136 nay a thanh bung truck, dual ba wan phdi. BO du'ai. CO hai ch6 khuyk là khuyet cua
day chang trim va khuygt cUa ddy ttii mat. O phia sau, bar dad khong rO.

2.4. LIEN QUAN CU' A GAN VOI PHUC MAC.

Gan hau hat du'oc phdc mac che phti, chi c6 melt phan sau cilia mat hoanh, not hai la cUa
day chang vanh quat ngdoc len co hoanh la khong co ph& mac phil goi la vUng trail (area
nuda) cilia gan hay vUng gan ngoai pink mac. Ngoai ra a h6 tui mat nal tili mat dinh sat vao
gan cling kitting co phdc mac che pita.

3. CAC DAY CHANG VA CAC PHILTONG TIEN CO DINH GAN

Gan &toe c6 dinh tai ch8 bai :

3.1. TINH MACH CHt DU-dI (vena cava inferior). Tinh mach chili duai dinh vao to chdc
gan va n6i vdi cac tinh mach gan a trong gan.
3.2. DAY CHANG HOANH GAN. Wm nhie'u tha sqi n6i vUng trail cua gan vdi co hoanh
(H.37.4).

3.3. DAY CHANG VANH (ligamentum coronarium hepatis). Di tit phan sau cua mat hoanh
tai co hoanh. Day chang vanh tao nen bai sd quat ngdoc ra truac va ra sau cua la ph& mac che
pita gan len co hoanh. Day chang vanh rat rOng di tit (tau phdi den dau trai cilia gan. Sit quat
nguoc ctia hai la trdac va sau nay lam cho gan co mot vUng trail ngoai pinic mac, vi vdy co the
m6 ap xe gan IthOng qua phdc mac (chin btu ap xe gan ngoai phzic mac) bang each di qua vUng
trdn nay va du'Ong m6 a khoang gian strOn IX, X, each dating gai song 11 cm. Day chang vanh
dai ra hai ben de lien ti6p vai cdc day chang tam gidc phdi, va trai, hep len tren cld lien tiep
veti day chang ligm a trade va hep ra sau d6 n6i vai day chang vi gan (mac not nho) (H.37.4).

3.4. DAY CHANG TAM GIAC PHAI VA TRAI (ligamentum triangulare dextrum, sinistrum).
O hai dau phai va trai cilia day chang vanh, hai la phtic mac tign gan lai va chap vao nhau a hai
dau gan tao nen hai nep phdc mac hinh tam giac, chang hai dau cilia phan sau gan vao co hoanh
tao thanh hai day chang tam gidc phdi va trai. M8i day chang tam gidc co ba canh mot canh dinh
vao co hohnh, mot quill dinh vao gan va mot canh td do a phia trdac ngoai.
3.5. DAY CHANG LIEM (ligamentum falciforme hepatis) hay day chang treo gan la mot
139
 ne-p phdc mac treo mat hohnh ciia gan vao mat dudi car hoanh va vao thanh bung truck, keo dai
tit day chang vanh cho tai tan r6n.
Day chang liem có ba bur : mot bo dinh vao thanh bung truck va co hoanh di tit r6n len tdi
day chang vanh, mot bar dinh vao mat hoanh gan va bis tu' do cang tit r6n tai bet dudi gan. GiQa
hai la cua bir -hi do có day chang troll gan (lig. teres hepatis).
3.6. MAC NOI NHO (omentum minus) la phdc mac n6i gan vdi bar cong be da day Om ce,
hai phan :
—Day chang gan vi aigamentum hepatogastricum) la ngp phdc mac not ba cong be da day
tdi khe day chang tinh mach ctia gan.
—Day chang gan to trang aigamentum hepatoduodenale) la phdc mac di tit mon vi va
phan tren td trang tgi cda gan.

Day chang I La tru'dc

vanh j La sau
Day chang hoanh gan

La tang Gan
PhOc mac
La thanh Mgc not nho

Da day

Hinh 37.4: Thi& do cdt clang doc qua gan.

3.7. DAY CHANG TRON CUA GAN aigamentum teres hepatis) la thung sgi do sit thodi
hoa va bit lai cern tinh mach r6n, di tit r6n len mat tang cua gan tao nen khe day chang troll
va tan cling ar nhanh trai cua tinh mach dia.
3.8. DAY CHANG TINH MACH aigamentum venosum) la do sor thodi hoa dm Ong tinh
mach (ductus venosum). Ldc phoi thai Ong tinh mach la mot Ong n6i -Ur he th6ng tinh mach cga
va tinh mach r6n den tinh mach clni dudi. Day chang tinh mach tao nen khe day chang tinh
mach (fissura lig. venosi) di tit tinh mach gan trai den tinh mach cha
Gan tuy co nhiL phirang tin c6 dinh nhung van di dung theo co hoanh khi thd. Khi gan
to, to có the sor dudi ha &fan phai th'dy mot kh6i chat di Ong theo nhip tha.
Gan có nhang day chang ngan each tao nhi'eu o quanh gan : o dudi hoanh phdi, o dudi
hohnh trai, o dudi gan track mac n6i nho, o clued gan sau va ben trai mac n6i nhO. MOt ap xe
gan khi vet killing Ian tit o nay sang o khac.

4. CAU TAO VA HINH THE TRONG

Gan dggc eau tao bed nhang bao gan, mo gan, nhi'du mach mau va &Ong mat trong gan.
4.1. BAO GAN. Gan duvc bao boc bai hai bao, do la ldp thanh mac a ngoai va lap xa a
trong (H.37.5).

140
 DOng mach
Tinh mach Bao xa

Hinh 37.5 : Sa coo bao xu cda gan.

4.1.1. Ldp thanh mac (tunica serosa).

Lap thanh mac la la tang cda phtic mac boc ben ngoai gan sau khi lat len tren hay xuong
&adi se tao nen cac day chang treo gam

Khe gicia gan

Khuye't tui mat

Hinh 37.6 : Sa dO phan chia thay gan a mat hoanh.

4.1.2. Ldp xcl (tunica fibrosa).

Lap xu la met bao xa rieng biet cua gan a gifra mo gan va bao thanh mac. Lap xu dinh
chat vao lap thanh mac a ngoai va dinh sat vao to chic gan. O cda gan, lap xcr di ding cac
mach mau va 6ng mat vao trong gan tao thanh bao xu quanh mach (capsula fibrosa
141
perivascularis) debao bac cac doting mach met va phan chia theo cac &king nay thanh cac
nhanh con Uri cac khoang gian tidu they (H.37.5).
Trong cham thoong, gan c6 thg they mau do6i 16p xo.

Thiry vuong
Teti mat
Day chang trOn

Thiry trai
Thiry phai
Mom gal

Mom
Khe day chang
TIM mach chO clu'di tinh mach

Thiry dual
Gan phai
.11
Gan trai

Hinh 37.7 : Sa do phan chia theiy gan a mat tang.

4.2. MO GAN
Gan tao nen bed nhang to bao gan, mach mau va doOng met trong gan. Cdc td bao gan sap
xgp thanh nhie'u be tao nen tidu they gan. C3 trung tam mai tigu thily c6 mot tinh mach n6i vdi
nhanh tinh mach cCta trong khoang gian tieu they va d6 vg cac tinh mach gan. Ba hoec ben
tidu thily quay lay mot khoang gian tidu thug, trong khoang c6 cac nhanh cue clOng mach gan,
tinh mach oh va 6ng den mat.

5. Slki PHAN THUY CUA GAN

Co hai cach chia phan they gan : phan they gan theo hinh the ngoai va phan they gan
theo doOng mach met.
5.1. PHAN THUY GAN THEO HINH THE NGOAI (H.37.6, H.37.7).
Day la each phan chia gan theo cac nha giai pilau hoc c6 didn. Theo cach chia nay, gan c6
bfin thily ma gidi hen nho sau :
- O mat hoanh to they doge thug phai (lobus hepatis dexter) va thily trai (lob us hepatis
sinister) ngan cach nhau bdi day chang

142
 - mat tang hai ranh doc va ranh ngang chia gan thanh 4 thity. Thiry phai a ben phai
ranh doc phai va they trai a ben trai ranh doc trai. Ghia hai ranh doc, trade ranh ngang la
they vuong (lobus quadratus), sau ranh ngang la thny duoi (lobus caudatus).
Nhu vay : Thiry phai va they trai d6u thay a ca mat hoanh va mat tang. Thiry vuong chi
thay a mat tang va they duoi thi thay a mat tang va mot phan a phan sau mat hoanh.

3 khoat Khe phy giCia

Khe phy giU'a ngon tay they trai
they phai

Hinh 37.8 : Sa d3 phan thay as ha phan thay caa gan.

A : Nhin to mat hodnh B : Nhin to mat king

143
 5.2. PHAN THUY GAN THEO DUGONG MACH MAT (H.37.8).
Gan day, cac nha giai pilau hoc dac biet la cac nha pilau thuat phan chia phan thity gan
theo dutng mach mat.
Ten goi cac thity, phan they va ha phan thity gan theo dutng mach mat van chu'a thong
nhat Oita cac tac gia. O day chting to mo to sit pilau thity gan theo Ton That TUng.

5.2.1. Khe giffa gan (khe chink).

- 43 mat hoanh, khe nay la du6ng not tit gitia khuyet tai mat den b6 trai tinh mach chil
diidi.
- C1 mat tang, khe la dutng n6i U.( giaa h6 tui mat den b6 trai tinh mach chil
Khe Oda gan chtia tinh mach gan gitia (v.hepaticae mediae) va chia gan thanh nda gan
phai va niia gan trai.

5.2.2. Khe lien phan thily phai (khe ben phcii).

Khe nay di tit b6 phai cua tinh mach chu Fan theo là tren dia day chang vanh roi
yang xuo-ng song song vdi b6 phai gan va each b6 nay 3 khoat ngOn tay.
Khe ben phai chila tinh mach gan phai (v. hepaticae dextrae) va chia gan phai thanh hai
phan thity : phan thily sau va phan thily triidc.

5.2.3. Khe lien phan thity trai (khe ben trdi).

- C1 mat hoanh, khe la dating barn cila day chang
- C1 mat tang, khe Wong ling vdi ranh doe trai.
Khe nay chtla tinh mach gan trai (v. hepaticae sinistrae) va chia gan trai thanh phan thily
gifia va phan thity ben.

5.2.4. Khe phi giaa thity phai. Thu'6ng khong r6 ret, nam ngang qua Oda gan phai va
chia phan thily tru'dc thanh ha phan thity V, VIII, phan they sau thanh ha phan they VI, VII.

5.2.5. Khe phu giiita they trai :

- Cl mat hoanh, khe di t6 b6 trai tinh mach chit diidi den not not 1/3 sau va 2/3 track b6
du'ai gan trai.
- mat tang, khe di t6 dau trai cita gan den not not 1/3 sau va 2/3 trudc be/ diidi gan
trai.
Khe nay chia phan they ben thanh ha phan thily II va III.
Tom lai, gan ducic chia thanh hai nth : gan phai va gan trai. M8i nda gan lai du'oc chia
thanh hai phan thby va mai phan thity lai cluqc chia thanh hai ha phan thug. T6ng tong có
tam ha phan thiry cu the la :
- Cj gan trai co :

144
 Phan thily gitia (segmentum medial& a. mat hoanh c6 ha phan thily IV va a mat tang c6
ha phan they IV Ira I. Ha phan thuy I Wang ling vdi thUy duoi.
Phan thiiy ben (segmetum laterale) gom ha phan thUy II va III.
— O gan phai c6 :
Phan thily trate (segmentum anterius) vdi hai ha phan they V va VIII. al ngafi Viet Nam
ha phan they VIII rat 16n nen &lac chia thanh ha phan thUy VIII va ha phan thity
Phan thUy sau (segmentum posterius) vdi hai ha phan thily VI va VII.

6. MACH VA THAN KINH

6.1. DONG MACH. Mach mau cung cap cho gan la deng mach gan rieng xuat phat tit
thing mach gan chung (a. hepatica communis) la nhanh caa Ong mach than tang (truncus
celiacus).
Deng mach gan chung khi tai ba trai cua tinh mach cda thi chia lam hai nganh la :
— Deng mach vi td trang (a. gastroduodenalis).
— Deng mach gan rieng (a. hepatica propria).
Deng mach gan rieng chay nguac len tren truac tinh mach cita, lath giita hai la caa mach
not nho r6i chia a cda gan thanh hai nganh ding :
+ Nganh phai (ramus dexter) to chay vao gan phai va chia the nhanh ben la : Ong mach
tui mat (a. cystica), cleng mach thily duel (a. lobi caudati), Ong mach phan thily trade (a.
segmenti anterioris), dung mach phan thily sau (a. segmenti posterioris).
+ Nganh trai (ramus sinister) chia cac nhanh : Ong mach they duoi (a. lobi caudati),
Ong mach phan they gifta (a. segmenti medialis), Ong mach phan they ben (a. segmenti
lateralis).
Deng mach gan rieng c6 met nhanh ben cho da day la dung mach vi phai (a. gastrica
dextra) (11.37.9). Deng mach gan rieng a nguai Viet Nam c6 chieu dai 20mm, &tang kinh
3,3 mm, 58% Ong mach gan rieng c6 dang dien hinh (11.37.9), 40,3% Ong mach till mat xuat
phat tit dung mach gan rieng. Co mot tnkng hap khong c6 Ong mach gan rieng vi Ong mach
vi to trang co nguyen Uy to nhanh gan phai. Ngoai ra c6 25,8% they gan trai nhan mau tit
nhanh gan phu la nhanh cua Ong mach vi trai.

6.2. TINH MACH CiJ''A (vena portae) la met tinh mach chac phan data v6 gan cac chat
dinh darting ding nhu cac chat dee d 6ng tieu h6a de gan chon loc luu tiff chg bign Ara dieu hoa.
Mau a gan se chay ve tinh mach cha duai bai cac tinh mach gan (tinh mach gan phai, tinh
mach gan giaa vd tinh mach gan trdi).
— Tinh mach cda duac hap bai tinh mach mac treo trang tren va tinh mach lath. Rieng
tinh mach lath can nhan them met nhanh 16n la tinh mach mac treo trang duai.
Ngoai ra, tinh mach ciia can nhan cac nhanh
145
 AN\
;,.,\*■ A
DOng mach •\\ Nganh trai DOng mach
ttli mat :01, gan rieng
111 Nganh phai
Ong gan chung
\ AM I 1 Ding mach gan r

DOng mach vi phai Deing mach lath

Tinh mach vi phai
Ong mat cher DOng mach gan chung

Tinh mach mac treo

trang (idol

Ding mach mac treo

trang tren
Tinh mach mac treo
trang tren

Hinh 37.9: Sa dd dCmg mach gan d cudng gan.

+ Tinh mach tai mat (v. cystica).

+ Cac tinh mach canh r6n (vv. paraumbilicales).
+ Tinh mach vi trai (v. gastrica sinistra).
+ Tinh mach vi phai (v. gastrica dextra).
+ Tinh mach trade mon vi (v. prepylorica).
— Tinh mach ca'a chay chech sang phai nghieng ra trade vao mac not nh6 ding clOng mach
gan rieng va oeng mat cher tao nen cuoeng gan. O cuaeng gan cac thanh phan lien quan tit nOng
Teen sau la 6ng mat cher, ke deen la Ong mach gan rieng va tinh mach tura a sau nhat. Sau
cu6ng gan la 16 mac n6i.
Den city gan, tinh mach tura chia 2 nganh phai va trai (ramus dexter, ramus sinister) de'
chay vao nits gan phai va trai. Nganh trai can nhan them hai tinh mach :
+ Tinh mach rOen (v. umbilicalis) cla tac thanh day chang troll gan (lig. teres hepatis).
+ Ong tinh mach (ductus venosus) cid the thanh day chang tinh mach (lig. venosus).

146
 VOng not : Tinh mach caa thong n6t vai he th6ng tinh mach cha bdi cdc \Tong not sau
(H.37.10).
—Vong n6i thu'c quan : do tinh mach vi trdi (v. gastrica sinistra) thu(ic he cda n6i vdi tinh
mach thuc quan (vv. esophagae) la nhanh caa tinh mach clan (vena azygos) thutic he tinh mach
chu (vena cava)
— Vong not true trang : do tinh mach true trang tren (v. rectalis superior) la nhanh cua tinh
mach mac treo trang dudi thuOc he ci a. n6i vai nhanh trkic trang gigs va dudi (vv. rectales mediae,
vv. rectales inferiores) la nhanh caa tinh mach chau trong (v. iliaca interna) thuOc he chil
—Vong not quanh r6n : do tinh mach day chang trail thuOc he caa n6i vdi tinh mach
thudng vi tren, duidi (v. epigastrica superior, inferior) va tinh mach nguc trong (vv. thoracicae
internae) thuOc he chili.
— Vong n6i qua phac mac n6i cdc tinh mach runt vdi tinh mach cha dual.
Khi dp he tinh mach oh tang len do tinh mach cita bi Vac, cdc yang n6i nay có the bt
gian va yd (va tinh mach thu'c quail va tinh mach truc trang do tang cip luc tinh mach cita).
.ej
mach don
Tinh mach chu tren
Tinh mach tht/c quan

Tinh mach Gila 77nh mach vi trai

Tinh mach thdong vi tren Tinh mach day chang trop

Tinh mach mac treo trang dudi

Rein
Vong ndi trong phac mac

Tinh mach chi) du'di

Tinh mach thddng vi dudi 17nh mach tufo trang tren

Tinh mach tnic trang gida

Tinh mach Mid trang dudi

Hinh 37.10 : So. do vang not

147
 6.3. TINH MACH GAN (vv. hepaticae). Tinh mach gan bat ngu6n a cdc tinh mach gian
tidu thity gan (venae interlobulares). Co ba tinh mach 16n dan mdu a cdc they gan vao tinh
mach chit duai la tinh mach gan phai (vv. hepaticae dextrae), tinh mach gan gift. (vv. hepaticae
mediae) va tinh mach gan trdi (vv. hepaticae sinistrae).
Ngoai ra lai con cdc tinh mach nho chay tii thity dual vao tinh mach chit clued.

6.4. BACH MACH.

Bach mach Cita gan di theo ba day Wang chinh cua gan (day Chang vanh, day chang liem
vet mac n6i nho) va chay a trong bung doh ca hoanh vao hach d cil'a gan va a canh dOng mach
chit phai d6 len 16ng natc, tren co hohnh vao cac hach canh tinh mach chit du'ai va hach sau
mom mid kiein.

6.5. THAN KINH

Than kinh cung cap cho gan tdch tit hai ngu6n
— Day than kinh lang thang trai (X trdi) qua mac n6i nho vao tura gan.
— Tit dam r6i tang vao cuta gan theo doc dOng mach gan Hang va tinh mach dia.

7. DIXING DAN MAT NGOAI GAN

G6m 6ng gan, 6ng mat chit, 6ng tui mat va tui. mat. Ong gan va 6ng mat chit' goi la
&fang mat chinh khOng cat 136 du'ac con 6ng till mat va tui mat la. &rang mat phu co the
cat 136 du'ac.

7.1. ONG GAN

Mat tiet tit to bao gan d6 vao cdc tidu quan mat (ductuli biliferi) trong gan. Sau do mat se
d6 vao oeng gan phai (ductus hepaticus dexter) va 6ng gan trai (ductus hepaticus sinister) a
ngoai gan.
Hai 6ng gan phai va trai hap lai thanh 6ng gan chung (ductus hepaticus communis) chay
trong cu6ng gan. Ong gan chung dai 3 cm, ding kinh 5mm khi tai ba tren to trang nhan 6ng
tai mat (ductus cysticus) r6i ding 6ng nay d6 vao mot 6ng chung goi là 6ng mat chit (ductus
choledochus) (H.37.11).

7.2. ONG MAT CHU

Ong mat chit' (ductus choledochus) di tit' ba tren to trang not gdp nhau giita 6ng gan chung
va 6ng tui mat tai sau phdn trail to trang r6i lath sau tuy de d6 vao nhu to lan (papilla
duodeni major) a niem mac phdn xu6ng to trang. O nhti to lan 6ng mat chit d6 vao bong gan
tuy (ampulla hepatopancreatica) ding \Teti 6ng tuy chinh (50% tru'ang hop). Nth day co ca yang
bong gan tuy (m. sphincter ampullae hepatopancreaticae). Khi khOng c6 bong gan tuy, 6ng mat
chit va 6ng tuy chinh c6 thd d6 chung vao to trang bang mot to hay hai 16' rieng bit (H.37.12
A,B,C). Ong mat chit dai 5-6 cm va. &tang kinh trung binh 5-6 mm, nth hep nhat a bong gan
tuy co duang kinh 3 mm.

148
 Ong gan phai

Ong gan trai

CO' ten mat

Ong tai mat Ong gan chung

Than till mat

Day till mat

Ong mat cha

Co vong gan tuy

Nhu ta lan

Bong gan tuy

Ong toy chinh

Hinh 37.11 : Su de, du'ang dan mat ngoai gan.

Ngddi ta chia 6ng mat chi' lam b6n doan :

- Doan tren ta trang : 6ng mat chU nam trong cuang gan, lien quan ben trai vdi Ong
mach gan rieng va phia sau vdi tinh mach cita.
- Doan sau ta trang : 6ng mat chili did sau phan tren &la ta trang.
- Doan sau tuy : eing mat chn xe sau d'au tuy mot ranh cang xu6ng du'di cang sau. Mu6n
lay sOi mat hoac giun trong 6ng mat chi' d doan nay, phai lat kh6i ta tuy khoi mac dinh d mat
sau mai tranh khOi rach vao dau tuy.
- Doan trong thanh to trang : 6ng mat chn chuff vao thanh ta trang d phan xu6ng nai n6i
1/3 du'di vai 2/3 tren.

7.3. TUI
Tdi mat (vesica fellea) co vai tro lute trit va co dac mat trtidc khi chay vao to trang. Tdi
mat nam trong h6 tdi mat d mat tang cUa gan nen phan nay khOng chtqc phdc mac the phi'.
Tdi mat co hinh qua le dai 8cm, ch6 rOng nhat 3cm va co ba phan :
149
 Ong mat chi)

Ong tyy chinh

Bong gan tyy

Ong mat chi)

Ong tyy chinh

Ong mat chi)

Ong tuy chinh

Hinh 37.12 : Cac clang de veto td trang czia z' ing mat chzi vci 6.rig tuy chinh.
A - Co bong gan tuy (50%).
B - Ong mat chit (xi Ong tuy chinh do ra hai to rieng.
C - Khong c6 b6ng gan tuy.

— Day till mat (fundus vesicae felleae) nam trong khuygt till mat can bo duai gan. 1\16u
chigu len thanh bung thi day ttli mat a giao diem giita bo su'an phai va ba ngoai co' thang bung

150
ben phai. Khi tui met cang to, an a diem nay, se dau eh& (diem dau Murphy).
—Than till mat (corpus vesicae felleae) : chay chech ra sau len tren va sang trai. Mat tren
than dinh vao gan va chi ngan each nhau bed mot lap to bao xo mong.
—Co t6i met (collum vesicae felleae). CO tin met phinh a giiia thanh mot be con not soi
hay dong lai. Hai Tau co tui m4t, hep, Tau tren gap vao than, Tau ditai gap vao 6ng WA met. CO
tui met nam each xa gan va c6 mot mac treo, CO chila d6ng mach tuii met.

7.4. ONG TOT MAT.

Da& co till met la 6ng tin mat (ductus cysticus) clan mat Ur ttii mat xu6ng 6ng met chii.
Ong tui met dai 3 cm, du'ang kinh 3mm, a mat trong 6ng, niem mac c6 n6p hinh xodn 6c (plica
spiralis).

7.5. MACH VA THAN KINH DTIdNG DAN MAT

—Mach mdu : Mau cung cap cho &rang dan met là cac nhanh &la Ong mach till met (a.
cystica). Tinh mach dia. dung ddn met la tinh mach tui met clan man v6 tinh mach cda.
—Bach mach : Bach mach cila dating dan mkt, nam tren diking di ciia 6ng mat. Co hai
hach lan : mot a co t6i met va mot d nga ba not 6ng tui met dO vao 6ng met dia.
—Than kinh : Than kinh cho duang met ding tach tit dam roi gan va day than kinh lang
thang trai nhit a gan.

CAU 1161 TRAC NGHIEM

Chon cau tra loci thing nhet

408. d mat tang cua gan, they vuong lien quan yeti :
a) Da day. d) a va b.
c) Doan dau to trang. e) b va c.
c) GOc k6t trang phai.
409. Sau khi sinh, tinh mach ro/n troy thanh :
a) Day chang Ong mach. d) Day chang
b) Day chang trail gan. e) Tat ca deu sai.
c) Day chang tinh mach.
410. Ong tinh mach dan mau tit TM ciia ve :
a) TM chii tren. d) TM then phai.
b) TM chti duth. e) TM r6n.
c) Nhau thai.
151
411. Chun cau thing :
a) Gan (bloc chia lam b6n thily : phai, trai, vuong, duei, data vao sit phan b6 cua dining mat
trong gan.
b) Gan có hai mat : mat tang, mat hoanh va hai ba : ba truac, bet sau.
c) Toan b5 b5 mat gan dirge philc mac tang bao boc.
d) Day chang ligm, day chang vanh, day chang tam giac la nhung day chang lien tuc veti
nhau.
e) Tat ca thing.
412. Day chang hem :
a) Co ba tir do la day chang ro-n
b) Co dinh gan vao thanh bung tru'dc va cu hoanh
c) La nui pinic mac la thanh quat lai thanh là tang.
d) Cau a Ira c thing.
e) Ca a, b, c deu thing.
413..Cac phi sing lien gift gan tai ch6 co tinh chat mot day chang g5m hai la plitic mac là :
a) Day chang hoanh gan.
b) Day chang vanh, day chang tam giac.
c) Day chang li5m, mac n6i nhO.
d) a, b, c thing.
e) Chi b, c thing.
414. 0 mat hoanh cua gan, phan gan nam giCia khe gida va khe trait là ha phan thUy :
a) III d) VIII.
b) IV e) V va VIII.
c) V.
415. gan, TM cil'a, DM gan va 6ng gan:
a) Xep lam ba lap
b) TM nam sau nhat.
e) Ong gan nam nong nhat.
d) a, b dung.
c) a, b, c dung.
416. ThOng thiOng DM ttii mat xuat phat U.( :
a) DM gan phai. d) DM gan chung.
b) DM gan trai. e) DM vi trai.
c) DM gan rieng.

152
Dung hinh ye sau de tra leri cat' 417.

(2) Ong mat chi)

(3) Ong tyy chinh

(4) B6ng gan tyy

417. Hinh ye tren duac chit thich sai a vi tri nal) ? (Ne-u hinh ve dung, chon cau e).
d) (4)
e) Hinh ve dung.

153
 38 RUOT NON

MUC TIEU BAI GIANG

A. MUC TIEU LY THUYET

1. M6 to vi tri, chile nang, kich thudc, hinh thg ngoai, hinh thg trong, sap xgp, tau tao
va lien quan cua runt non.
2. M6 to vi tri, hinh the va lien quan cua mac treo runt non.
3. M6 to dOng mach mac treo trang tren.
4. Neu cac (lac digm &la tang doan ddu, giaa va cu6i cua runt non.

B. MUC TIEU THUC TAP

1. Chi ducic tren xac vi tri, kich thuac hinh thg, six sap xep va lien quan cua runt non.
2. Chi m6c tim doan ddu va m6c tim doan cu6i cua runt non.
3. Chi tren xac mac treo runt non va cac thanh phdn trong do.
4. Doc dive phim runt non binh tinkng khi chup X quang cc!, u6ng thu6c can quang.
5. Tim dirge cac nhanh cua Ong mach mac treo trang tren.
6. Nhan xet cac dac diem cUa runt non khi mo cho song.

RuOt non theo dung Ur la tinh la runt mOng (intestinum tenue) la phan Ong tieu hoa na'm
giaa da day va rut gia, tit mon vi dgn 16 h6i manh trang, chigm .phdn lan 6 bung, phia dudi
mac treo kgt trang ngang. RuOt non chia lam ba phdn chinh : to trang, h6ng trang va h6i
trang. Ta trang da duct hoc trong bai Khol to tuy, do do trong bai nay chi dg cap dgn hong
trang (jejunum) va h6i trang (ileum).

I. KICH THIXIC

1.1. CHIEU DAI : dai tut 5,5 m den 9 m, trung binh la 6,5m, khi can co thg cat b6 3,5 m
154
met non. Chi-eu dai nay thay cl6i try theo nguti, gidi tinh, tinh trang twang lurc ca caa thanh
runt, phu'ung phdp do.
1.2. CHIEU RONG : giam dam tit cac kh6c rut dau (3 cm) den cac khdc rut cu6i (2cm).
Do d6 nhang vat la nhut soi mat co the di qua hang trang nhu'ng bi ket d doan cu6i h6i trang.
Tren xac tcioi, chigu dai cua h6ng trang va h6i trang a ngitdi Viet Nam do ar ba tut do la
441,2 cm va clutng kinh dep do a dual g6c to h6ng trang 15 cm IA 4,06 cm va d phia tren van
h6i manh trang 15 cm la 2,6 cm.

2. VI TRI (H.38.1).
RuOt non cuOn lai thanh cac quai runt hinh chit U hay con goi la kh6c runt, m6i. k.hdc dai 20-25
cm. Co 14-16 khac, chia lam hai nh6m : mot nhom nam ngang 0 ben trai 6 bung, met nhOm- nam
trang o ben phai 6 bung, rieng 10-15 cm cu6i ding trot lai, chat' ngang vac manh trang.
Tren to c6 mot qui lust tong quat là 1/3 dau cua met non nam u ha sutn trai va
khong cham vac &tang rach glib. bung, 1/3 gilia nam o phan trung tam dm bung va. 1/3 can lai
dam o chau hong va h6 chau phai.

3. LIEN QUAN
—Phia tren : vdi ket trang ngang va mac treo ket trang ngang.
—Phan duti : vdi cac tang trong chau hong be (talc trang, tang sinh duc, bang quang).
Khi cac tang nay day, cac quai runt &roc day len bung va khi cac tang r6ng, cac khdc runt lot
vac cac khe giita cac tang do, c6 khi lath xu6ng tan tui cling sinh due talc trang.
— Ben phai : vdi manh trang va ket trang len.
—Ben trai : vdi ket trang xu6ng. Cac quai runt de len k6t trang xu6ng ya lien quan vdi thanh
bung truck nen khi dan xuyen qua hong trai, runt non bi thong trade r6i mdi Uri ket trang.
—Phia trade : vdi thanh bung trade qua trung gian ciia mac n6i ldn.
Do cac quai runt kha dai trong khi site chda cua 6 bung gidi han nen khi vita ma ph6c mac
bung hay khi thanh bung bi xuyen thong, cac quai runt non c6 khuynh huOng phai ra ngoai
trade tien, ngoai ra cluing con de l'an qua cac diem yell cua thanh bung gay thoat vi.
4. PHAN BIET HONG TRANG VA HOI TRANG
KhOng c6 ranh gidi no rest giita h6ng trang va h6i trang, tuy nhien phan dau den cua h6ng
trang kirk hoan toan so vdi phan cu6i ding caa h6i trang. Sau day là mot s6 diem khac biet :
—Dutng kinh h6ng trang hai ldn hon h6i trang.
—Thanh caa h6ng trang day han, nhieu mach mau han va co nhieu ne-p yang cao han la.
h6i trang.
—MO bach huyel u h6ng trang tao nen cac nang don d6c, 0 h6i trang la cac mang bach huyel.
—Cac quai h6ng trang nam ngang phia tren trai 6 bung, con cac quai h6i trang nam doc
ben phai va phia
—1% - 3% co met tai thita h6i trang (tui. thita Meckel).
155
 Gan
Lach

Ta trang
Ke't trang ngang

Ke't trang len

Ket trang xueing

Goc hdi
manh trang H6ng trang

RuOt theta

Hoi trang
Ke't trang xich ma

(Hinh 38.1 : Sa do vi tri runt non trong o bung

5. CAU TAO (H.38.2 - H.38.3).

Gam co nam lap, Ulf trong ra ngoai la :

5.1. LOP NIEM MAC (tunica mucosa).

Là lap quan trong nha vi dam nhiem gan toan 136 qua trinh h6p thu ciia. ca 6ng tieu hoa.
- Tren be mat niem mac the ang xuyen co rat nhieu ne-p vOng (van trong) (plicae
circulares) la nhung ne-p hinh hem chian 1/2 hay 2/3 chu vi mat do niem mac va tam cludi
niem mac nho len tao thanh. Nep vOng cao lchoang 8mm day 3 mm, có nhieu a don dal hang
trang, tang ve phia h6i trang, cac ne-p nay tang nho clan va bie-n mat a (loan cu6i h6i trang.
ma non cilia nguai co khoang 800 ne-p yang. Cac ne-p nay lam tang dien h6p thu dia niem mac
mat non len gap 2 lam.

156
 Thuong bi root

-3
Mach doting trip

Tinh mach D ng mach

Hinh 38.2: Cdu tao czia mao treing

Mang kroi mach man
mat cat doe dm mao trang
Bieumo trd don vcn
cac tc biro niem mae
I. I.. hp Man mac di:il Mem, t6 1.3310 ca twit,
clic mach matt
:4
Mach bath huy6t trung tam --
Cat; to khe (dm Lieberkuhr),,,,
Lap co niihn
?.Tam dtsc'ri Mal
3
Co vong ,; ---
3.1,4 co ngoiti 4
4.Tam da6i thanh mac„ Co doe,
5.Thant' mac,

Hinh 38.3. Su d6 cdu tao runt non

- Tren 138 mat niem mac kd ca teen mat cac ngp yang có rat nhigu num nho goi IA mao
trang (villi intestinales). M6i mao trang cao 1,5-1mm, ben ngoai là lap thuong bi ruOt, ben
trong là to chile lien ligt có chila mach mau va mach bath huygt (H. 38.2). Nhiem vu cua mao
trang là 14p thu cac dung trap.
—Lap dem niem mac (lamina propria): eau tao g6m nhi8u lap mo lien kgt, ca chilc 'fang
h6 tro cho lap bidu mo, a day ca nhi8u mang mach mau de nhan hap thu dinh doting va tao
nen phan lOi cUa mao trang.
157
 - Cdc nang bach huye't g6m c6 hai loai:
* Nang bach huyel dun dOc (folliculi lymphatici solitarii): nhm a tam du'ai niem mac runt.
* Nang bach huyet chum (folliculi lymphatici aggregate) nhm trong lap niem mac va dudi
niem mac, c6 a h6i trang nhat la a cac doan cu6i, m8i nang hinh bdu duc dai 1,2-7,5cm, rOng
1-2,5cm dot theo bar ty do ctia runt. Day la nhang vi tri ygu bi loet va thUng trong bOnh
sot thuang han va lao runt.
- Cdc tuye-n runt (gll. intestinales) c6 tren su6t chieu dai cUa runt non nhm a lap niem
mac, c6 to tiet nhm xen cac mao trang, tiat ra dich trang.
Lap ca niem mac. (muscularis mucosae): c6 16rp cc dot d ngoai va lap ca vong a trong tao
nen phdn day cUa lap niem mac.
5.2. TAM DU'OI NIEM MAC (tella submucosa) chda nhieu mach mau va dam r6i thdn
kinh.
5.3. LOP CCf (tunica muscularis)
Thutic loaf cu tran va chia ra hai tang:
- Tang co dot (stratum longitudinales): mong a ngoai.
- Tang ca yang (stratum circulare): ddy, a trong.
Den doan cu6i h6i trang, ca hai tang co nay rat mong.
5.4. TAM DU'OI THANH MAC (tela subserosa) rat ming, 16t dudi lap thanh mac.
5.5. LOP THANH MAC (tunica serosa) la lap pinic mac boc quanh runt non lien tiefp Arai 2
la cUa mac treo trang, nhu vay nai mac treo dinh vao runt non se khong c6 thanh mac the
phi'. Do d6, khong nen bat ddu khau hay ket fink dudng khau a bd mac treo.
VI lap thanh mac c6 tinh chat de dinh vao nhau nen dirge sir dung trong cac thti thOt
khau n6i met.

6. HINH ANH X QUANG

- Neu khong u6ng chat can quang khong thd thay &lac hinh anh h8ng-h6i trang.
- Khi tieing chat can quang, 20-30 phut sau, kinic h6i trang ddu tien ngam thu6c.
+ H8ng trang c6 hinh nhu long ga hay xuang ca do sit sap xgp cua cac van manh trang.
+ H6i trang hinh mot dai md vi cac van trang it phdt trie2n.
Sau 8 gid, chat can quang qua 11.6t a runt non va day sang rut gia.

7. TO THeA H6I TRANG (H. 38.7)

Tui thira hoi trang ngu tem tai la di tich cua 6ng noan hoang dai tit 1 de-n 13cm, trung
binh 5-6cm, gan vao bar tit do cUa h8i trang d mot ch6 each goc h6i manh trang chUng 80cm.
Dau tdi thira c6 the tai do, hay dinh vao thanh bung a vimg rein bang mot dai xu, nen co thd
gay tac runt do xoan quai runt. Khi tui thira viem, gay triOu chang benh ly va tai bin nhu
viem runt thira. •

158
8. MAC TREO RUOT (mesenterium) (H.38.4. H.38.5).

La ne'p phdc mac n6i cac quai runt non vao thanh bung sau, qua do vita de treo vita de
dinh during runt vi trong c6 chi?a mach mau.

Hinh 38.4: Hinh dnh dui chie'u tren Wang cda re mac treo runt non

8.1. RE MAC TREO (radix mesenterii) la &Ong dinh cila mac treo vao thAnh bung sau, di
tit goc to h6ng trang d6n goc h6i manh trang, dai khodng 15 cm. N6 di cheo tii canh trai d6t
song that lung 2, xueing dudi di phia trudc d6t that lung 3,4 r8i sang phdi den phia trudc khdp
cong chdu d h6 chau phdi. Nhu vdy re ldn ludt di ngang qua phan ngang to trang, dung mach
chic bung, tinh mach chili dudi, cd that lung, nieu quan phdi va dung mach sinh duc phdi.

Mac treo trang tao nen mot vach ch6ch xu6ng dudi va sang phdi, chia tang dudi mac treo
ke't trang ngang cilia 6 bung thanh hai khu; ben phdi thong vdi h6 chau phdi, ben trai thong
vdi Chau hong be.

8.2. BO MAC TREO la nai mac treo gan vao h6ng h6i trang nhung khong cach d6u hai
mat, ma ldn sang ben phai hoin ben trai. Tai b6 mac treo, hai la phdc mac tach xa nhau 7 - 10
mm. Chieu dai cilia 136 mac treo bang chieu dai 1114 non nen mac treo phai gdp n6p nhu n6p
vay, moi n6p IA mot quai runt.
8.3. CHIEU RONG Gt.T' A MAC TREO la khodng cach t6 re d6n b6 mac treo, thudng 16n
nhdt 6 khoang giaa (12 - 15cm) va giam.ddn d hai dau, tai day re va b6 mac treo gan nhau.

159
 Re mac treo
kgt trang ngang
)

C-
to Wing trang

Ta trang

DOng va tinh mach

mac treo trang hen

Kgt trang len

Hinh 38.5 : Re ciia mac treo runt non (citiong cheim chtim).

8.4. CAU TAO CU' A MAC TREO

Mac treo do hai la phdc mac dp sat vao nhau, a giaa c6 :

—Cac nhanh ruOt caa &Ong mach va tinh mach mac treo trang tren.
—Cac bach mach va chuOi hach bach huye-t.
—Cac nhanh than kinh caa dam rOi mac treo trang.
— TO chiic phan phOi theo qui luat la hic dau c6 nhiau are mac treo, cang xu'ang cac
loan cloth mu cang ti6n gan den bar mac treo cua ruOt.
Con a ruOt gia, mar dinh han vao cac dai car doc a thanh ruOt.

DONG MACH MAC TREO TRANG TREN

DOng mach mac treo trang tren (a. mesenterica superior) là dOng mach tie-p to mon cho
mot phan tuy, tat ca ruOt non va ruOt gia aft manh trang den goc trdi 1dt trang).

160
1. NGUYEN UY (H.38.6).
Sinh ra tit mat tru'ac dung mach chili bung (aorta abdominalis) khoang 1cm dutd dOng
mach than tang ngang mtic cl6t song that lung 1. Thurang la mot than dOc lap hay ca the chung
than vdi dang mach than tang, Ong mach ldch hoac dang mach gan.
2. DIMING DI
Di tha.ng, dai khodng 20-25 cm, bat dau tit phia sau tuy, di xuong mom mac tuy va phan
ngang to trang, vac 1.6 mac treo trang, chay trong mac treo den h6 chau phdi.
D'ang mach mac treo trang tren a ben trdi va hui phia sau tinh mach tren snot dung di.

3. TAN CUNG
Cach gac hai manh trang 80cm, tuung Ling vai g6c tai thila h6i trang ne-u ca.

4. LIEN QUAN •
Daqc chia lam b6n doan :
4.1. DOAN SAU TUY (H.38.6) dai khodng 4-5 cm, Ong mach nam giura Ong mach chi'
bung phia sau va tuy tang phia triiac, chung quanh la mot ttl giac tinh mach, cdc canh ttl
gide khong na'm trong ding mot binh di8n.
- C1 sau phac mac : ben phdi la tinh mach chit' dttai, phia dudi la tinh mach than tral.
- Cf track pinic mac : b8n tral la tinh mach mac treo trang dtidi, phia tren la than tinh
mach ldch.
Chung quanh dOng mach la dam r6i than kinh va hach bach huyet.

Tinh mach chi) dcrai

DOng mach than tang
Tinh mach ca'a

Tinh mach lach

Tinh mach than phai

, ,411$ 17f:iiimek
‘11 il , ; DM mach than trai

Tinh mach
mac treo trang duel

DOng mach cher bang

, .
••100016.---
aing va tinh mach
mac treo trang tren

Hinh 38.6: Lien quan cila dOng mach mac treo trang tren (doan sau tuy).
161
 4.2. DOAN TREN VA TRI.RIC TA TRANG
nang ket trang ngang len thi thay do", ng mach xuat hien a gifra cac cdu true sau :
- Phia tren là eo toy.
- Ben phai la tinh mach mac treo trang tren.
- Ben trai là phan len cilia to trang.
- Phia sau la mom m6c toy va phan ngang to trang.
Tinh mach than trai va phan ngang td trang bi kep gifta dOng mach chit (phia sau) va
dOng mach mac treo trang tren (phia trztoc) nen c6 the N. tAc to trang hoac lam cham dang
mau o tinh mach than.

4.3. DOAN TRONG RE MAC TREO TRANG.

DOng mach di gifia re" mac treo trang, lien quan nhu' sau :
- Phia sau : vdi khe giCi'a Ong mach va tinh mach chit.
- Phia trade : vdi cac quai runt non.

4.4. DOAN TRONG MAC TREO TRANG.

DOng mach di vao giCia hai la mac treo trang theo mot duVng cong 16i sang trai tach ra
nhi6u nhanh ben va tan cung bang mot nhanh n6i vdi nhanh h6i trang cua Ong mach h6i ke't
trang. Doan nay rat di dOng.

5. CAC NHANH BEN (H.38.7)

5.1. CAC DONG MACH TA TUY DVOI (aa. pancreaticoduodenales inferiores) a." hoc
trong bai Td toy.

5.2. CAC DONG MACH HONG TRANG (aa. jejunales) VA HOI TRANG (aa. ilei)

Co khoang 12-20 nhanh Ong mach phat sinh tit ben trai dOng mach mac treo trang tren
di song song yeti nhau dgn mit non, c6 hai nhom : nh6m tren vao cac quai h6ng trang, nh6m
dikri vao cac quai h6i trang.
- M6i &Ong mach runt sau khi di vao giita hai la mac treo chia lam hai nhanh len va
xuang song song vdi TWO, not vdi cac Ong mach Id can tao nen cung dung mach that 1, tit cung
nay c6 th6 sinh ra cung thd 2, 3, 4.

- Tiff cung Ong mach gdn runt nhdt c6 nhang nhanh d(ing mach thang dgn runt, dung
mach thang cila h6n.g trang dai gap doi cua h6i trang.

Theo lY thuy6t c6 the data vao so' phan b6 cac cung mach trong mac treo de xac dinh cac
quai runt.

- Cac quai runt dau chi co mot cung mach, dOng mach thang dai vb. to.
162
 - Cac quai gida co tit 1 den 5 cung mach.
- Cac quai culfci co it cung, dOng mach thang ngan vet manh.
5.3. DONG MACH HOI KET TRANG (a.ileocolica).
Sinh ra t6 ba phai ciia &Ong mach mac treo trang tren den vUng manh trang chia lam 5
nhanh (H.38.7).
5.3.1. Deng mach len (a.ascendens) di len doc then b6 mac treo cua k6t trang len, n6i
v6i mot nhanh cua dOng mach ket trang phai.

Tinh mach ctYa

°Ong mach
mac treo trang tren

Cac dOng mach runt

DOng mach
ket trang phai

Cung mach

DOng mach thang

DOng mach
hoi 1(61 trang

Dong mach len

Tinh mach
DOng mach manh trang sau- mac treo trang tren

DOng mach manh trang tru'dc

DOng mach runt theta

DOng mach h6i trang

Tui theta hoi trang

Hintz 38.7 : Ccic nganh caa dOng mach mac treo trang tren

163
 5.3.2. DOng mach manh trang trtiac (a. cecalis anterior) den mat truac manh trang.
5.3.3. Di;ing mach manh trang sau (a. cecalis posterior) den mat sau manh trang.
5.3.4. DOng mach runt thiia (a. appendicularis) di phia sau h6i trang den be( tv do caa
mac treo runt theta.
5.3.5. Dung mach hoi trang di doc theo hai trang de n6i vdi nhanh tan cua dung mach
mac treo trang tren.
5.4. DONG MACH KET TRANG PHAI (a.colica dextra) di den goc phdi &la ket trang chia
hai nhd.nh len va xu6ng, nhdnh xu6ng n6i vdt dOng mach len la nhanh cua &Ong mach hoi ket
trang, nhanh len n6i vdi nhanh phdi &la dung mach ket trang giaa.
5.5 DONG MACH KET TRANG GICA (a. colica media) chia ra hai nhanh phdi va trdi not
vdi dOng mach ket trang phdi va Ong mach ket trang trdi tao nen mot cung mach (cung
Riolan) di doc theo ket trang ngang.
3% tru'ang hop khong c6 dOng mach ket trang

6. CAC NHANH NOI CI.J' A DONG MACH MAC TREO TRANG TREN
6.1. NoI VOl BONG MACH THAN TANG do cac nhanh to tuy dual n6i vdi cdc nhanh cila
Ong mach vi to trang.
6.2. NOT VOI BONG MACH MAC TREO TRANG DWI qua dOng mach ket trang gida va
tra.i.
Dac diem caa dOng mach mac treo trang tren a ngvai Viet Nam: DUng mach mac treo
trang tren c6 nguyen Cy a ngang mac 1/3 du'ai d6t ging that lung 1 va c6 dung kinh la. 6mm.
S6 nhanh ben ciia. Ong mach mac treo trang tren va ruOt non trung binh la. 9 nhanh notai
Au ta' 12-20 nhdnh). 33,8% dOng mach mac treo trang tren cho ba nhanh dOng mach h6i ket
trang, ket trang phdi va ket trang &a den ket trang. 24% dOng mach ket trang phdi va Ong
mach ket trang gtita chung than vdi nhau, 6,45% dOng mach hoi ket trang va dung mach ket
trang phai chung than vdi nhau. 12,9% 'thong cho nhanh ket trang gida. 11,29% dOng mach
mac treo trang tren cho them met nhanh ket trang gitra. phu (ngoai nhcinh ket trang gilZa dei
co) va 1 truang hop c6 &mg mach ket trang phai phu. Dac biet c6 2 twang harp dung mach
mac treo trang tren cho ra cdc nhanh lam nhiem vu the dOng mach than tang (trong tru'ang
hop nay dOng mach than tang khie'm khuye't).

TINH MACH MAC TREO TRANG TREN

(v. mesenterica superior)

Cdc tinh mach gi6ng flint cdc Ong mach gam c6 :

—Cdc tinh mach hang va hai trang (vv. jejunales et ilei)
—Tinh mach la& ket trang (v. ileocolica), tinh mach runt theta (v. appendicularis)
— Cdc tinh mach tuy td. (vv. pancreaticoduodenales).
—Cdc tinh mach tuy (vv. pancreaticae).

164
 — Tinh mach kdt trang phai (v.colica dextra).
— Tinh mach kdt trang gala (v.colica media).
Ngoai ra con nhan them tinh mach vi mac n6i phai (v. gastroepiploica dextra).
Tinh mach mac treo trang tren len ddn phia sau than tuy thi hqp vdi tinh mach nach tao
thanh tinh mach caa.

BACH HUYET

Bach huy6t cua runt non dudc da'n di theo mot he th6ng g6m cac chu6i hach chinh sau day :
— Chu6i hach mac treo trang tren (nodi lymphatici nzesenterici superiores).
— Chu6i hach h8i ket trang (nodi lymphatici ileocolici).

CAU HO1 TRAC NGHIt‘ M

Chon cau tra 11i thing nhgt

418. ROA non :

a) Dai trung binh khoang 6m.
b) ThuOng cu8n 1ai thanh 14 - 16 khilc (quai) runt.
c) Cac khdc runt tren nam ngang a ben trai 6 bung.
d) Cac kink runt difdi nam doe ben phai 6 bung.
e) Tgt ca dung.

419. RuOt non :

a) Nhan mau tit DM mac treo trang tren.
b) Di Ong toan b8 chd khong bi dinh mot vai doan nhu' keet trang.
c) CO diking kinh to clan tii tren xiang dudi.
d) a, b, c dung.
e) a, b, c sai.
420. H6i trang khac h6ng trang a didm :
a) CO dutng kinh nhO hon.
b) Thanh day hon.
c) MO bath huydt a h6i trang tao thanh cac mang, con me bath huydt a hang trang tao
thanh cac hach dun dOc.
d) a, b, c deu thing.
e) a, b, c deu sai.
165
421. Tui thita hang hei trang :
a) La di tich cua 6ng nieu r6n.
b) Dau tui thila có the tit do hay dinh vao mat sau rein bai met day xo.
c) Cach pie h6i manh trang khoang 80 cm.
d) a, b, c thing.
e) b, c thing.

422. lig mac treo runt non :

a) Dai khoang 25 cm.
b) Di eh& tit ba ben trai d6t that lung 2 den kheip ding chau (P).
c) La. nth DM mac treo trang dual di vac de den runt.
d) a, b, c dung.
e) a, b, c, deu sal

423. Re mac treo runt non KHONG di ngang qua :

a) Ta trang. d) Nieu quern (P).
b) DM chil bung. e) Tuy.
c) TM cha &fed.

Dung cac chi tie't sau tra loci cau 424.

I. Da day. V. Manh trang.
II. Doan di Ong ctia to trang. VI. Kat trang
III. Doan c6 dinh cua to trang. VII. RUet thira.
IV. H6i trang VIII. Tuy.
424. Dung mach mac treo trang tren KHONG cung cap cho :
a) I, VII. d) I.
b) I, II. e) I, II, III.
c) II, VII.

425. DM nao sau day KHONG la nhanh ctia DM mac treo trang tren :
a) DM to-tuy dudi. d) DM h6i-ket trang.
b) DM sau to trang e) DM kat trang gida.
c) DM h6ng trang.
426. DM h6i ket trang thnocng cho... nhanh ten :

a) 2. d) 5.
b) 3. e) 6.
c) 4.

166
427. DM mac treo trang tren n6i vdi DM than tang qua :
a) DM ket trang glita.
b) DM kgt trang phai.
c) Cac DM to tuy.
d) Nhanh DM h6ng trang d'au den.
e) DM mac treo trang tren KHONG cho nhanh not vdi. DM than tang.

167
 39 RUOT GIA

MUC TIEU BAI GIANG

A. MUC TIEU 1.4)? THUYET

1. MO to vi tri, chile nang, phan chia, hinh th6 ngoai, kith thole, hinh th6 trong va lien
quan ctia ruOt gia.

2. So sanh su gi6ng nhau va khac nhau giaa runt non vii runt gia v6 phuang din sinh lY,
giai phau, phau thuat.
3. MO to Ong mach mac treo trang du'Oi.

4. Ve cac vi tri ctia ruOt thtla so vii manh trang.

B. MUC TIEU TERIC TAP

1. CM tren xac va phu'ong tin thuc tap khac vi tri, kith thuac, phan chia, hinh the, va
lien quan cUa ruOt gia.
2. CM tren xac mach cUa ruOt gia.

3. CM tren phim X quang chup khung runt gia cc!, chuan bi cac chi tiet giai pilau binh
finking dia mat gia.
4. Xac dinh didm mat aim tren thanh bung.
5. Tim du'oc cac nhanh ctia d6ng mach mac treo trang dudi.
6. Nhan xet runt gia khi m6 cho siring, so sanh

Rut gia, theo &Mg tit la tinh goi la runt day (intestinum crassum) n6i tit h6i trang den
hau mon, g6m bon phan : manh trang (cecum), ket trang (colon), true trang (rectum) va 6ng
hau mon (canalis analis).

168
I. VI TRi, KICH THIAC VA HINH THE NGOAI
1.1. VI Tr& RuOt gia tao nen mot khung hinh chit U ngikic vay quanh ti'eu trang, tit phai
sang trai la (H.39.1) :
—Manh trang va rut thita.
—1cdt, trang
—G6c kdt trang phai.
—Ket trang ngang.
—G6c kdt trang trai.
— Ket trang xu6ng
— Kdt trang xich ma.
— Trite trang.
— Ong hau mon
1.2. KICH THVOC
— Dai tit 1,4 — 1,8 m bang 1/4 chieu dal ctia runt non.
—Dtiang kinh manh trang 7 cm giam clan ddn ket trang xich-ma, a trite trang phinh ra
thanh bong. Trong benh to kdt trang barn sinh, ket trang phinh to c6 thd gay tao bon lau
ngay.
Kich thudc met gia a ngutri Viet Nam c6 dac didm : Chieu dal trung binh cua met gia là
148,2cm. Diking kinh cua manh trang la 5,92 cm va &la kdt trang xu6ng la 2,89 cm.

G6c trai

G6c phai Ke't trang xueing

Ket trang len

treng ngang

Manh treng
va rut thda

Ke't treng xich ma

Xdong che:u

Trdc treng

Ong hey mon

Hinh 39.1 : Vi tri khung rimy gid

169
 1.3. HINH THE NGOAI
Ngoai trit frac trang, runt thaa va 6ng hau mon co hinh clang clac biet, phan runt gia con
lai co nhung dac diem sau day gidp to phan biet dude mat gia vdi runt non :
—Cac dai co doc (teniae coli) gam ba dai tit manh trang den ket trang xich ma, do phan
ldn lap co* doc tap trung lai.
• Dai mac treo ket trang (tenia mesocolica) a phia sau trong.
• Dai mac n6i (tenia omentalis) a phia sau ngoai.
• Dai to do (tenia libera) a phia trudc.
—Tui phinh ket trang (haustra coli) la nhung tdi nam giva cac dai ca doc, each nhau bdi
nhung ch6 that ngang, di chuydn thuOng xuyen, khong c6 dinh.
—Cac ttii thaa mac n6i (appendices epiloicae) la nhung tai phdc mac nhO chaa ma bam vao
cac dai cot doc, trong có mat nhanh clang mach, do do khi that co the gay hoai -Um runt.

2. CAC PHAN CUA RUOT GIA

2.1. MANH TRANG VA RUOT THUA (H.39.2) (cecum et appendix vermiformis).
2.1.1. Hinh Bang.
— Manh trang có hinh ttii ding, nam phia dadi 16 h6i manh trang (ostium ileocecale). Manh
trang CO b6n mat : tru'dc, sau, trong, ngoai, mat day trail phia dadi, phia tren lien tie-13 vdi ket
trang len.

TOi thug mac not TOi phinh ket trang

Nep ngang

Dal co doc
Hdi trang

NeP h6i manh trang

Manh trang Mac treo runt thug

RuOt thOg

Hinh 39.2 : Hinh the ngoai manh trang

170
 1.BEn trong
2. Chau
3. Dudi manh !rang
4. Trudc manh trang
5. Sau manh (rang
6. Dudi hoi (rang
7. Sau hoi (rang

2
Hinh 39.3: Vi tri runt theta.

- Ruet thita co hinh con giun dai U.( 3 - 13cm, trung binh 8cm, ma vao manh trang qua 16
runt thita (ostium appendicis vermiformis) du'crc day bdi met van. Ruet thita do phan dau cUa
manh trang thodi h6a.
2.1.2. Vi tri (H.39.3)
- Binh thuOng manh trang nam trong gee tao bai he chau phai va thanh bung trade
nhung ding c6 the a vi tri cao dudi gan hay thap trong chau do kit qua dm sit quay bat thutrng
cUa quai met lac phoi thai.
- Gee cua runt thim dinh vao mat sau trong cua manh trang, each phia dadi goe hoi
manh trang 2 - 3cm, noi hoi to cUa ba dai co doc. Tuy nhien, toan be met thaa thi vi tri rat
thay d6i co the trong chau hong, sau manh trang hay sau kat trang (H.39.3).
ngadi Viet Nam 53,3% runt thita a vi tri chau va ke den la vi tri sau manh trang chiem
ti le 30%.
2.1.3. Lien quan
Manh trang va ruet thita la met khei lien quan chat the vdi nhau. Manh trang nam ngay
sau thanh bung truck dm he chau phai, trade co that lung chau Ara cad 161J can va mac cUa co
do. Phia trong c6 h6i trang va phia ditdi la g6c tao nen bed he chau phai va thanh bung trade
(H.39.1).
Ruet tiara tuy c6 gee dinh vao mat sau trong manh trang, nhu'ng vi vi tri rat thay dei so
vai manh trang nen lien quan ding thay deli theo. Trong tracing hop a vi tri binh thaOng, runt
thita nam a phia trong manh trang, ngoai cac quai runt non, trade he chau va mach chau ngoai,
sau thank bking trade. Tref' thanh bog, g6c cua rut thita chieu len met diem (diem Mac
Burney) nam gifta doing n6i tiff gai chau trade teen ben phiii den ren (tritang phai Phdp). Tuy
nhien theo sach gia.o khoa my me to diem Mac Burney la ebb- not gifra 1/3 ngoai vdi 2/3 trong
cUa during nay.

171
 Mac treo ket trang

Tdi theta mac n6i

Dam rdi co

Ldp fhanh mac

Dam r'di dtidi Mem mac
Lop co doc
Lop &tat nie'm mac

Lop Mem mac

Nang bach huye't

Hinh 39.4: Sa d6 cau tao runt

2.2. KET TRANG LEN (colon ascendens) dai 8-15 cm, tit manh trang chay doc ben phai 6
phdc mac den mat tang caa. gan. Tai day ket trang cong sang trai tao nen g6c ket trang phai
(flexura coli dextra) nam a ha aeon phai, sau sun sodn 9.
2.3. KET TRANG NGANG (colon transversum) dai tit 35cm - lm, trung binh 50cm tit g6c
gan den phia dodi lath, cong mang cloth tao nen ket trang trai (flexura coli sinistra).
2.4. KET TRANG XUONG (colon descendens) dai tit 25 - 30cm tit goc lc& trang trai chay
thang doc ben trai 6 Ode mac xu6ng den mao chau, cong lOm sang phai den 136 trong co that
king dd n6i vdi ket trang xich-ma.
2.5. KET TRANG XICH-MA (colon sigmoideum) dai 40cm di tit bar trong co' that long trai
den phia trade deft song ding 3, tao nen mot &ging cong lOm xu6ng cloth (kieu bung) hoac lOm
len tren (kieu chau).
Trong ca hai kidu, quai ket trang nay c6 hai dau c6 Binh, mOt, a boy trong cc; that long trai
va mot d phia trade 'along ding.
2.6. TRIIC TRANG (rectum) dai 12-15 cm nhin trade tdi thi thang nen goi là troc trang
nhong nhin nghieng thi cong theo dodng cong cua xu'ong clung cut, ldc dau cong lOm ra trodc
tao nen goc ding (flexura sacralis) va tai ch8 n6i vdi 6ng hau mon thi cong lOm ra sau tao nen
goc day chau (flexura perinealis).
V6 lien quan, true trang nam trodc xoong cong cut va cac mach mau than kinh ar trudc
xocing ding. Cl nam thi true trang nam sau bang quang, cac quai ru'dt, non, tai tinh, 6ng tinh,
tuy6n tien li8t, va ngan each vdi cac tang sinh due nay bdi mac tin Het - pink mac chay tit tui
cong talc trang bang quang (excavatio recto vesicalis) Uri day chau, con d nit gidi thi tru'c trang

172
nam sau tit cung va thanh sau am dao ngan cdch v6i thanh nay bdi mot mac goi IA mac true
trang am dao rat d8 bac tdch trong phau thuat chita do am true trang.
O hai ben, truc trang lien quan ar phia teen thong qua phlic mac veil cac quaff runt non va
ket trang xich-ma va u phia clued phuc mac v6i bao xa ch(a dam r6i thin kinh ha.
2.7. ONG HAU MON (canalis analis) tiff g6c day chau caa truc trang, 6ng hau mon di
xuyen qua hohnh chau hong va tan ding hau mon.

3. LIEN QUAN VdI PHUC MAC (11.39.5)

3.1. PHUC MAC MANH TRANG VA RUOT
- Manh trang cluoc boc hoan toan bed ph& mac. Gidi han giita phan kat trang c6 dinh
va manh trang di dOng la duOng ngang qua b6 tren 18 h6i manh trang. C6 the hai ben bar
manh trang dinh vao ph6c mac thanh bung sau tao nen ngdch sau manh trang (recessus
retrocecalis).
- Mac treo runt thila (meso appendix) On runt thita vao h6i trang co 136 tu do chtita dOng
mach runt
3.2. MAC TREO KET TRANG LEN (mesocolon ascendens)
Mac treo kgt trang len dinh vao pink mac thanh bung sau tao nen mac dinh ket trang
phdi (Ke't trang phdi go m có: ket trang len, goc ket trang phdi va phdn ddu ti'en czia ke't trang
ngang). Gidi han ctia mac treo ket trang len la:
- Phia tren: duOng di tit nguyen uy &la dOng mach mac treo trang tren den phan xuang
cua tá trang.
- Phia trong: du Ong di cila Ong mach mac treo trang tren.
- Phia duai: dudng cheo tit ch8 phan doff cua do, ng mach chil bung dgn g6c h6i manh trang.
3.3. MAC TREO KET TRANG XUONG (mesocolon descendens)
Mac dinh kat trang xuang ducrc gidi han bai:
- Phia tren: tit nguyen uy ca'a &Ong mach mac treo trang tren den g6c trai kat trang.
- Phia dudi: tit u nho 6 ben tali dung giila di doc then bc7 trong co that lung trai.
3.4. MAC TREO KET TRANG NGANG (mesocolon transversum) la gidi han dudi cua hau
cung mac n6i. Re" mac treo la gidi han tren cila mac dinh kat trang phai va trai. Chia 6 bung
lam hai tang tren va duffri mac treo.
3.5. MAC TREO KET TRANG XICH-MA (mesocolon sigmoideum). C6 hai r8:
- R8 nguyen thuy: do re" cila mac treo runt nguyen thily tit u nho den phia trade dgt sang
ding 3.
- 118 thd phdt: la giai han dudi cua mac dinh kat trang trai.

4. CAU TAO VA HINH THE TRONG CUA RUOT GIA

4.1. CAU TAO CHUNG. Tit trong ra ngoai, kat trang c6 nam lap:
173
 4.1.1. Ldp niem mac (tunica mucosa)
- Ke-t, trang khong có n6p vong va mao trang, chi nhilng n6p ban nguy0 (plicae semilunares
coli) Wang Ling vdi cac nep ngang nh6 vao long 1(61 trang va bien mat khi ket trang tang pheing.
- Nhie'u nang bach huye't darn clot (folliculi lymphatici solitarii), khong c6 nang bach
huye't ch6m (folliculi lymphatici aggregati) ngoai trir a runt thira.

Lach
Deng mac
chti
Than trai
Tuy
Goc trai
Than phai
Re mac treo

G6c phai Oc 0 hong trang

et trang xu6ng
Ke't trang len

—Nieu ciao trai

Ta trang Re mac treo
tieu trang
Ong mach mac
treo trang tren
Deng mach cha
chung phai Deng mach
mac treo
trang duel

Dung mach Fro mac treo

chau ngoai ke't trang
cheu hong

Talc trang

Ong heu mon

Hinh 39.5: Lien quan-cda cdc phein co dinh cda runt giet vai phzic mac vet cdc tang phia sau
174
 4.1.2. rgm &dal niem mac (tela submucosa) nhigu mach man va than kinh.
4.1.3. Lap cd (tunica muscularis) co hai tang:
- Tang trong la co' yang (stratum circulare).
- Tang ngoai la co doc (stratum longitudinale), phan lOn tap trung tao thanh ba dai co
doc. Ghia ba dai, lap co doc rat mOng. Cac dai co nay thay rod manh trang va kgt trang len,
hoi phan tan a kgt trang xu6ng va khong thay o kgt trang xich-ma.
4.1.4. Tgm chiral thanh mac (tela subserosa).
4.1.5. Lap thanh mac (tunica serosa) tao loth la tang pinic mac, co tie thda mac n6i.
4.2. CAU TAO VA HINH THE TRONG CUA MANH TRANG
Van h6i manh trang (valva ileocecalis) có hai la tren va dad, la duai dai hon la tren, m8i
la co hinh moi, d gida la 16 h8i manh trang (ostium ileocecale) hinh bau due hay khe ngang.
hai dau, van keo dai tao nen ham van h6i manh trang (frenulum valvae ileocecalis).
4.3. CAU TAO VA HINH THE TRONG CUA RUOTIffA.
- Rut thda do thang vao manh trang qua 16 rut thita (ostium appendicis vermiformis),
doi khi tai day niem mac tao nen mot la vach nhO.
- Thanh runt thda day, nhung khi viem thanh d8
- Thanh mac runt thila co the tach ra d8 khi bi viem, do del có the cat bo rut thda duti
thanh mac khi lap nay dinh vao cac co quan lan can (ruOt theta sau manh trong ket trang).
- RuOt thda co rat nhigu nang bath huygt chinn (folliculi lymphatici aggregati appendicis
vermiformis), con goi la tuygn hanh nhan bung, o nguti gia cac tuygn va nang teo 14i, niem
mac bign thanh mos soi.
4.4. CAU TAO VA HINH THE TRONG CUA TRIIC TRANG VA ONG WI'U MON
4.4.1. Trtic trang
Khi trong, niem mac trate trang tao nen rat nhigu cac ngp doc d phan dadi cila no va bign
mat khi truce trang cang. Tryc trang thutng cif) 3 ngp ngang hinh ban nguyet (s6 lucmg co the
thay dOi tit 3 den 4) ma duoc nhin thay rO khi true trang cang goi IA cac van true trang hoac
ngp true trang. Ne-p teen gum niem mac, mot 10p co yang, mot phan co dot va duvc thay rO
rang ben ngoai bai vet lom. Nep gida thigu 10p co doc va khong co dau higu ben ngoai. N6p
tren tai ch6 bat dau talc trang có thg ben trai hoac ben phai va thdang bao quanh lay Ong
true trang. N6p gida lan nhat va c6 dinh nhat. NO nam ngay teen bong true trang, no nho ra tit
thanh trade phai va ngay duti mitt ne-p phdc mac the phd truce trang lot ra truck, lap co yang
6 van talc trang giira de nhan thay hon cac ne-p khac. Ngp duti hay van true trang duti thay dgi,
thing a ben trai va duti nep gida. Thinh thoang co n6p this 4 a ben trai va ngay tren ngp gala.
4.4.2. Ong hOu mon
Phan tren Ong hau mon duct lot bai bigu mO try trong tut nha trip trang. NO china cac t6
Joao bai tigt va hap thu vai nhigu Ong tuygn. MO du'di bidu mo thi di dung, kha cang ph6ng va
chda cac dam rgi tinh mach, Ong mach &fait niem phong phi. Cac mach mau true trang teen
di xu6ng duti hating ve cac cot hay mon. Tinh mach du ti niem mac clan luta dgn dam r6i tinh

175
mach tryc trang duai niem mac va aing di qua cac sari cua phan tren cu that heu mon trong
de vao dam rei tinh mach gian cac.
C6 6-10 nep doc a gida 6ng lieu mon dudc goi la cat hau mon. O tre em thi cac. cat nay ra
rang barna ngudi ldn. Mat cat chda mat nhanh ten dia. Tang tinh mach tryc trang tren. Phan
day cUa cac cat hinh thanh cac nep hem dude goi la cac van hau mon. Nam gida cac van hau
mon la cac ngach nho la cac xoang hau man. Cac van va xoang hau mon tao nen diking lade.
Co khoang 6 tuyen hau mon de vao cac khe nh6 trong cac van hau man. Cdc tuydn nay dui is
lot bai bleu mo tru tang. Ski gian na cua cac nang tuyen co the ma rang xuyen qua co that
trong va them chi vao car that ngoai.
Niem mac dad diking ludc mem mai. NO ducfc lot bai bleu ma let tang khong sung h6a, it
tuyen mo hoi, tuyen be nhan va cac nang long nhung chda nhieu dau ten cung &la than kinh
ban the. Niem mac ma rang xueng du di tdi ranh gian cc that (can goi la during trong Hilton),
mot die lam vao tai gidi han dual cua cd that trong. Ong hau man dadi renh gian car that dude
lot bai bieu ma tang, sang Me vai cac nang long, lien tyc vdi da xung quanh hau mon. Lap
ditai niem cUa viing nay chila cac dam r6i clang tinh mach phong phu va co nhieu ma lien ket
han phan tren eng hau mon. NO dude treo vao cac sdi cua lap ca doc ket hdp trong khu vi c
cua renh gian cac thdt.
Cho n6i giaa bieu ma tru va bieu ma let dude biet den nhu' Wing chuyen tie!) hau mon
(anal transition zone). Vang nay ming khong c6 dinh ve chieu cao cOng nhti vi tri, va thuting
chtla cac ciao bidu mo let (islands of squamous epithelium) ma rang len tren vao niem mac try,
no khong gieng nhui diking lade, nO là mat diking khong re rang khi nhin vao eng hau mon.
Cac dau ten ding than kinh bao g6m cac thy thd cam nhan nhiet, ton tai trong ldp dulffi niem

-141.4147:s

Ch6 not tra'c trang - xich ma

Van tra'c trang gida Van tra'c trang tren
Ch6 lat lei Van tnic trang du6i
a-1a phac mac
COt hau mon
Dudng Itioc
Van hau mon
Dam (-67 tinh mach
tnic trang trong Co' doc ket hop

Xoang hau mon

Tuyen hau mon

Ranh gian co that

Dam roi tinh mach tn,ic trang ngoai

Hinh 39.6: Cdu tao va hinh the trong clia true trang va dng hau mon
176
 Mac n6lIeln
Ke't trang ngang

RJ mac treo ke't trang ngang

Tui theta mac not Goc to h6ng trang
Phan ngang to trang Mac treo ke't trang ngang
Mac Binh ket trang xu6ng
Ke't trang xu6ng
Mac treo runt non Phan len to trang
KO't trang len
Ke't trang chau hong

/ I
Manh trang \ \ \ Mac treo 141- trang chau h6ng
,.. \
DOng mach r6n
Nep h6i trang runt theta /
\\ \ Ket trang chau hong
Mac treo ru6t theta \ -
Ru6t theta Day ro'n giCia

Anh XXXV : Rut gia vet re mac treo

177
 -

mac xung quanh phan tren caa yang chuyen tigp, cluing dung vai tre quan trong trong viec
nhin dai tien bang each tao ra mot car dig dac biet dg nhan biat cac chat thai cua doan cludi
tate trang khi doan tren 6ng hau mon gian ra da cho cac chat thai tryc trang clan tiap xuc vai
bigu mo phan tren 6ng hau mon.
Lap ca niem re rang dm tryc trang lien tyc•xu6ng phan tren ang hau mon. Cac soi tit lap
co doe di xuyen qua ca that trong va quay quanh dam r6i tinh mach dorm niem mac trade khi
yang len teen Uri map hau mon veil lap ca niem va hinh thanh nen ca dad them hau mon
(musculus submucosae ani). .
Dam r6i tinh mach tate trang trong nau gian na lan se tao nen tri nei, nguqc lai dam r6i
tinh mach tate trang ngoai nau gian, na lan se tao thanh tri ngoai.

5. CIIffC NANG CUA RUOT GIA.

- Ruet gia co chdc nang khac han runt non va do nhu citing khong thuang xuyen nen c6
the khong thay dagc khi soi X quang.
Khi thdc an vao da day, hoat thing a runt gia tang len, phan tan ding cua h8i trang ngam
chat can quang sau 8 gia kg tit he u6ng. H6i trang day tiing dat vao manh trang, m6i dyt tit
10-20 giay each nhau 3-15 phut. Khi thdc an vao, manh trang gian ra va sa xu6ng durori, cac
boat' kat trang bian mat. Manh trang, kat trang len va kat trang ngang theta day rat cham do
qua trinh hap thu xay ra trong nhieu gib% Ca kat trang c6 &I' Ong kh6i that nhanh va manh,
ph6i hyp vai sy thanh lap cac bueru kat trang cha yau a kat trang ngang. Ngoai ra a kat trang
xu6ng va xich-ma, m6i ngay c6 2-3 dqt cir Ong nay day kh6i phan vao kat trang xich-ma de
duqc di tai day truac khi di dai tien.
- Thanh phan phan day qua tii h8i trang con chda khoang 90% nude, phan lOn nude
chive hap thu a manh trang va kat trang len.
- Chat nhay la met chat bao ye quan trong trong kat trang duqc tidt ra nhieu trong
nhang trYang hyp ca thurang ton hay kith thich, hoac ngan can hap thu met s6 chat dec.

6. MACH MAU RUOT GIA (H.39.7).

6.1. MACH MAU CUA KET TRANG PHAI
6.1.1. DOng mach mac treo trang teen (a. mesenterica superior). Deng mach nay da dayc
me to a bai runt non. 0 day chi kg cac nhanh caa dung mach cap huygt cho kat trang phai:
- Deng mach hoi kat trang (a. ileocolica) cho cac nhanh:
- Deng mach kat trang len (a. ascendens).
- Deng mach manh trang truck (a. cecalis anterior).
DOng mach manh trang sau (a. cecalis posterior).
- Deng mach runt thita (a. appendicularis).
- Deng mach kat trang phai (a. colica dextra).
- DO ng mach kat trang giCta (a. colica media).
6.1.2. Tinh mach: Thuang di theo cac dOng mach va chay vao tinh mach mac treo trang
tren (h0 thong cii'a).
6.1.3. Bach huyet. Co b6n nhom:
178
 - Nh6m nam sat thanh k6t trang.
- Nh6m nam doc theo cung &Ong mach.
- Nhom trung gian nam doc theo cac dong mach.
- Nhom chinh nam d g6c cac dong mach.
6.2. MACH MAU CUA K.& TRANG TRAI (H.39.8).
6.2.1. Cfic dOng mach deu tach ra tii Ong mach mac treo trang du& (a. mesenterica inferior).
Nguyen y: dOng mach mac treo trang duai tach tit dong mach chti bung 5cm phia tren
nai phan dOi cua dong mach chU, Wang ang vdi phia twac d6t ging that lung 3.
Deng mach di xueing dudi va sang trai, trong mac treo ket trang xuong va tan cling a phia
trurac d6t song ding 3, sau cue tren truc trang va chia lam hai nhanh ding la Ong mach trye
trang tren.
Cdc nhdnh ben cila Ong mach mac treo trang dad la:
- Deng mach k6t trang trai (a. colica sinistra): di len tren va sang trai trong mac treo
ket trang xueng chia lam hai nhanh len va xu6ng n6i vdi Ong mach ket trang gitia va Ong
mach ket trang xich-ma.
- Cac Ong mach xich-ma (aa. sigmoideae) c6 tiff 2-4 Ong mach n6i vdi nhau.
- Deng mach truc trang tren (aa. rectalis superior) n6i vdi Ong mach xich-ma va dung
mach true trang gitia (a. rectalis media).
DOng mach mac treo trang duai d ngudi Viet Nam c6 dung kinh la 3,3mm va c6 chieu
dai la 42mm do tit nguyen Uy den cho phan nhanh dau

DOng mach
kat (rang giiia DOng much
mac treo (rang ckldi
f4ng mach
mac treo (rang tren DOng mach
keit trang trai
°Ong mach
kat (rang phai
Cac clOng mach
xich ma

DOng mach
trcic trang tren

Hinh 39.7: DOng mach cd a runt

179
 6.2.2. Cac tinh mach
Cac tinh mach khong kern theo cac &Ong mach, ma cac dam r6i tinh mach trong thanh
runt chay vao tinh mach xich-ma va tinh mach ket trang trai. Sau do hai tinh mach nay chay
vao phan tren tinh mach mac treo trang dutri ve he th6ng
6.2.3. Bach huygt. CO hai dong bach huygt:
# Deng tren theo &Ong mach ket trang trai di vg chuin hach chinh gen g6c d'Ong mach
mac treo trang du'ai.
# Deng duoi theo tinh mach mac treo trang diidi va di v6 cac hach sau tuy tang.
°Ong mach
chO bang

Tinh mach cela

Tinh mach tech

Tinh mach vg
citing mach
DOng mach ket trang trai
mac treo
trang iron
1

77nh mach
mac treo
(rang tren

— Tinh mach
mac tree
(rang thidi

DOng mach
mac treo
(rang dudi

Cgc Ong-
tinh mach
xich-mg

DOng mach va tinh mach

trot !rang iron

Hinh 39.8: DOng mach mac treo trang du'ai.

180
 CAU HoI TRAC NGHIEM
Chon cau tra loci dung nhat

428. W hinh the ngoai, ket trang khdc ruet non a nhfing diem:
a) Co thanh mac bao boc ben ngoai.
b) Co cdc dai co doc.
c) Co cdc bulau ket trang.
d) Co cdc tui thlfa mac n6i.
e) Cau b, c, d deu thing.
429. Phan nAo clued day oua ket trang KHONG co clac diem hinh the ngoai chung cUa k6t
trang:
a) True trang.
b) Manh trang.
c) Ke't trang ngang.
d) K6t trang chau hong.
e) Ke't trang len.
430. Vi tri cua khoi manh trang va rivet thita:
a) Thuang a h6 chau phai.
b) G6c met thira chie-u len thanh bung a didm giiTa dieing n6i gai chau truac tren yeti r6n.
c) Bat thuerng CO the a duai gan hoac h6 chau trai hodc. duai chau hong.
d) a, b dung.
e) a, b, c dung.
431. Van hau mon:
a) LA hai nep niem mac nam a ranh duai cila truc trang va 6ng hau mon.
b) LA met nep niem mac bat thu'Ong che kin met phan 16 hau mon.
c) LA nhang nep niem mac hinh cung n6i lien than cua hai cot hau mon.
d) LA ba nep ngang hinh lir i 1i6m a trong long truc trang.
e) Tat ca. deu sai.
432. BO cludi cilia mac dinh ket trang trai IA:
a) Du'Ong Ong theo mao chau trai.
b) Du'Ong tit mom nho doc theo be! trong co that lung trai.
c) Duteng tit ch6 chia dOi cUa DM chii bung doc theo bo ngoai co that lung trai.
d) Duang tit ch6 chia doi ciia DM chU bung di ngang sang trai.
e) Tat ca Teti sai.
433. Cau nao clang: ROA thiia:
a) Co met mac treo thuc sit dinh no vao thanh bung.
b) Khong có phdc mac che phd.
181
 c) CO vi tri thay doi va gek dinh vao marsh trang cach goc h6i marsh trang 3cm.
d) Thtkng dtrqc cap mau bai mot nhanh caa dung mach h6i trang.
e) a, c, d
434. DM nao khong cho nhanh clan nuoi &Ong cho runt gia:
a) DM chau ngoai.
b) DM chat.' trong.
c) DM mac treo trang tren.
d) DM mac treo trang
e) a va b thing.
435. Dong mach mac treo trang
a) Mat phat tit DM chii bung a khoang clot song that lung III.
b) Di trong mac treo ket trang xidng Ara chi cung cap mau cho kat trang xuang.
c) Cho cac nhanh ben là Ong mach ket trang trai, cac dOng mach kat trang xich-ma
va cho nhanh tan IA Ong mach trifc trang
d) a va c dung.
e) a, b, c deu dting.
436. acing mach h6i-kat trang KHONG cung cap mau cho:
a) Kat trang len.
b) Manh trang.
c) Rutit thifa.
d) Doan cuoi h6i trang.
e) Tui this hoi trang (Meckel).
437. Dam r6i tinh mach Judi niem mac trip trang dan mau vg:
a) TM chau trong.
b) TM mac treo trang
c) TM chil dudi.
d) TM mac treo trang
e) a va b dung.

182
 40 THAN - TUYEN TWA:NG THAN

MVC TIEU BAI GIANG

A. MITC TIEU LY THUYET

1.MO to vi tri chdc nang, kith thudc, hinh thd ngoai, hinh the trong va lien quan &la than.
2. MO to cau tao dia. then.
3. MO to mach, than kinh caa than.
4. MO to vi tri, hinh the, chitc nang, lien quan va mach than kinh ciia tuyen thccrig than.
5. Ve thiet do cat ngang va cat diing doc then phai.
6. Ve hinh chieu cilia then tren khung xtfung sang, xucng scan va xucng chau.
7. Ke ten cac phan they clang mach than.

B. MIJC TIEU THTIC TAP

1. CM tren xac, mo hinh, tieu ban, vi tri, hinh the, lien quan va cau tao ciia then, cac la
mac then.
2. CM tren xac va ph rang tian that tap khac cac b6 mach va than kinh then.
3. Chi tren xac va phuzing tian thkic tap khac vi tri, hinh the, chiic nang, mach than kinh
caa tuyen thccng then.
4. CM cac dai, be then tren phim X quang c6 chuan bi.
5. Xem then khi mO ch6 song, so sanh vai ngudi.

Than (ren) la mat cc quan chan c6 vai tro quan trong trong viac duy tri thang bang nude
dian giai trong cc the va thai mat s6 chat dac dai vdi cc the ra ngoai qua sit thanh lap va bai
tiet ni.rdc tidu; do do, than co the ducc xem nhc mat tuyen ngoai tiet. Tuy nhien, then can c6
vai tra not tiet co anh twang tai so' dieu chinh huyet ap va tao hang huyet cau. Tuyan thcong
183
 than ding la met cc quan chin, la tuyen not tiet có lien quan tdi nhieu chuyen hoa quan trong
trong cc the. Ve phiicrng dien chirc nang, than va tuyen thavng than it có lien quan nhung ve
mat giai pheu hai cc quan nay co lien quan chat the nen durcc hoc chung mot bai.

THAN
1. HINH THE NGOAI

Then hinh hat den, mau nau dO, be mat trcn lang nlif dace boc trong met bao xat
(capsula fibrosa) ma binh thaing co the boc ra de clang. Moi then co (H.40.1) (H.40.2) :
— Hai mat : mat trudc (facies anterior) led, mat sau (facies posterior) phang.

Tuygn thuang than

Ddng mach than

Tinh mach than

Be than

Hinh 40.1 : Than va cueing than phdi (nhin truac).

Dang mach than

Tinh mach than

Be than

Hinh 40.2 : Than va cuong than phdi (nhin sau).

184
 — Hai b6 : bU ngoai (margo lateralis) 16i, ba trong (margo medialis)18i a Oran tren va duti;
phan giaa beY trong tom sau goi la ro'n then (hilus renalis) là not Ong mach vao then, tinh
mach Ira nieu quan ra kir& then.
— Hai dau : tren va duti (extremitas superior et inferior).
Than a thai nhi c6 hinh nhieu mai, a nguti trudng thanh dei khi than ding c6 hinh mai
do kern phat trien. Trong nhang trutng hop bat thutng, c6 the chi c6 met than hay hai then
dinh vao nhau nh6 met mong ngkra nam bat ngang qua cot

Hintz 40.3. Vi tri va kith Ulu& than

2. KICH THVOC

Than cao khoang 12cm, Ong 6cm, day 3cm. Can Ong khoang 150 gam, then a nil hui nhe
hon a nam. Binh thutng, khi kham lam sang, ngri6i to kheng the sa &roc than, chi sa thay
than khi than to (cart hiOu cham than).

3. VI TRI

Than nam sau ph6c mac, trong g6c hop bai )(acing saran XI va cot song that hung, ngay
phia trutc cu that king. True lan &la than chay chech tit tren 'Rang duti, tit trong ra ngoai va
tii tru'ac ra sau. Hun nifa, then hui xoay quanh true nay nen mat truck vita nhin ra trust vita ra
ngodi, mat sau vita nhin ra sau vita vao trong. Than phai thdp hon then trai khoang On 2cm,

185
có the do ben phai có gan de len. Vi tri .then co the hai thay d6i then nhip tha va tit the. di to
the nam thi :
—R6n then phai a ngang mile mon vi va each duang gida khoang 4cm.
—Ron than trai hai cao hun mile nay.
Neu d6i chieu len thanh sau co the :
—RO'n than trai o ngang mire mom ngang clot song that lung I hay a giao diem gia ba
ngoai kh6i co dung song (m. erector spinae) va ba dual xu'ung sin XII. Deu tren then trai
ngang bc1 tren xtlemg satin XI. Deu dual each diem cao nh'et mao cheu khoang 5cm.
—Deu tren then phai d ngang bar dual xuung suan XI. Deu dudi cach mao cheu khoang
3cm (H.40.3).
Bong than có the they du'oc tren phim X quang bung khong chuen bi. Doi chieu bong then
vdi cac m6c xuang de noi, tren lam sang, to có the danh gia su JD° tinh trang binh thuang hay
bet thitang v6 hinh dang, vi tri va kith thudc than.

Mac than
Bao xo
Co' vuong - that king

Bao m0
(md quanh than)

Phitc mac

Tinh mach chi ch(di

Ddng mach chi byng

Hinh 40.4. Mac th(in, thie't d6 nein?. ngang

4. MAC THAN (H.40.5).

M6i then va tuyen thu'ung then clung ben dune bao boc trong mot mac goi la mac then.
Gina than va tuyen thucing than, mac than c6 mot tre ngang ngan each hai cu quan nay. mac
than g8m hai la., mot la trudc va mot la sau throe sap x6p nhu sau :
- phia tren tuyen thuong then, hai la mac then chap vao nhau va dinh vao la mac
mat dual co hoanh.
- dual : Hai la mac sat nhau nhung van rieng biet, r6i haa Ian vao lap mo ngoai phde
mac. Co tac gia cho rang no haa lan vao mac cheu (fascia iliaca).
- CI trong : la sau hoa. lan vao mac cc that lung va qua do den barn vao than cac d6t song
that lung. La trudc di trudc bci mach than va dung mach chi r6i lien tiep vdi la truck ben d6i
dien. Tuy nhien, hai la phai va trai deu dinh ca vao cu6ng than va cac to chile lien ke't quanh
cac mach mau a fen then nen hai 6 then khong thong vdi nhau. Ap xe a mot ben then khong
lan sang ben kia

186
 Cd hoanh
Tuy •
Gan
'Da day

/sap vi mac nOi

Lach
Phdi
Tuyen thcidng than
Mang phd thanh
Ngach skin hoanh

Vach than - tuyen thcldng than

Cd hoanh
Than
Tui mac not

Mac sau than

Mac dinh
Than kinh gan sUOn 1
ya than kinh bung - sinh duc
Md quanh than
Md canh than
Cd wring that lung
Mo ddai phtic mac I
r4

Kai trang ngang

t
Mac nd

Anh XXXVI : Thiet do cOt dung doe qua uUng than trai

187
D6ng mach cheu trong
Nieu quen
D.:Sag mach chOu trong
lac nhenh Saul Deng mach cheu - th4 lung
DOng mach ch.& trong
DOng mach chau ngaii
Deng mach clung ngaii tren
DOng reach then trong
Deng mach cling ngo.ii dud
DOng mach r6n
Deng mach mong dudi
()Ong mach bang quang,
DOng mach truc trang gida
tree
DOng mach b#
-6ng dEn tinh
tinh
DOng mach bang quang dude'

Bang quang

Anh XXXVII : DOng mach ch4u ngoai viz chetu trong

188
 Co hoanh

Gan

Tuygn thu'Ong than

PhOc mac

Md canh than Than

Bao xo
Co vuong that king
Bao and
(md quanh then)
M?c cheu

Hinh 40.5. Mac than, thie't dd clang d9c.

- d ngoai : hai la ding chap vao nhau va hoa Ian vao ldp ma lien ket ngoai pinic mac.
Cung có quan didm cho rang no hoa Ian vao mac ngang. Sd di co six khac nhau gifia cac quan
diem nay la vi co tac gia cho rang mac than xuat phat tit mac ngang, co tac gia cho rang mac
than du'oc tao nen do sti day len cila lap mo ngoai pink mac tiIc IA lap mO lien kat rieng ctia
phdc mac.
Mac than ngan cach vdi bao xa clia than bdi mot lap moi goi la bao mcr (capsula adiposa)
hay lap and quanh than. Can lap mc1 ngoai mac than goi la ldp mc1 canh than.

5. LIEN QUAN.
5.1. PHiA TRU'OC (H.40.6).
5.1.1. Th4n phai. Than phai nam ghn hat trong tang tren mac treo ket trang ngang
nhu'ng ngoai phac mac.
—Dau tren va phan troll ba trong lien quan vdi tuyan thvong than.
—Bo trong va cueing than lien quan vdi phan xuthig cua to trang.
Bo nay cang ghn tinh mach chil duai nen khi cat than phai CO the gay ton thvang cho to
trang va tinh mach nay.
—Mot phan ldn mat trvac than phai lien quan vdi \rang gan ngoai pink mac. Phan con lai
lien quan vdi pie kat trang phai va rug non.
5.1.2. Th4n trai. Than trai nam nig ncia a tdng tren, mot ncia a tdng duai mac treo ket
trang ngang, có re mac treo ket trang ngang nam bat cheo phia truac.
—Dau tren va pilau tren ba trong ding lien quan vdi tuy6n thuang than.
—Dual do Lan 'dot lien quan vdi mat sau da day qua tai mac n6i (bursa omentalis), vdi
than tvy va lath, vdi goc ket trang trai, phan tren ket trang xulfing va rug non.
189
 TM DM
Tuygn thuging than
Tuygn the/ging than chi] chi]
detei
Da day
Gan
Lach

Tuy
Ta trang
Kgt trang
Kgt trang
Hang trang
Nigu quan
A

Tuygn thudng than

Tuygn thudng then

lasing da day

King lath

Goc kgt
trang trai

Wing
Wong trang

DM kgt trang trai

Goc kgt trang trai Deng mach chi.)

Tinh mach chi) de/di

Hinh 40.6, Lien quan cila mat tru'ac Chart.

A. B6 ccic tang di
B. De nguyen clic king.
5.2. PEHA SAU (H.40.7)
Mat sau là mat phau thuat caa than. Xuang akin XII nam than ngang than a phia sau
chia than lam hai tang : tang nguc a tren, tang that lung a dutri.

190
 – Tang nguc : lien quan chu ye-u v6i xuong akin XI, xuang su'6n XII, co hoanh va ngach
wan - hoanh cua mang ph6i.
– Tang that lung : tii trong ra ngoai, mat sau than a tang that lung lien quan vai co that
lung, co vuong that lung va co ngang bung.

Tinh mach chi clUdi

XUang suon 12
Xuong suon 12
Co hoanh
Co' hoanh

— Ca ngang bung
Co ngang bung
— Co vuong-that lung
Ca vuong-that lung
CO that lung
Ca that lung --
NiOu (pan

DOng mach chi)

A

Day chang that lung-suan

Xu'ang suon 11
Xu'ang suon 12
Co dung song
Ca vuOng-that lung
Ca vuong-that lung Co that lung

B
Hinh 40.7. Lien quan etia met sau than
A. Bo cae xuong ca B. Be nguyen ccic xuang cc
5.3. MIA TRONG
Tit sau ra tritdc, m6i than lien quan yeti :
– Co that lung va phan bung cUa than than kinh giao cam a b6 trong cd nay.
– B6 mach tuye'n thdong than, b6 mach than, be than va phan tren nieu quan, 136 mach
tinh hoar' hay bu6ng trting, tinh mach chil dudi (d6i voi than phcii) va Ong mach chU bung (ddi
vei than trcii). Lien quan phia ngoai khong quan trong.
191
6. HiNH THE TRONG

6.1. DA.I THE. Than duoc boc trong mot bao sai (capsula fibrosa). Nhin tren mot thidt dO
clang ngang qua then to thay a giria la xoang than (sinus renalis) c6 be) mach, than kinh va bg
then di qua. Bao quanh xoang then là kh6i nhu ma than hinh ban nguyOt (H.40.8).

Cot than
Xoang than
Dai than to

Dai than nha

Thap than
(Tay than)

Xoang than

B
Hinh 40.8. Hinh the trong caa than.
A. Thi& d cat clang ngang qua than. B. Thi& d ndm ngang qua than.

6.1.1. Xoang than. Xoang than thong ra ngoai a rein then (hilus renalis). Thanh xoang có
nhiOu ch6 lOi ldm. Ch6 lOi hinh non goi la nhu than (papillae renales). Nhil than cao khodng
4-10mm. Bali nhti co nhidu 16 ctia cdc 6ng sinh niOu dd nudc tieu vao bd then. Ch6 ldm up vao
nhd than goi la cdc dai than nh6 (calices renales minires). Thilang in6i then có tit 7-14 dai
than nho, hap lai thanh 2 hay 3 dai then lan (calices renales majores). Cdc dai then lan hap
lai thanh bd then (pelvis renalis). Be than va cdc dai than co thg th0 duoc tren phim X quang
chkip then có bom thu6c can quang. Bd than n6i tidp vai niOu quan.

192
 6.1.2. Nhu mo than. Nhu me then chia lam hai yang :
- Tay then (medulla renis) : duvc ceu to Om nhieu kh6i hinh non goi là thdp then
(pyramides renalis). Day thdp (basis pyramidis) quay ve 'Ana bao then, dinh hung ve xoang
than tao nen nhu than. Thap then thuang nhieu horn nhu then. Cl phen gifla then, 2-3 thdp
thaang chung nhau mot nIni then; can a hai cue co khi 6-7 thdp chung nhau mot nhu then; Cdc
thdp than sap xep thanh hai hang doc theo hai mat trade va sau then.

Vd than

DM gian tieu thity

Nhanh xue't Ong hian
Nhanh nhOp
Tigu the than

Phan luan
— Phan tia

Quai Henle

Ong thu thep

Thep then
DM, TM
gian thty
CO2t then

Hinh 40.9. Cdu true vi the' vet cdc mach mdu trong than.
—Vo then (cortex renis) gom co :
+ COt then (columnae renales) : la phen nhu mo nam giaa cdc thdp than.
+ Tigu they vO (lobuli corticales) : IA phen nhu me tit ddy dial) then tai bao sgi. Tigu they
vO lai chia lam hai phen :
• Phan tia (pars radiata) : gom cdc kh6i hinh thdp nhO, ddy narn tren ddy thdp then, dinh
hu'ang ra bao sal than.

193
 . Phan luan (pars conuoluta) : la phan nhu mO xen gicia phdn tia (H.40.9).
Theo cdc sdch c6 dign, than duac chia lam nhieu they data vao cau true cUa nhu mO than.
M6i thUy than (lobi renales) g6m met thdp than va phan vo than xung quanh thdp.

6.2. VI THE.' W phuang dien vi the, nhu ma than duac cat' tao chi yefu bdi nhfing dun
vi chdc nang than goi la nephrOn. M6i nephron gem : mot tidu the than (corpuscula renis)
va met he th6ng ong sinh nieu. Tieu the than gem c6 met bao d ngoai (capsula glomeruli)
va ben trong la met cuen mao mach (glomerulus). He th6ng 6ng sinh nieu gem : cdc tidu
quan Wan (tubuli renales contorti), 6ng lucfn gan, quaff Hanle, 6ng luan xa, va 6ng thu thap.
Tieu the than, 6ng Juan gan, 6ng lu'an xa nam trong phdn luqn oda vO than. Quai Henle,
6ng thong, 6ng thu thap nam trong phAn tia cua va than va toy than (H.40.9). M6i phdn
ctia nephron c6 met vai tro rieng trong viec bai tigt, hap thu nude va met s6 chat trong
qud trinh thanh lap nude tidu.

7. MACH MAU VA THAN KINH (H.40.10)

7.1. BONG MACH. Deng mach than (arteriae renis) xuat phat tit Ong mach chil bung,
ngay dudi dung mach mac treo trang tren. Deng mach than phai dai han va hai dial) han dung
mach than trai. D6i chigu len cot s6ng, nguyen Uy ctia dung mach than a khoang ngang than
d6t s6ng that lung I. M6i dung mach nam sau tinh mach Wang dng.
7.1.1. Nganh tong. Khi tai gan run than, m6i dung mach than chia lam 2 Ong mach :
nhanh trudc (ramus anterior) va nlidnh sau (ramus posterior). Cd.c nhdnh Ong mach nay
thutng chia ra khoang 5 nlidnh Ong mach nhu di vao xoang than, met nhanh di a phia tren
met nhanh di a phia sau tren be than, cdc nlidnh con lai di a phia trudc be than. De lay sai be
than, nguti to thuang rach vao mat sau be than de trd.nh cdc Ong mach nay. Cdc nhanh Ong
mach khi vao xoang than se cung cap mdu cho tUng vUng mO than rieng biet, goi la phan they
than (segmenta renalia).
Day la sit phan chia phan thily theo long mach then. Co nam phan they than la : phan
they tren (segm. superius), trudc - tren (segm. anterius superius), trudc - dual (segm. anterius
inferius), duVi (segm. inferius) va sau (segm. posterius) (H.40.12). Cung co nhiing quan diem
khdc trong six phan chia thily than nhung nhin chung, cdc phan they nay khong Wang duang
vai cdc thily than c6 dien data vao ca7u true cUa nhu mO than.
Cdc nhanh cila dung mach than a phia trudc cung cap mau cho met khu Ong han cdc
nhanh a phia sau. Giaa hai khu co met vUng it mach mdu han goi la duang Hyrtl. Dung nay
la met duang cong, each bet ngoai than ve phia sau de 1 cm. Thutng rach than theo dating nay
de lay soi than (H.40.11).

194
Deng mach thueng then tren
Deng mach hoenh dddi

Deng mach thueng than giCia

Deng mach thdeng than dddi

Deng mach then trai

Veng DM ngoei then

Nhanh xuyen

DM nieu quen
Deng mach
mac treo trang iron

Deng mach sinh chic

Deng mach ket treng phei

Hinh 40.11. Cac gong mach cho than, tuye'n thueng than va yang gong mach ngoai than

Outing ve mach
(Hyrtl)
Nieu quan

MAO ta all
VIP NIP 111111111111111111111
x/AWAP.oweeee.11

AIMIP 1 NI I a I I 1‘,
Altagig J NA A vila

Phia trifeic Deng mach then

Hinh 40.11. Thie't do cat ngang qua than cho day sd phan bd mach mciu
trong than a hai khu truck va sau

195
 Trong xoang than, cac Ong mach than se chia ra nhiing nhanh di vao nhu mO than a gicta
cac thap goi la dung mach gian they than (a. interlobaris renis). Khi tai day thap than, Ong
mach gian they than chia thanh cac thing mach cung (a. arcuatae) na'm tren day thap. Tit
dung mach cung di ve phla vO than (pha n law') co cac nhanh Ong mach gian tidu they
(aa. interlobulares), r6i cho cac nhanh &Ong mach nhap (vas afferens) di vao tien the than. Trong
bao tien the than, nhanh Ong mach nhap se tao nen met, men mao mach ram gun trong bao r6i
tit dO ra khoi bao bai nhanh deng mach xuat (vas efferens). Nhanh Ong mach xuat sau do lai chia
thanh mot hrdi mao mach xung quanh he th6ng eing sinh nieu r6i clan mau tra ve he tinh mach. VI
vay tai than ngu i to noi dOng mach xuat la met he th6ng deng mach caa.
Di ve phia xoang than có cac tidu dung mach thang (arteriolae rectae) cap man cho thap
than. Nhang tidu Ong mach nay có the tach tit Ong mach cung (H.40.9).
7.1.2. Nganh ben va nganh nevi.
—Ngdnh ben : g6m cac Ong mach :
+ Deng mach tuye'n thu'ong than dual.
+ Nhanh thing mach cho nieu quan.
—Ngemh noi (vOng ctemg mach ngocii than).
Cdc nhanh cua Ong mach than khOng n6i nhau a trong than, nining a ngoai than thi
thong noi vai cac Ong mach lan can nhu : &mg mach hohnh Judi, Ong mach sinh dye, deng
mach ket trang tao nen met \Tang deng mach ngoai than (H.40.10) nam trong ldp mop quanh
than. Cl ngdai Viet Nam vi tri d6i chieu nguyen uy caa Ong mach than thay dOi tit dot song
that lung I de'n d6t song that lung III va nhieu nhgt la a ngang dat, sang that lung II. Chieu
dai caa Ong mach than phai (55mm) dai ban chieu dai caa. Ong mach then trai (48,36mm) vb.
&tang kinh caa m6i dOng mach tit 4,2-4,34mm, 12,9% cc!, dOng mach clic tren than xuat phat tit
dOng mach hoanh &raj. 8% co dOng mach eve dadi than phai, 6,45% co Ong mach clic dadi
than trai, 4,8% co Ong mach citc tren than phai, 4,8% ding met lac co ca 2 dOng mach eye
clued than a 2 ben. Nha vey a ngutti Viet Nam có 37% co Ong mach ctic tren hay clic du'ai than.
Dieu nay co 3'r nghia quan trong vd mat phdu thuat, vi de bi bO sot dung mach eye than khi cat
ba than. Dac biet Ong mach clic chilli có the gay tac nieu quan ch6 doan n6i.
7.2. TINH MACH. Tinh mach bat ngu6n tit \TO Ara tay than. Trong vO than, tinh mach bat
ngu6n tit cac tidu tinh mach sao (venulae stellatae) d6 vao cac tidu tinh mach gian tidu they
(vv.interlobulares). Trong tay than, tinh mach bat ngu6n tit cac tidu tinh mach thong (venulae
rectae). Cac tinh mach a ca hai vang than sau do dell d6 vao cac tinh mach cung (venae
arcuatae), r6i tap trung ve tinh mach gian they (venae interlobares), tinh mach than va cu6i
ding d6 vao tinh mach cha &Md.
7.3. BACH MACH.
Cac bach mach a than, chil yen dO vao cac hach bach huyet quanh cu6ng than.
7.5. THAN KINH.
Than &Jac phan phoi than kinh tit cac nhanh dm dam roi than (plexus renalis) thuOc he
than kinh tit chil di doc theo dung mach than. Hau het la cac than kinh van mach. Con cac
than kinh cam giac dau, cha yeu a be than, di vao tay gal qua cac than kinh tang.

196
 TUYEN THIIQNG THAN

1. DAI WONG.
Binh thing c6 hai tuyen thuong than (glandula suprarenalis) nam a hai ben cot song va ngay
phia tren than. Tuy goi la tuydn thuong than nhung that sU chi 1/10 tuydn nay trim len dau tren
than, con 9/10 tin nam doc theo bit trong cUa than, ngay phia tren r6n than. M6i tuydn thuong
than can nang tit 3-6 gam luc truang thanh; luc mai sinh, tuydn thuong than hai to hon.
2. HINH THE BEN NGOAI VA LIEN QUAN (H.40.6).
2.1. TUYEN THUONG THAN PHAI. Tuydn c6 mau xam yang, hinh tam giac vdi ba mat :
mat trade (facies anterior), mat sau (facies posterior) Ira mat than (facies renalis) ng6i a chic
tren va be( trong than. Phia sau tuyen thiiçrng than lien quan vdi ca hoanh. Phia truck, lien
quan vdi vUng gan ngoai pinic mac va vdi tinh mach chil dad.
2.2. TUYEN THTIgNG THAN TRAI. Tuyen thurong than trai hcci det horn tuyen thu'ong
than phai, c6 hinh ban nguyet va ding c6 ba mat : mat trate, mat sau va mat than. Lien quan
a phia sau vai co hoanh. Phia truck, tuyen thu'ong than duoc the phu bai pink mac. Phia dudi
la tuy va Ong mach lath.
M6i tuydn thuong than c6 hai ba : bar tren (margo superior) va bar trong (margo medialis).
O ba trong c6 r6n tuydn thuong than (hilus) la noi tinh mach trung tarn (vena centralis) tuyen
thuong than di ra khoi tuyen.
Tuyen thuong than du'oc bao boc chung quanh bai mac than, a dudi c6 met tre ngang ngan
each tuyen thuong than vdi than. Tuydn thuong than c6 thd nhin thay tren phim X quang bang
each chup c6 barn hai vao trong mac than.
Ngoai hai tuyen thuong than binh thurang, doi khi co nhfing tuyen thuong than phu
(gll. suprarenales accessoriae) d trong bung hay trong viing chau.

3. HINH THE TRONG VA CHIC NANG

B6 doc tuyen thuo'ng than, to thay CO hai Wing : ben ngoai là vO (cortex) va ben trong la
tuy thu'ong than (medulla). M6i \rung co mot chdc nang nOi tiat rieng, nen trong m6i tuyen
thuong than c6 hai tuyen nei tidt. VO thu'ong than tie't ra cac loai kith thich to steroit co lien
quan tai sur chuydn h6a nude dien giai, chuydn h6a cac chat during, chat dam. Thy thoong than
tiett ra cac chat epinephrine va norepinephrine, co tac dung gi6ng nhu nhting chat tiett ra tii
dau tan cung cUa cac than kinh giao cam.

4. MACH VA THAN KINH

4.1. BONG MACH. Tuydn thuong than duroc cung cap mau tit :
—Deng mach thuong than tren (a. suprarenalis sup.) : xuatt, phat tii Ong mach hoanh dudi,
—Deng mach thu'ong than gilta (a. suprarenalis media) : xuat phat tit dOng mach chii.
—Deng mach thu'ong than dudi (a. suprarenalis inferior) : xuat phat tit dOng mach than (H.40.10).
197
 4.2. TINH MACH. Phan ldn mau deu d6 vao tinh mach trung tam tuy6n thu'ong than, tinh
mach nay rad r6n tuy6n. Tinh mach trung tam tuy6n thuong than phai d6 vao tinh mach chil
dudi, tinh mach ben trai dai hen va d6 vao tinh mach than trai.
4.3. BACH MACH. Bach mach it d \Tung vO tuy6n thu'ong than nhung nhieu d bay thu'ong
than. Cac bach mach nay di theo cac tinh mach va d6 vao hach bach huyel lan can.
4.4. THAN KINH. TU dam r6i tang (plexus celiacus) va dam r6i than (plexus renalis). Hau
h6t là cac sqi than kinh giao cam trade hach chi ph6i tru'c ti6p cho cac t6 bao tiiy thuong than.

Phan thOy tren

Nhanh sau D.M than
Phan thew trifac tren
001,
Nhanh
trudc Phan MO)/ sau

than
Phan they Mick dtidi
udng vo mach (Hyrtl)

Phan they
dudi

Hinh 40.12. Sit phan nhoinh cda deing mach than viz cac phan thily than.

CAU Hell TRAC NGHIEM

Chon cau -bra loi clang nhat

438. Bao xe (hay bao soi) ctia than là lop mo xa :

a) Bao boc mat ngoai than.
b) Bao boc ben ngoai bao ma.
c) Bao boc ben ngoai ldp and quanh than.
d) Con goi la mac than.
e) Tat ca deu sai.
Dung cac chi tiet sau de tra loci cau 439.
I. To thanh bdi phtic mac.
II. Gom hai la trade va sau than.
III. Do lap mo ngoai phtic mac tao nen.
IV. Hai 6 than hai ben thong nhau a r6n than.

198
439. Mac than c6 nhang dac diem nao :
a) I, IV. d) II, III
b) I, II e) II, III, IV.
c) I, II, IV.
Dung hinh ye va bang tra 141i dtfdi day de tra 1di cau 440, 441, 442.
a) Cu hoanh. d) Ta trang.
b) Gan. e) Goc ket trang (P).
e) TM. chili du6i.

440. Wing (1) lien quan vai :

441. Wing (2) lien quan vdi :
442. Wing (3) lien quan v6i :
443. Chon eau dung :
a) Xoang than can duoc goi la r6n than.
b) Dai than la dinh cac thap than.
c) Tay than là phan nhu mo tao nen bdi cac thap than.
d) C6t than la phan tuy than nam giira cac thap than.
e) V6 than bao g6m hai phan la phan tia va phan luqn.
444. Cac tidu the than (vi cau tlgin) chii 376u narn trong :
a) Phan tia ciia v6 than. d) Tay than.
b) Phan lucrn cua vo than. e) COt than va tay than.
c) COtthan.
199
 445. Dd chia then thanh cac phan they, nguai to data vao :
a) Cau trtic cua nhu m6 than.
b) Su' phan b6 cua cac 6ng sinh nieu.
c) Su' phan b6 cua thing mach then.
d) Su' phan b6 cUa tinh mach then.
e) Su' phan b6 cua cac dai then.
446. Tuydn thuang then nem a :
a) Cuc tren than. d) a, b dung.
b) Phan tren bar ngoai than. e) a, c thing.
c) Phan tren bar trong then.
Dung bang tra 16i nay cho 2 can 447, 448.
a) DM gian thUy d) Tidu DM thOng.
b) DM gian tidu thug. e) c hay d.
c) DM tai cung.
447. DM nhep (DM ddn) xu'at pita -Ur :
448. Nail diking cho vUng ttly then la :
Can 449, 450, 451. Chon :
a) Ndu (A) thing, (B) dung. (A), (B) co lien quan nhan qua.
b) Ndu (A) dung, (B) thing. (A), (B) khong lien quan nhan qua.
c) Ndu (A) dung, (B) sai.
d) Ndu (A) sai, (B) dung.
e) Ndu (A) sai, (B) sai.
449. (A) Phan thuet vao than, thuang di tii thanh bung phia sau, VI

(B) Than nam sat thank bung sau, sau pinic mac nen khong phai rach vao phtic mac va
khong vu ang cac tang Ichac.
450. (A) Then nam trong 6 bung, nhung chidu len thanh lung cu thd a ca thanh ngu'c va thanh
thdt lung, Vi
(B) Than duuc treo vao co' hoanh bai mot nep phtic mac.
451. (A) Rach thanh bung sau vao than c6 nguy co' cham vao mang ph6i, VI
(B) Mang ph6i di phia dual cuc cila then.
(Xem them bdi 31)

200
 41 NIEU QUAN - BANG QUANG - NIEU DAo

MUC TIEU BAI GIANG

A. MUC TIEU LY THUYgT

1. MO to vi tri, chile nang, kich thitac, ceu tao, lien quan cua cac doan nieu quail, nieu dao
va bang quang.
2. MO to cac phu'ong tien c6 dinh ctia bang quang.
3. Ve thiet d6 (king doc qua cheu hong nam.
4. Giai thich nguyen tdc thong nieu dao nam dila vao cac dee diem giai phau.

B. MUC TIEU THTIC TAP

1. Chi tren xac, cac phu'o'ng tien thu'c tap khac vi tri, kich thodc, lien quan cua nieu
bang quang, nieu dao.
2. Chi tren xac, cac phoung tien thkic tap khde cac phoong tien c6 dinh bang quang.

NIEU QUAN

I. DIV CU'CiNG

Nieu quan (ureter) la 6ng don nude tidu tit be than xu6ng bang quang. Nieu quan nam sau
phdc mac, doc hai ben cot song that hung va ep sat vao thanh bung sau.
Diking kinh nieu quan khi tang vao khoang 5mm, de'u tit tren xu6ng clued trit ba ch6 hep:
mot a kink not be then-nieu quan, mot a not nieu quan bat die° dOng mach chau (a cidang
cung xu'ang chet) va mot not nila a trong thanh bang quang. Do cac ch6 hep nay ma cac sOi
then hay be then khi roi xu6ng nieu quail di the ket lai do gay nen con dau quell then va tren
lam sang khi kham co the tim they cac diem dau nieu quail tren, gide. va dodi yeti cac ch6
hep. nay (H. 41.1).

201
 Chi6u dai cria nieu quail thay cidi theo chidu cao ca th6, gidi tinh, vi tri caa than va bang
quang. Trung binh nieu van dai tit 25-28 cm va chia lam hai doan : doan bung ((pars
abdominalis) va doan chau hong (pars pelvina), moi doan dai khoang 12,5 - 14 cm. Nieu quan
trai dai han nieu quail phai vi than trai cao hon. Nieu quail d nam dai hun a nit. Nieu quan cci
thd they du'oc tren phim X quang chup be than - nieu quail có born thu6c can quang.

Tuye'n thciOng than

Be than

Doan bung

D'Ong mach chau ngoai

Tinh mach chau ngoai

Doan chau

Hinh 41.1 : Cdc doan nieu qudn vci ccic cho hep (so 1-3)

Tinh mach chi) clUdi D'Ong mach chd

Nieu quan phai Nieu quan trai

DOng mach
chau chung

DOng mach chau ngoai

DOng mach
chau trong

Hinh 41.2 : Bdt cheo gitla nieu quan va Ong mach chdu

2. NIE:U QUAN DOAN BUNG (H.41.2) (H.41.3).

Di tit b6 than tdi ding cung xtrang chau. Nieu wan doan nay di xu6ng du'di va vao trong
va lien quan :

202
 '-e.,-w7rwmrielurrwrine n

Tinh mach
chb dudi

Tuye'n
thu'cng than

Nieu qua n
Cd that king
Ca vuOng -
that ping
TK sinh dyc dui

TK bi dui - ngoai

DO ng mach
chau chung

DOng mach
chau ngoai

DOng mach
chau trong
86 mach sinh duc

Hintz 41.3 : Lien quan oda nieu qudn doan bung.

- C1 phia sau : v6i co that lung va mom ngang 3 d6t song that lung cu6i. Nieu quan con bat
cheo 6 tren, yeti than kinh sinh due did va or clued v6i dOng mach chau ngoai (ben phai) hay dOng
mach chau chung (ben trai) r6i di vao trong chau. Ca hai nieu quan hic bat cheo v6i cac dOng mach
chau deu each dueIng giiia de 4-5 cm. Deng mach chau chung phan nhanh ar ngang mite g6c nho va
cach goc nho 3,5 cm a ben phai va 4,5 cm ei ben trai. Mu6n tim nieu quan thi tim ch6 nieu quan
bat cheo dung mach, tile la ch8 each goc nho hay duOng giita khoang 4,5 cm.

- C1 phia track : nieu quan duvc plitic mac the phu. Co dOng mach tinh hoan hay dOng
mach bung trang bat cheo qua phia truck. Ben phai, phan tren nieu quan va be than con lien
203
quan vdi doan xu6ng to trang, re mac treo kgt trang ngang va cac nhanh (Ring mach &la ket
trang phai. Ben trai, phan tren nieu quan cling lien quan vdi re mac treo kgt trang ngang va
trade nita la Ong mach ket trang trai.
— C1 trong : nieu quan phai lien quan vdi tinh mach cha duai, nieu qUan trai lien quan vdi
&Ong mach cha bung.

3. NIEU QUAN DOAN CHAU HONG

Di tit &rang cung xuzing chau tai bang quang. Nieu quan doan nay di canh dung mach chau
trong r6i chay che-ch ra ngoai va ra sau theo dung tong caa thanh ben chau. Teti nen chau
hong, ch8 gai ng6i, nieu quail yang ra trudc va vao trong de tai bang quang.
CI doan chay doc theo dOng mach chau trong, nieu quan phai thuang di tru'ac Ong mach, nieu
quan trai thuang di a phla trong va sau Ong mach. Ngoai ra, nieu quan con lien quan vdi :
— Phia sau : là khap cOng - chau, ca va mac ca bit trong, bo mach - than kinh bit bat check
phia sau nieu quan (H.41.4).
NiOu quan Ddng mach
chau chung

Ddng mach chau ngoai Ddng mach

mo ng tren

Dam re31
CO bit trong than kinh cOng

Than kinh bit

Ddng mach bit

aing mach
mcing du'ai

Eking mach
thpn trong

Co nang hau mon

Hinh 41.4: Lien quan cda nieu qudn voi theinh ben chau hong.
— Phia truac : Lien quan khac nhau a nam va nit :
+ C1 nam : khi nieu quan rai thanh ben chat', chay ra truac va vao trong de tai bang quang
thi doan cu6i cua nieu quan lath gala mat sau bang quang va tui tinh r8i cam vao bang quang.
204
 ••■

Bang quang
Phac mac

Nig u quan
1 •

Ong °On tinh

Tui tinh

Tuygn tign liet

Hinh 41.5 : Lien quan czia nieu guar' a mat sau bang quang (nam).
DOng mach bu6ng tra'ng

Nig u quan

DOng mach chau trong

Buong trong
Ter cung

Am ago

DOng mach tti cung

Hinh 41.6. : Lien quan ctia nieu (pain doan cheat hong (nd)
day, nieu (pan bat cheo vdi o'ng dan tinh (6ng dan tinh d trok nieu wan) (H.41.5).
+O nit : khi r6i thanh ch4u, nieu quan chui vac) day day chang r'6ng.
Khi tdi phan giita day chang rOng, nieu quail bat cheo d phia sau dOng mach tit cung, ch6

205
bat cheo nay each c6 tii cung va thanh am dao khoang 8 - 15 mm. Dung mach tit cung lue
ddu a ngoai va sau nieu quan nhang a day thi di vao trong va bdt cheo trade nieu quan
(H.41.6) (H.41.7).
Khi hai nieu quan tdi cam vao bang quang, cluing each xa nhau khoang 5 cm lac bang
quang r8ng. Khi vao trong thanh bang quang, nieu quan chay that die-eh vao trong, ra tradc va
xu6ng clued. Doan nieu quetn nOi thanh nay dai khoang 2 cm. Hai nieu quail ma vao bang quang
bang hai khe nh6 goi IA 16 nieu quan (ostitum ureteris). Hai 16 nieu quan each xa nhau 2,5 cm
khi bang quang r6ng va. 5 cm khi bang quang day.
Nude tieu chay vao bang quang 'thong thanh clang lien tuc ma thanh nhiing clang ngan
phun ra m8i 10 - 30 giay do tac Ong cua nhAng lan song nhu dOng xuat phat tit be than va di
doc xu6ng khdp nieu quan. Khi nude tieu chay vao bang quang, 16 nieu quan se ma ra trong
khoang 2-3 giay r6i khep lai cho tdi khi có lan song nhu citing ke tie-p. L6 nieu quan killing ca
van, nhung do du'dng di cilia doan nieu quan nui thanh kha dai va chech kem theo sa co that
ctia cu bang quang (cac ye'u to nay có tcic dung nhu mot van) nen nude tieu khong trao ngadc tit
bang -quang len nieu quan duvc.
4. CAU TRI:TC CUA NItU QUAN
Thanh nieu quan day khoang 1 mm chive eau tao g6m ba ldp :
— Ldp niem mac (tunica mucosa) lien tuc yeti niem mac be than a tren va them mac bang
quang a dudi.

Ah-Ou quan

Tinh mach to cung

DOng mach tU cung

Am dao

Hinh 41.7 : Lien van, caa nieu qudn vai co tit cung va ct(mg mach vung
Ldp co (tunica muscularis) g6m ba ldp : Lap trong cd doc, ldp giffa ea vong, ldp ngoai th6
sa va chi g6m Vai bó ca doc.
Ldp bao ngoai (tunica adventitia) bao boc ben bgoai.

5. MACH MAU VA THAN KINH

5.1. BONG MACH (H.41.8). Nieu quan tit tren xu6ng du'di dadc nuoi du'ang bai nhieu mach
mau :

206
 DOng mach than

DOng mach sinh chic

DOng mach chli

DO'ng mach
chau chung

Deing mach chau trong

DOng mach chau ngoai

DOng mach
bang quang du'ai

Hinh 41.8 : Mach mciu nuoi ditUng nieu quern

- Nhanh cila dung mach than (a. renalis) cung cap mau cho be than va phan tren nieu quan.
- Nhanh cna dOng mach tinh hoan (a. testicularis) hay thing mach bung trting
(a. ovarica) nuoi during phan tren doan nieu quan bung.
- Nhanh cika ("Ong mach chau chung (a. ilica comnunis) nuoi chrerng phan claCri doan
nieu quan bung.
- Nhanh cua dOng mach bang quang &len (a. vesicalis inferior) hoac doi khi nhanh
cua Ong mach true trang gida (a. rectalis media) nuoi &fang nieu quan doan chau.
5.2. TINH MACH. Mau trd v6 tit nieu quan d6 vao cac tinh mach tuong a:ng di kern dOng mach.
5.3. BACH MACH. D6 van cac hash bath huyet thdt lung va bath huyet doc theo Ong
mach chau trong.
5.4. THAN KINH. Cac than kinh (16n nieu quail tit dam raj than (plexus renalis) va dam
rai ha vi (plexus hypogastricus), g6m cac sai van Ong chi ph6i van Ong cho co trcrn thanh
nieu quan va cac scri cam giac mang cam giac chau khi c6 six tang cl6t ng6t thanh nieu

207
 A

Hinh 41.9 : Hinh clang bang quang khi r'ong va khi deb,.
A. Thie't do clang doc B. Nhin tic tren xu6ng
- Ditang lien net : bcing quang r6ng
- Ditang chdm chcim : bang quang day

BANG QUANG
Bang quang (vesica urinaria) la met tang r6ng ma hinh dang, kich thdac va vi tri that' d6i
theo s6 laqng nu& tidu chda ben trong no. Bang quang nhan nuqc tidu til hai than qua hai nieu
quan r6i thai nit& tidu ra ngoai qua nieu dao. Trung binh bang quang co thd chda tai 500 ml
nude tidu ma khong qua tang. Ldc binh thdang khi bang quang chda ddqc khoang 250 - 350 ml
nuqc•tidu thi ta cam gide mu6n di tidu. Neu ta c6 nin tidu thi dung tich bang quang c6 thd tang
len nhieu. Trong trutmg hap bi tidu, bang quang tang len rat tova c6 thd chda tdi vai lit nude
tidu.

208
1. HINH DANG - VI TRi

Bang quang la met tang nam (lath phdc mac. C1 nguti trttang thanh va khi rung, bang
quang nam hoan than trong phdn tnidc vimg chdu. Phia trade bang quang la xung mu, phia
sau là cac tang sinh due va trktc trang, phia duti la hoanh chdu (diaphragma pelvis). Khi cang
day, bang quang c6 hinh can va nam trong 6 bung (H.41.9).
tre con, bang quang c6 hinh gi6ng qua le vdi cueing la 6ng nieu - ran (urachus) va phan
ldn bang quang nam trong 6 bung. Khi tre ldn len, bang quang tut clan xuong vimg chdu, phan
6ng nieu ran hep clan va bit han lai tao thanh ddy chang ran gala (lig. .umbilicale medianum).
0 nguti gia, do tracing he cua cac ca thanh bung yau, bang quang c6 hoi nho len tren v6 phia 6
bung.
De tien m6 ta, ta xem nha bang quang c6 hinh td dien tam gide vdi ban mat : mat tren,
mat sau va hai mat Judi-ben.
- Mat tren : dutc the plid bai phdc mac, 16i khi bang quang day, lOm xuang khi bang
quang r6ng lam cho long bang quang c6 hinh *chit Y hay T tren thiat d6 clang doc.
- Mat dadi - ben : nam tu'a tren hoanh chdu, hai mat nay gap nhau a phia trade bdi met
ba trOn ma doi khi duzjc goi la mat trade.
- Mat sau : phang, doi khi 16i (nheet la a nguiri gici). Mat nay con daqc goi la day bang.
quang (fund us vesicae). Phan tren ciia ddy bang quang ding &toe ph& mac che phii.
Mat tren va hai mat dadi ben gap nhau a phia trade goi la dinh bang quang (apex vesicae),
tit day c6 day chang ran giCta treo bang quang vao ran. Phan bang quang giita dinh va ddy goi
la than bang quang (corpus vesicae). CI dctdi , tai goc hop bdi ddy va hai mat Judi-ben la 16 nieu
dao trong (ostium urethrae internum), qua do bang quang thong vdi nieu dao; phan bang quang
xung quanh 16 nieu dao trong goi la c6 bang quang (cervix vesicae).

2. LIEN QUAN

2.1. LIEN QUAN vdI PHUC MAC.

Mat tren va phan tren day bang quang &toe phdc mac che phi" Pink mac sau khi phu len
bang quang se trdi ra xung quanh va ldt len tren de phd len thanh ben chdu va thanh bung
trudc a ngay tren 136 tren khdp mu khi bang quang ring. Khi cang day, bang quang nho len
tren v6 phia 6 bung, ch6 phdc mac tit bang quang ldt len tren de phii len thanh bung trudc
ding bi day cao hon, do do, co met ph'dn bang quang &la mat dudi - ben (khong co phtic mac
che nam sat mat sau thanh bung trudc va ngay tren )(dung mu. VI vdy nguti ta co the lam
cang bang quang de vao bang quang bang ngd tren xu'ung mu lay sai ma khong phdi di qua
phdc mac. 0 phia sau, ph& mac sau khi phu len bang quang se pH len tit cung nit) ho4c tdi
tinh nam) tao nen tui bit bang quang sinh due.

2.2. LIEN QUAN VC11 CAC CO QUAN XUNG QUANH

2.2.1. Hai mat &led ben. Lien quan vdi xdang mu, khdp mu va dam r6i tinh mach bang
quang (flexus venosus vesicalis), nam trong kh6i and trong khoang sau xdong mu (spatium

209
retropubicum). Vi 'arcing mu nam ngay trade bang quang nen khi giy =mg mu, cac manh
xitang giy CO thg choc vao bang quang lam thiing bang quang. Hai ben, bang quang lien quan
chu ygu vdi khoang sau xuang mu. Khoang sau xuang mu nam mot Olin a Wing chau va mot
phan d \Tung bung, la mot phan cua khoang ngoai plitic mac trai dAi tit nen chau tdi r6n.
Khoang nay ditac giai han
—Phia sau : là mac ti6n lit (fascia prostatae) thuOc Id tang mac chat' (fascia pelvis
visceralis).
—Phia ngoal : là mac co bit trong (fascia obturatoria) thuOc la thanh mac chau (fascia
pelvis parietalis).
—Phia trong : la id mac phi"' len hai mat duai - ben &la bang quang
—Phia dudi : la mac phil len mat tren ca nang hau mon (mac hoAnh chat' tren) (fascia
diaphragmatis pelvis superior).
—Phia tren : IA pink mac di tit bang quang tdi thanh ben chau va thanh bung trade.
Trong khoang nay là cdc mo lien kgt theta, mo mor va cdc mach mdu thin kinh tai bang
quang. Bang quang nam trong khoang nhii dirge dung trong mot cdi sot nen co tdc gia goi
khoang la. 6 bang quang.
2.2.2. M4t tren. Lien quan vdi runt non hay kgt trang xich-ma. nit, mat trim bang
quang lien quan vdi than td cung khi bang quang r6ng.
2.2.3. Mat sau: nam, lien quan vdi bong Ong din tinh (ampulla ductus deferentis), ttii
tinh va true trang. CI nit, lien quan vdi thanh truck am dao va c6 tit cung. ThAnh trito:3c am dao
va c6 td cung dinh vac) mat sau bang quang bdi mot mo lien kgt long leo.

3. CAC PHUCING TIE; N CO DINH BANG QUANG

Bang quang &Plc c6 dinh yang chat lah'dt a ddy va c6 bang quang. Co bang quang duoc gin
chat vao hohnh chau. Tigp not vdi c6 bang quang là tuygn tign liet va niOu dao, gin chat vao hohnh
nieu - due. Co bang quang con duac gilt c6 dinh bdi day chang mu - tin lit (lig. puboprostaticum) a
nam hay mu - bang quang (lig. pubovesicale) a nit. Cdc day chang nay là nhfing ch6 day len cda
mac chau (fascia pelvis), n6t tuygn tign 114, (hay co bang quang) vao mat sau khdp mu.
Mot s6 day chang khac cung c6 nhiem vu c6 dinh bang quang la :
—Day chang r6n giita : la Ong nieu r6n da hoa xa va bit tic 141, treo dinh bang quang vac)
mat sau r6n.
— Day chang r6n trong : IA Olin dOng mach r6n trong hic phoi thai dal hoa xa, co nhiOm
vu c6 dinh hai mat duai ben cda bang quang.
Cdc day chang nay that su' chi gilt cho bang quang luon ap vao thAnh bung track, ngay ca
khi tang day va nho len khai yang chau.
O phia sau, bang quang con throe c6 dinh bdi mac tin ligt. Ngoal ra, phan phdc mac di tit
mat tren bang quang tai cdc thAnh bin chau va thAnh bung trade cung co mot phan tdc dung
trong vice c6 dinh bang quang.

210
 Day chang r6n giCia

Bang quang Phut mac

Khoang sau
Wang mu
Tui tinh
Day chang mu
tuyen ti4n 110
Tui cling
tn/c trang sinh dyc
The hang TrVc trang

Tuyen tin fiat

The x6p
Dam r6i
Niau dao
tinh mach
tuyen nen fiat

Hoanh nieu duc

Hinh 41.10 : Thiet do dzing doc qua chdu hong nam

(ccic du'ang khong lien tqc twang trong cho bang quang khi ddy)

4. BINH THE TRONG BANG QUANG

Mat trong bang quang dutqc the phi bai met 16p niem mac co mau h6ng nhat. Khi bang
quang r6ng, niem mac xep nap tao nen cdc nap niem mac. Khi bang quang tang, cdc nap niem
mac mat di. Bac biet co met vimg ma niem mac khong bi xe'p nap va c6 mau do 11.6n cdc nal
khac, viing nay c6 hinh tam gide ma ba dinh la hai 16 nieu quern (ostium ureteris) va 16 nieu
dao trong, nen dive goi la tam gidc bang quang (trigonum vesicae). Giiia hai to nieu quern, niem
mac n6i gar len tao nen nap gian nieu quern (plica interureterica). chinh gifIa tam gide chay
xu6ng 18 nieu dao trong, tit phia sau c6 met ch6 not g6 len dm niem mac goi là lif6i bang quang
(uvula vesicae) (H.41.11).

5. CAU TAO CU' A BANG QUANG

Thanh bang quang du'oc caw tao bai b6n 16p :

211
 gian nigu quail

Nigu quan

L6 MO qua!?

Tam giac bang quang

Lu6i bang quang

Loi tinh
L6 Ong ph6ng tinh
Tuygn tign 110
Lei toi bau duc
tuygn iron liOt
Mao nigu dao
L6 ciia Ong tuygn tio'n li'Ot

Nigu dao

Hinh 41.11 : Mat trong bang quang va nip dao tin

—Lap niem mac (tunica mucosa) dd.- mo to a tren.

—Tgm dadi niem mac (tela submucosa) khong có a viing tam gide bang quang.
—Lap ca (tunica muscularis) gom cdc bó tro'n xe-p thanh ba lap :
+ Lap ngoai la cc doc. Tit lap nay, có mot s6 scri chay ra phia trade tai xaang mu tao nen
ca mu - bang quang (m. pubovesicalis). Mi5t, s6 sai khac chay ra phia sau tao nen ca trtic trong -
bang quang. (m. rectovesicalis).
+ Lap girla la ca yang day han lap ngoai, ddc biet la a phan troll tam gidc bang quang.
+ Lap trong la ca doc, phdt tri6n nhdt a \rung tam gide bang quang va hutrng cda the co
cling chay doc v6 phia c6 tao thanh mot quai day a phia sau co bang quang.
—Lap thanh mac (tunica serosa) chinh la phde mac. tt nhOing not khong có phdc mac, bang
quang du'ac bao phd bdi mot ldp mo lien ket. Du'ai lap thanh mac la tam dual thanh mac (tela
subserosa).

6. MACH MAU VA. THAN KINH.

6.1. BONG MACH (H.41.12). Bang quang duve nuoi du'ang bdi cdc mach mdu xudt phat to
&Ong mach chdu trong hay nhdnh cua &Ong mach chdu trong.

212
 acing mach chau trong la mot trong hai nhanh ding ciia. &ling mach chau chung cap huyat
chii yes-u cho cac cap quan trong chat' hong va cac viing d thanh chau hong. Wing mach di sat
thanh ben chau hong, sau (ben phcii) hoac trudc (ben trai) nieu quail va cludc vai centimet thi
chia thanh mot chain 11 nhanh ding.
D6 la cac citing mach : chau lung, ding ben, bit, mong tren, mong du'di, r6n, bang quang
duoi, tit cung, am ciao, trate trang giira va then trong.

Nieu quAn

DOng mach chOu chung

DOng mach chau ngoai

DOng mach chau trong

DOng mach rdn

(DM bang quang tren) \

DOng mach
bang quang du'di D6ng mach
along tren

DOng mach
mong dudi

DOng mach
than trong

Nha nh cua
dOng mach thgn trong

DOng mach
trtfc trang giUa

Hinh 41.12: Cc c nhdnh ctia cit)ng mach chp trong vet mach mdu cho bang quang

Cac nhanh cua thing mach chau trong di vao bang quang là :
— Dung mach bang quang tren (aa. vesicales superiores) la phan khong bi hda xi &la
dOng mach r6n, cung cap mau cho mat tren va 111(A phdn mat dudi - ben bang quang.

213
 —DOng mach bang quang chidi (a. vesicalis inferior) cung cap mdu cho phan sau mat
clued - ben caa bang quang va tuygn tiett
—Nhanh ctia dOng mach trtfc trong giaa (a. rectalis media) cung cap mau cho phan
ddy bang quang. CI nit, ddy bang quang con duvc nuoi duang bai nhiing nhanh cua dOng mach
tit cung (a. uterina) va clang mach am dao (a. vaginalis).
— Nhanh cua ciOng mach then trong (a. pudenda interna) va dOng mach bit (a.
obturatoria) cung cap cho phan track - dual dm bang quang.
nguai Vikt Nam, dOng mach chau trong ben phai có chie'u dai 35,2mm va du'Ong kinh la
5,27mm. Eking mach chau trong ben trai dai 34mm va du'Ong kinh la 5mm. DOng mach bang
quang tren xuat phat tif phan can lai caa dung mach run thu-Ong có hai Ong mach (67,6%) va
co du'Ong kinh trung binh la 1,02mm. DOng mach bang quang duai có nguyen uy tit Ong mach
run (73,5% hoac chung mot than voi d'Ong mach miring dadi va dOng mach then trong (26,4%),
duang kinh dia deing mach bang quang duoi lel 1,3mm).
6.2. TINH MACH.
Cdc tinh mach tao nen mot dam r6i a hai ben bang quang, dam r6i tinh mach bang quang
(plexus venosus vesicalis) rOi tit do d6 vao tinh mach chau trong (vena iliaca interna).
6.3. BACH MACH.
Cat mach bach huyet di doc theo cdc tinh mach va d6 vao cdc hach bach huye't doc dOng
mach chau trong.

6.4. THAN KINH. GOm cdc than kinh tach tit ddm r6i ha vi va cdc than kinh ding 2 yd.
cling 3 (S2, S3). Cdc than kinh nay chi ph6i van dOng cho lap co bang quang &Ong thOi nhan
nhiing cam gide Ur bang quang, chit ye-u la cam gidc tang day, cam gide dau va rat bong.

NIEU DA 0

NiOu dao (urethra) la 6ng dan nuresc tidu to bang quang ra ngoai. NiOu dao nam va nci khac
nhau.

NIEU DAO NAM

NiOu dao nam vita la 6ng clan nu'ac tigu vita la &ging xudt tinh.

I. DAI CeCING
1.1. DTIONG DI. NiOu dao bat dau tii c6 bang quang a 16 niOu dao trong (cdch cho giaa gd
mu 3cm ve phia sau) di thang xu6ng dtrai xuyen qua tuye-n tin likt, sau do di qua hoanh chau
va hoanh niku due, tong ra truck va len tren Om 10 bet dtrai khap mu (cach ber nay 1,5cm) r6i
di vao g6c va than dumg vat tai dinh cua quy dau.

214
 1.2. PHAN DOAN (H.41.13). Ve phuong dien giai phau, nieu dao &toe chia lam ba doan :
doan tien liet (pars prostatica), doan mang (pars membranacea), va doan x6p (pars spongiosa).
Ve phu'ong dien sinh ly nguai ta chia nieu dao lam hai doan : nieu dao sau : gom doan tien
liet Ira doan mang, va nieu dao trade la doan x6p.

ieuciao tien lie t NiOu

da o
sau
NiOu dao mang

NiOu (Igo x6p

Hinh 41.13: So a nieu dao nam

Ve phitong dien phau thuat ngitai ta chia nieu dao lam hai doan :
—Doan co dinh : go'm doan tien het, doan mang va phan nieu dao x6p tit nieu dao mang
den day treo duong vat.
—Doan di &Ong : la phan nieu dao x6p gidi han tit day treo du'ong vat den 18 nieu dao ngoai.

1.3. KICH TH1I C.

Khi &tong vat mem, nieu dao dai khoang 16cm. Trong do doan tier' het dai khoang
2,5-3cm, doan mang khoang 1,2cm va doan x6p khoang 12cm.
Liic khong ti6u, nieu dao chi la mot khe thang doc a doan dau du'ong vat, hinh chit T
ngitoc trong than diking vat, khe ngang a doan mang va tong ra sau a doan tien 1*. Liic di
tidu, nieu dao nor thanh mot ong khong deli. Co ba doan phinh va ban doan hep.
Cac doan phinh gom :
—H6 thuyen (fossa navicularis urethrae) a dau du'ong vat.
—Doan nieu dao a hanh &long vat (bulbus penis).
—Xoang tien liet (sinus prostaticus) a doan tien liet.
215
 Cac doan hep gOm :
—L6 nieu dao ngoai (ostium urethrae externum).
— Doan nieu deo trong vat x6p.
—Doan nieu deo mang.
—Doan nieu dao a c6 bang quang.
Tuy nhien, nieu dao co the duvc nong to va keo dai thanh met 6ng thong khi th6ng nieu
deo bang 6ng thong sat.

2. HINH THE TRONG

2.1. DOAN TIEN LI 'E'T (H.41.11).
Thanh nieu dao doan tien liet ngay gifla of' met ch6 n6i g6 len goi là mao nieu deo
(crista urethralis). Mao nieu deo dOi khi lien tiep vdi lu-di bang quang a tren va di xu6ng ten
nieu dao mango diteti. O ch6 not giila 1/3 gida va 1/3 dutri cua doan nay, mao nieu dao nd r6ng
thanh met 16i hinh bau duc goi la 16i tinh (colliculus seminalis). 0 gicia 16i tinh có 16 ciia tui
beu due tuyen tien liet (utriculus protaticus), va hai ben có hai 16 cila 6ng phong tinh. Tdi bau
duc tuyen tien Het la deu vet can 14i ciia phen cu6i dia 6ng can trung then, Wong dug vdi tii
cung va am dao a nil.
Hai ben 16i tinh là hai ranh, a day ranh có nhieu 16 nhO cila cac 6ng tuyen tien liet d6 vao.

2.2. DOAN MANG (11.41.14).

CO nhieu nep doc. Khi di tidu cac nep nay met di.

2.3. DOAN XOP.

Ngoad cac nep doc can co :
— L6 cua hai tuyen hanh-nieu dao (gl. bulbourethralis), d6 vao doan deu cila nieu deo x6p.
—L6 cila cac h6c nieu dao (lacunae urethrales) la nhfing ch6 loom dao sau vao niem mac
nieu deo, có cac tuyen nieu deo (gl. urethrales).
—Van 11.6 thuyen (valvula fossae navicularis) la mot nep ngang o mat tren nieu dao each 16
nieu dao ngoai khoang 1-2cm.

2. LIEN QUAN
3.1. DOAN TIEN LIFT.
Nieu dao doan nay xuyen qua tuyen den liet tit day den dinh nhung khong chey theo true cila
tuyen. Nieu deo chay fthong xu6ng dutd, hod tong lOm ra trutic. Con true ciia tuyen chey chech
xu6ng dutd va ra trutic. Nieu dao va true &la tuyen bat cheo u phia dutd gen dinh tuyen nen Mu
het nieu dao a trikc true tuyen, co khi chi co met phen nho cda tuyen d twac nieu deo.

216
 Co bang quang
Ca that trun
Lot tinh
Ld 6ng phOng tinh

Ld tigt Ld tat bau dug

tuygn tio'n liet tuygn ties liet

Tuygn hanh nieu dad

Cc that van
Ranh x6p

Vat hang

Vat x6p

H6 thuygn

Quy clau

Ld ngoai nieu ciao

Hinh 41.14 : Thanh sau nieu dao nam (mat trong)

3.2. DOAN MANG.
Nieu dao mang di Ur dinh tuyen tin het tth hanh &fang vat (bulbus penis), qua ca hoanh
chau va hoanh nieu duc. Trong hoanh nieu due, nieu dao &lac co that van nieu dao (m.
sphincter vesicae) bao quanh. Khi ra khoi hoanh nieu duc, thanh sau nieu dao di ngay vao vat
x6p, trong khi thanh trade con met phan a ngoai vat x6p. Day la chi3 de bi thong khi thong
nieu ciao bang 6ng thong sat.
O phia truck, nieu dao lien quan vai dam r6i tinh mach bang quang. Doan mang de bi ton
thuang khi nga kidu ngeli ngkia. Ngoai ra vi lien quan vdi mac day chau gifta nen lien quan vdi
)(Yang chau, do do nieu dao mang co the dart khi gay 'awing chau.
3.3. DOAN XOP.
Nieu dao down x6p lien quan cha yea vai vat x6p a xung quanh.

217
4. CAU TRI:TC CUA THANH NIEU DAO
Thanh nieu dao duoc cau tao be i hai ldp :

4.1. LOP NIEM MAC rat chun gian nen c6 the tang ra khi di tidu hay nong nieu dao.
Nhung ding vi dac tinh nay ma khi nieu dao hai dau tach xa nhau lam midc tidu de bi
ngam vao mo xung quanh va phau thuat vien kho tim hai dau dirt dd n6i. lai. Niem mac c6
nhieu tuygn nieu dao, tiet ra met chit lam trail long nieu dao. Cac tuyen nay c6 khi nam sau a
day cac h6c nieu dao, nen khi bi viem niem mac nieu dao, tinh trang viem de tra thanh man
tinh va lam hep nieu dao (nit& l¢ viem do vi trang lecu). Ldp niem mac bin dOi thanh hang
tinh mach, dac bit ar doan nieu dao dtiong vat tra thanh vat x6p.
'4.2. LOP CO g6m cac thd cc doc ar trong va cc \Tong a ngoai. Lap ca doc doan tien Het Ara
doan mang la sU tiep n6i vdi lap co a bang quang phia tren. Ldp co vOng a c6 bang quang day
len va tao nen met cau frac c6 chile nang nhu met co that gitip cho nude tidu du'oc gift trong
bang quang giita hai Fan di tidu. Vi cau triic nay a tren to 6ng phong tinh, nen khi giao hop,
tinh dich khong trio nguoc len bang quang ma chi c6 the xu6ng throng vat va duoc ph6ng ra
ngoai.

5. MACH MAU - THAN KINH

5.1. BONG MACH.

—Doan tien het : du'oc nuoi diking bai Ong mach bang quang dudi va Ong mach truc
trang
—Doan mang : duqc nuoi &rang bai deng mach hanh diking vat (a. bulbi penis).
—Doan x6p : duo'c nuoi dating bdi Ong mach nieu dao (a. urethralis) va met s6 nhanh cua
Ong mach sau du'ang vat (a. profunda penis) va Ong mach mu du'o'ng vat (a. dorsalis penis).

5.2. TINH MACH.

Mau tinh mach clan tii cac doan nieu dao d6 ve dam r6i tinh mach tuyen tien liOt (plexus
venosus prostaticus) va tinh mach then trong (v. pudenda interna).

5.3. BACH MACH.

Bach mach tit nieu dao tien liet va doan mang d6 vao cac hach doc dOng mach then trong
r6i d6 vao cac hack doc dOng mach chau trong. Doi vdi doan x6p, hau h.& bath mach dO vao
cac hach ben sau, mot s6 dO vao cac hach doc Ong mach chau ngoai.

5.4. THAN KINH.

Xuat phat tit dam r6i tien lit (plexus prostaticus) va cac nhanh dm than kinh then.

218
 NIEU DAO NC

Nieu dao nd Wong Ling v6i nieu dao doan tin het va doan mang a nam, di tit 16 nieu dao
trong a c6 bang quang -Lai 16 nieu dao ngoai d am 110, dai khoang 3-4cm.
L6 nieu dao ngoai là not hep nhat cua nieu dao, nam gida hai moi nho, d phia trade 16 am
dao, 6 phia dual va sau am vat. Tren diking di, nieu dao cung xuyen qua hoanh chau va hoanh
nieu duc va c6 lien quan vdi cac hoanh nay.
Hinh the trong : niem mac ding c6 mao nieu dao a phia sau (nhung khong có lOi tinh) va
nhdrig ne-p doc. On 16 nieu dao ngoai, c6 hai 16 thong &la tuyan Skene.
Mach mau va than kinh Wang tit nhu' a nam.

CAU HoI TRAC NGHWM

Chon cau tra loci dung nhat

452. Nieu quan c6 cac ch6 hep la :

a) d not not gida be than vdi nieu quan, not nieu quan bat cheo dung mach chau, doan
nieu quail trong thanh bang quang.
b) Noi n6i gida doan bung va doan chau, gida doan chau, not nieu quan bat ch6o ang cran
tinh.
c) Noi nieu quan bat cheo DM td cung, gida doan bung, doan nieu quan trong thanh bang
quang.
d) Noi nieu quan bat cheo dOng mach sinh duc, not nieu quan bat cheo 6ng clan tinh, doan
lieu quail sau bang quang.
e) Tat ca deu sai.

Dung chi tik giai pilau sau clg tra Rii cac cau 453, 454, 455.

a) TK chau -ben. d) DM sinh duc (DM tinh hodn hay bung

b) DM chau ngoai. e) a, b dung hoac a, c dung.
c) DM chau chung.

453. Bat cheo phia sau nieu quan doan bung (ben phai) la :

454. Bat cheo phia sau nieu quail doan bung (ben trai) la :

455. Bat die() phia triidc nieu quan doan bung la :

219
456. Nieu quail doan chau :
a) La doan tii mao chau tai bang quang.
b) Ben phai di two:5c DM chau trong, ben trai di sau va trong DM chau trong.
c) Bat cheo phia trade 6ng clan tinh a nam.
d) Bat cheo phia trade dOng mach tii cung a nit.
e) a, b, c, d thing.

457. Deng mach nao KHONG cho nhanh den nuoi dung nieu quart :

a) DM cha bung. d) DM chau chung.

b) DM than. e) DM bang quang
c) DM tinh hoan.

458. Phaang tien c6 dinh yang chac nhat ciia bang quang la :

a) Hoanh chau va hoanh lieu due.

b) Day chang mu tien liet.
c) Day chang r6n gida.
d) Day chang ron trong.
e) Phan philc mac tit mat tren bang quang den thanh ben chau va thanh bung trade.

459. Tam gide bang quang du'ac gidi han bai :

a) Hai 16 nieu quail va nieu dao tien het.

b) Hai 16 nieu quan -ye. 16 nieu dao trong.
c) Co bang quang, Judi bang quang va 16 nieu dao ngoai.
d) L6 nieu dao trong, itrai bang quang va 16 nieu quan ben phai.
e) Tat ca deu sai.
460. Deng mach nao sau day KHONG cung cap mau cho bang quang :
a) DM bang quang tren. d) DM then trong va DM bit.
b) DM bang quang dual. e) DM trate trang giaa.
c) DM trate trong
461. Met trong nhang ch6 phinh cua nieu dao nam la :
a) L6 nieu dao ngoai. d) Nieu dao doan mang.
b) Xoang tien het e) Nieu dao d c6 bang quang.
c) Nieu dao doan x6p.

220
462. NiOu dao doan mang la :
a) Doan nieu dao d c6 bang quang.
b) Doan nieu dao di qua hoanh chau.
c) Doan nieu dao di qua hoanh nieu duc.
d) Doan nieu dao ngay dudi hoanh nieu due, sap di vao vat x6p.
e) Doan nieu dao d hanh diking vat.
463. Nieu dao sau theo cdch goi ctia cdc nha lam sang Wang ging vdi doan nieu dao nao theo
each phan chia giai pilau :
a) Nieu dao tin Hat (doan tien HO.
b) Nieu dao x6p.
c) Nieu dao mang.
d) Nieu dao tin het va nieu dao mang.
e) Neu dao tin liat, nieu dao mang va phan c6 dinh cUa nieu dao x6p.
464. Thanh phan nao sau day KHONG có trong doan nieu dao tin hat :
a) Lai tinh.
b) Tui bdu due tuydn tin li6t.
c) L6 6ng phong tinh.
d) Tuydn hanh nieu dao.
e) Cac 6ng ngoai tidt cua tuye'n tin li6t.
Cau 465 cign 468. Chin :
a) Neu (A) thing, (B) dung. (A), (B) có lien quan nhan qua.
b) Ndu (A) thing, (B) thing. (A), (B) khong lien quan nhan qua.
c) Neu (A) thing, (B) sai.
d) Ndu (A) sai, (B) dung.
e) Ndu (A) sai, (B) sai.
465. (A) Nga kidu ng6i ngu'a (nga ng6i xoac hai than tren vat cling) thing gay dap nieu dao
doan mang. VI (B) Nieu dao a doan nay di ngay dudi )(dung mu.
466. (A) Nieu dao di thing it bi dap von, Vi (B) No nam trong vat x6p cua dung vat.
467. (A) Khi m6 lay sOi bang quang ngudi to thuang phai lam tang bang quang, VI
(B) Khi tang, bang quang se có hinh eau.
468. (A) Bang quang khong thd bi va khi gay xuong mu, Vi
(B) Gina xi ang mu va bang quang có khoang sau )(acing mu.

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 42 CO QUAN SINH DUC NC

MUC TIEU BAI GIANG

A. MUC TIEU LY THUYET

1. MO to vi tri, chile nang, hinh thd, lien quan caa bang tiling, vai tii cung, tit cung, am
dao va am ho.
2. MO to clang mach bang thing va Tang mach td cung.
3. MO to cac phdang flan gilt tit cung tai ch6.
4. Ve thiet d6 thing doc qua chau hong nit.
5. Ve thidt d6 thing doc qua vu.
6. Ve so do cat doc qua day chang rang.
7. Ve so do td thd binh thaing ctia tit cung.

B. MUC TIEU THTIC TAP

1. Chi tren xac, mo hinh vai va cac phdcing tien than tap lthac vi tri, hinh thd, lien quan
ciia bang truing, vai tit cung, tii cung va cac phating tien gift chang tai ch6.
2. Chi tren xac va cac phu'ang tien thoc tap ladle, mach bung truing va mach tit cung.
3. Chi tren xac be) phan sinh doc ngoai &la
4. Xem hinh X quang caa td cuing va voi tit cung (chap sau khi barn thualc can quang).

Crt quan sinh duc nil (organa genitalia feminina) g6m co : bung truing dd san sinh ra
truing, vol tar cung dd dan truing v6 bang tit cung, tit cung nai truing lam t6, am dao va bo phan
sinh doc ngoai dd giao hop va Wing thai tir tar cung ra ngoai. Ngoai ra can co la tuydn tidt ra
sfta trong thai ky nutli con.

1. BUONG TRUNG

Bang truing (ovarium) la mat tuydn vita ngoai tidt, (de' Wet ra vita not tidt (tie't ra

222 .
cac nOi tie't to na quye't dinh gidi tinh sinh duc phu). CO hai bu6ng truing, mot ben phai va mot
ben trai nam ap vao thanh ben dm chau hang, sau day chang rOng, c6 mau hang nhat tren
ngu'di song va mau xam nhat tren xac. Be mat buang trdng thudng nhan nhui cho tdi 16c day
thi, sau do tang ngay tang san sin vi hang thang mot trill-1g (ovum) ti6t ra tii mot nang truing
(folliculi ovarii vesiculosi) vao voi ti cung lam rach vo bung trung va tao thanh nhung vet seo
tren mat bung trimg.
1.1. HINH THE NGOAI VA LIEN QUAN.
Bang tiling co hinh mat hat dau det, kith thudc khoang 1cm be day, 2cm be rOng, va
3cm be cao.
Bung truing c6 hai mat : mat trong (facies medialis) va mat ngoai (facies lateralis). Mat trong,
16i, tiep xuc vdi cac tua cua phew voi tii cung va cac quai runt. Mat ngoai nam ap vao phut mac c6a
thanh ben chau hong trong mot h6 lOrn goi là h6 bung truing. H6 Wang thing duuc gidi han do cac
thanh phan nam ngoai pink mac dai len. Phia trade dudi la day chang rung, phia tren la eking
mach chau ngoai, phia sau là Ong mach chau trong va ni8u quan. 0 day h6 la ding mach r6n va
mach va than kinh bit (H.42.1). 0 ngudi de nhieu Mn, bung truing c6 the sa xu6ng that) hen, nam
trong h6 Claudius (Anh Mat ngoai Wang trimg c6 mot vet 16m goi la r6n bang truing
(hilus ovarii) la no'i mach va than kinh di vao bang thing.
Bung truing c6 hai boy : bar tii do (margo liber) va bar mac treo bung truing (margo
mesovaricus). Bd tii do quay ra phia sau va lien quan vdi cac quai mat con bd mac treo thi c6
mac treo, treo Wang trttng vao mat sau day chang Ong.
Bung trung c6 hai Tau : dau voi (extremitas tubaria) va dau tit cung (extremitas uterina). Dau
voi, troll hudng len tren va la nth barn c6a day chang treo Wang trang con dau tux cung nhO han
quay xu6ng dtidi, hu'dng ye phia tit cung va la nui barn cila day clang rieng Wang triing (H.42.2).

Mach bung tning

Niau quan
Mach chau ngoai
Ding mach chat, trong

Mach va Day chang reing

than kinh bit
Ring mach rein

Bang quang
Xuing mu

Hinh 42.1 : H6 bung trtZng

223
 Day chang rieng buong trang
Day chang
Day cung Eo trot treo buong trting
Bong voi
Vol tit cung

PhJu voi tit cung

Day chang r'Ong

Hinh 42.2: Bueng tri2ng va cdc phitang tiOn treo bueing trong

1.2. PHIIONG TIEN GTO BUONG TRIING VA CAC DAY CHANG BUONG TRUING.
Bu6ng trang dacfc treo la hing trong 6 pinic mac nhO mot hd th6ng day chang. Ngodi mac
treo bu6ng trying (dla mo td d tren) con co day chang treo bir6ng trying (ligamentum
suspensorium ovarii) va day chang rieng bu6ng trang (ligamentum ovarii proprium). Day chang
treo bu6ng trting barn tit dau voi cua buong trang di gida hai la day chang rung tai thanh chau
hong. Day chang nay &rue eau tao cha ydu bed than kinh va mach bu6ng trong di vao hoac di
ra khoi bu6ng trying. Day chang nay co thd lan len phia tren 6 yang that lung va d6i phtic mac
len thanh mot ndp. Day chang rieng bu6ng trang cling la mot dai mo lien kdt nam Oita hai la
day chang rOng barn tit dau tit cung caa bu6ng trang tai goc ben caa tit cung (H.42.2).
Ngoai ra có thd có mot day chang rat ngan goi là day chang voi - bu6ng trong barn tit dau
voi cua bu6ng trting t6i mat ngodi caa phdu voi tit cung.
1.3. MACH VA THAN KINH BUONG
acing mach chit ye'u la Ong mach bu6ng trdng (a. ovarica) tach ra tit Ong mach cha bung
o vang that long di trong day chang treo bu6ng trong de vao bu6ng trong o dau vol. Ngodi ra
can co nhanh bu6ng trang ctia dOng mach tit cung (H.42.10).
Tinh mach di theo Ong mach Ara tao thanh mot dam r6i tinh mach hinh day leo (plexus
pampiniformis) d On r6n bu6ng trang.
Bach huye't theo cac mach va d6 vao cac hach bach huyet 0 yang that lang.
Than kinh tach tit dam r6i bu6ng trang (plexus ovaricus) di theo dOng mach bu6ng trting
de vao bu6ng trong.

2. V6I TU CUNG
Voi ter cung (tuba uterina) con goi là voi tiling hay voi Fallope la hai Ong dai khoang hun
10cm chay ngang tit bu6ng trong tai goc ben tit cung (H.42.2), na'm gida hai la caa ba ta do caa
day chang r6ng.

224
 2.1. HINH THE NGOAI
Voi to' cung CO the phan lam bon doan : ph6u vOi, bong voi, eo voi va phan tit cung.
2.1.1. Phu voi (infundibulum tubae uterinae) loe ra nhur hinh cdi pheii co 16 bung cila voi
td cung (ostium abdominale tubae uterinae). Qua 16 nay, vOi tit cung thOng vdi 6 pink mac de
nhan trung d bu6ng trung rung vao voi. Xung quanh 16, ph'e'u voi co khoang horn 10 tua voi
(fimbriae tubae) trong do c6 met tua dai nhat goi la tua bu6ng trung (fimbria ouarica) dinh vao
&du voi ciia bu6ng trung. Trong thdi ky rung trung, nhd cdc not tiet to cdc tua nay cuang len de
chuen bi hang trang rung vao voi td cung (H.43.2.).
2.1.2. Bong voi (ampulla tubae uterinae) la phan phinh ra to nhat va dai nhat ciia voi td
cung. Thudng cat va that voi tit cung d doan nay trong Ulu thuet triet sdn. Dudi bong vOi, gida
hai la dm day chang Ong la vat tren bu6ng trung (epoophoron) di tich cua trung then (H.42.7).
2.1.3. Eo voi (isthmus tubae uterinae) la doan hep nhat cua voi, ti'ep theo b6ng voi tdi
dinh vao g6c ben td cung. Trong trudng hap chda vOi tit cung, trung thudng hay tac va lam to
doan nay.
2.1.4. PhAn cung (pars uterina) : doan nay nam trong thanh td cung dai khoang 1cm
va thOng vao bu6ng td cung Jodi 16 td cung cOa vOi (ostium uterinum tubae).

2.2. CAU TAO

Voi td cung du'ac boc phia ngoai Jodi Idp thanh mac (tunica serosa) là phdc mac cila day
chang r'eng. Dudi ldp thanh mac la tam dudi thanh mac (tela subserosa) r6i tdi Idp ca (tunica
muscularis) va trong ding la ldp niem mac (tunica mucosa) co nhieu nip voi (plicae tubariae).
Thu'ang me cOa niem mac voi c6 long chuyen chi chuyen met chieu de day tiling ve phia bang
tiff cung.

2.3. MACH VA THAN KINH

Deng mach va tinh mach la cdc nhanh voi cila mach td cung va mach bueng trung not
nhau dot bd dudi vOi. Bach mach Ira than kinh gifing nhu cua bu6ng trung.

3. TU CUNG (uterus).

Tit cung là mot co quan chda thai va day thai ra ngoai lac de. Tit cung nam trong chau
hong ngay tren dudng gida phia sau bang quang, trade true trang, dudi cdc quaff runt non va ke't
trang xich-ma va trail am dao. Kich thudc trung binh la 2cm be day (truck sau), 4cm ch6 rOng
nhat va 6cm be cao. Td cung hinh non cut hai det trade sau ma dinh quay xuang dudi, c6 mot
than, mot c6 va phan that lai gii?a than va c6 goi la eo (isthmus uteri).

3.1. HIANG VA TU. THE

Tu the sinh 1Y binh thudng cua tit cung la gap ra trade va ngd ra trade (H.43.3).
Td cung goi la gap ra trade (anteflexio) khi true caa than tit cung hap vdi true cUa c6 tit
cung mot g6c khoang 120° quay ra phia truck.

225
 Tit cung goi là nga ra trade (anteversio) khi true caa than tii cung hdp vdi true cua chau
hong (hoeic trac caa am dao) mot goc vuong quay ra phia trade.
Day la to the 1ST tuang cua tai cung nham lam cho trong tam caa tit cung rdi ra phia trade
true am dao de tit cung khong bi sa xu6ng am dao. Vi vay mot trong nhiing nguyen tac chaa sa
tit cung la lam tit cung gap va nga ra tru'dc.

Hinh 42.3: Hicang va tic the cila td cung.

a. Truc than td cung. b. Truc co tit cung c. True am dao.

3.2. HINH THE NGOAI VA LIEN QUAN. Chang to Mn ladt xet lien quan phan than va
lien quan phan c6.
3.2.1. Than. Than tit cung (corpus uteri) có hai mat : mat bang quang va mat runt.
Mat bang quang (facies vesicalis) 16i hadng ve phia triidc dual, co ph& mac pha tdi tan eo
va lat len mat bang quang tao thanh ttii cung bang quang - tit cung (excavatio vesicouterina).
Qua ttii ding nay, tit cung lien quan vdi mat tren bang quang.
Mat runt (facies intestinalis) 16i, hadng len tren va ra sau cung dddc pink mac phil. Pluic
mac lath xuiing tan phan tren am dao r6i vat len pha mat trade trate trang tao nen till cung
trate trang - tit cung (hay tai cung Douglas) (excavatio rectouterina). Qua till cung, tit cung lien
quan vdi runt non va ke't trang xich-ma (11.42.4). M. ding nay la nai thap nhat caa 6 pinic mac
nen dich trong 6 pink mac thadng dong lai a day.
Tit cung có hai 136 ben phai va ben trai (mango uteri dexter et sinister) day va trOn có day
chang rang barn. Doc bet ben gala hai la caa day chang tang, co mach tit cung va 6ng canh
bu6ng trang (paroophoron) di tich cua eing trung than (ductus inesonephricus).
Day tit cung (fundus uteri) la bet tren cua than có phut mac phi!' lien tie'p tit mat bang
quang sang mat runt. Day ding lien quan vdi cac quai runt non va kgt trang xich ma, Hai goc
ben dm than tit cung lien tigp vdi eo voi tit cung la nth barn ciia day chang trOn va day chang
rieng bu6ng

226
Day ch6ng
treo bu6ng trCing

Buong trang

Tip cung

Tui cung
bang quang
Xtio'ng mu
ter cung
Tnrc trang
Bang quang
Tat cung
Am dao. !we trang
cung

Hinh 42.4: Thieft d6 thing doc qua chau hong nil.

3.2.2. CO tit cung. Co tit cung (cervix uteri) c6 am ciao bam vao chia co ter cung thanh hai
phan : phan tren am dao va phan am dao. Am dao barn Ong quanh c6 tit cung theo mot &tang
che-ch xu6ng dadi va ra tradc, a phan sau barn vao khoang gifia c6 tit cung can a phia track barn
th6p Iran vao khoang mot phan ba du'ai c6.
3.2.2.1. Phan tren am dao (portio supravaginalis). C1 mat truac, c6 tii cung dinh vao mat
sau dadi bang quang bai mot to chile to boo long leo de bac tach con a mat sau thi ce phdc mac
phi', qua tui ding trkfc trang - tit cung c6 tit cung lien quan vdi tryc trang.
3.2.2.2. Phan am dao (portio vaginalis). Phan am dao c6 tit cung trong nha mot mom
ca me the vao trong bu6ng am dao. O dinh cua mom c6 16 tii cung (ostium uteri). L6 hInh troll
ngu la ngdai chu'a de, con a nguai da de thi 16 be ngang ra (H.42.5). L6 du'ac gidi han bai hai
map : mep truck (labium anterius) va mop sau (labium posterius). L6 thong vac) 6ng c6 tit cung
(canalis cervicis uteri). Ong nay thong a trong vdi bu6ng tit cung (cavum uteri). O thanh trade
va thanh sau 6ng, niem mac c6 mot ngp doc va cac ne-p ngang goi là ne'p la co (plicae
palmatae) (H.42.6) va co cac tuyen c6 tit cung (gll. cervicales uteri).
Cac thanh am dao quay xung quanh ram ca me tao thanh Om am dao (fornix vaginae).
Warr am dao la mot ttli bit veng g6m b6n doan : t6i bit trudc, tai bit sau va hai t6i bit ben. T6i

227
bit sau sau horn ca va lien quan d sau vdi tui cung trkfc trang - tit cung. Do dO co the th6 ng6n
tay vao am ciao tdi tdi bit sau de tham kham tinh trang cua ttli ding trkfc trang - tit cung
(chdng han trong trifling hop ce ma hoc mciu long tai cang thi benh nhdn se reit dau).

Mep sau

Hinh 42.5 : Lo trl cung

A : Chita cU ldn new
B : De mot ldn
C : De nhieu liin

Buong cung

Cac neP ngang

} NO ta co
Nep doc

Lo ter cung

Hinh 42.6: Ong co trl cung vet biking till' cung.

3.3. CAC DAY CHANG. Tit cung gift tai ch6 nhai mot s6 day chang n6i tit cung vdi
cdc thanh cua chau hong.
3.3.1. Day chang rOng (lig. latum uteri) (H.42.7). Day chang Ong la mot nep gom hai la
phdc mac lien tiell) vdi phOc mac d mat bang quang va mat runt cua tit cung bdm tit bar ben td
cung va Woi tci cung tdi thanh ben chau hong. Day chang rOng co hai mat va brin 'DO :

228
 buang ming
Day ching thdt lung buOng trjng Mau quan

BOng vol
Day chkig &on H6 CLIUGYIJS
Buang trdng Nob td cung cling
Tii cung Tdi cling truc trang - td cung
Than td cung,, Td cung
Bang Tiii cung am dao sau
Tui cling hi cung bang quang
/Truc trang
Khoang hucic
bang quang

Am dao

Anh XXXVIII : Thiet do cluing doe qua.ch4u hong nu

229
 V6i td cung

Vat fres n buong trang Day chang

treo buong trang
Day chang rieng bu6ng tn'ing

Bu6ng trang

Day chang rOng

Niau quan

D6ng mach tii cung

Hinh 42.7 : Day „hang rOng (nhin sau).

— Mat truck dual lien quan vai bang quang va co mot ne-p pink mac di tit g6c ben tit cung
tai thanh chau hong do day chang troll dOi len.
—Mat sau tren lien quan vai cac quai runt non va ke't trang xich-ma c6 day chang rieng
bu6ng trang dOi len va c6 mac treo bu6ng truing dinh vao.
— Bo trong dinh vao ba ben tit cung
—Ba ngoai dinh vao thanh ben chau hong do 2 la philc mac cila day chang Ong lien tie-p
ra phia truck va phia sau vai philc mac thanh.

Vei to' cung Buong trang

Mac treo vOi tU cung

Mac treo bu6ng triing

Day chang trOn

Day day chang rang

DOng mach cung Nrau quan

Hinh 42.8 : Thie't d6 thing doc qua day chang rOng.

230
 — BO tren td do, boc lay vol tit cung.
— BO duai goi la day day chang rung, not hai la phut mac tach xa nhau ra de lien ti6p yeti
phia trade va phia sau phut mac thanh.
day day chang rung c6 thing mach tit cung bat cheo phia truck niOu wan. Cho bat cheo
each c6 tit cung khoang 1,5 cm.
Phan day chang rung d tren day goi la phan earth g6m ba mac treo : mac treo cung
(mesometrium) o trong dual, mac treo voi tit cung (mesocalpinx) d tren va mac treo bu6ng truing
(mesovarium) a sau (H.42.8). Giaa hai la mac treo vai tit cung c6 vat tren bu6ng thing
(epoophoron) la di tich caa vat trung than (H.42.7).
3.3.2. Day ch'Ang tron (ligamentum teres uteri) là mOt scri day chang mO lien lcgt diidi
pink mac dai khoang 15 cm barn td goc ben dia day tit cung chay ra phia track dOi la trade caa
day chang Ong len r6i chuff vao 16 ben sau di trong 6ng ben ra 16 ben nong r6i toa ra thanh
nhieu sgi nh6 de tan 11.6t 6 me lien ket dia go mu va mOi ldn dia. am N.
3.3.3. Day chkng tiit cung - cung la mOt dai m6 lien ket va co tran barn tit mat sau c6 tit
cung a gdn 136 ben r6i toa ra sau va len tren di hai ben trdc trang dOi phut mac len thanh n6p
trdc trang - tit cung. 1\l'ep nay la gidi han ben dia tai ding trdc trang - tit cung (H.42.9). Sau
ding day chang tit cung - ding bam vao mat truck xdung ding.

DOng mach rein

Bang quang

Tui cling bang Day chang tr6n

quang tit cung
: i...:1,zumgru,s+011)
-4V.
TU cung

Day chang rung

Toi cung
talc trang - tit cung Buong triing

Day chang
ttY cung ding

Try'c trang

Hinh 42.9 : So d6 cac day cluing girl tie cung (nhin tren xudng)

3.3.4. Day chang ngang co tut cung hay day chang Mackenrodt cung la mOt dai mo xcr
lien ket barn tit bd ben c6 td cung ngay tren phan ben vain cilia am dao r6i di ngang sang
thanh ben chau hang °lath day day chang Ong va tren hoanh chau hong.

231
 3.4. H1NH THE TRONG CUA TI LUNG.
3.4.1. Buiing tut cung (cavum uteri) (H.42.6)
Tit cung &roc doc rang thanh mot khoang det theo chie- u sau va thdt lai a ch8 eo tit
cung chia khoang thanh hai bang : bang nh6 a cludi nam trong c6 tit cung goi là 6ng c6 tit
cung (cid not a pha'n co tiC cung) va bu6ng to a trong tit cung goi IA bang tit cung c6 hinh tarn
gidc ma 3 canh 161 ve phia long tam gide. Hai goc ben thong vai vOi cung, con g6c dual
thong vai eing c6 tit cung. Hai thanh truck va sau cera bang tit cung dp sat vao nhau. Chieu sau
trung binh tit 18 tit cung tai ddy bang tit cung khoang 3 cm.
3.4.2. Cat' tao mid tut cung. Tit cung duz.fc can tao tit ngodi van trong g6m :
– Lap thanh mac (tunica serosa) hay lap ngoai tii cung (perimetrium).
Lap nay là ph& mac boc ter cung da du'ac ma to a phdn lien quan. Dual lap thanh mac là
tam cluai thanh mac (tela subserosa)
– Lap ca (tunica musculosa) hay (myometrium) hai khdc nhau a plidn than va phan c6.
phAn than tit cung, c6 ba tang ca. Tdng ngoai g6m cac thei co doc va mot it ca yang.
Tang gida rat day goi là lap ca r6i g6m cdc than co dan cheo nhau chang chit quail lay cdc mach
mdu. Vi c6 nhi6u mach mdu nen ngttisi to goi tang nay là tang mach (stratum vasculosum).
Chinh nhO tang co gida nay ma mdu chive cam lai sau khi sinh de. Tang trong chu yeeu g6m cdc
than ca yang.
DOng mach chau trong

Eking mach &Ring trang

Nhanh buong trang
Nhanh trot tn'!

NI-0u quan Nhanh

than to cung
DOng mach to cung

CO bit trong Nhanh

cc to cung
Nhanh niOu quan — Nhanh am dao

Co* nang hair mon

Hinh 42.10 : DOng mach td cung

232
 phan co ti.'t cung, ca 'ming hcn nhieu va khong c6 tang ca rel. CM cod mot tang ca yang
kep giaa hai tang car doc.
— Lap niem mac (tunica mucosa) hay ldp trong tit cung (endometrium) Tang manh va dinh
chat vao ldp ca. Niem mac day mang theo chu lc* kinh nguyet hang thang va khi bong ra thi
gay hien tucing kinh nguyet.
3.5. MACH VA THAN KINH CUA TIC CUNG.
3.5.1. DOng mach. Ta cung nhan mdu tit deng mach tit cung. Deng mach tci cung
(a. uterina) la met nhanh caa Ong mach chau trong di theo ba doan (H.42.10) :
— Doan thanh ben chau hong : Ong mach dp sat vao mac co bit trong gidi horn nen phia
du'di h6 bung trang.
— Doan day day chang reng : &Ong mach chay ngang tit thanh ben chau hong di trong ddy
day chang Ong tdi 136 ben tut cung.
Deng mach bat die° phia trudc nieu quan ar cdch co ti cung khoang 1,5 cm. Can chi' 3'i de
khong kep vao nieu quan khi that Ong mach tit cung.
— Doan 136 ben tit cung : d'eng mach tit day day chang Ong tdi sat c6 tit cung roi qu'a't len
chay sat vao ba ben than tit cung. doan nay Ong mach chay xoan 6c de c6 the gian ra khi
tit cung to len laic chaa thai.
Tren dtrang di, Ong mach cho cac nhdnh ben cho nieu quan, bang quang, am dao, c6 va
than tit cung. Deng mach tan clang a g6c ben than tit cung gitra ch6 bam dia day chang tr6n va
day chang rieng Wang tiling bang each chia hai nhanh cung la nhanh bang truing (ramus
ovaricus) va nhd.nh voi. trang (ramus tubarius). Hai nhanh nay nOot vai hai nhanh Wang ging caa
Ong mach bung truing.
3.5.2. Tinh mach. Tinh mach to cung (v. uterinae) d6 vao cac dam r6i tinh mach day dac
a 136 ben tit cung. Cdc dam rol nay se n6i vai cac dam rol bung truing rai ding d6 va cac tinh
mach tit cung va sau ding va tinh mach chau trong.
3.5.3. Bach mach. Cdc bach mach d c6 va a than tit cung thong n6i nhau va d6 vao met
than chung chay doc ben ngoai Ong mach tit cung va cu6i ding do vao cac hach bach huye't caa
cac &Ong mach chau hoac Ong mach chu bung.
3.5.4. Than kinh. Tit cung duac chi ph6i bdi dam r6i than kinh tit cung am dao (plexus
uterovaginalis). Ddm r6i nay torch ra tic ddm r6i than kinh ha vi dual (plexus hypogastricus
inferior) di trong day chang tit cung - ding de tdi tit cung d ch6 eo tic cung..

4. AM DAO.
Am dao (vagina) la met 6ng co mac rat dan hei dai trung binh khoang 8 cm barn tic c6 tit
cung tdi tien dinh am ho. Am dao norm sau bang quang va tru'ac truc trang, chay chgch ra trudc
va xu6ng dudi theo true chau hong nen truc am dao hap vdi dung ngang met g6c 70° quay ra
phia sau. Hai thanh trtidc va sau am dao dp sat vao nhau va thanh sau dai hon thanh trudc
khoang 1 hoac 2cm.
233
 41. LIEN QUAN. Am dao có hai thanh : tru'ac va sau; hai ba ben va hai dau tier' va daai
(H.42.4).
4.1.1. Thanh trithe (paries anterior) lien quan a tren vdi bang quang Ira nieu quail Ira a
daai Arai nieu dao. Giaa am dao va cac ea quan nay ngan each bai mot vach m6 lien ket. Co the
bi do bang quang am dao trong cac traang hap de kilo bi rach thanh trade am dao.
4.1.2. Thanh sau (paries posterior) lien quan tit tren xiang dadi vdi tai ding tryc trang tit
cung, r6i vdi mat traac tru'c trang cho tai tan cac lap mac day chau. Cl phla tren lap mac co' day
chau, khi am dao tiep tut di chech ra track thi 6ng hau mon be gap ra phia sau tao thanh
khoang tam giac am dao - true trang, nai co trung tam gan curia day chau. Am dao cling ngan
each vdi tru'c trang bai mot vach mO lien ket xa. CO the bi do am dao - tryc trang trong twang
hap de kho nhu chi bang quang - am dao.
4.1.3. Bd ben am dao. O 2/3 tren ba nam trong chau hong va lien quan vdi nieu quan va
cac nhanh dm mach va than kinh am dao cling nhu lap mo to bao lien ket trong khoang chau
hong &raj pink mac. d 1/3 clued am dao bo lien quan vdi lap can ca day chau, cu the la be(
trong ca nang hau mon va lap mac ca day chau gida.
4.1.4. DAu tren dinh xung quanh c6 tit cung thanh yam am dao (dei noi a pha'n co td
cung).

4.1.5. DA.0 &fed am dao ma vao tien am hO. C1 trinh nit, 16 clued am dao nay du'ac day bai
mot nep niem mac thUng a giita goi là mang trinh (hymen). Khi de mang trinh bi rach ra va
thanh cac manh rach mang trinh (carunculae hymenales). L6 daai am dao có cac did ca hanh
hang bao quanh nhu là mot ca that am dao (sphincter vaginae).
4.2. HINH THE TRONG. CI mat trong am dao co nhang nep ngang do niem mac day len
goi là cac ger am dao (rugae vaginales). mat trade va mat sau lai có mot 16i doc goi là cot am
dao (columnae rugarum). COt tru'ac (columna rugarum anterior) thaang phat tridn han cot sau
(columna rugarum posterior).
W tau tao : am dao g6m hai lap : lap ca (tunica muscularis) có hai tang : tang doc a
ngoai, tang yang a trong va lap niem mac (tunica mucosa) thaang khong co tuyen. Cac chat
nhay a am dao là do cac tuyen cua c6 tit cung tiet ra. Thin du'di niem mac co nhieu mach mau
githig nhu mot tang Wang.
4.3. MACH VA THAN KINH. DOng mach cho am dao (a. vaginalis) tach tit Ong mach WI
cung hoac tit dOng mach truc trang gifia ho4c trip tie-p tii &Ong mach chau trong. Tinh mach
tao thanh mot dam r6i n6i vdi dam rooi tinh mach cung a tren, dam rol tinh mach bang
quang a tru'ac va sau ding dO vao tinh mach chau trong. Bach huyet de vao chu6i Ong mach tit
cung hoac &Ong mach am dao r6i vao cac hach chau. Than kinh tach Ur dam roi ha vi.

5. BO PHAN SINN DUC NGOAI CUA NC Gad'

BO phan sinh due ngoai. cua nii gidi (partes genitales femininae externae) g6m co am hO,
am vat va 16 nieu dao.

234
 A--

5.1. AM HO (pudendum femininum) gom c6 go mu, mai lin, mai be va tier). dinh (H.42.11).
5.1.1. Go mu (mons pubis) 1.a mat ma not len a track am hO lien 66p phia du& vii mai
lan, phia tren vii thanh bung va hai ben vii nep lan ben. di dtrai lap da \Tung ge mu la 'mat lap
to chic and rat day.
5.1.2. Mil Lein (labium majus pudendi). Mai Ian la hai ne-p da lan giii han hai ben am ha.
Mai lan dai khoang 8 cm va rang 2 cm, ngan cach vii da dui bai mat ranh goi la ranh sinh due
did. Bo' trong tit do gieri han nen khe am ha (rima pudendi). Hai mai lan gap nhau a phia trait
tao thanh mop mai trout (commissura labiorum anterior) c6 nhieu long mu the phu va gap
nhau a phia sau tao thanh mep mai sau (commissura labiorum posterior) each hau mon khoang
3 cm. W cau tao, mai Ian gem co da, lap tran dac - tot (tunica dartos labialis) va mat lap ma
day co nhieu sai Chun dan hei. Day chang trail qua ong ben se barn vao day. (Thodt vi ben a
nil tuy reit hie'm gap, có the xdy ra a day). MOm bac phdc mac am ha (processus vaginalis
peritonei) tdc la ang Nuck dai khi bam a phan nay &la mai Ian.
5.1.3. MU be. Mai be (labium minus pudendi) la hai nefp niem mac nho, be dai khoang
5 cm va rang 0,5 cm nam sau mai lan va ngan each yeti mai lan bai ranh gian mai. Diu truck
tach ra thanh ngp nhO de bac lay am vat goi là mu am vat (preputium clitoridis). Dau sau dinh
vii ben dai din de thanh mat ngp khac goi la ham mai am ha (frenulum labiorum pudendi).

G6 mu
Mop mai truac

MCI am vat
Mai Ion
--- Am vat
Lei ngoai nieu dao Ham am vat
Moi be Tian dinh
L6- Het L6 am dao
tuyen tign dinh Ian
Ham mot am ho
Mang trinh
Mep m6i sau

Hinh 42.11. Am h0
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 5.1.4. Tien dinh. Tien dinh am ciao (vestibulum vaginae) là mat lam gidi horn hai ben beri
mat trong mOi be, trade la am vat, sau la ham mai am he. ei day ten dinh co 16 ngoai niOu dao
(ostium urethrae externum), to am dao (ostium vaginae), hanh tien dinh (bulbus vestibuli) va
cac 16 tiet ciia cac tuyen tien dinh ldn (gl. vestibularis major) Ara cac tuyan tier' dinh be (gl.
vestibularis minor).

5.2. AM VAT. Am vat (clitoris) Wong throng vdi &tong vat ar nam gidi nhu'ng nhO hon
nhieu. Am vat la mat tang caong nhu' dacrn.g vat nam ngay a dau trade khe am h0 doh
khdp mu. No cling daoc cau tao bai hai vat hang (corpus cavernousum clitoridis) va cling
gam hai tru (crus clitoridis), mat than (corpus clitoridis) va mat quy dal' am vat (glans
clitoridis). 0 phia du'di, quy dau dinh vdi mai be bdi mat nap niem mac goi la ham am vat
(frenulum clitoridis).

5.3. MACH VA THAN KINH Cif' A BO SINH DUC NGOAI

—Bang mach cilia go mu va mai ldn, moi be la clang mach then ngoai torch tit clang mach
din. Bang mach da am vat va hanh tien dinh, tuy6n lien dinh la cac nhanh day chau nang,
nhanh hang va nhanh mu am vat torch tit dung mach then trong.
— Tinh mach d6 vao cac tinh mach mu nong Ira mu sau r'ei van cac dam r6i tinh mach d6
ve tinh mach then trong Ara ngoai.
—Bach mach dia be sinh .duc ngoai d6 ve cac hach ben ming. Rieng cila am vat thi d6 ve
cac hach ben sau hoac cac hach chau.
—Than kinh cUa go mu va mai ldn la cac nhanh sinh duc (ramus genitalia) cila day
than kinh chau ben (n .ilioinguinalis) va sinh duc dui (n. genitofemoralis). Cac phan khac
la cac nhanh day chau (r. perinealis) ctia than kinh then (n. pudendis). Cling co mat s6 soi
giao cam va thac vat tit dam r6i ha vi di vao hanh tien dinh, tuyan tien dinh va vat hang
am vat.

6. VU
Vu (mamma) la hai co quan chda cac tuyan stia (glandula mammaria) ram a thanh tradc
ngiic, hinh nita khoi cau, trail va 16i hon d phia du'di tao thanh ranh dadi vu ngan cach vu vai
da ngae. Ranh nay cang sau neu n.gaOi cang nhieu tu6i do vu bi chay xe xu6ng. ThuOng chi có
hai vu, nhang traOng hop di dang có the co mat day vu phu (mammae accessoriae).

6.1. HINH THE NGOAI

Cl trung tam mat trade c6 mat 16i troll goi la nhti vu (papilla mammae) hay dau vu, c6
nhieu 16 nhO la 16 fiat cua cac 6n.g fiat sda. Xung quanh dau vu co mat ldp da xam hon goi la
quAng vu (areola mammae). 0 mkt qudng vu n6i len nhiing cue nhO do cac tuy6n ba cua quang
vu (glandulae areolares) clgy 16i len.

6.2. CAB TAO

Tit Ming vao sau, vu du'o'c cau tao bed (H.42.12) :

236
 Cac tuye'n &la
Dgu vG
Lap ma sau vu

Mac ming ngu'c

Hintz 42.12 : Cdu tao cda vii.

— Da : mem mai doge tang cu'ang bai cac the ca trail a quAng vu.
—Ma lien ket duai da tao thanh cac h6 ma (hay bi dp-xe dudi da).
—Cac tuy6n sita (glandulae mammaria) là loci tuy6n chum tao thanh cac tidu they (lobuli
glandulae mammariae). Nhie'u tidu thOy hap thanh cac thUy (lobi glandulae mammaria). M6i
thby d6 ra dau vii bai mat 6ng ti6t sita (ductus lactiferi). Truac di d6 ra dau vti, 6ng ti6t sita
phinh ra thanh xoang seta (sinus lactiferi).
—Lap ma sau vu rat day ngay tren mac "long cua ngitc (hay bi cip xe vii d day).
6.3. MACH VA THAN KINH
—Dong mach là cac nhanh tach ra tilt clang mach ngoc trong va clang mach ngoc ngoai.
—Tinh mach tao thanh mat mang Ming nhin rO khi có thai hoac nuoi con bu. Cac tinh
mach sau d6 v6 cac tinh mach ngoc trong va ngoc ngoai.
—Bach mach d6 ve ba chu8i hach là chu6i hach nach, chu6i hach ngoc trong va chu6i hach
tren don.
—Than kinh do cac nhanh tren don &la dam r6i co 'long va cac nhanh xien cua cac day
gian soon II, III, IV, V va VI.

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 CA.0 HOI TRAC NGHIEM
Chon cau tra lisi dung nhAt

469. H6 bung dude gidi han :

a) O trade du'di IA day chang Ong.

b) tren la DM chau ngoai.
c) C1 sau la DM chau trong va nieu quan.
d) Day h6 IA DM r6n va IA mach than kinh bit.
e) a, b, c, d dung.

470. Dan vdi cua bung trying Id nth barn cua :

a) Day chang treo bung thing.

b) Day chang voi bung tritng.
c) Day chAn.g rieng bung tning.
d) a va c dung.
e) a, b dung.

471. Mac treo bung thing treo bung trdng vao :

a) Thanh ben chau hong.

b) Mat sau day chang rOng.
c) Mat tradc day chang rOng.
d) Voi tit cung.
e) Gdc ben cua tit cung.

472. R6n bu6ng truing nam a :

a) Mat ngoai bung

b) Mat trong bung
c) Bay tit do bung tritng.
d) Ddu voi bung triing.
e) Dau tit cung cua bung

473. DQng mach buong trying :

a) Là mot nhanh cua DM chi' bung xudt phat diiUi Ong mach mac treo trong tren va tren
Ong mach mac treo trang dad.
b) Di trong day chang treo bung trying de den bung trang.

238
 c) La mot nhanh caa d6ng mach tit cung.
d) a va b
e) b va c dUng.
474. VOi tit cung :
a) Chay ngang iii bu6ng trying tdi goc ben tit cung, gala hai la ctia day chang rung.
b) G6m ba doan : ph6u vOi, bong vOi va eo voi.
c) CO hai 16 : 16 phe'u vOi thong vdi 6 bung va 16 eo vOi thong vdi bu6ng tit cung.
d) a, b, c
e) Chi a, b
475. Tit cung :
a) CO chie'u cao khoang 10 cm lac binh thuOng.
b) Gap ra trudc 90°.
c) Nga ra triidc 120°.
d) CO am dao barn vao gida c6 tit cung.
e) L6 tit cung dinh mom ca me.
476. Day chang nao sau day barn vao co tit cung :
a) Day chang Ong.
b) Day chang tit cung ding.
c) Day chang ngang c6 tit cung.
d) b va c.
e) a, b, c thing.

Dung hinh ve sau de tra loci cau 477, 478.

(1) VOi tiY cung

(2) &Jong trO'ng

(3) Day chang trOn

86 mach tit cung

NiOu quan

239
 Ham bao quy dau
Co' biu (b6 ngoai) Co quy day
Bao quy dau
Cd biu (bo trong)
Day treo &Icing vat
TTnh mach mu dudng vat
DOng mach mu dUcing vat
Than kinh mu dlidng vat

Mac n6ng

Mac sau

Anh XXXIX : Ccic lop cact tinh hoan vci cldy treo du'ong vett

240
477. Hinh ye tren muo-n m6 to
a) Lien quan cda yoi td cung.
b) Lien quan ciia bang trong.
c) Lien quan cda nieu quan.
d) Lien quan cda nieu quan va Ong mach tiY cung.
e) Noi barn cda day chang rOng.
478. Hinh ye tren :
a) Ddng. d) Said chi tie-t (3).
b) Said chi tigt (1) e) Sai d chi tie-t, (2) va (3).
c) Said chi tie-t (2).
479. DM td cung la nhanh caa :
a) DM chdu trong d) DM trdc trang gida.
b) DM chdu ngodi. e) DM then trong.
c) DM bang quang dddi.
480. Ngutri to c6 the choc do tdi clang trdc trang - td cung qua :
a) Tin ding trade cda yam am dao.
b) Tdi cung ben phai cda yam am dao.
c) Tui cung ben trai cda yam am dao.
d) Tdi ding sau cua Om am dao.
e) Khong the choc do tdi ding trdc trang - td cung qua nga am dao.
481. Am dao:
a) La eing co mac rk, dan h6i dai khoang 8 cm.
b) Chay che-ch xuo-ng dudi ya ra throe, hop mot goc 70° vdi ding ngang.
c) Thanh trade lien quan vdi nieu quan, bang quang, nieu dao.
d) a, b, c dung.
e) Chi b, c thing.
482. Ti8n dinh am dao dude gidi han bdi :
a) Hai ben la moi ldn. d) a, b, c dung.
b) Tru'dc : am vat. e) a, b, c, d8u sai.
c) Sau : mop moi sau.
483. Tuye-n vu d nil gidi :
a) Co ngu6n g6c nhd tuye-n m8 h6i. d) a, c &mg.
b) Co ngu6n go-c nhu tuye-n bd. e) b, c ddng.
c) D8 bi ap-xe khi cho con bd vi c6 nhi8u mo md.

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 43 CO QUAN SINH DK NAM

MUC TIEU BAI GIANG

A. MUC TIEU IjsIT THUYET

1. MO to vi tri, chic nang, hinh the caa tinh hoan, mao tinh, Ong clan tinh, ttzi tinh va 'Ong
phong tinh.
2. MO to mach than kinh cua ca quan sinh due nam.
3. Ve thie't d6 ngang thUng tinh.
4. Ve so d6 cau tao biu (cdt clang ngang) de giai thick sit lien tiep cac lap cua biu vai cac
lap dia thanh bung.
5. Mo to can tao caa du'ang vat.
6. Ve thie't d6 ngang duang vat.
7. MO to cdu tao va chdc nang cua tuyen tien

B. MUC TIEU THVC TAP

1. Chi tren xac, me hinh vai va caC phuang tien thuc tap khac vi tri, hinh the caa tinh
hoan, mao tinh, Ong da.n tinh, tdi tinh, Ong phong tinh va thing tinh.
2. Chi tren xac, cac phdang tien thuc tap khac c'du tao caa biu, duang vat.
3. CM tren xac, cac phuang tien thuc tap khac mach va than kinh caa co quan sinh duc nam.

Co quan sinh due nam (organa genitalia masculina) g6m co : tinh hohn, mao tinh hoan, 6ng
clan tinh, Ong phong tinh, tui tinh, thirng tinh, tuyen tien het, nieu dao va cac phan sinh due ngoai
caa nam gidi (partes genitales maseulinae externae) nhu duang vat, ni'eu dao nam va biu.

1. TINH HOAN
Tinh hoan (testis) IA mot tuyen vita ngoai tiet tao ra tinh trang va vita not ti6t, lam cho
ngttai có nhimg dac diem nam tinh phu.

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 1.1. HINH THE NGOAI.
Tinh hoan nam trong biu (scrotum) d ben trai thu'ain.g xuang thap hun ben phai. Tinh hoan
phat tridn nhanh trong hie trudng thanh, hinh train hai det, mau trdng xanh, mat nhan, true
hai chech xuang du'di va ra sau. Nang do 20 gam, dai 4,5 cm, Ong 2,5 cm. SO thay ran ran va
ndn có cam gide dau dac biet.
Tinh hoan có hai mat : mat ngodi (facies lateralis) 16i, mat trong (facies medialis) phang;
hai talc tren (extremitas superior) va du'di (extremitas inferior) va hai bar : bar truck (margo
anterior) va bat sau (margo posterior).
13 cue tren CO mot 16i con goi la mau phu tinh hoan (appendix testis) la di tich cda o'ng can
trung than.
cyc dudi có day biu (gubernaculum testis) cot tinh hoan vao biu. Tinh hohn ducfc boc
trong Ink bao the day trong va khOng dan h6i goi la lap trong (tunica albuginea).
1.2. HINH THE TRONG (H.43.1).

Ong xugt

Ong lac tren

Mgu mao tinh

Mao tinh
Luei tinh
Ong dan tinh
Mgu phy tinh hoan
Ong sinh tinh thgng

Ong sinh tinh xoan

Ong mao tinh hoan

Vach tinh hoan

Tieu thew

Lop trang
Ong lac dadi

Hinh 43.1: Sa do hinh the trong cda tinh hocin Lid mao tinh hoan

Nhin tren thik d6 b6 doe, tinh hoan dUcic phan chia thanh nhieu tigu thily (lobuli testis)
(khodng 400 tieu thdy) bdi cac vach (septula testis) di tit mat trong cUa lap trong va hQi to ve
mot ch6 goi là trung that tinh hohn (mediastinum testis) d gait tren sau cua tinh hoan. M6i tidu

243
they co tit 2-4 6ng sinh tinh xog.n (tubuli seminiferi contorti). M6i 6ng dai dO 0,7m Ira chinh cac
6ng nay san xuat ra tinh trung do? vao 6ng sinh tinh thang (tubuli seminiferi recti) chay tit dau
mai tidu thdy clan lirdi tinh hoan (rete testis) nam a phan ducli da trung that tinh hoan. Hai
thanh phan sau nay nam ngay trong trung that tinh hoan, nen chi co ldp not mo.
Tit hied tinh tach ra dO 12 - 15 6ng nha goi là 6ng xuat (ductuli efferentes testis).

2. MAO TINH (epididymis).

2.1. HINH THE NGOAI. Mao tinh CO dang hinh chit C, g6m dau (caput epididymidis),
than (corpus epididymidis) va duoi (cauda epididymidis) nam chay doc theo dau tren va bar sau
cda tinh hoan. Dau mao tinh up vao tinh hoan mot cai mu. Than khong dinh vao tinh
hoan tao thanh mot h6 bit hay xoang mao tinh (sinus epididymidis). Con duoi thi chi dinh vao
tinh hoan bai cac sdi thd.
2.2. HINH THE TRONG. O dau mao tinh, cac 6ng xuat cuOn lai thanh hinh cac non dai
(coni epididymidis) tao nen cac tidu they mao tinh (lobuli epididymidis). Cac 6ng nay d6u d6
vao mot 6ng duy nhat, goi là 6ng mao tinh (ductus epididymidis). Day la mot 6ng nho duttng
kinh khoang 0,4 mm va dai clan 6 - 7 m cutin ngoan ngoeo trong than mao tinh va xu6ng dgn
duoi thi flap tic yeti 6ng dan tinh. Tren 6ng mao tinh có cac 6ng lac (ductuli aberrantes) nhu
6ng lac tren (ductulus aberrans superior) tao thanh mai phi mao tinh (appendix epididymidis)
va 6ng lac dadi a trong duoi mao.

3. ONG DAN TINH (ductus deferens).

Ong dan tinh di tit clued mao tinh dan 16i tinh. Ong so thay ran, mau trang sang nen d6
phan bit cac thanh phan khac cua thimg tinh trong thd thuat that 6ng dan tinh. Chi6u
dai cua 6ng khoang 30 cm, diking kinh 2 - 3 mm nhu'ng long 6ng hep chi khoang 0,5 mm. Mid
vay thanh 6ng kha day va tao bdi ba ldp : ldp do ngoai (tunica adventilia), ldp co (tunica
muscularis) va ldp niem mac (tunica mucosa). Dutrng di cda. 6ng co tha chia lam 6 doan : mao
tinh, thiing tinh, 6ng ben, chau hong, sau bang quang va trong tuyan tin het. O doan sau bang
quang, khi eing den canh ttii tinh thi se phinh to ra tao thanh bong 6ng dan tinh (ampulla
ductus deferentis) ma trong long di rat nhieu tin (diverticula ampullae). Sau ding, 6ng kgt hdp
vdi 6ng tigt (ductus excretorius) cda ttii tinh de tao thanh 6ng phong tinh (ductus ejaculatorius)
(H.43.2). Ong nay dai khoang 1,5 - 2 cm. Tai ch6 bat dau cda 6ng, a mat sau gan day tuygn
tin lidt 6ng co duetng kinh chting 1,5 - 2mm nhung sau do nh6 dan, di trong tuy6n tidn hat
theo chieu hitting xu6ng du tri va ra tradc de d6 vao trong nieu dao bai hal 16 nho nam tren 16i
tinh (colliculus seminalis).

4. TUI TINH (vesicula seminalis).

Tui tinh la hal tui tach a phan cu6i 6ng dan tinh de dv' trif tinh dich va gdp phan tao nen
tinh dich. Tui hinh qua le, dai khoang 5cm, &Ong kinh rOng nhat khoang 2cm. Mat ngoai xu
xi, mat trong có nhieu nap gap, khi phan tich giai phong bao ttii co the keo dai tdi gap Ted
(10 - 12cm). Vay ttii tinh ductc xem nhu' mot 6ng gap doi lai. Tui nam chach xu6ng dual va vao
trong chay doc bet ngoai 6ng dan tinh nen hal tdi tinh tao thanh tam giac gian tui tinh, a trong
có tam gide gian 6ng tinh. Hai tdi cling nhu hal 'Ong lien quan a phia trade vai bang quang va
244
phia sau veri trite trang nen co the tham kham tt.it tinh qua du6ng true trang. Phdc mac lath
gitia bang quang Ira hai tui tinh r6i lath gifia hai tui va true trang tao nen hai tut cung : tut
ding bang quang sinh due va till ding sinh chic true trang. Do do tut tinh va 6ng tinh nam gicta
hai la dia mac tin liet philc mac. Mac nay duqc coi nha day chang rOng cua dan 'Ong.
Bang guang

Ong dan tinh

Nigu quan

Tui tinh

Bong Ong dan tinh

Tuygn tien ligt

Ong phong tinh

Cd nang hail mon

Tuygn hanh nigu dgo

Nig u dgo

Ranh )(Op

Hinh 43.2 : Sa do du'ang clan tinh a sau bang quang

Da
Ldp cd barn da
T6 chirc duel da Vach biu
Darn rgi tinh mach
Mgc tinh ngoai
hinh day leo
Co' biu Ddng mach tinh hoan
Cd biu
Mgc tinh trong
Ong dan tinh
Day chang Ddng mach
pink tinh mac 6ng clan tinh

Ddng mach cd biu

Hinh 43.3: Thie't do cdt ngang qua thing tinh (6' doan tren biu)

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5. TH1ING TINH (funiculus spermaticus).

Thimg tinh la mot 6ng chda cac thanh phdn tit biu qua 6ng ben vao trong 6 bung.
5.1. CAU TAO CflA THING TINH. Tit ngoai vao trong gom có :
— Mac tinh ngoai (fascia spermatica externa) có ngu6n g6c tit ca cheo bung ngoai, là ldp
ngoai nhdt cua thimg tinh.
— Ca biu (m. cremaster) va mac car bin (fascia cremasterica) có ngu6n g6c tit cc cheo bung trong.

DOng mach chi) bung

DO:ng mach tinh hoar?

Eking mach chau trong

DOng mach
chau ngoai
Deing mach rfin

Tui tinh
Ong an tinh

Bang quang
DOng mach
thu'ong vi duel

Dcing mach ong an tinh

De)ng mach tinh hoan

DOng mach cc biu

Mao tinh hoan

Tinh hoar?

Hinh 43.4 : Sc d6 ctOng mach tinh hocin, mao tinh hoan vet etOng mach cc biu

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 —Mac tinh trong (fascia spermatica interna) c6 ngu6n g6c tit mac ngang, la bao xo trong
cung thitng tinh.

5.2. CAC THANH PHAN CHIIA TRONG THING TINH g6m (H.43.3) :
—Ong clan tinh, Ong mach, tinh mach va ddm r6i than kinh cua otng clan tinh, Ong mach
cu biu.
— DOng mach tinh hoan a gida thong tinh, chung quanh cd tinh mach lam thanh ddm roi
tinh mach hinh day leo (plexus pampiniformis).
—Di tich mom boc tinh hoan (vestigium processus vaginalis) con goi la day chang pink
tinh mac.
5.2.1. DOng mach.
DOng mach tinh hoar' (a. testicularis) : acing mach tinh hoan tdch tit Ong mach chi' bung
ngang mdc d6t song that lung II, III. Chay d sat thanh bung sau, sau ph6c mac. Khi tdi 18 ben
sau chui vao thong tinh qua 6ng ben tdi biu de cung cap mau cho tinh hoan va mao tinh hoar'.
O ngudi Viet Nam Ong mach tinh hoan a nam hay Ong mach bung trdng a nil c6
nguyen dy tit mat trudc ben cila Ong mach chil bung (92,7%) phia dudi nguyen dy dm Ong
mach than va 7,25% cd nguyen Cy to Ong mach than. Dating kinh cua dung mach tinh hohn
ben phai la 1,12 mm va 1,01 mm a ben trai.
DOng mach 6ng clan tinh (a. ductus deferentis) : Là nhanh cila Ong mach r6n, cap mdu
cho 6ng dan tinh, tui tinh va 6ng ph6ng tinh.
Thing mach cu biu (a. cremasterica) : Tdch tit Ong mach thudng vi dudi, di trong thitng
tinh cap mdu cho cd biu va thong not vdi Ong mach tinh hoar' (H.43.4).
5.2.2. Tinh mach
Di kern vdi cdc Ong mach. Trong thitng tinh cdc tinh mach nay tao thanh dam rol tinh
mach hInh day leo.
5.2.3. Bach mach
Bach mach cda tinh hoan va mao tinh hoan chay vao dam hach canh chd, Bach mach eing
Ban tinh vao chui hach chau ngoai (nodi lymphatici iliaci externi) va &la tui tinh vao chui
hach chau trong (nodi lymphatici iliaci interni).
5.2.4. ThAn kinh
Dam roi tinh hoan tdch a ddm r6i lien mac treo trang va dam rea than. Cdc dam r6i nay
d6u thuOc 10 thong than kinh ti chd. Can dam rea 6ng clan tinh tdch a ddm r6i ha vi dudi.

6. TUYEN TIEN LIST (p ro stat a) .

Tuye'n tin Het la mot tuygn a dudi bang quang va boc chung quanh nieu dao sau. Tuygn
tin liet ngoai chdc nang ngoai tiet, tigt ra tinh dich d6 vao nieu dao .con c6 chdc nang not

247
Tinh dich ctia tuyen &Plc tigt ra bai nhieu ang tien liet (ductuli prostatici) de; vao nieu dao tier'
het a ranh hai ben 16i tinh (H.41.11). Trong tuyen tien liet can có met tin bit nha la tni bau
duc tuyen tien liet (utriculus prostaticus) ca 16 d6 a gala 16i hinh. Tin la di tich cua dau duai
'Ong can trung than va du'ac coi nhii tuang Ling vai tit cung a Mi.

Bong O'ng clan tinh

Bang quang

Tut tinh

Eo tuygn tien liet

Ong ph6ng tinh

Nie:u dao

Hinh 43.5: Sa do tuyen tien liet

6.1. VI TRf VA HINH THE NGOAI.
Tuyen tien het nam tren hoanh chau hong, duai bang quang, sau )(Long mu, giaa hai ca
nang hau mon va trade truc trang. Tuyen den liet co hinh non ma day (basis prostatae) c tren,
Binh (apex prostatae) dual, co b6n mat la mat truck (facies anterior), mat sau (facies posterior)
va hai mat duai ben (facies inferolateralis) (cludi ben phcii va dual ben trai).
W phu'ang dien giai phau ngtkri. to chia tuyen den liet lam ba thily la thUy phai va thuy
trai (lobus dexter et sinister) ngan each nhau bai met ranh a mat sau. Thiry thct ba goi la eo
tuyen tien Het (isthmus prostatae) hay they gida (lobus medius). Eo tuyen tien het nam gicia
nieu dao va 'Ong phong tinh (H.43.5). Tuyen tien Het Ong 4cm, cao 3cm va day 2,5cm. Trung
binh a ngu'ai lan tuyen nang 15 - 25g, a nguai gia tuyen co the to gap bei, thuang phat trign to
ra a phk sau, trong benh u xci tuyen tien liet, gay bi tigu.
6.2. MACH VA THAN KINH
6.2.1. Mach mau.
—DOng mach : tuyen tien het &lac cap mau bai dOng mach bang quang dui (a. vesicalis
inferior) va Ong mach true trang giiia (a. rectalis media).
—Tinh mach : tao thanh dam r6i tinh mach tien het (plexus venosus prostaticus).
6.2.2. Thdn kinh. Dam r6i tuyen lien het tach tit dam r6i ha

7. TUYEN HANH NIEU DAO.

Tuyen hanh nieu dao (glandula bulbourethralis) la hai tuyen nam trong co ngang sau, a

248
hai. ben nieu dao mang. Tuyen to bang hat ng6 va d6 vao nieu dao hanh x6p bdi 11* Eng tit
(ductus glandula bulbourethralis) (H.43.2).

8. DISCING VAT
Datong vat (penis) thuiic phan sinh due ngoai, dam nhiem ca hai chi.Ic nang nieu va sinh
duc.
8.1. MO TA. Duong vat có hai phan :
—Phan sau c6 dinh.
—Phan truck di &Ong.
Khi throng vat mem, dai d6 10cm nam trade biu.
Mixing vat Om mot re, mot than va quy dau.

Lei Mau dao ngoai

Quy dau
Ham bao quy dau
Vanh quy ddu
Co" quy dal.]
Bao quy dau
Du'ri'ng gifia &king vat

Than dueng vat

Mac during vat

Vat hang

Vat x6P

Co ngdi hang

Ca hanh x6p

.
IN

„rag=
m u,
1..1■1 „am
=MIMI
Hau mon

Hinh 43.6 : Ducing vat (nhin mat du'ai)

249
 8.1.1. la (hieing vat (radix penis) dinh vao xu'ong mu bdi day cuang treo duang vat va
dinh vao nganh dual xuang mu Lodi vat hang.
8.1.2. Than (corpus penis) hinh tru, mat tren hal det han goi la mu duang vat (dorsum
penis) va mat dtiai hay mat niau dao (facies urethralis) chicle phan ra hai nda. bed &Ong gliita
thong vat (raphe penis).
8.1.3. Quy dau (glans penis). Quy dau chicle bao boc nhigu hay it trong mat ngp nda niem
mac nda da goi la bao quy dau (preputium penis) ma a mat duai day len thanh mat ngp goi la
ham bao quy dau (frenulum preputii) (H.42.6). Bao quy dam a tre em thi rat dai. Nhigu khi bao
quy dam phi' kin quy dau chi de mat 18 rat hep d truck quy dam, khong thg trat len dugc goi la
banh hep bao quy dau (phimosis) hoac tat bao quy dau dai.
Quy dau mau hang nhat gifia c6 18 sdo hay 16 niau dao ngoai (ostium urethrae extenum).
ddy gith han bdi vanh quy dau (corona glandis). Vanh la mat ba 16i chay chgch xu6ng clad va
ra truck nen quy dau d tren dai gdp di:5i a du'ai. Gifia than va vanh quy day c6 c6 quy dhu
(collum glandis).
8.2. CAU TAO.
Dicing vat &rile cdu tao bdi cac tang cuang va cac lap boc duang vat.
8.2.1. Cac tang cutting gam c6 hai vat hang va mat vat x6p duang vat.
Cdu tao cUa ba the nay c6 nhieu h6c nh6 nhu to ong ma mdu se clan vao do khi duang vat
Wang.
—Vat hang duang vat (corpus cavernosum penis) gam hai thg hinh tru det dal 15cm thu
hep d hai dau. Phan sau dinh vao nganh dual xuang mu, co ca ng6i hang (m. ischiocavernosus)
Om quanh ba mat cua vat hang. Phan trade cua hai vat hang tkia vao nhau nhu hai 'long sung.
—Vat x6p duang vat (corpus spongiosum penis) hinh try det nam trong ranh d mat ducal
cua hai vat hang, ben trong c6 niau dao. Phan sau cua vat x6p phinh to thanh hanh duang vat
(bulbus penis). Vat x6p lien tigp vdi to chile x6p cua quy dau.
Hai co hohnh x6p (m. bulbospongiosus) dinh vao nhau &Ong gida nhu mat yang de' vat
x6p nam tren. Ca hanh x6p con torch ra mat 136 ca treo len tren lung duang vat de dinh vai b6
d6i dian.
Khi cac ca ng6i hang va hanh x6p co thi mdu se d6n len truck d trong cac tang cuang va
khong cho mdu troy vg tao nen ski Wang cua duang vat.
8.2.2. Cac lap boc &icing vat.
Dicing vat dive boc tit nong vao sau bdi cac lap nhu sau :
—Da a ngoai ding, mem, lien tip vai da cua bao quy (tau.
—Ldp to chile to bao nhao Judi da.
—Mac duang vat nong (fascia penis superficialis) nam trong lap to chile to bao nhao.

250
 Ddng mach mu doing vat
Tinh mach mu during vat
Than kinh mu diking vat
Ldp trang Vach during vat

Mac diking vat sau Mach mau mu dadng vat

Mac diking vat nong

Da
Than kinh mu
Ddng mach sau diking vat
dudng vat
VOt hang
Vat x6p
Lap trang

Hinh 43.7: Gehl tao &tang vat (thie't cid cat ngang)

- Mac du'ang vat sau (fascia penis profunda) boc quanh vat hang va vat x6p. Cac mach va
than kinh ding nam trong bao mac nay.
- Lap trang (tunica albuginea) bao boc chung quanh hai vat hang va vat x6p (H.42.7). Ldp
trang nay cua hai vat hang gap nhau tao thanh vach &tang vat (septum penis).
8.3. MACH VA THAN KINH WONG VAT.
8.3.1. Mach mau.
- Dung mach nong : la cac nhanh nho nam trong lap to chac to bao nhao du'ai da co ngu6n
g6c tit thing mach then ngoal va d6ng mach day chau nong.
- DOng mach sau : cap mau cho tang cung tach tit Ong mach then trong g6m có :
+ D'Ong mach sau duang vat (arteria profunda penis) chay giita true vat hang.
+ D6ng mach mu cluung vat (arteria dorsalis penis) chay a mu throng vat va a du'ai lap mac
throng vat sau.
- Tinh mach : cac tinh mach &tang vat d6u dO v6 tinh mach mu throng vat sau (v. dorsalis
penis profunda).
8.3.2. Thdn kinh.
Than kinh cung cap cho du'ung vat g6m :
- Than kinh mu throng vat (n. dorsalis penis) tach tit than kinh then (n. pudendus).
- Cac than kinh vat hang throng vat (nn. cavernosi penis) thu(ic 10 than kinh tit chd.

251
 9. BIU (scrotum).

Biu la mot tdi do thanh bung trill xu6ng de chda tinh hoan, mao tinh va mot phdn thdng
tinh. Thy ang thdang biu trai lan va sa xueing thgp han biu phai. Gina hai biu la mot vach soi
(septum scroti).
9.1. CAU TAO tit ngoai vao trong g6m bay lap to:mg dng vii cac lap dia thanh bung
(H.43.8).
Da : mong, có nhieu ngp nhan ngang nen có the cang rOng hay co lai throe. Co mot
—

du'ang doc, ro ngan each hai biu goi la &fang gala biu (raphe scroti).

Deing mach thdo'ng vi cludi

Day chang rdn trong
Day chang rein Oda

Co ngang bung Phac mac

),. Mac ngang
•`1,;.., ._.1
Co cheo bung tron 3_, •-\. Co' thing bung
Gan kgt hap
Can ca the
bung ngoai Can ca cheo
Da bung ngoai
ii arang vat
Ca bam da bi
Co biu
Lap and dual da li all 1

II gAll
Mao tinh
Mac ruing
Co Nu
Tinh hoan
Mac sat'

La bao , La thanh klkiljyji4

!IL
tinh hoan --
La tang ----------
Hinh 43.8 : So do cdt ddng ngang qua biu
—Lap cd bam da (tunica dartos) : la lap tao bai cac soi co tram, sal dan h6i va sqi lien
kgt Wang td nhu mot co barn da. Da biu co lai ducrc nha sit co cda lap ca barn da nay.
— Lap to bao dutdi da : la lap ma va te' bao nhao du'ai da.
—Lap mac 'long : lien tuc ben tren vii mac tinh ngoai cua thUng tinh.
— Lap cd biu : ca biu do co cheo bung trong triu xuo-ng biu trong qua trinh di xu6ng biu
cda tinh hoan. Tac dung co nay la nang tinh hohn len tren ai'ng dung tim phdn xa biu) :
252
 - Lop mac sau : la mot phan cda mac ngang (mac tinh trong) qua 18 sau cda 6ng ben
xu6ng boc quanh thimg tinh, mao tinh hoan va tinh hoan.
- Ldp bao tinh hoan (tunica vaginalis testis) : &toe tao nen do phdc mac bi loi xu6ng biu
trong qua tri.nh di xu6ng ctia tinh hoan (descensus testis) nen g6m cif) hai la : la thanh (lamina
parietalis) va la tang (lamina visceralis). Luc dau phdc mac thoc xu6ng biu thanh mot 6ng goi
la mom boc (prosessus vaginalis). Sau dO, 6ng se bit lai chi con la mot di tich khi tre da sinh ra
dOi. Neu mom nay con ton tai se gay nen thoat vi ben giap ti6p nui tiles.
9.2. MACH VA THAN KINH.
- Mach man.
+ DOng mach nong : là cac nhanh tach tit dOng mach then ngoai va dung mach day chau
nong.
+ D'Ung mach sau : do cac dUng mach dm thimg tinh cung cap.
- Tinh mach Cac tinh mach biu truck (vv. scrotales anteriores) d6 v6 tinh mach did va cac
tinh mach biu sau (vv. scrotales posteriores) d6 v6 tinh mach chau trong.
- Thin kinh. Cac than kinh biu tru'eic (n. scrotales anteriores) tach ra tit than kinh
chau ben, cac than kinh biu sau (n. scrotales posteriores) tach tit cac day day chau cila than
kinh then.
- Bach mach. Bach mach cua biu d6 v6 chu6i hach ben nong.

9
CAU HoI TRAC NGHIEM
Chon cau tra lai thing nhat

484. Thanh phan nao sau day KHONG nam trong tinh hoan va mao tinh hoan :
a) Ong sinh tinh xoAn. d) Ong phong tinh.
b) Ong sinh tinh thang. e) Ong xuat.
c) Ludi tinh.

485. Thanh phan nao sau day KHONG co trong thimg tinh :
a) Ong clan tinh.
b) DM tinh hoar'.
c) Di tich 6ng phdc tinh mac.
d) Dam r6i tinh mach hinh day leo.
e) DM thdong vi dtiot.
253
486. Thanh phan nao sau day c6 chile nang san xuat tinh trUng :

a) Ong sinh tinh thang. d) Ong xuat.

b) Ong sinh tinh xodn. e) Mao tinh.
c) Lu'di tinh.
487. D4c digm nao KHONG thing vdi 6ng clan tinh :
a) Nui san xuat tinh trUng. d) a va b dung.
b) Ncci du trif tinh dich. e) a, b va c dung.
c) Thanh 6ng mong.
488. Tuyen tin het là mot tuye'n c6 dac didm :
a) G6p phan tie't ra tinh dich.
b) Nam tren hoanh chau va du'di bang quang, sau xu'ang mu, tru'dc true trang.
c) Nang Ichoang 20g.
d) a va b dung.
e) a, b, c dung.

489. Co hanh x6p va ca ng6i hang c6 chdc nang :

a) Lam cho du'o'ng vat nh6 lai.
b) Lam cho duang vat ngan lai.
c) Lam cho mau trong vat hang va vat x6p bi i lai va lam du'ung vat cncrng.
d) Lam du'o'ng vat mem.
e) Tat ca cac cau tren d6u sai.

480. Hien Wang cu'ung du'ung vat là do :

a) Mau ui day trong vat hang va vat x6p.
b) Dich d day trong mo lien ket a duung vat.
c) Mau Cr gii a hai lap mac neing va mac sau du'ang vat.
d) Mau Cr d cac tinh mach &mg cUa &tang vat.
e) Cac cau tren d6u sai.

491. Biu duac cau tao g6m bay kip. Neu tinh tit nong vao sau, co' biu la ldp thu :
a) 2. d) 5.
b) 3. e) 6.
c) 4.
254
 Hay ghep cac thanh phan Wong king dia co quan sinh ddc nam vai ca quan sinh ddc nit
(dimg cho cac cau 492, 493, 494).
a) Tit cung. d) Am vat.
b) Bung tning. e) Mei lan.
c) Am ho. (Xem them beti 59).

492. Tinh hoar). :

493. TM bau duc tuyen tin li6t :

494. Biu :

Cam 495, 496. Chcal :

a) Neu (A) clang, (B) dung. (A), (B) c6 lien quan nhan qua.
b) Neu (A) ddng, (B) thing. (A), (B) khong lien quan nhan qua.
c) Neu (A) thing, (B) sai.
d) Neu (A) sai, (B) dung.
e) Neu (A) sai, (B) sai.

495. (A) Ngudi ta thing cat va that o'ng clan tinh de triet san a doan thUng tinh ngoai 6ng
ben ngay du'ai 16 ben nong, VI
(B) Ong tinh a doan nay c6 the nan th'ay ran ngay dudi da.

496. (A) Nguai ta ding cat va that a doan trong 6ng ben, V1
(B) Co thd rach thanh o'ng ben r6i tim ting tinh trong thUng tinh.

255
 44 DAY CHA U

MUC TIEU BAI CrIANG

A. MUC TIEU Ls;" THUYgT
1. Xac Binh vi tri, gidi han, sit phan chia va chile nang caa day chau.
2. MO to cac ldp mac, co caa day chau trudc va than kinh chi ph6i cac co day chau truck.
3. MO td cac thanh phan trong day chau sau.
4. MO td hoanh chau hong.
5. MO to mach than kinh dm day chau.
6. Giai thich y nghia cua trung tam gan day chau trong lac sinh de.
B. MUC TIEU THUG TAP
1. Chi tren xac, khung xu'ong chau vi tri gidi han va each phan chia day chau.
2. CM tren xac, cac phu'ong tien thic tap khac cac lap va cac thanh phdn trong day chau
truck va sau.
3. CM tren xac, cac phuong tien thuc tap khac mach than kinh yang day chau.

Day chau (perineum) la thanh dual ciia 6 bung. Gidi hand tren la hoanh chau hong g6m
co nang hau mon va co cut, phia tru'dc la xuzmg mu, phia sau la )(dung cut, hai ben la u ng6i,
nganh dual xtrong mu va cac day chang cang-u ng6i (lig. sacrotuberale).
Day chau du'oc chia lam hai phan bdi met dung ngang di qua ngay phia trudc hai u ng8i,
phan trade goi la day chau trudc, có hoanh nieu-duc, phan sau goi la day chau sau, CO hoanh
chau. Cac cau true cilia yang day chau d nam va rid khac nhau chit yea a day chau trudc
(H.44.1).

1. DAY CHAU TRU'dC

1.1. NAM. Day chau trudc con goi la yang nieu due (regio urogenitalis), a nam co nieu
256
dao xuyen qua, tit nong vao sau gem cdc lap (H.44.4.). Da, mac ddy chau nong, khoang ddy
chau nong, mac hohnh nieu (Inc khoang ddy chau sau, mac hoanh nieu-duc tren va hoanh
chau hong.

Khdp mu

Day chang
cung khdp mu

Day chau trudc

(tam giac nieu duc)

1) ngoi

Day chau sau

Airing cut (tam giac hau mon)
Day chang cung-
y ng6i

Hinh 44.1 : Phan yang day chau

1.1.1. Mac day chau nong.

Là ldp mo ditai da a yang ddy chau. Mac nay gem hai ldp : lap ma nong va lap mac a sau.
— Lap and nong : trong ldp ma c6 met s6 sqi car trun. Cl phia sau, cdc sqi ca nay ti6p n6i vai
met lap co Wang to' a day chau sau. d phia trtrac, ldp ma mat dan khi tdi biu va duc thay the
bai ldp car tron barn da biu.
—Lap mac : a phia sau, lap mac di yang len tren sau cdc tang axing dia diking vat de d6n
bam vac, bb' sau caa hoanh nieu-duc (diaphragma urogenitale) va citing thai cung barn vao trung
tarn gan ddy chau. hai ben, lap mac barn vao nganh xiiang chau. CI phia track,
lien tie'p vdi lap ca barn da biu.
1.1.2. Khoang day chau ming (spatium perinei superficiale).
Khoang ddy chau nong dirac gidi han bai :

- Cl dual : là lap mac ciia mac day chau nong.

- tren : la mac hoanh-nieu-duc dudi (fascia diaphragmatis urogenitalis inferior).
257
 Trong ngan day chau nong có g6c cua cac tang dicing cilia doong vat, cac co ngang day chau
nong, co ngoi hang, co hanh x6p, ding cac mach mau va than kinh den cac co nay. Cac tang cuting
dooc mo to trong phan co quan sinh due, 6 day chi de cap t6i cac co va cac cgu true lien he.
Cd ngang day chau nong (m. transversus perinei superficialis) : thirOng it phat trien, co
khi khong co (H. 44.2-A).
Nguyen ziy : phan cloth mat trong nganh xdong ngoi.
Bdm tan : trung tam gan day chau.
Than kinh : nhanh day chau dia than kinh then.
Chac Tieing : khOng clang ke.
Diking vat

Co hanh xdp

Cd ngoi hang

M?c dudi &la

hoanh nigu duc

Ca ngang
Trung tam gan day chau
nong day chau

Ca that ngoai hau mon

A - NAM

Am vat

Migng nigu dgo

Hanh tion dinh

Co ngoi hang

Mgc du'di cda

hoanh nigu duc
Am do

Ca hanh x6p
Co ngang nong
day chau
B-NU'

Hinh 44.2 : Hod/2h niOu duc - Khoang ddy chdu nong

258
 Cd ng6i hang (m. ischiocavernosus)
Nguyen ay : mat trong nganh xucing ng6i, tit do bao boc xung quanh vat hang.
Barn tan : mat trong va mat dudi vat hang.
Than kinh : nhanh day chau dia than kinh then.
Chi2c nang : lam cudng duang vat do tac dung de op len vat hang lam Kiang mau troy vd tit
ducing vat cham lai.
Cd hanh x6p (m. bulbospongiosus).
Nguyen ay : trung tam gan day chau va during gala.
Barn tan : -Ur nguyen Uy, cac tha co chay len tren va ra t'ru'ac bao boc xung quanh hanh vat
x6p. M6t s6 sai cren barn tan vao mac hoanh niau due dadi, mat s6 sal barn vao vat x6p, mat s6
s6i tach thanh mat b6 rieng vang len tren diiang vat va Ilea tan vdi cac s6i cua ca ben clo-i dian
va mac sau cUa du'ang vat.
Than kinh : nhanh day chau cila than kinh then.
Chile neing : hai ca a hai ben ding co se gay ra cac Tang tac :
• Lam cuang &tang vat.
• Tong nining giot nudc tidu hay tinh dich cueii ding ra khoi niau dao.
Tom lai, cac ca trong ngan day chau nang CO nhiam vu chu ye-u la lam along chrang vat va
duy tri sit cu'ang cUa duang vat. Than kinh van clang cac ca nay là nhanh day chau cUa than
kinh then. Mach mau nuoi cludng la clang mach day chau, nhanh dm clang mach then trong (a.
pudenda interna).
1.1.3. Khoang day chau sau (spatium perinei profundum) (H.44.4).
Khoang day chau sau chtac gidi han bai. :
- tren : là mac hohnh niau - duc tren (f diaphragmatis urogenitalis sup.).
- choi : la mac hoanh niau - due dudi. (f diaphragmatis urogenitalis inf).
Chi.dm tron ngan nay là hoanh nieu - duc g'6m hai ca ngang day chau sau va co that niau
dao (H.44.3A).
Cd ngang day chau sau (m. transversus perinei profundus).
Nguyen dy : mat trong nganh xuang ng8i.
Barn tan : trung tam gan day chau. Trong ca c6 cac ttlygn hanh niau dao.
Than kinh : than kinh lung &fang vat, mat nhanh cUa than kinh then.
Chdc ruing : * ghip co dinh trung tam gan day chau.
* co that niau dao mang.
* co bap tuyen hanh niau dao.
259
 Cd thAt nieu dao (m. sphincter urethrae).
Nguyen dy : mat trong nganh diidi micing mu. Tit day cac the ca chay ra trutc va sau nieu
dao. Ca that nieu dao khong gi6ng nhu' cac ca that khac d ch6 no khong phai la met ca yang.
Barn tan : clan Ian vao cac soi ben del dian.
Thein kinh : than kinh mu &tong vat.
Chdc nang : tong cac giot nutc tidu hay tinh dich cu6i cling ra khoi nieu dao mang.
Hai ca nay dutc the phu a tren bdi met la mac mong goi la mac hoanh nieu - dye tren va d
duti bdi met la mac khac day hon goi la mac hohnh nieu - due duti. Hai la mac nay hai ben barn
vao nganh ng6i - mu xumig chau ngay phia tren vat hang. ei phia sau, hai mac dinh vao nhau clang
thai ding dinh vao lap mac caa mac day chau nang va trung tam gan day chau. C1 phia trade, hai la
mac nay him Fan vao nhau tao nen day chang ngang day chau (lig. transversum perinei).
Mach mau nuoi &tang cho cac ca cua hoanh nieu - due cling la Ong mach day char'.
1.1.4. Trung tarn day chau (centrum tendineum perinei).
IA met nut ea va soi nam giUa 6ng hau mon va hoanh nieu-duc. Tat ca cac ca ngang day
chau nang, co ngang day chau sau, ca hanh x6p, ca nang hau mon., ca that ngoai hau mon deu
barn vao do. Ngoai ra, mac day chau Ming, hai mac hohnh nieu-clac ding barn vao trung tam
gan day chau. Trung tam gan day chau clac biet quan trong a phi' nit vi no c6 the bi xe rach
trong lac sanh. De trdnh ton thrtang nay, trong lac sanh ngatti to lam 'Urn thuat cat am N.
Trung tarn gan day chau cling quan trong trong nhang phau thuat d ca quan sinh due trong hay
hau mon - trac trang di vao bang nga day chau. De den cac ca quan nay, phai cat trung tarn
gan day chau, vi vay no elute coi flint la chia khoa ma toang vang day chau.
1.2. Nil.
Day chau tru'ac d nit tit nang den sau cling g6m cac ldp twang to nhu a nam. Tuy nhien vi
con dill'a phan duti am dao va co' quan sinh due ngoai, nen met s6 cau true co khac yeti nam,
dac biet la cac ca. Can cac mac co, mach mau, than kinh thi tu'ang tkt nhii nam.
1.2.1. Khoang day chat' nang. Trong khoang day nang cling có cac tang cutng va ba ca :
ngang day chau Ming, co ngai hang, co hanh x6p. Cac tang awing not chung nhO non d nam.
Hanh x6p va ca hanh x6p bi tach TIM bdi am dao (H.44.2.B).
Hanh xdp : drtoc goi la hanh tin dinh (bulbus vestibuli).
Cd hanh yaip : bi tach khoi ca ben cl6i din bdi phan du'eti am dao.
Nguyen uy : trung tarn On day chau.
Barn tan : tit nguyen ay, hai co chay doc ra trate yang quanh phan dried am dao. Tren
&tang di, no bao quanh hanh tin dinh r8i barn tan met phan vao xu'ung mu, met phan vao g6c
va king am vat.
Oak nang : lam khit am dao. Than kinh van deng cling là nhanh day chau caa than kinh then.
260
 Day chgng cung
khop mu

Day chgng
ngang day chdu

Ca that nidu ciao

Co ngang sau day chdu

Trung tam gan day chdu

A - NAM

Day chgng cung khdp mu

Day chgng ngang day chdu

Co that nidu ciao

Am ciao

Co' ngang sau day chdu

Trung tam gan day chdu

B-N

Hinh 44.3 : Hoanh nieu due - Khoang day chdu sew.

1.2.2. Khoang day chau sau (H.44.3.B).

Cd ngang day chau sau (m. transversus perinei profundus) kern phat tridn so \red nam
vi bi chia doi bqi am dao.
Nguyen uy : mat trong nganh xu'ang ng6i.
Barn tan : cac sqi phia sau barn yao trung tarn gan day chau, cac sqi phia truck barn vac)
thanh ben am ciao.

261
 Than kinh : than kinh lung am vat (n. dorsalis clitoridis).
Chi& ruing : gidp c6 dinh trung tam gan day chau.

Mac bang quang

Cung gan oda
co nang hau mon

Mac hoanh chau trot?

Cung gan cua mac chat'
Mac bit
D/C mu tign lio:t ngoai
Mac hoanh Tren Mac hoanh chau duel
nieu duo Du al
H6 ngoi frac trang
Khoang Sau (ngach tradc)
day chau L
Now Try chiang va:t
Ca ng6i hang
Mac cang can deli
Mac day chau ruing
Mac day chau sau

Hinh 44.4: Thie't d6 dang ngang qua hodnh nieu duc (nam)

Cot that nWu ciao.

Nguyen uy : mat trong nganh du'ai xudng mu.
Barn tan : da s6 sqi barn vao thanh ben am dao, chi c6 met it sai di ra trudc nieu dao va
di giaa nieu dao-dm dao.
Chile nang : co khang c6 chdc nang cua met co that that sq.

2. DAY CHAU SAU.

Day chau sau hay viing hau mon (regio analis) gom phan cu6i true trang, 6ng hau mon, cc
that ngoai hau mon (m. sphincter ani externus), cc nang hau men (m. levator ani), cc cut (m.
coccygeus) va kh6i ma nam trong h6 ng6i-trkfc trang (fossa ischiorectalis). Trong bai nay, khong
me to true trang Ira 6ng hall mon.

262
 Mgt phgng thief dd

Mac hoanh
chOu tren Cung gan caa
co ang au mon
X ry

Cd bit trong
-Ca nang hau mon
Mac hoanh chgu duidi
Mac hoanh niOu duo tren Mac bit
HO' ngdi treic trang
(ngach tru'dc)
Khoang day chau sau

Mgc tang can deli Try am vat

Mac hoanh nigu duo dt.tei
Ca ngdi hang
Khoang day chau nong
Hanh xdp
Tuyeh tidn dinh Ian
Mac day chau nong

Hanh troll dinh

Hinh 44.5 : Thielt cid clang ngang qua hoanh ni'eu duc (na)

2.1. HO NGOI - TREIC TRANG (fossa ischiorectalis) (H.44.6).

Là viing dacic gidi han bai da viing hau mon it dudi va hohnh chau hOng a tren. Trong h6 chu
y6u la mo mo. Tren mot thigt d6 dung ngang qua h6 ng6i-talc trang, h6 co hinh tam gide vdi :
— Thanh ngoai : la cc va mac cc bit trong. C1 thanh nay co 6ng then (canalis pudendalis),
dadc tao nen bai sit torch doi dm mac co bit trong. Trong 6ng then co than kinh then va bó
mach then trong.
— Thanh tren - trong : la hoanh chau hong va co that ngoai hau mon.
— Thanh dudi : da vOng hau mon.
H6 ng6i trust trang dude gidi hand phia trade bai bar sau cua hohnh ni4u-duc, tuy nhien h6
con co mot ngachl!I phia trudc norm giitahoanh chau va hoanh ni6u-duc, khi ra tan khoang
sau )(Long mu (spatium retropubicum). O phia sau, h6 duqc gidi han bai day chang ding -
ng6i, hai h6 a hai ben thong nhau a phia sau 6ng h41.1 mon, vi vay dp xe a mot ben h6 ng6i -
true trang co the lan sang h6 ben kia.

263
 Co va mgc Haanh chau
cd bit trong

Ong th?n Ha ngoi - talc trong

Cd that ngoai hau mon

Hinh 44.6 : Ho ngoi - tru'c trcing.

2.2. CO THAT NGOAI HAU MON (m. sphincter ani externus) (H.44.7).
La mot ca van yang xung quanh 6ng hat' mon. Thaang duac chia lam ba phan :
- Phan dudi da (pars subcutanea) : yang quanh phan thap nhat cua Ong hau mon. Cac sal
cua phan nay dan ran vao nhau ar phia tradc va sau 6ng hau mon.

Lap cd dac thanh

talc trong

Ca nang had mon

CO phan sau
that
ngoai phan nong
hau
mon phan dual da
Da quanh hau mon

Hinh 44.7 : Cd thcit ngoai hau mon

- Phan nong (pars superficialis) : a sau han phan dual da. Phia sau barn vao dinh xuang
cut va day chang hau mon cut (lig. anococcygeum), phia truck barn vao trung tam gan day chau.
- Phan sau (pars profunda) : bao quanh phan tren 6ng hau mon. Phia sau cac sal dan lan
vao ca mu - true trang (m. puborectalis), phia trade có mot s6 sqi barn vao trung tarn gan day
chau.

264
 Cd hanh hang
Co ng6i hang

_ - Cd ngang n6ng
Cd that ngdai hau mon
/ HO' ng6i trVc trang
Cd Wang hau mon

Anh XXXX : Ccic ca hoanh chet:u hong

265
 Ca hinh 10

Ca cot

Cd cha:u cr,it
ICC
Co' mu cot nang
Ca mu - tafc hau
trang mon

Hinh 44.8 : Hoanh ch(tu hong (nhin tren)

Co' bit trong

Cung gan cOa

ca nang hau mon Cc cut
Ca chau cot

4-- Cd mu cut
—
—__ Ca mu Nib trong
Chhat ngoai hau mon

Hinh 44.9 : Hoetnh chctu hong (nhin trong)

266
 Than kinh van dung la nhanh day chau dia than kinh ding 4.
Chac nang: Co thdt 6ng hau mon.

3. HOANH CHAU HONG (diaphragma pelvis) (H.44.8) va (H.44.9).

Geim co ca nang hau mon (m. levator ani) va co cut (m. coccygeus) ding hai là mac bao phu
hai mat tren va cludi dia. ca. Hoanh chau hong la gidi han tren cua viing day chau (ca day
chau truck vet day chau sau).
3.1. CO NANG HAU MON. Thing du'ac chia lam ba phan : ca mu cut (m. pubococcygeus),
co mu - true trang (m. puborectalis) va car chau - cut (m .iliococcygeus) tuy theo hudng di va ch6
bam cua cac phan ca.
+ Cd mu cut (m. pubococcygeus).
Nguyen ay : mat sau than xlicing mu va cung gan cUa ca nang hau mon. Tit do chay doc ra
sau den xu'ung cut.
Barn tan : d nhieu nai :
• Cac sai trong ding bam tan d :
—Tuye'n tin liet (nam) : tao nen ca nang tuyen tien liet (m. levator prostatae).
—Nieu dao va am dao (m?) tao nen co mu - am dao (m. pubovaginalis).
• MQt s6 sal khac barn vao trung tam gan day chau va thanh 6ng hau mon.
• Cac sai ngoai ding barn d day chang hau mon - cut.
+ Cd mu - triic trang (m. puborectalis).
Nguyen ay : mat sau than xitang mu.
Barn tan : tit xitang mu, cac thd co chay doc ra sau va not vdi co ben deli dien, tao nen met
yang ca d phia sau, ch6 not ong hau mon - tru'c trang. Mat s6 sai khac hoa fan vao co' thdt
ngoai hau mon va ldp cc doc cUa thanh trac trang.
+ Cd ch4u - cut (in. ilicococcygeus).
Thaang it phat tridn, có khi phan ldn là can.
Nguyen ay : gai ng8i va cung gan cUa ca nang hau mon.
Barn tan : xitung cut va day chang hau mon - cut.
3.2. CO CUT (m. coccygeus).
O sau ca nang hau mon. Met phan hay toan be ca có the là met tam can.
Nguyen ay : gai ng4i.
Barn tan : bc1 ngoai phan dudi xuang cung va xu'ang cut.
Than hinh : van Ong cho ca hai ca tren la nhanh tradc cila cac day than kinh ding 3,
ding 4 (S3, S4). Phan tru'dc cc; nang hau mon claac chi ph6i bdi nhanh day chau cda than kinh
then.
267
 Chile nang &la hoanh chau hong :
• Nang del cac tang trong 6 bung va yang chau, cludi ap hic ben trong bung.
• Cang vai cac ca thanh bung lam tang dp luc trong 6 bung.
• Ki6m soat su di tidu (phan ca ming tuye'n tien lift hay ca mu - am dao).
• Phan ca mu-true trang c6 vai tro trong vi6c lam gap ch'6 n6i 6ng hau mon true trang.
Luc dai ti6n, at nay dan lam cho ch8 gap nay thang ra, khi6n phan d6 thoat ra ngoai. O nit, ca
nay con c6 vai tro hudng dan dam thai nhi di thang ra ngoai trong hic sank.
3.3. MAC CH.:^iU (fascia pelvis).
G6m nhi6u phan philc tap. D6i vdi hoanh chau, c6 hai la dia mac chau bao phu a mat tren
va mat dudi hoanh chau (f diaphragmatis pelvis superior va f diaphragmatis pelvis inferior).
Tom lai, \Tung day chau v6 phuang din giai phau kha philc tap va quan trong, dac bit
day chau trudc, nth c6 lien quan nhi6u v6 cau true va chirc nang vdi ca quan tit nieu va sinh
duc.

CAU HoI TRAC NGHIEM

Chon cau tra loci clang nhat

497. Thanh phan nao sau day KHONG co trong khoang day chau nong o nam gidi :

a) G6c cua cac tang cuang d) Ca ng6i hang.

b) Ca ngang 'long day chau e) Ca hanh x6p.
c) Ca that nieu dao.

498. Khoang day chau sau clu'ac gidi han gliita hai là :

a) Mac day chau nong va là mac hoanh nieu duc

b) Mac hoanh nieu due trail. Ira mac hoanh nieu duc dudi.
c) Mac day chau nong va mac hoanh nieu duc tren.
d) Mac day chau nong va mac day chau sau.
e) Cac cau tren d6u sai.

499. Ranh gidi gicia khoang day chau 'long va khoang day chau sau la :
a) Mac day chau nong.
b) Mac hoanh nieu due tren.
c) Mac hoanh nieu due clued.
d) Hoanh nieu due.
e) Mac chau.

268
500. Tren thidt d6 dung ngang, h6 ng6i - true trang duuc giai han :
a) O tren bed hoanh chau. d) d trong bai b6ng true trang.
b) C1 du'ai bdi hoanh ni'eu duc. e) a, b &mg.
c)d ngoai bai u ng6i.
501. Hoanh chau hong :
a) LA ca nang hau mon.
b) G6m cu nang hau man va co cut.
c) G6m cu nang hau mon va cu bit trong.
d) G6m cu nang hau mOn, cu cut va Cu bit trong.
e) G6m ca nang hau mon, cu cut, ca bit trong va cc; hinh le.
502. Cu nho khong barn vao trung tam gan day chau :
a) Ca ng6i hang. d) Cu nang hau mon.
b) Cu hanh x6p. e) Cu thdt ngoai hau mOn.
c) Cu ngang sau day chau.
503. Cl yang nieu - due cac cc; trong khoang day chau nong duuc van d6ng bdi than kinh :
a) TK day chau nong.
b) KT day chau sau.
c) Nhanh day chau cUa TK then.
d) M6t nhanh cUa thdn kinh ng6i..
e) ThAn kinh lung duung vat.
504. Chon cau dling :
a) Gidi han phan chia day chau tru'dc va day chau sau la &fang ngang di qua 2 u ng6i.
b) Day chau tau& là day chau ni6u - sinh due, khac nhau gida nam va
c) Day chau sau là day chau tiet phan, gi6ng nhau giita nam va nir.
d) a, c dung.
e) a, b, c idling.
505. O nhiing nguai de con so, d6 cho thai des' s6 ra, nguai to thudng cat am hod cac didm 4 gib
hoc 8 gia dd :
a) Tranh rach am h6 176 phia sau lam rach trung tam gan day chau va true trang.
b) Tranh rach ni6u dao.
c) Tranh rach h6 ng6i true trang.
d) a, b thing.
e) a, b, c dung.
269
 45 PHUC MAC VA Sl1 PHAN KHU 6 BUNG
MVC TIEU BAI MANG
A. MUC TIEU L'sk THUYET
1.Dinh nghia ddoc phdc mac mot cdch có hinh Wong.
2. Phan biet cac la phdc mac, 6 phdc mac, cac loaf tang lien quan vdi phdc mac, cac
ngd.ch, cac nip, cac h6, cac tui cling cda pinic mac.
3. MO to ddgc mac n6i nho, mac n6i 16n, mot s6 ang dung ctia no trong lam sang.
4. MO to ddoc cac thanh cda ttii mac n6i.
5. Ve thigt d6 cat ngang tdi mac nol va thigt d6 cat citing doc tdi mac n6i de' chi dliqc cac
dtkin.g vao tdi mac n6i va y nghia cua Bing dutrng vao.
6. MO to 6ng tieu hoa hic ph& thai va ski phat trign cda pluic mac ar ba doan : quai da day,
quai runt va quai runt cu6i.

B. MUC TIEU THIIC TAP

1. Chi tren xdc, mo hinh, tieu ban va ch6 song cac la phdc mac, 6 phdc mac, cac tang
trong phdc mac, cac tang ngoai phdc mac, cac tang bi thanh h6a, tang ngoai 6 pinic mac, cac
ngp, cac h6, cac ngdch, va cac tkii cling ph& mac.
2. Chi tren xdc va chi:5 song cling nhti cac phi ung tien thdc tap lihdc cac thanh va skt lien
quan ctia tdi mac n6i.
3. Xem phim Video vg ski phdt trign phOi thai cua phdc mac.

1. DAI CVONG.
1.1. DINH NGHIA. Phdc mac hay mang bung (peritoneum) là mot mang thanh mac trail
ldng Ira Ong anh che phti tat ca cac thanh 6 bung, bao boc cac tang thuOc he tieu hoa. (ke cd cac
bó mach thdn kinh cda tang do) va che phd phia tru6c hay phia tren cac tang thufic b0 tiet
nieu sinh duc.
270
 1.2. HII\TH TVONG VP PHUC MAC.
Phtic mac rat ph& tap, mu6n c6 mot y niem hinh Wong v6 pinic mac ta xem 6 bung nhti
la v6 da cua qud banh. Ngu ta ba vao vo da nay cac tang trong o bung r6i nhet runt qud banh
vao v6 da. RuOt qua banh là mot tui kin ma thanh ttii ap sat vao nhau se len loi gifia cac tang,
the phu cac mat caa cac tang va thanh vo da. Rut qud banh Wang &rang vdi philc mac
(H.45.1A).
Cung c6 ngtiiii vi pinic mac nhti mOt, ldp son quet khong de ha mot ch8 nao vao thanh
trong 6 bung, cac tang, cac mach, thin kinh chay vao cac tang do hay tit tang no dgn tang kia.

1.3. MOT SO KHAI NIEM.

1.3.1. O bung va 6 phtic mac.
- O bung (cavum abdominis) la mot khoang kin nhu v6 qud banh gidi han a xung quanh
bai thanh bung, tren la ca hoanh, dual la day chdu. O bung cluug tat ca cac tang va chda pinic
mac.
- 6 phtic mac (cavum peritonei) la mot khoang kin Wit a plied na) nam trong 6 bung gi6ng
nhu trong runt qua banh du'oc gidi han bdi pink mac tang va pinic mac thanh. 0 ph6c mac la
met khoang do vi cac thanh c6a no ap sat vao nhau khong chda thing gi a trong do cac tang
nam sat vai nhau va nam sat vdi thanh bung.
1.3.2. La, phtic mac. Ph6c mac la mot mang lien tvc g6m co hai phdn :
— Ph-tic mac thanh (peritoneum parietale) la phan pink mac lot mat trong thanh bung.

Vd da qua banh
(thanh bung)

LOng qua banh

(6 bung)
L6ng runt qua banh
VOt (6 phOc mac)
(tang)
Rut qua banh
(phtic mac)

Hinh 45.1A: Hinh Wang ve phtic mac.

271
 Tang trong phdc mac Tang trong 6 phdo mac

Mac treo
La thanh —/
Philo
mac Tang sau
phdc mac
La tang Tang
Toi Gang ngoai
phdc
mac
Tang chidi
Day chang phdc mac

Mac n6i
Tang dinh
Mac dinh (tang bi thanh hoa)

Hinh 45.1B : Hinh tugng ye cac thanh phoin cila phitc mac.

—Phtic mac tang (peritoneum viscerale) là pilau philc mac bao boc mat ngoai cac tang.
—Lien tiep giita phdc mac thanh va pink mac tang là cac mac treo, mac nai, mac
chAng, mac dinh. Cac mac nay thuting g'Orn hai la pink mac treo hoac chang cac tang vao
thanh bung hoac noi hai tang vdi nhau. Gida hai la cila cac mac thirOng có mach va than kinh
di vao cac tang.
1.3.3. Tang trong o phtic mac, tang trong phtic mac, tang ngoai phtic mac, tang
bi thanh hoa va tang (kith thanh mac.

—Tang trong 6 pink mac : la tang nam hoan toan trong 6 phtic mac, khong có phdc
mac tang bao phu. Bu6ng trirng là tang duy nhat nam trong 6 pink mac.
—Tang trong phtic mac : là tang du'oc phdc mac che pha Wan het mat ngoai caa tang va
có mac treo hoac mac chang. Vi du : 6/ng tieu hoa tit da day Mr" phan tren troc trang d6u là
tang nam trong phiic mac. Gan, tuy, lath cung là nhang tang trong phtic mac.
—Tang ngoai phtic mac : là tang chi &roc phdc mac che phu mot phan mat ngoai cua
tang va khong có mac treo hoac mac chhng. NguOi to chia ra lam hai loai :
+ Tang sau pink mac : nhu' than, ni'eu quan.
+ Tang dirai phOc mac : g6m cac tang thuOc he nieu sinh duc d chau hOng nhu' bang quang,
tit cung, tui tinh...
—Tang bi thanh h6a : là tang kw dau duc ne-p phtic mac che phu gan het nhung sau do

272
ca mac treo Ira pink mac tang che pha tang nay bi dinh vao phut mac thanh cua thanh bung
sau. Lac dau tang di dOng nhu'ng sau do trCr len c6 dinh sat thanh bung sau Ira tang nha bi day
ra ngodi ph& mac. Nhiing tang bi thanh hoa là to trang, k6t trang len, k6t trang xuang
(H.45.1B).
—Tang dtidi thanh mac : là nhiing tang nam trong phut mac nhu'ng phut mac che pha
tang nay rat d6 bac tach ra khoi tang, nhat la khi bi viem nhi6m la phdc mac nay day len lai
tang de bOc tach.
ling dung trong phau thuat de cat tang duVi thanh mac khi tang bi viem. Nha'ng tang
dodi thanh mac la runt thita, tai mat.
1.3.4. Cac cgu true khac ciia phtic mac.
—Till cung (excavatio) la do la phut mac lath gida cac tang 6 chau hong tao thanh mot
ti sau caa phdc mac. Day la nhiing not thap nhat &la 6 phut mac ma cac dick trong 6 bung
trong cac tracing hop benh lY thu'6ng dong 6 do. Vi du : tai ding tract trang - tit cung (excavatio
rectouterina), tai cung bang quang - tit cung (excavatio vesicouterina), tai cung tract trang - bang
quang (excavatio rectovesicalis).
—Ho (fossa) la do phut mac thanh lot vao ch6 lom xuang dia. 6 bung. Vi du : h6 tren bang
quang (fossa supravesicalis), h6 ben trong (fossa inguinalis medialis), h6 ben ngoai (fossa
inguinalis lateralis) (xem bai yang ben).

Ron

NO rein giCia

Ne'p ro'n trong

Nep ro'n ngoai

H6 ben ngoai

He ben trong

HO' tren
bang quang
Bang quang

Hinh 45.1C : Cie n'e'p yet ho" clia phut mac.

273
 - Ngitch (recessus) cung do la phtic mac lath gitia cac tang hay gifia cac tang vii thanh
bung de tao thanh mot rinh hoc mot h6c nhung nhitng ranh, h6c nay khong la ch6 thip nhit
cila 6 bung. Vi du : ngach ta trang tren (recessus duodenalis superior), ngach ta trang ditch
(recessus duodenalis superior), ngach gian xich-ma (recessus intersigmoideus), ngach sau marsh
trang (recessus retrocecalis), ngach dUdi hoanh (recessus subphrenici), ngach dual. gan (recessus
subhepatici), ngach gan th4n (recessus hepatorenalis) v.v...
- Ne-p (plica) la not phzic mac bi do, i len dgy 16i vao trong 6 phtic mac bal mot to chtit hay
mot mach mau n6i len trong 6 bung. Vi du : nep to trang tren (plica duodenalis superior), ngp
ta trang dual (plica duodenalis inferior). Chinh hai ngp ph& mac nay tao ra hai ngdch ta
trang tren va dual, ne-p rein trong (plica umbilicalis medialis) do phdc mac phil len thimg dOng
mach r6n, ngp rein ngoai (plica umbilicalis lateralis) do phdc mac phil len Ong mach thdang vi
dUdi. Chinh hai ngia nay tao nen h6 ben ngoai va h6 ben trong (H.45.1.C). Hai ndp vi tuy
(plicae gastropancreaticae) la do phdc mac bi dOi len bai dung mach vi trai va Ong mach gan.

2. CAU TAO VA CHIIC NANG CUA PHUC MAC.

2.1. CAU TAO CUA PHUC MAC.

Phdc mac duttc ciu tao bai hai lap :
- Be mat phdc mac dive tao bai mot lap ti bao bidu mo hinh vay goi la lap thanh mac
(tunica serosa), lap to bao bidu mO nay lam cho pink mac rat tran lang Ara Ong anh. Mkt khac
chinh lap bidu mo nay luon tit ra mot lap dich mOng lam thim dat plitic mac. Nhei do ma bg
mat phdc mac lam tigp xuc trteic tidp Arai nhau nhang lai trap trout len nhau rat a dang, tao
digu ItiOn cho cac tang di dOng khOng có sit ma sat trong 6 bung, VI vay khi bidu mo hinh
vay nay bi ton thdang do viem nhi6m hay chin thuang lam tray xat thi cac tang rat de bi
dinh veti nhau hokc dinh vao thanh bung.
- Lap trong hay tam duai thanh mac (tela subserosa) la lap mo soi lien kit, lap nay có dO
dan h6i cao. Lap mO sal lien kit nay rat day a phdc mac thanh con a phiic mac tang va mac
treo thi mOng. NhO lap sqi lien kit ma phtic mac có dO chat chgn va dan h6i cao, gidp ta khau
n6i cac tang có phdc mac the phu (tang trong phzic mac) rat de clang so Arai tang ngoai phdc
mac. Vi du : khau n6i mit de hcrn khau n6i thttc

2.2. KfCH THIRIC PHUC MAC.

Tuy 6 ph& mac nam trong 6 bung nhung vi phdc mac gap thanh nip, tao thanh nhang
mac treo, mac n6i, mac thing, ttii ding... nen din tich phdc mac rat lan tutrng &tang with din
tich da cda ca thd.

2.3. MACH VA THAN KINH CUA PHUC MAC.

2.3.1. Mach mau. Phdc mac khong có mach mau rieng bit ma ddoc nuoi bai cac nhanh
thanh bung lan can (phzic mac thank) va nuoi &tang do mach mau tit cac tang ma no bao boc
bai ming mach mau dual thanh mac co thd thiy &tic bang mat thtking va ming trong thanh
mac (phzic mac tang).
274
 Lach
Mac n6i tuy lach
• Mac not vi lach
Day chang hoanh kat trang
Thanh king tui mac not
Than --
Tui mac not -
Re mac treo kat trang ngang
Day chang to - kat trang
Day chang hoanh ke't tran
Mac dinh tru'dc tuy

Mac dinh ke't trang len

Kat trang xu6ng
Kat trang len -----
Mac treo runt non —
H6 gian SIGMA
Re mac treo kat trang SIGMA
(phan cheo)
Re mac treo kat trang SIGMA
(phan thang)

Quai SIGMA

Anh XXXXI : Su dinh ceta ccic mac treo tc tretng, ke't tretng len vet ke't trang xtio'ng

275
 Tuye'n tinfOng than trai
Ding mach hoanh du'di
Tuyoh thilOng than phai
DO.'ng mach than tang
DOng mach mac treo
DO:ng mach thLIOng than gina
trong tran
Ding mach than
Tinh mach than _ -- Than trai
Trnh mach than
Niau guar,
— Mgc quanh than
Dang mach tinh hoan phai Tinh much tinh hoar? trai
— Dang mach tinh hoan trai
Tinh mach chu dUdi
Dang mach mac treo trang dtldi

Tinh mach tinh hoan phai — Niau quan

Tihh mach chau chung trai Tinh mach tinh hoan trai

DOng mach chau chung

Dang mach chau trong
Dang mach chau ngoai

Anh XXXXII : BOng mach chd bung va tinh mach chd du'oi

276
 Plnic mac cung có he th6ng bath mach a lap dudi thanh mac va trong thanh mac flint
mach mau.
2.3.2. Thdn kinh. Thin kinh cung cap cho phut mac g6m co cac nhanh tit : than kinh
hoanh, than kinh gian sutin XI, XII, cac nhanh ti dam r6i than kinh that lung - ding.
Than kinh cung cap cho phac.mac la cac sui than kinh cam gide va van mach.
Phac mac thanh rat nhay cam vdi cam giac dau. Ngdoc lai phut mac tang gi6ng mang
ph6i, mang tim khong co, cam giac.

2.4. VAI TRO VA CHIC NANG CUA PHUC MAC.

—Phuc mac lot mat trong 6 bung va bao boc cac tang dd the cher cac tang va lam cho
thanh caa cac tang \rang chat them.
—Nha dac tinh tran lang gitip cho cac tang di dung a clang trong 6 bung giam thidu ski
ma sat.
—Phac mac có vai tro de khang vdi nhiem trimg. Khi bi char' thuang hay nhi6m trang,
pinic mac tidt dich. Khi co nhiem trang thi phut mac co khuynh hurdng lam Wang vay quanh dd
khu tra 6 nhiem trang hay ton thuang. Khi pinic mac bi viem, tinh chat trail lang bi mat gay
dinh pinic mac (nguyen nlaan ciia tdc ruOt).
—Phac mac do kha nang hap thu rat nhanh nha c6 dien tich be mat rung nen khi tiem
dich vao ph& mac se dudc hap thu ngay.
-Ong dung : gay me cho sac vat bang each tiem dung dich h6n hop Barbiturate vao 6 phac mac.
—Chat nang phu caa phac mac la dkt tra' ma, re nhat la 6 mac n6i km nen nguai ta con
goi mac n6i ldn la ma chai.

3. PHOI THAI CUA PHUC MAC.

Sit phat tridn cua pink mac rat pink tap. Dd hidu dugs giai phau hoc cila phac mac 6
tru'ang thanh ta can phai nam so luvc vd sit tidn tridn phoi thai ciia phac mac.
Mu6n hidu phoi thai phac mac ta phai hoc :
—Ong tieu haa lac phoi thai.
— Sir phat tridn 6ng tieu h6a dudi co hoanh.
— Cac hien tudng xay ra er phac mac.
3.1. ONG TIED HOA LUC PHOI THAI.
Lac ph6i thai, ecng tieu 1-16a la met 6ng dung thang gida 6 bung, du'uc treo vao thanh bung
sau bai mac treo lung chung (mesenterium dorsale commune), trong do có ba Ong mach. chay tir
thanh bung sau vao ba doan caa 6ng tieu
Ngoai ra lai co mac treo vi tr_tdc chi treo da day vao thanh bung trddc. Doc theo bar dual
caa mac treo vi trust có tinh mach run (H.45.2).
277
 Mac treo vi tru'dc
Da day

Ddng mach Gan

vi gan nhd

Ddng mach lach

Ddng mach vi gan to

Quai runt

Nu tyy king

Day chang tran

Ddng mach mac
treo trang tren
- Ong noan hoang
Mac treo king
Ny manh trang
Rudt cu6i

Ddng mach mac Ddng mach rein

treo trang du'di

6 nhop
Hinh 45.2: Su as oing tieu hoa hic phoi thai

3.1.1. Cac loan cua 6ng tieu hoa. Ong tieu hoa ter trail xu6ng clued Om co :
—Quai da day, ma bet truck thi lom, 136 sau
— Quai td trang.
—Quai runt hay quai r6n gom c6 hai nganh : nganh tren va nganh du'di.
CO 1/4 tilt& cua nganh duldi co nu manh trang. Hai nganh not nhau 6 rein heti 6ng loan
hoang. Ong nay chay qua r6n vao thiMg r'6n, doi khi de lai di tich la tui runt Meckel.
Tui runt Meckel cung gi6ng nhu' nganh ding cua Ong mach mac treo trang tren dude coi
nhif ch8 gidi han gala hang trang va he3i trang.
tre set sinh co khi con mot phan eing noan hoang nam ar trong thing r6n, nen khi bueic
r6n can phai bu8c each xa r6n di) 8 - 10 cm de khOi that vao 6ng noan hoang. CO khi 6ng noan

278
hoang bit hai dam, mot dau la tdi runt Meckel, mot dau d r6n, can r6ng a gifta. Ch6 r6ng nay ve
sau co the tian tridn va gay thanh nang thang r6n.
Nganh tren pilot tridn thanh h6ng trang.
Nganh dudi tit 6ng noan hoang tdi nu manh trang phat tridn thanh h6i trang. Nu
manh trang bian thanh manh trang. Phan sau nu phat trien thanh ket trang len va kat
trang ngang.
—Rut cu6i di den hau mon va phat tridn thanh ket trang xuang, ket trang xich-ma va
tryc trang. Doan nay cung vdi nang nieu mac chay vac) 6 nhdp.
3.1.2. Mac treo. C6 hai mac treo, treo 6ng tieu hoa vao thanh bung trade va sau (xem
H.45.2).
3.1.2.1. Mac treo lung chung (mesenterium dorsale commune) la mot mang lien tiap tit da
day tdi runt cu6i nhu'ng ten goi khac nhau thy theo cac doan cUa 6ng tieu h6a. nint :
— Mac treo vi sau.
—Mac treo to trang.
— Mac treo tieu trang.
— Mac treo ket trang phai.
—Mac treo kat trang ngang.
— Mac treo ket trang trai.
— Mac treo ket trang xich-ma.
— Mac treo truc trang.
Trong cac mac treo nay c6 b6n mac treo : vi sau, tieu trang, kat trang ngang, kat trang
xich-ma, can gilt mai tinh di thing. Can ban mac treo khac lat sang ben va c6 dinh vao thanh
bung sau bai mac dinh.
3.1.2.2. Mac treo vi (mesogastrium) can goi là mac treo bung chi treo da day vao thanh
bung trtrac, ca tinh mach rein chay doc theo ba dudi &la mac treo.
3.1.3. DOng mach. CO ba Ong mach tach tit dOng mach eh& di tit thanh bung sau tdi
cung cap mau cho ba doan cua gng tieu
3.1.3.1. DOng mach than tang phat sinh tit dOng mach chu ngay sau da. day. Phan chia
lam ba nhanh :
—Nhanh dOng mach vi gan nho chay 1cit tai tam
—Nhanh Ong mach vi gan to chay xu6ng mon vi.
— Nhanh dOng mach lath chay doc tuy dd ddn bit tong lan da day,
3.1.3.2. DOng mach mac treo trang tren chay ngang tdi 6ng noan hoang nhii mOt, cai truc
cua quaff runt.
3.1.3.3. De.)ng mach mac treo trcing dudi chay xu6ng dudi doc theo runt cuoi.
279
 3.2. SLi PHAT TRIEN CUA ONG TIEU HOA CCi HOANH.
O bung khong phat tridn nhanh cluing nha 6ng tieu hda, va lai 6ng nay dinh a troll
vao thu'c quern, a 'Judi la hau mon, lai bi chang vao thanh bung a sau va trudc nen phai
quay, cuOn hay lat sang ben. Quay, cuOn hay 'at sang ben xay ra ding mot hic a trong ba
doan cua 6ng tieu hoa.
—Da day quay trong khu tong mach than tang.
—Quai ruOt cu6n va quay trong khu Ong mach mac treo trang tren.
—Rut cuooi lat sang ben a trong khu dOng mach mac treo trang dudi.
Trong khi cac doan 6ng tieu hda quay cu6n hay lat thi phat sinh ra gan, tuy va lach.
3.2.1. Si quay ctia da day.

Mac treo vi sau do six phat tridn cua ngach gan ruOt thanh tdi mac n6i hay hau cung mac
not nen ductc gian mong vi the da day có the quay dadc. Da day quay theo hai true :
— Theo true doc : quay 90° lam cho da day thing thang se lat sang ben, mat trai se thanh
mat trudc va b6 sau se thanh ba trai.
—Theo truc ngang (trztdc sau) lam cho tam vi nga sang trai va mon vi nga sang phai
(H.45.3).

DOng mach 14 trai

D'Ong mach gan chung

Hinh 45.3 : Sit quay clia da day

Hai Ong mach vi gan ldn va nho (sau thanh dOng mach gan va dOng mach vi trai) ding quay
theo da day va thay d6i vi tri tit binh dien clang thang nay se che-ch xu6ng dudi va sang phai.
Hai dOng mach nay se dOi mang bung len thanh hai ne-p hinh hem goi la ndp vi-tuy. Hai
ne-p gidi han mot to thong tien dinh vdi tdi chinh.

Su' quay cila da day lam cho than kinh lang thang trai nam phia trudc va than kinh lang
thang phai nam ra sau der day.

280
 3.2.2. Sur xu'at hiOn cua ngach gan rui)t.
Tren thie't a cat clang doc thi vi tri da day hic nguyen thdy la met 6rig dinh vao thanh
bung sau bai mac treo vi sau. Trong mac treo nay co chila cdc nhanh cua Ong mach than tang.
Mac treo dai len tren tai thkic quan va xu6ng tai to trang. Bar truck cua da day ddoc dinh vao
thanh bung tradc bdi mac treo vi truck. Trong mac treo nay c6 chda marn gan va ngay dual gan
co diking mat. Sau do Id phai cda mac treo lung Mug vao trong be day dia mac treo tao nen
mot tdi a mat phai cua da day. DO la ngach gan runt (H.45.4A, B, C, D). Ngach nay thoc mai
len tai co hoanh va se bign thanh tien dinh cda tai mac not (vestibulum bursa omentalis) co
hai vdch gidi han hai ben.
— Wit vach di tit gan tai tinh mach chii du'ai nen ddgc goi la mac treo gan chu. Vach nay
chinh la tre da tach a mat phai cda mac treo sau (H.45.4B).
Dung mach chi

['Ong mach gan

DOng mach lach

6 phOc mac Dg day

Gan

Hinh 45.4A . Vi tri da dciy vet gan hic chu'a quay va kit
TTnh mach chi dodi Dung mach chef

Ngach gan runt

Eking mach lach

Mac treo gan chi)

Dg day

Mgc chang (n6i)

vi gan
PhOc mac gan

Hinh 45.4B : Su hinh thdnh ngdch gan runt

281
 - Mdt vach di t6' da day tdi ddng mach chil trong dO co tuy va mach mau.
Vach nay la pha'n chinh cua mac treo con lai nen sau nay van goi la mac treo vi sau.
Ngach gan runt se phat trien theo hai be va tao nen ttli mac n6i hay hdu cung mac not (bursa
omentalis).
+ Be ngang : Ngach d phia sau da day thoc gida hai ddng mach vi gan 16'n va nhO, thtic
sang ben trai tdi thanh bung trai va ddy tuy ra phia sau. Ttii nay tao nen ttli mac n6i chinh.
+ Be doe : ngach gan runt thoc xu6ng du'di tao nen mot ttii triu xu6ng tdi tan xu'o'ng mu goi
la till mac n6i ldn sau dinh lai thanh mac n6i ldn.

Tinh mach chd dUdi

Ddng mach gan

Mac treo gan ch5 Ddng mach chti

Ddng mach lath

Ngach gan runt

De day

Mac not vi gan

Gan

Mac cheng gm

Hinh 45.4C : Ngach gan runt phdt trien

Ddng mach gan

Ddng mach lath

Ngach gan runt Ngach gan runt phat trien

De day
Mac not vi gan
Ddng mach vanh vi

Mac cithng gm Gan

Hinh 45.4D. Ngcich gan runt ph& trien sang trdi

282
 3.2.3. Si. phat trien cika gan. Gan phat sinh trong mac treo vi trade (bung) va phat tridn
rat nhanh sang ben phai len tdi cct hoanh. Gan phan chia mac treo vi trudc thanh ba phan :
—Phan trudc va tren di ta' gan tdi car hoanh va thanh bung trade goi là mac chang liem
(ligamentum falciforme hepatis).
—Phan gida bao phu quanh gan là ph& mac gan.

Da day

Gan

No toy king
7111 mat
Ta trang
Nu toy bung

Da day

Gan

Tui mat

No toy ling
Ta trang
Nu toy bong

Hinh 45.5 : Sit phcit trien ctict tci trong, tuy, gan vet mat
A. Khi diva quay.
B. Khi da quay va ldt sang ben phcii.

—Phan sau va dudi n6i gan vao da day tao thanh mac n6i vi gan hay mac n6i nhO
(omentum minus).
Gan phat tridn rat to ra sau a trong mac treo gan chu tdi tan co hoanh va tinh mach chii
ditdi. Mat sau gan dinh ngay vao car hoanh troll mot khoang rat r'Ong hinh tram det, có hai nap
phtic mac gidi han or tren va a ditdi tao nen day chang vanh (ligamentum coronarium hepatis).
Nhung hai dau phai va trai dinh sat vao nhau tao nen mac chang tam giac (ligamentum
triangulare).

283
 ssvA*t \*\

Quai to trang

Quai runt cu6i

DO:ng mach mac

treo trang tren
Ny manh trang
TO! Meckel

A. QUAI RUOT CHUA QUAY B. QUAI RUOT DANG QUAY DUOC 90°

Lach

Ke't trang
ui' :-
PI • ///i, ..'
/-,;-:. xu6ng
'.-- \ '
'\-\. -.,
'---..=-..-- :
Mac treo
trang Mac Binh
ke-t trang
trai
RuOt non

C. QUAI RUOT DANG QUAY DUOC 180° D. QUA! RUOT DA QUAY XONG DIJOC 270°

Hinh 45.6 : Sv quay cila quai rut

3.2.4. Sig phat trien ca' a tuy. Ty phat trign c hai nui : phia sau, a to trang la nu tuy
king se phat tridn thanh than tuy : phia trade, a gan la nu tuy bung se phat trign thanh du

284
tuy. Nu bung xoay quanh to trang ra sau de dinh vao nu lung, vi the Tau tuy d trong mac treo
to trang va than tuy a trong mac treo vi sau. Dieu d6 giai thich dose tuy co hai Ong &an la
Ong tuy chinh a than phan dam nam d dudi di ding vdi Ong mat chii de d6 vao nhi to ldn va
Ong tuy phu d phan tren cua dau d6 vao td trang d nhd O. be (H. 45.5A, B).
3.2.5. St' phat trign cua lath.
Lach phat sinh cham, sau tuy va gan, tren doting di cda Ong mach lath trong khoang
gida thanh ben trai caa hau cung mac n6i. VI the mac n6i da day vdi tuy bi phan ra hai phan
d6 la day chang hay mac n6i vi lath (ligamentum gastrolienale) va mac n6i tuy - lath hay day
chang hoanh - Lich (lig. phrenicolienale).
3.2.6. Sif quay va cutin thanh kinic ctia quai rui5t.
Nh6 to da thay d tren quai runt g6m co nganh tren va nganh dddi. True sau d giita
hai nganh là dOng mach mac treo trang tren va ong noan hoang. Nganh tren tie"p noi vdi da
day bdi quai to trang, gidi han la dOng mach gan. Nganh dudi tieep vdi runt cu6i, gidi han la
dOng mach mac treo trang dad. Vay quai ron bi mac a tren va dudi vao cac d6ng mach, bi mac
tradc vao fon va bi chang d sau bdi mac treo.
Quai rOn phat tri6n nhanh va dai hcn so vdi 6 bung. Mac treo runt ding phattrign, nhung
khong nhanh bang.
Quai ran dang thing doc nay phat trign rat dai va mu6n dung docic trong 6 bung phai quay
270° (3/4 yang traw) ngdoc chieu kim d6ng h6 chung quanh truc trade sau la Ong mach mac
treo trang tren (H.45.6A,B,C,D).
Khi quay ddoc 180° thi nganh tren (quai to trang) chay sang phai va nganh dudi (quai ke't
trang) chay sang trai. Khi quay tdi 270° (H.45.7) vi c6 mac treo bu6c chat vao phia sau va cac &Ong
mach Cs tren va d du'di, nen hai nganh ch6ng len nhau, quai ke't trang de len trade quai to trang.

Eldu dudi quai Ddng mach

to trang mac treo
trang trot,

Ddng mach mac

treo trang tren GLIL, Dau dUdi
• quai to trang
,
- ,

Manh trang

A B

Hinh 45.7: So, dd sv quay cria quai runt

A. Vi tri ban delu. B. Khi del quay xong.

285
 VI vay sau khi quay xong, dau tren to trang bi mon vi keo sang ben phai,- dau dudi bi lei
sang trai, to trang nam ap sat ra sau, trade cot song. RuOt non cu6n thanh kink ta dau dudi ta
trang tdi nu manh trang, nghia la tit trai sang phai. Kgt trang bat dau ta nu manh trang, có
met phan d ben phai (ldt trang len) va met phan chOng trudc to trang (ldt trang ngang).
Trong qua trinh quay caa quai ruOt có the xay ra cac di dang sau day :
- Su' quay có the khOng xay ra.
- Su quay vdi chieu hu'dng bat thudng theo clung chieu kim demg h6, kern theo sit ciao
ngudc toan be cac tang trong 6 bung.
- Su quay killing hoax). toan : quai rgn khong quay du 3/4 vOng trim hoac quay qua, hie do
manh trang va ruOt thaa khong xu6ng h6 chau phai ma co the o h6 chau trai, dudi lath va
nhat là dudi gan.
- Ong noan hoang là ranh gidi giaa nganh tren va nganh dudi caa quai r6n. Trong qua
trinh phat trien 6ng noan hoang se bign mat, nhung co khoang 1 - 2% 6ng noan hoang de lai
di tich clued dang met ttii thaa goi la ma.'u phu hay tai tha'a Meckel ma khi viem co trieu cluing
gigng viem ruOt thaa.
3.2.7. Sit tign trien va lat sang ben cda runt cudi.
Skr tign trier' va lat sang ben rat don gian, co hai diem chinh :
- Dau tren cua met cu6n bi quai r6n khi quay keo len tren va sang ben trai (H.45.6.D).
- Doan dudi 'at clung mac treo sang ben trai, trii phan cu6i clung (truc trang) thi van thing
giaa.
RuOt cu6i phat trien va dai khong deu nhau. Khtic giita phat trien nhanh hon ca va cu6n
thanh khdc (kgt trang xich-ma). Vay sau khi tign trien, ruOt cu6i co ba doan : kgt trang xu6ng,
kgt trang xich-ma va true trang.
Di dang : - Kgt trang co the rat dai gay chting tao bon.
- Kgt trang xlch-ma co chieu dai thay dOi, Ngu qua dal de" gay xoan.

3.3. HIEN TI.NNG DNB MIA PHUC MAC.

3.3.1. Hien ttio'ng dinh cua picnic mac met.
Khdi thily cac doan cua 6ng tieu hoa deu di Ong va có met mac treo lung chung
(mesenterium dorsale commune). Ve sau met s6 doan caa 6ng tieu hda bi dinh vao thanh bung
sau do so( dinh giaa la sau caa mac treo vdi la philc mac thanh caa thanh bung sau. Tit tren
xu6ng dad ta có :
- Mac dinh to trang (H.45.8).
- Mac dinh kgt trang len (H.45.9 A,B).
- Mac dinh kgt trang xu6ng.
Cac mac dinh lam cho cac tang nhu N. day ra ngoai phdc mac.

286
 Di clang Ara ling dung :
+ Su' dinh caa k6t trang len có khi khong hoan toan va do do tao nen met ranh ket trang phu.
+ Ngu'o'c 141, su' dinh cua ket trang len có the xu6ng tan mat sau cda day manh trang va ca
runt thira cang dinh vao thanh bung sau. Trong truing hap nay mu6n tim runt thiia phai bac
tach mac dinh sau manh trang.

Tihh mach chO duel DOng mach chef

Mac dinh to trang Mac dinh ket trang

Ta trang
(loan 2)

•,/i fifp 12-7-r4>

7/.2.(7,7/7.771 eN,

Ket trang Ket trang xueng

•

Tyy

Hinh 45.8 : Sit hinh thcinh ccic mac dinh cda ket trang vet cda td tuy

H6ng trang
Mac treo h6ng trang
Wing mach mac treo trang tren
Mac treo ket trang len
Mac treo
ket trang xueng

Ket trang len

Ket trang xueng

A. LOC CHUA DINH

HO'ng trang
Mac treo h6ng trang
DOng mach mac treo trang tren
it

Ket trang len

Mac treo ket trang

Ket trang xu6ng da dinh

B. DA CO MAC DINH

Hinh 45.9. HiOn tu'ong 16t sang ben va dinh cda rut cu5i

287
 + Hoax' toan 'thong có six dinh : tao thanh mac treo chung, hic do rat a N. tac runt do
xoan hoac 16ng runt.
+ Ve mat phiu thuat, to co thd hoc tdch cdc mac dinh dd dang va khOng gay chay mau.
3.3.2. Mac dinh cua till mac nai.
Tdi mac n6i cila 6 bung phat trign ngang.sang ben trdi d sau da day, a tradc to trang va
tuy, phat trign xu6ng duai a sau thanh bung truac va a sat ngay tren mac treo kat trang
ngang. Mac treo vi sau dinh vao Id thanh sau &la phdc mac a ben trdi va vao mac dinh to
trang a ben phai. Vi the tuy va tá trang bi dinh vao thanh bung sau va trong nhu' nam ngoai 6
phdc mac. Cf duth, mac treo vi sau dinh vao mac treo kat trang ngang (H.45.10).
Hai thanh &la till mac n6i lan do mac treo vi sau tao nen cling dinh vao nhau a du'ai tao
nen mac n6i 16rn (omentum majus) gom b6n la pink mac.
Phia tren a tan tam vi hai thanh caa tui mac n6i cling dinh vao nhau r6i 14i dinh vao
thanh bung sau de ding tao nen mot mac treo da day goi la day chang vi hoanh (lig.
gastrophrenicum).

Mac dinh cu Da day

mac treo vi sau

Tyy

Tui mac n6i

Mac treo
ke't trang ngang

dinh caa
mac treo vi sau vao
mac treo ke't trang ngang
Cho dinh cua
tui mac n6i
Ket trang ngang
Mac n6i Ian

Hinh 45.10: Cdc phein dinh cd a tdi mac ndi

288
4. MAC NoI NHO VA MAC NoI LON.
4.1. MAC NoI NHO (omentum minus).
Mac n6i nho la mang gom hai la phtic mac n6i tii gan vao b6 cong nhO da day va vao to
trang.
Gan Day chang gan to trang Mac
I 176i
Day chang gan If/
nho

Tdi mat

Da day
Co mac n6i goo
\V otsts

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441 0 10 41%11 I 411
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Hinh 45.11 : Mac not ldn va mac not nhci

289
 4.1.1. Phoi thai hoc. Luc phoi thai, da day dinh vao thanh bung truac bai mac treo bung.
Gan phat sinh trong hai la mac treo va phat trien len tren sang phai nen chia mac treo ra lam
ba phan : mac chang treo gan, phtic mac gan va mac n6i nho (H.45.11). Mac n6i nh6 dang la
'at vach thing doc nhung ve sau, vi six quay dm da day, nen a binh dien clang ngang hai chefch
ra truac, xuring dual Ara sang trai, vay mat tra6c dm mac n6i nho hai nhin sang trai.
4.1.2. MC) ta. Mac n6i nho c6 b6n ba va hai mat :
- Bor gan : dinh vao gan theo Tat g6c yang gam doan ngang va doan thong.
+ Doan ngang : a mat dal gan barn doc theo ranh ngang (ranh day chang dia gan) lien
quan vdi cda gan va gan b6 gan a phia sau ho'n phia tra6c.
+ Doan thdng : a mat sau gan doc theo ranh dm day chang tinh mach.
Hai la dia mac n6i se tiap lien vdi la dai cilia mac chang vanh.
- Bd vi : dinh vao 136 phai that quit:1,136 cong nho da day va vao phan di dOng cua phan tren
to trang. CI to trang mac n6i khong dinh dung vao gifia bar tren ma hai Fan ra mat sau. Hai la, sau
khi bam vao that quan va da day tip not a &tad theo doc 136 cong 16n vial mac n6i 16n.
- B6 tren : (ba hocinh) rat ngan, chay ngang tit b6 gan t6i thktc quan. Hai la lien tie-p vdi
pinic mac gan.
- Bd phai : tang tit r6n gan t6i to trang nen goi la day chang gan to trang (ligamentum
hepatoduodenale). B6 nay giai han a phia trate 16' mac n6i (foramen epiploicum).
- Mat trtieic : huang sang trai va bi thug trai gan the nha iat, mai hien.
- Mat sau : tao nen thanh truac cua tin dinh hau cong mac n6i lien quan vdi ditty duoi
cua gan.
4.1.3. Cgu tao.
Mac not nh6 gam c6 hai phan :
- Day chang gan vi (ligamentum hepatogastricum) la phan n6i tit ranh cilia day chang tinh
mach gan den b6 cong nhO da day. O ben phai mac not mang han vi khong c6 mach than kinh
goi là phan rang cilia mac n6i nho.
- Day chang gan ta. trang (lig. hepatoduodenale) là phan phtic mac n6i tit ranh cilia cua
gan (ranh ngang) clan vdi phan tren cila to trang, phan nay chda cu6ng gan g6m : 6ng mat chti,
dOng mach gan rieng va tinh mach cilia. Mac not be chda than kinh, mach mau va bach mach
(xem bail Da day).
4.1.4. Ap dung. Mac n6i nho cling da day tao mot vach clang ngang d tang tren ctia 6
pink mac, chia 6 ph6c mac thanh hai khoang. Khoang truac la 6 phut mac len, khoang sau la
ti'en dinh tui mac n6i (vestibulum bursa omentalis). Mu6n vao tui mac not c6 thd lam sap phan
irking cilia mac n6i nh6, phan nay cd it mach matt.
- Ap xe gan a phia trtrdc mac n6i, se vo chay vao 6 phut mac ldn. Can dp xe a phia sau

290
thi to d hau cung.
- O bar phai mac n6i nho có 6ng clan mat, co thd Lay bd nay lam dich de Tat ngOn tay vao
16 mac n6i tham do 6ng mat.
— L6 mac n6i bi bit do thd lam sap phan mOng va choc neon tay sang ben pha.i de tach va
and lai 16.
4.2. MAC NoI LON (omentum majus).
Mac not ldn la do mot phan cua mac treo vi sau bi triu xu6ng bdi stt phat tridn xu6ng dutch
cua ngach gan runt. Mac n6i ldn di tit boy cong ldn cua da day Uri k6t trang ngang nen con du'dc
goi la day chang vi idt trang (ligamentum gastrocolium). Mac not ldn trong mot tam khan
d phia sau thanh bung tru'dc va phil len cac tang a 6 bung (H.45.11).

Co hoanh

Day chang vi hoanh

Ch6 dinh cua 0 thanh Tui mac not

vao thanh sau cua till mac n

Da day Than trai

Tuy

Mac Hai là sau

not
lon Hai la trLldc •
%ft / Ket trang ngang

Hinh 45.12: Thie't d6 thing doc qua ttii mac not

4.2.1. C'Su tao.

Hai la pink mac cua mac treo vi dinh vao nhau theo doc boy cong ldn cua da day, chay
xueing dui, tOa ra flint mot tam khan dai va day, r6i quat ngu'dc len tai tan k6t trang ngang,
va dinh vao mac treo cua k6t trang ngang (mesocolon transversum). Sau do hal la lai tach ra dd
bao phu to trang va tuy tang, r6i ti6p tilt chay len tren tai cc hoanh. O day hai 16.14i dinh vao
nhau de tao thanh mac chang treo vi hay day chang vi-hoanh (lig. gastrophrenicum) (H.45.12).

291
 BO'n la (hai id trithe vet hai lci sau) caa tiii mac n6i dinh vao nhau tao tlianh mac n6i
'Ali mac not rang hay hep thytheo sit dinh do. Nhung thuang dinh nhieu a ben phai horn ben
trai vi the khi rach vao 41i nen rach a ben trai.
Giu a. cac la co to chdc lien ket ma. Nhieu khi co it ma thi mac n6i lan trong nhu mot tam
khan 16m cl6m tilling hay mat tUng mang. Ginn hai la trade vA doc theo bc7 cong vi lan co dung
mach vi mac n6i phai, 1a mot nhanh cua Ong mach vi to trang. Ghia hai la sau c6 clang mach
vi mac not trai, IA mot nhanh dia Ong mach lach.

T5ng tren Gan

mac treo O lach Lach
ket trang
gan Da day
ngang
O da
day
Ket trang ngang

Mac treo
tieu trang

Ket trang len

Ket trang xu6ng
Hoi trang

R5nh thank
ket trang trai
H6 chOu trai Tang
duel
O ben trai mac
mac treo tieu trang treo
- O ch5u h6ng be ket
trang
O ben phai mac treo tieu trang ngang

H6 ch5u phai
Ranh thanh ket trang phai

Hinh 45.13 : Sa de; phan khu o bung.

Ghi chti : Cdc mai ten chi hiding dick di chuyen trong cdc 6 cda o bung.
4.2.2. Tinh chgt.
Mac n6i lan có hai dac tinh : Tinh thgni but Ira tinh dinh, vi the :

292
 —Mac nol kin là mot hang rho ch6ng cloy va tieu huy vi trUng nhung khi khong du sac
ch6ng do thi bi viem va gay viem philc mac.
—Mac n6i lan thuang chay tai co lap cac tang bi viem bang each bao phii chung quanh,
cach ly khong cho viem nhi6m lan truydn hoac tai bit ch8 h6ng khi thanh bung hay tang bi
thUng.
Mat khac, mac n6i ldn thing vai tro torn bat hay "chai" cac to bao ung thus.

5. PHAN KHU O BUNG.

Cac nap pink mac phan chia 6 bung ra tUng khu lam cho mil dung lai trong khu hay lam
co lap mot viing philc mac bi viem (H.45.13).
—Mac n6i lan va cac mac nol khac (mac no'i nhd, mac no'i vi - lath, mac rai tuy - lath)
quay 6' trong 6 pink mac lan mot hau cung goi la tui mac n6i hay hau cung mac n6i (bursa
omentalis).
— Mac treo Ic.6t trang ngang chia 6 phdc mac ra lam hai tang : Tang tren va tang duOi mac
treo Idt trang ngang. Hai tang nay c6 c6u tao va tinh chat bOnh 157 khac han nhau. 0 tang
tren, cac tang nhu' gan, da day, lath, to trang, tuy de'u quay quanh tui mac n6i, a tang tren nay
day chang treo gan phan chia khoang dudi co hoanh lam hai O. Hai '6 nay de'ti bi gidi han a sau
gan bai la tren cUa mac chang vanh. D6 là o du'ai hoanh phai hay 8' gan thOng xu6ng dudi theo
ranh thanh kat trang phai va o dudi hoanh trai ma thong vao 8 da day, 8 lath.
— tang dudi mac treo k6t trang ngang thl mac treo tidu trang chay ch6ch tit trai sang
phai nhu mot vach tieing di tit d6t that lung I va II tai khdp cling chau, chia 6 pink mac a tang
dual mac treo kat trang ngang lam hai khu : khu phai va khu trai mac treo tidu trang.
—K6t trang len va xu6ng tao vdi thanh bung ben mot ranh goi là ranh thanh ke't trang
phai va trai. Ranh thanh ke't trang phai thong n6i o gan vdi h6 chau phai. Ranh thanh kat
trang trai thong n6i o da day, '6 lath vdi h6 chau trai.
—Mac treo k6t trang xich-ma thy theo ldn hay nho day nhu mot cai nap kin hay ha tren
chau hong be, tao thanh o chau hOng be tach rieng cac tang a day khoi 6 philc mac lan.
T6m lai, cac cau trilc cua philc mac phan chia 6 pluic mac thanh cac 8 :
+ O 6 pink mac lan c6 : o gan phai va trai, 8 da day, 6' lath, o phai va trai mac treo tidu
trang, ranh thanh ket trang phai va trai, h6 chau phai va trai.
+ O dudi 6 philc mac lan c6 : o chau h8ng be.
+ O sau 6 phdc mac lan co tdi mac nal.

6. TO MAC NOI (bursa omentalis).

'DE mac n6i hay hau cung mac n6i la mot ngach cila 6 philc mac tao nen bdi si phat tridn
cua ngach gan runt. Co cac mac n6i quay a mat trudc, a ben trai va a mat sau. COn a ben phai,
till mac n6i thong vdi 6 phdc mac 'an bai mot 16 goi la 16 mac n6i (foramen epiploicum) la 16
thong tit nhien cilia ttli mac n6i vdi 6 phtic mac lan.
293
 Mu6n hidu cac thanh caa tan mac no-i va cac la phac mac the phd, hay Mn theo phac mac
tren thidt d6 cat doc va cat ngang a 6 bung (H.45.12 va H.45.15).
6.1. CAC 0 CUA TOT MAC N6I.
Tit mac not g6m co hai phdn : tin dinh va tui chinh. Tien dinh thong vai. 6 bung bai 16
mac nO-i, thong vdi tai chinh bdi 16 nep vi tuy.

6.1.1. LL mac nal (foramen epiploicum) con goi la khe Winslow, la mot khe doc tit gan
tdi to trang, thong till mac no-i \raj. 6 phac mac ldn. CO gidi han nhd sau (H.45.5) :
- Bd tru'dc là bo phai caa mac nal nho trong co cu6ng gan. Bd nay che-ch len tren va sang
phai.
- Bd sau la tinh mach cha dudi.
- BO tren là gan.
- Bd dudi là bd tren cila mac dinh ta. trang.
6.1.2. Tien dinh (vestibulum bursae omentalis) la mat khoang di tit 16 mac n6i tdi 16 gidi
han bed cac nep vi tuy (plicae gastropancreaticae). Tien dinh co mat ngach tren, thoc gida cu
hohnh va gan.
Tien dinh có bon thanh va hai 16 thong : do la 16 mac no-i va 16 nep vi tuy.
+ Thanh trudc la phdn mong caa mac no-i nha.
+ Thanh sau là khoang gain clang mach cha bung va tinh mach cha dudi.
+ Thanh tren la they duoi.
+ Thanh dadi rat hep va lien quan vdi bd tren caa mac dinh to trang va nep vi tuy dudi
(liem deing mach gan).
6.1.3. Lo nep vi tuy la mat 16 bdu due a tren binh dien chdch xu6ng du'di va sang phai.
Gidi han a trudc la bar tong be da da day, a tren va du'di bai cac nep vi - tuy.

6.1.4. 'nil mac n451 chinh. Tai hay hau cung chinh g6m CO hai phdn : mat phdn a sau da
day va mat phdn a trong hai thanh caa mac noi ldn. CO ba ngach : ngach tren (recessus
superior omentalis), ngach du'di (recessus inferior omentalis) va ngach lath (recessus lienalis).
Tui chinh thong a ben phai vdi ti6n dinh Va có ba mat (truac, sau, treii), mat day ddai va mat
bd tren (H.45.14). Thanh truzic la da day a tren (da day a trong hai la pluic mac) va mac n6i
'an a du'di (hai la truck).
Thanh sau lien quan vdi tuy va then. Tuy a trong hai la dia mac treo vi sau, mac nay dinh
vao la. thanh. Thdn trai a sau la pinic mac thanh.
Thanh trdi la mac n6i (day chang) vi-lath va mac no-i lath-tuy (day chang hoanh Lich).
Day dual na'm tren ket trang ngang va mac treo ke-t trang ngang. Ndu keo ket trang
ngang ra trade, thi day treo tang nhd mat tam phan ngang. Lac thu'dng khi cac tang sat vao
294
nhau, day dudi a tren mot binh didn thing ngang.
O bd tren, hai la phtic mac turn vao nhau dd dinh vao co hoanh va tao nen day chang treo
da day.

/
N
Day cha'ng A Gan
hoanh gan
I I
1
' f i Mac no7 nhei
\ 4I
i1
,% ......,
, \
, , 1
1 ,
Tyy — t t Ke't trang ngang
% 1
i i
Mac dinh to trang --- I VOng d'Ong mach
---- bd cong vi Ian
,
Ta trang %\
%1 i ---- - - - .. Mac neii Ian

Re mac treo
ke't trang ngang Kgt trang ngang

Hinh 45.14 : So' d6 cdt clang doc qua ttii mac n6i.

Cdc mai ten chi &tang veto ttii mac ndi (1 : Sdp phdn mOng ctict mac n6i n1-16. 2 : Rach mac
nefi ldn tren yang mach ber cong vi 16n 3 : Rach mac neri 16n dudi mach bOr cong vi ldn. 4 : B6c
phan dinh ctia mac rt6i 16n va mac treo lee't tretng ngang. 5 : Lam titling mac treo lee't trang
ngang).
'6.2. DU(1JNG VAO TUT MAC NOI.
Thy theo muc dich cua nha phdu thuat, có nhidu dating de di vao tdi mac n6i (H.45.14).
— Qua 16' mac n6i : dd lath ngon tay tham sat curing gan.
— Lam sap phan mong ctia mac n6i nho dd quail sat mat sau da day.
—Rach mac noi ldn theo bd cong ldn da day tren hay cludi yang ddng mach vi mac n6i.
Dung rach cludi \Tong n6i ddrig mach vi mac n6i la ding vao tdi mac n6i thu6ng dude sing
dung nil:A.
—136c mac dinh gala mac MA ldn va mac treo kdt trang ngang.
—Lam mot 15 thUng a mac treo kdt trang ngang dd n6i da day vdi h6ng trang.
295
 Tinh mach chu song mach chi) byng

Gan Than D6ng mach lach

Than

Tuy
Lach
L6 mac not

Phew{ La tang
mac La thanh

Mac chang vi lack

Mac not nha

TCJi mac not

D6ng mach gan Da day

Cueing gan Tinh mach tha
Ong mat chi)

Hinh 45.15 Sa d6 cdt ngang qua tat mac no'i.

Tinh mach chi) dddi Co hoanh

D6ng mach hoanh dcidi
D6ng mach thciong than giCia
D6ng mach than tang

D6ng mach mac treo — D6ng mach than

trong tren

DOng mach sinh duc "-

— D6ng mach mac treo trang dddi

Cac clemg mach that king

DOng mach chau chung

D6ng mach cLing giCia - D6ng mach chau ngoai
D6ng mach chau trong

Hinh 45.16: Cdc nhanh cda de)ng mach chi bang.

296
7. DONG MACH CUA O BUNG.

Cac tang trong 6 bung ditoc cap huye't bAi Ong mach chi' bung. D6ng mach chi' nguc sau
khi chui qua 16 Ong mach chit caa co hoanh d6i ten thanh Ong mach chit bung r6i di thang
xu6ng nam hoi lech sang trai cot song that lung de tan ding d ngang muc d6t song that lung 4
bang each chia dOi thanh hai Ong mach chau chung. Tren dung di, Ong mach dui bung cho
cac rthanh ben la : Ong mach hoanh durdi, Ong mach thuong than gida, Ong mach than tang,
d6ng mach mac treo trang tren, Ong mach sinh due, Ong mach mac treo trang dUdi, cac d6ng
mach that lung (a. lumbalis) va Ong mach ding gida (a. sacralis mediana) (H.45.16).

CAU HOI TRAC NGHICVI

Chon cau tra lAi thing nhat,

Dung cac chi deft sau cid tra liii cac eau 506, 507, 508

1. Gan 4. Lach.
2. Tuy. 5. Tiir cung.
3. Than. 6. Ke-t trang len.

506. Tang nao IA tang ngoai philc mac :

a) 1. d) 3, 5.
b) 1, 3. e) 2, 3, 5, 6.
c) 1, 2, 3.

507. Tang nao la tang bi thanh h6a :

a) 1, 2. d) 1, 2, 3.
b) 2, 6. e) 2, 3, 5, 6.
c) 1, 6.

508. Tang nao la tang trong philc mac :

a) 4. d) 1, 4, 5.
b) 4, 5. e) 1, 2, 4.
c) 1, 4.

509. Trong qua trinh phat trign cua 6ng tieu h6a va phlic mac a phoi thai, da day se quay :

a) Theo true thing doe 90°. d) a va c thing.

b) Theo true ngang 90°. e) a, b, c deu sai.
c) Theo true tru'dc - sau.

297
510. Trong qud trinh phdt tridn ar plied thai, met se quay mat gOc :

a) 360° nguvc chieu kim dang ha.

b) 270° nglick chieu kim clang h6.
c) 180° ngtick chieu kim dang ha.
d) 90° theo chieu kim clang ha.
e) 60° theo chieu kim dang ha.
511. Truc quay dia. mat trong qud trinh phdt trien phoi thai la :
a) DM mac treo trang tren. d) DM r6n.
b) DM mac treo trang e) TM ron.
c) DM than tang.
512. Mac not nhO tang tit gan dgn 136 tong nhO da day va :
a) Tuy. d) Phan tren to trang.
b) Ket trang ngang. e) Lach.
c) Phan chidri manh trang.
Ming cac chi Wet sau d tra Idi cac cau 513, 514.
I. Day chang gan-vi. IV. Day chang vi-hoanh.
II. Day chang vi ke't trang. V. Day chang vi-lath.
III. Day chang gan - td trang. VI. Day chang than - lath.
513. Day chang nao la thanh phan dia mac not nhO (mac treo track) :
a) I. d) I, II, IV, V, VI.
b) I, IV. e) III.
c) I, III.
514. Day chang nao la thanh phan ctia mac n'eci. lOn (phan sau mac treo vi sau) :
a) II. d) II, IV, V, VI.
b) II, IV. e) I, II, III, IV, V, VI.
c) IV, V, VI.
Wing bang tra loci sau cho cac cau 515, 516, 517 :
a) Day chang vi - hoanh. d) Day chang gan -
b) Day chang vi - lath. e) Day chang gan - td. trang.
c) Day chang vi - keft trang.

298
515. Cu6ng gan nam trong day chang nao ?
516. Day chang nao gop pilau tao nen phdn du'di thanh tru'dc tui mac n6i (hau cung mac nol.) ?
517. Khi d6n da day, deng mach vi trai nam trong :
518. Cau nao sau day DUNG :
a) Tdi mac n6i (hau cung mac nol) la mot phAn cUa 6 pink mac.
b) Tui mac n6i nam sau da day, mac n6i nha va trade kh6i td tuy.
c) Khong co con doing nao co th6 di vao tdi mac n6i ma kheng pha rach cac mac cUa
ph& mac.
d) a va b thing.
e) a, b, c deu clang.
519. Thanh teen cilia tin dinh tui mac n6i (tien dinh hau cung mac n6i) la :
a) Thuy vuong. d) Day chang vi - hoanh.
b) Thiry duoi. e) Cci hoanh.
c) Day chang vanh.
Dung hinh ye sau tra loci cau 520, 521 :
520. Trong hinh ye, chti thich nao sai :

(e) Day chhng yanh

(a) Mac no? nho

r fl •

(b) Da day
(d) Tuy

(c) Kot trang ngang

299
521. Con du'Ong theo mui ten (A) la con dung thing &Plc sir dung de di vao tdi mac n6i vai
muc dich :
a) Tharn do tim sai a 6ng mat chi'.
b) Tham kham mat sau da day.
c) Tien hanh phau thuat n6i vi trang.
d) Lam cac phau thuat a tuy.
e) a, b, c, d (tell dung.
Dung hinh ye nay d tra ldi cac cau 522 sten 525.

Thie't coo cat ngang qua 6' bung

Cho bigt ten cac chi tie-t duvc danh s6 tren hinh ye :
522. Chi tieet s6 (1) la :
523. Chi tigt s6 (2) la :
524. Chi tie't s6 (3) la :
525. Chi tie't nao co ngu6n g6c la mac treo vi tru'ac trong thai Icy phoi thai :
a) 1. d) 1, 2.
b) 2. e) Khong chi tigt nao durgc danh s6 tren hinh.
c)3.

300
 O
PHAN VII - THAN KINH TRUNG TING

46 TUY GAI

MUC TIEU BAI GIANG

A. MUC TIEU LY THUYET
1. MO to vi tri, chile nang, hinh the ngoai va trong cua taw gai.
2. Neu su lien quan caa cac doan fay gai vdi cot song va ung dung thuc td.
3. Ve va cha thich thie't dO cat ngang tay gai.

B. MUC TIEU THTIC TAP

1. Chi tren xac, me hinh, tranh ye vi tri va hinh thd ngoai cua tay gai.
2. Chi tren tieu ban me hinh, tranh ye cac chi tidt giai phan dia chat xam, chat trang cua
tay gai.

I. DAI CthING
Hd than kinh trung acing (systema nervosum centrale) dtioc chia lam hai phan : nao bO
(encephalon) va tay gai (medulla spinalis) ma scr dO phat tridn du'oc tom tat nha sau :
Tay gai phat sinh tit ldp ngoai bi caa plied. Nguyen thay la mOt, 6ng nam doe d tren. lung.
Ong tily gai dans clan tach khOi.Jap ngoai bi va chui vao sau, a sau cac cung cua d6t song. Khi
cac cung nay Oat tridn dan da'n ra sau, quap lai, dinh vdi nhau tren duang giita tao thanh
mom gai thi tay gai nam lot trong 6ng song (H.46.1).

2. HiNH THE NGOAI

Tay gai có dang mot cot tru det mau trg.ng xam, can na'ng khoang 26-28g, dai 45 cm a
nam va 42-43 cm a nit, chie-m 2/3 tren caa 6ng sting va chia lam b6n phan (H.26.2).
301
 BO thon
BO gian b6 BO vach vien
86 &lam\
86 king chinh thOP Ranh gh7a
86 thap ben (B6 vo gai ben)

B6 do gai
Re king than kinh gai
BO gai tieu nee sau
Wing tan cOng
Wing x6p
Chat keo

BO doc cOa cot

chgt xam sau
Being sau

BO rieng toy gai ,, tao Judi

86 gai thi
tnidc va ben
Ong trung tam
B6 gai doi tht ben Sting trUdc

86 gai tigu nao tru'dc

BO tram gai

Cac bO rieng
86 gai ddi thi Mick Re bung than kinh gai
86 vä gai trUdc (thap taidc)
BO doc trong
86 mai gai Khe giCa

Anh XXXXIII : Hinh the trong tuy gai cue minh hoa chi tie't hon So cid a H.46.4

302
 NAO BO
Nao tru'dc Doan nao va Gian nao
(prosencephalon) (telencephalon) (diencephalon)
Nao gills. Trung nao
(mesencephalon) (mesencephalon)
HE THAN KINH
Nao tram (rhombencephalon) :
O
TRUNG TING
Nao sau Cau nao va Tidu nao
(in eteneephalon) (pons) (cerebellum)
Tay nao Hanh nao
(myelencephalon) (medulla oblongata).

TOY GAI

Ngogi 61

Ong tuy

Day nguyen song

Ong song
Tizy gai
Thin kinh gai song

Hintz 46.1 : Su hinh thcinh tay gai

— Phan c6 (pars cervicalis) cho 8 air day than kinh c6

Phan ngtjc (pars thoracica) cho 12 dei day than kinh ngkic.
— Phan that lung (pars lunzbalis) cho 5 deli day than kinh that lung.

303
 — Non thy (conus medullaris) la phan tan ding dia thy gai thu hep lai gio-ng cal ph6u cho 5
&I day ding va mot dal day cut.
Hai phan toy c6 va that lung do phai dam nhan viec chi ph6i than kinh cho chi tren va
chi di.tai nen phat tridn manh tao thanh phinh co (intumescentia cervicalis) va phinh that king
(intumescentia lumbalis).
Thy gal bat dau tii bor tren d6t sting do", i (Ci), nai lien tuc vdi hanh nao va tan tong a 136
diidi cl6t s6ng that lung I (Li) hay ba tren d6t s6ng that lung II (L2). Trong 2 thang dau cua
thai nhi, thy gal chigm troll chigu dai dia 6ng s6ng. Nhung tang vg sau do t6c d6 phat trign
cua cot song nhanh harp nen toy gal mai a vi tri cao atm' vay. Di6u nay giai thich tai sao cac
day than kinh gal song (nervi spinalis) cUa cac phan toy cuoi phai di xuong mot khoang dai
trong 6ng s6ng tao thanh duoi ngura (cauda equina), truck khi thoat ra ngoai qua 16 gian d6t

Phinh c6

Ranh trung gian sau

Ranh giCia

Ranh ben sau

Phinh that lung

Non toy

Day tan cang

Hinh 46.2: Hinh the' ngodi cda toy gai (twit sau)

304
song, va chinh vi vay khi choc do dich nao toy a lung, vi tri thuang chon la khe gian cl6t song
that lung L4-L5 nai khong can toy gai. Day tan cOng (filum terminale) la mot soi manh khOng
phai là than kinh do mang toy mem (pia mater spinalis) tao thanh, se n6i tit chop non toy
xang tan lift a ddy Ong song khoang ngang d6t song cling V (S5) (H.46.2).
Mat ngoai coa toy gai duoc chia ra lam hai nita den nhau bdi khe gida (fissura mediana) 6
tru'ac va ranh gala (sulcus medianus) d sau. Khe Wang d6i saw va rOng hon. Ranh co chia mach
mdu ya mot ne-p gap cUa mang toy mem. Moi nu'a lai du'oc chia thanh ba thUng : fining till&
(funiculus anterior), thOng ben (funiculus lateralis) va thOng sau (funiculus posterior). Gidi han giita
hai thOng sau va ben la ranh ben sau (sulcus lateralis posterior), not cdc soi cUa re" lung (radix
dorsalis) than kinh gai song di vao toy. Con gidi han gaita thimg truac va thOng ben la mot vimg
doc khong deu, nal cac sal cUa re bang (radix ventralis) cUa day than kinh gai song tit toy di ra. We'
lung va r6 bung se chap vao nhau de tao ra day than kinh gai song. Ngodi ra, 6 phan toy c6 va
ngu:c tren con c6 ranh trung gian sau (sulcus intermedius posterior) chia tie-p thOng sau ra lam hai
b6 : b6 thon (fasciculus gracilis) o trong va b6 them (fasciculus cuneatus) 6 ngoai.
Ranh gifia Ranh trung gian sau

Theing sau Chit xam (chit trung

gian trung tam)
Ranh ben sau
Re king than kinh gai
Theing ben
Re bung than kinh gai
Theing truec

Ranh ben truPc Khe giu'a

Hinh 46.3: Hinh the ngocii ctia toy gai (mat trithc)
86 thon
Bo chain
Bo king ben
Chit keo
— Bo gai thew nao sau

Nhan ngVc 86 thap ben

BO do gai
Nhan trung gian ben
Bo gai tiiu nao tru✓dc
Cdt nhan trudc ngoai Bo kidi gai

Cdt nhan tn/dc trong Bo gai doi thi ben

BO mai gai
Cac Lid rieng I I BO tram gai
BO gai dal thi tn/dc
Ong trung tam
Bo tion dinh gai
trong ctia toy gai Bo thap trudc
Hinh 46.4: Hinh the

305
 3. HiNH THE THONG.
Cau tao cua thy gat g6m ba phan : 6ng trung tam, chat xam va chat trang.
3.1. ONG TRUNG TAM (canalis centralis) la met 6ng nhO khong chda dich nao -bay (vi qud
nho) nam a giaa tay chay doc su6t chieu dai cua tuy gat. Cj tren 6ng thong vdi nao that IV
thuec tram nao va a dual phinh ra tao thanh toy that tan cang (ventriculus terminalis) nam
trong phan dudi caa non thy. Sau do, 6ng thu hep lai Ira tan h‘t trong Tau tren ctia day tan
cang (H.46.4).
3.2. CHAT XAM (substantia grisea). Chat xam cua tuy gat g6m ba cet : cOt trade (columna
anterior), cOt ben (columna lateralis) va cOt sau (columna posterior). Tren thigt d6, cdc cOt nay
xgp thanh hinh chit H. Net ngang glac goi la chat trung gian trung tam (substantia intermedia
centralis) chia 6ng trung tam ma d hat dau dm net d6i ten là chat trung gian ben (substantia
intermedia lateralis). Net doc g6m co ba sting : truck, ben va sau.
—Sang trudc (cornu anterius) hay sting van dOng, thudng co hinh to gide, tdch ra re bung
day than kinh gat.
—Sang ben (cornu laterale) hien dien tit thy c6 VIII (Cs) den tuy that lung II-III (L2-L3). CI
bef ngoai dm sang ben, gidi ham giaa chat xam va chat trang khong rO rang do ski hien dien
cua mot cau true dac 'Diet goi la cau tao (formatio reticularis).
—Sang sau (cornu posterius) hay sang cam gide hep va dai, ch6 phinh rOng dia sang du'oc
chigm bed mot kh6i ban trong su6t goi la chat keo (substantia gelatinosa) ke" tigp la clan sang
hay dinh sang sau (apex cornu posterioris). Chit xam caa bay cha ye-u la do cdc nhan tap hop
lai. Nhan cila chat xam g6m Me than to bao than kinh tap hop lai nam trong cdc sang.
O sang trudc co hat cOt nhan tradc ngoai va track trong.
O sang ben tit doan toy c6 C8 den doan tily that lung L2 có cOt nhan trung gian ben thuOc
phan than kinh giao cam va a cdc doan toy ming S2, S3, S4, co cot nhan ty chu thuOc phan
than kinh d6i giao cam.
O sang sau : ngoai cot chat keo, ar bar trong cua nhan sang sau có met nhan hien dien kha
rO to C8 de'n L2 goi la nhan ngu:c (nucleus thoracicus), tram clang ciao tien cua bd gat tidu nao
sau.
3.3. CHAT TRANG (substantia alba). Chat trang nam bao quanh chat xam va gam co
hat rola n6i vdi nhau a phia trudc chat trung gian trung tam bdi mep trang (commisura
alba). M6i nita nay du'oc chia lam ba thong : trade, ben va sau. Chit trang dacic tao nen bdi
cdc 136 hoac dai soi dan truyan than kinh co bao myelin va chia lam ba nhom soi data theo
elide nang.
• Cac sqi van dOng ly tam di to nao xu6ng.
• Cdc soi cam gide hudng tam di len nao.
• Cdc soi lien hop n6i cdc tang tily vdi nhau.

306
 Cdc bo cua cl4t trang (H.46.4) daqc torn tat nha sau :

THING CAC BO, CAC DAI CHtiC NANG

B6 thdp truck (tractus pyramidalis anterior) Van Ong coy iliac

BO tien dinh gai (tractus vestibulospinalis) Thu6c he van dOng ngoai
Trvidc thdp (v(in d'Ong vo Y thttc).
B6 gai ai thi truck (tractus spinothalamicus anterior) )(Lk gidc nhe
Cdc bo rieng (fasciculi proprii) G6m nhang soi lien hop
gai - gai

B6 thdp ben (tractus pyramidalis lateralis) Van Ong Co y. thac

BO dO gai (tractus rubrospinalis)
Ben B6 mai gai (tractus tectospinalis) ThuOc he van Ong ngoai
BO loth gai (tractus reticulospinalis) thdp
136 gai tieu nao trudc (tractus spinocerebellaris anterior).
B6 gai tieu nao sau (tractus spinocerebellaris posterior). Cam gide sau vo Y thac
B6 gai d6i thi ben (tractus spinothalamicus lateralis). Cam giac th6ng nhiet
B6 lung ben (tractus dorsolateralis) G6m cae soi cam gide nong
tao nen 2 bo gai a thi

B6 thou (fasciculus gracilis)

S au B6 them (fasciculus cuneatus) Cam gidc sau co y thac

4. SI/ LIEN QUAN gab, vi tri cUa mom gai vdi cdc doan tuy va day than kinh gai ging (H.46.5).

VI tily ngAn hon cot song nha da trinh bay a phan 2, nen tang dot tuy khOng Wong ling
vdi tang dot song. M6i d6t song là Ling vdi doan thy d thgp hon.
vung c6 : s6 cUa doan thy va day than kinh gai là s6 cila mom gai Ong them 1. Thi
du : so' thay mom gai cua &It song c6 loi C7 thi doan tally va day than kinh gai thodt ra ngang
mac do la C8.

307
 C1
2

Dual ngtja

Day tan cling

5
Cut 1

Hinh 46.5 : Su lien quan giact tziy gai va cot song

C : cl(it song co hoc thdn kinh gai song
T : ddt song nguc hode thdn kinh gai song nguc.
L : deft song thdt lung hoc than kinh gai song thdt lung.
S : than kinh gai song cang.

308
 • d yang nguc tren tit d6t nguc I (T1) dgn T5 : s6 caa doan tay la s6 caa mom gai Ong
them 2, va o yang nguc cluai tit T6 den T10 thi ding them 3. Thi du : sa thay mOm gai cua d6t
s6ng nguc IX thi doan tay xuang ling la T12.
• MOm gai cua d6t song nguc XI va khoang lien gai ngay clued lien quan vdi ba doan tay
that lung II, III, IV.
• MOm gai caa d6t song nguc XII va khoang lien gai ngay dual lien quan vai cac doan toy
ding tren.
• MOm gai d6t s6ng that lung I (Li) lien quan vai cac doan toy cang (lath va cut.
Bie't duqc su lien quan caa cac doan toy vai mOm gai cua d6t song va dila them tren cac
t6n thuang lam sang (khi khdm cdm gidc vd van dOng theo yang) to co thd nhan dinh duac nai
cat song bi t6n thuang.

CAU HO! TRAC NGHIEM

Chon cau clang nhA

526. HO TK nguai phat trign

a) Tit ngu6n g6c ngoai bi.
b) Tii ngu6n g6c trung bi.
c) Qua ba giai doan : TK hinh luui, TK hinh hach va TK hinh 6ng.
d) b, c clang.
e) a, c clung. (Xem them bed 61).

527. Tay gai có ch6 phinh a :

a) Phan c6. d) Non toy.
b) Phan nguc. e) a va c.
c) Phan that lung.

528. Doan -bay Wang Cmg yeti d6t s6ng nguc 9 la :

a) Nguc 7. d) Nguc 12.
b) Nguc 9. e) TA ca cl6u sal.
c) Nguc 10.

529. Tay gai tan a:mg a d6t song :

a) Nguc 10. d) That lung 2.
b) Nguc 12. e) c hoac d.
c) That lung 1.
309
 530. B6 thdp ben chaa cde sal :

a) Van clang coy thiic. d) Cam gide thong nhiet.

b) Van clang vo 3-7 thae. e) Cam gide sau ye 3-7
c) Cam gide xtic gide.
Dung hinh ye ya bang tra 1di sau cho cac cau 531 den 535.
a) B6 thdp ben. d) BO gai - d6i tii trade.
b) B6 gai tigu nao trade. e) B6 gai - d6i thi ben.
c) B6 thon.

531. Chi tie-t s6 (1) la :

532. Chi tiet s6 (2) là :
533. Chi ti6t, s6 (3) la. :
534. Chi tie't s6 (4) là :
535. Chi tie't s6 (5) là :

310
 06i cha'm
Th6' go7 trong
L6i nao tren
L6i nao du'di

The g6i ngoai

- • Dai thi giec
• The vu
Tieau thby vuong Than kinh thi giec
Giao thoa thi giec
TiJu thdy ban nguyjt tren
PhJu
• TuyO'n yen
Cu6ng dai nao
Than kinh sinh ba
Cau nao
Than kinh trung gian
Than kinh mat
Than kinh tion Binh 6c tai
Than kinh van nhan ngoei
' Than kinh thijt hau
Than kinh ha thijt
Khe ngang
Ti‘u thdy ben nguyjt dddi
Tigu they hai than .
Nhung nao
Hanh nhan tiefu nao -
Sdi cung ngoei _
Than kinh phu Than kinh lang thang
Than kinh gai song
- Tram hanh

Tu.)/ gai

Anh XXXXIV : Tram nao vet trung nao

311
 47 TRAM NAO - TRUNG NAO

MUC TIEU BAI GANG

A. MUC TIEU L-S'r THUYET
1. MO to vi tri, chile narig, hinh thd ngoai va hinh thd trong cua hanh nao, cau nao, tidu
nao va trung nao.
2. Ve mat trudc cUa than nao.
3. So sanh sit bidn dooi chat xam, chat tra'ng tit ttiy gai, hanh nao... den trung nao.
4. MO to nen va mai dia nao that IV.
5. Ve thidt do dung doc qua nao that IV.

B. MUC TIEU THTIC TAP

1. Chi tren nao that, ma hinh, tranh ye, vi tri, hinh the ngoai va trong cua hanh nao, cau
nao, tidu nao va trung nao.
2. CM tren nao that va mo hinh the chi fiat ctia nen va mai nao that IV.

1. TRAM NAO (rhombencephalon)

Tram nao g6m c6 hai phan la tuy nao (myelencephalon) tao nen hanh nao Ara nao sau
(metencephalon) tao nen cau nao va tidu nao. Sa di tram nao c6 ten nhit vay la do trong qua
trinh phat tridn, thanh lung bi toac rOng thanh hinh tram dd tao thanh nao that IV. Hinh
anh nay githig nhu mot ang cao su vdi mot khe xe doc 6' mat sau bi gap khilc lai. Nhu vay
tram nao se g6m hanh nao, cau nao, tidu nao va nao that IV.

1.1. HANH NAO (medulla oblongata).

Hanh nao dung theo tii la tinh goi la tuy hanh là phdn dudi ding cila nao b0, nam tya. len
16 ldn va phan nen cua )(ming chdm, c6 kith thudc : cao 25-30 mm, ch8 rOng nhat 20mm, day
312
 1.1.1. Hinh the ngoai (H.47.1 va 47.2). 'facing tq nha d tuy gai, hanh nao c6 4 khe va
ranh lien tue tit dual len.

CuCing dai nao

(trung nao)

Chu nao

Tram hanh
Thap han

Hinh 47.1. Than nao (mat track)

- Khe gala bi ngat quang bai cac soi nong c6a 136 bat cheo thap (decussatio pyramidum).
phia dadi va tan hat a phia tren bdi 16 tit (foranen coecum) a ranh hanh eau.
- Ranh gida: chia nen nao that IV ra lam hai nita bang nhau.
- Ranh ben trade c6 re caa day than kinh so VI ar cue tren va day so XII d phan
- Ranh ben sau: nai thoat ra caa cac re day so IX, X va XI.
Cac khe ranh nay cung chia m6i ben c6a hanh nao lam 3 cot:
cot trudc (mat trade) c6 thap hanh (pyramis) a hai ben khe gida.
cot ben (mat ben) c6 tram hanh (oliva) la mot khai bau due cao 12mm ma a dau teen c6
day so VIII va dau dudi c6 soi cung ngoai (fibrae arcuatae externae).
COt sau (mat sau) d naa dadi c6 ea nhan thon (turberculum nuclei gracilis) va cu nhan
them (tuberculum nuclei cuneati). Cl nda tren, hai cot sau toac Ong di vao tieu nao trd thanh
hai cu6ng tidu nao dadi (pedunculus celebellaris inferior).

313
 Ala° that Ill
The tong

The goi ngoai

Canh tay lai nao tren

Lai nao tren Canh tay lai nao dual
Lai nab dual
Ham man toy trot?
Man tay tren tren
Ranh gas giCra Cueing ties'u nao.
GO trong
duo?
Ranh gidi han
VOng flan dinh
Lai mat
Van toy nao that IV Ca nhan chem
San nao that IV Tam giac thgn kinh ha thiet
Chat nao
Tam giac than kinh lang thang
CO nhan thon

Hinh 47.2: Than nao (mat sau)

Nhan thon
Nhan diem
Ong trung tam
Nhan chern phy
Chat xam trung tam Nhan lung TK X

Nhan va b6 gal TK V

BO gal sau
Nhan TK ha thlet
tigu nao r_ trade
BO thap ben
BO do gal

86 gal d6i thi ben Nhan ben

Sot cung trong Bat oho° thap
Lim trong Soi cung ngoai
r- lung
Nhan tram phy I
trong
Nhan tram
BO thap truec

Hinh 47.3 : Hinh the trong caa hanh nao dual

314
 1.1.2. Hinh thg trong
Co su thay dai re rQt tren cac thi6t d6 ngang qua hanh nao. C1 naa datdi, thi6t d6 trong
tuong tu nha a tay gai nen can goi la hanh nao Ong (H.47.3). d nita tren, hai cot sau toac
Ong nen goi la hanh nao ma (H.47.4).
1.1.2.1. Chdt xam. Chat xam cua hanh nao gam co :
- Tram tram nao (tegmentum rhombencephali) la mot yang xam ngang kha day nam a nen
nao that IV.
- Nhan than kinh ha thiet (nucl. n. hypoglossi) nam canh (Wang gida, nguyen ay dia day
so XII.
- Nhan lung than kinh lang thang (nucl. dorsalis n. vagi) gam hai phan : phan van Ong
(tang) va phan cam gide (tang).
- Nhan chen ke (nucl. intercalatus) nam chen gida hai nhan tren, chic nang chaa re.
- Nhan lung than kinh thiQt hau (nucl. dorsalis n. glossopharyngei) la phan tren cua nhan
hung than kinh lang thang.
- Nhan bo clan dtic (nucl. tractus solitarii) la nhan cam gide (tang) caa cac day VII, IX
va X.
- Nhan hoai nghi (nucl. ambiguus) la nhan van Ong (than th6) cua cac day IX, X, XI.
- Nhan bo gai than kinh sinh ba (nucl. tractus spinalis n. trigemini).

Nhan chen ke
Nhan than kinh ha thiet

Nhah tien dinh

ngoai
lung
Nhan va bó don er6c
86 dot rtrong
_
Nhan lung TK lang thang
Cueng tieu
Nhan va b6 gal TK sinh ba
nao dudi
X Nhan ben
B6 gai doi thi ben
Nhan hoai nghi
BO gai nab nao twee
lu'ng
86 tram tieu nao Nhan tram phy
trong
Nhan tram
Liem trong 86 thap
Xlf
Nhan cung

Hinh 47.4 : Hinh the trong clic& hanh nao tren

315
 - Nhan ben (nucl. lateralis) thuOc eau tao lath cua hanh nao.
- Nhan. thon (nucl. gracilis), nhan chem (nucl. cuneatus) va nhan chem phu (nucl. cuneatus
assesorius) cang len teen cang chay dat ra phia sau ngoai.
- Nhan tram (nucl. olivaris), nhan tram phu trong va lung (nucl. olivaris assessorius
medialis et dorsalis) la cau tao trong cua tram hanh.
- Cdc nhan cung (nuclei arcuati) nam track trong bo thdp.
1.1.2.2. Oat trdng. Chat trang hanh nao Om co:
- Sqi cung trong (fibrae arcuatae internae) phat xuat tit hai nhan thon va nhan chem di ra
trade, bat cheo qua dating giCia, troy thanh ligm trong (lemniscus medialis) nen ch8 bat cheo
nay goi la bat cite() cam gide (decussatio sensoria) hay bat cheo liem (d. lemniscorum).
- Sqi cung ngoai (fibrae arcuatae externae) phat xuat tit cdc nhan cung di ra sau cu6ng tigu
nao cladi cling ben.
- BO tram tigu nao (tractus olivocerebellaris) di tit run cdc nhan tram (hilus nuclei
olivaris) bang qua &rang giita d6 vao cu6ng tidu nao clued caa ben d6i dien.
- BO thdp (tractus pyramidalis) gom soi vo nhan (fibrae corticonucleares) va soi vo gai
(fibrae corticospinales), 2/3 s6 sal vo gai se bat cheo qua daring giCia (bat cheo thdp) de tao nen
bo thdp ben.
- BO doc trong (fasciculus longitudinalis medialis) va bo doc lung (fasciculus longitudinalis
dorsalis) nam gan daang giita, sau hem trong thuOc he tilting lien hap trong than nao.
1.2. NAO THAT IV (ventriculus quartus). Nao that IV la mot khoang hinh thoi kha rung
nam giiia hanh, cau nao d phia trade va tidu nao a phia sau, g6m co hal thanh: thanh tradc.
chiai hay nen, thanh sau teen hay mai va Mn goc: teen, dadi va hai ben.
1.2.1. Nen nao thgt IV (H.47.2) hay h6 tram (fossa rhomboidea) co hai ranh:
- Ranh giiia (sulcus medianus) chia doc 116 tram ra lam hai nata hinh tam gide ma dinh la
hai goc ben caa nao that IV.
-. Ranh gidi han (sulcus limitans) di tit goc dual, nai nao that IV thong vai 6ng trung tam
ctia tay gai, len tren va hcci chgch ra ngoai.
Gina hai ranh nay la mot 18i nao doc, nam tren do ke tit clued len co: tam giac than kinh
ha thiet (trigonum n. hypoglossi), van thy nao that IV (striae medullares ventriculi quarti), loi
mat (colliculus facialis) va go trong (eminentia medialis). J teen ranh gidi han co hai h6 nhO:
h6 dual (fovea inferior) ram sat met yang tam gide mau xam dam goi la tam giac than kinh
lang thang (trigonum n. vagi) va h6 teen (fovea superior) lien quan -yeti nhan van &Ong caa day
V. CI ben ngoai ranh gidi han la yang tin dinh (area vestibularis).
1.2.2. Mai nao thfiet IV (tegmen ventriculi quarti) (H.47.2 va H.47.8) dace day bdi hai
manh chat trang mong hinh tam gide goi la man thy (lath ye. teen (velum medullare inferior et
superior). Hai canh day &la hai man tay gap nhau là ch8 cao nhat cita mai nao that IV. Hai
canh ben cila man tily teen lien toe vdi hai cu6ng tidu nao tren va dinh duqc treo bai ham
man tily tren (frenulum veli medullaris superioris) nam tren &Ong gitia. Doc theo ch8 gan ciia
hai canh ben man thy dual vao hanh nao co hai dai chat trang goi la san nao that IV (tenia
316
ventriculi quarti). San la do tam mang mach nao that IV (tela choroidea ventriculi quarti) sau
khi phic len mat trudc man tdy clued den gin vao va day len tao thanh. Hai da.i nay gap nhau
a ranh giita tao thanh ch6t nao (obex). Co ba 16 ma de thong thuung dich nao tuy trong he
th6ng nao that vdi khoang dada nhen bao ben ngoai. DO la 16 giiia (apertura mediana) nam
tren dung gida cda man tdy dual va hai 16 ben (apertura lateralis) d hai ngach ben Ilan that
(recessus lateralis ventriculi quarti). Nao that IV thong a troll vdi tong nao.
1.2.3. Bon goo: Trong s6 been g6c thi g6c tren thong vdi ding nao cda bung nao va g6c
dudi thong vdi 6ng trung tam cita tuy gal.
1.3. CAU NA." 0 (pons)
1.3.1. Hinh the ngoai. Cau nao la phan nao nho ra trudc nhu met u, n6i lien cu6ng dai
nao d tren va ngan each bed ranh cau cu6ng va hanh nao doh ngan each bdi ranh hanh cau.
Co 4 mat:
- Mat trade: nam tua tren phan nen =tug cham va lung yen xdong bddm, cao khoang
25-30mm, co nhieu ranh ngang bang qua hai u u hai ben va mot ranh doc d gida goi la ranh
nen (sulcus basilaris) trong chda Ong mach nen.
- Hai mat ben thu hep clan, phan each vdi mat trade bdi re day than kinh sinh ba.
- Mat sau bi the lap bdi tieu nao va n6i yeti tieu nao bang 3 cap cueing tieu nao: gida
(pedunculus cerebellaris medius), tren (p. c. superior) va dudi (p. c. inferior). CO hai thiing di
toac tit tren xueing tao thanh hai cu6ng tieu nao tren co man tay tren (rectum medullare sup.)
tang giiia hai cuOng.
1.3.2. Hinh the trong (H. 47.5)

trongi
BO doe
lung
Nao that IV G6i than kinh mat

Cu6ng tieu nao Iran tren

ngoai Nhan tien dinh
Cu6ng tieu nao git7a

e-it•41-00140vuil
Nhdn than kinh VI

Cu6ng tieu nao duel Nhan Va bo gal than kinh V

go: 0744,1,11,7.7, 1
tren Nhan than
duel kinh mat
•Nhan nude bot tren

Ligm ngoai
Ligm trong
Thg hinh Chang
BO (hap
Nhan cau

Hinh 47.5. Hinh the trong cua cdu nao

317
 Teen cac thiet de, cau nao gem hai phan : lung cau va bung cau.
1.3.2.1. Phd n lung cau (pars dorsalis pontis) :
- Chat xdm : gem cac nhan.
• Nhan than kinh van nhan ngoai (nucleus n.abducentis).
• Cdc nhan than kinh sinh ba (nuclei n. trigemini) gem c6 mot nhan van d6ng (nucl.
motorius) va ba Allan cam gide : nhan cam gidc chInh (nucl. sensorius principalis), nhan 136
trung nao (nucl. tr. mesencephalici) va nhan bo gai (nucl. tr. spinalis) cda than kinh sinh ba.
• Nhan than kinh mat (nucl. n. facialis) cho cac the; di ra sau Ong quanh nhan than kinh
van nhan ngoai tao thanh g6i than kinh mat (genu n. facialis) tu'ong vai 16i mat cda nen
nao that IV.
• Cdc nhan tien dinh 6c tai (nuclei n. vestibulocochlearis) gem :
- Cdc nhan 6c bung va lung (nuclei cochleares ventralis et dorsalis).
- Cdc nhan tien dinh trong, ngoai, tren, clued (nuclei vestibulares medialis, lateralis,
superior et inferior).
• Nhan bung the thang (nucl. ventralis corporis trapezoidei) va nhan lung the thang (nucl.
dorsalis corporis trapezoidei).
- Chat trAng : diem dac sac dia chit trung a phan lung eau la cac dai bang cam giac
twang tam, d6 la :
• Liem trong thuOc ducting cam gide sau coy thdc.
• Liem gai (lemniscus spinalis) la ski lien tut len teen cua cac b6 gai doi thi, dun- truyen
cam gide Ming.
• Liem sinh ba (lemniscus trigeminalis) clan truyen cam gidc yang mat.
• Liem ngoai (lemniscus lateralis) va the hinh thang (corpus trapeizoideum) thuOc dudng
thinh gide cila than kinh 6c tai, va hai b6 doc trong va lung vi tri. gi6ng nhu' a hanh nao.
1.3.2.2. Phan bung cau (pars ventralis pontis) : duqc chiem bai 136 thdp nam xen ke vai cac
nhan cau (nuclei pontis). Cdc nhan la not tan het aia be vd cat' (tr. corticopontinus) va tit d6 se
cho ra nhiing soi cau ngang (fibrae pontis transversae) di vao cueing tieu nao gifia ben d6i then.
1.4. TIgU NA.- 0 (cerebellum).
Tieu nab nam trong h6 so sau, d teen &roc day bdi leu tieu nao ngan each vdi thtly chdm
dai nao, a dudi va sau tufa len xu'ong chum va a trade dinh vao mat sau than nao bed ba doi
cu6ng tieu
- Kich thuffic : cao 5 cm, ngang 10 cm va day Wady sau) 6 cm.
- Can Ong : a ngudi truang thanh, khoang 140-150g, nam Jiang hon
1.4.1. Hinh the ngoai (H.47.6 va 47.7) Tieu nao gem melt thUy nhOng tieu nab (vermis) a
gitla va hai ban cau tieu nao (hemispherium cerebelli) d hai ben. Gi6ng nhu a dai nao, cac khe
tieu nao (fissurae cerebelli) nhu khe ngang (fissura horizontalis), khe chinh (fissura prima), khe
phu (fissura secunda) va khe sau ben (fissura posterolateralis) se chia mat ngoai tieu nao ra
nhieu hei hay tieu thUy.

318
 They
nhOng Ban cgu tieu nab
Ludi Canh tieu they trung tam

Khe chinh

Khe ngang

Tieu they ban

nguyet
dtiai
I
Ludi i Hanh Khe phy
ga nhan than

Khe sau ben

4IC
Nhung nab
Cueing nhung nab

Hinh 47.6 : Hinh the ngodi ctia tieu nao (sa dej)

Man tew tren

Chgch tren
gi6a Cu6ng tieu nao
Tieu they trung tam
(Judi
Lu'di Cu6ng nhung nab
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Hanh nhan
h:Taa_ Tieu they
1,1 halthan
1
10

Khe
ngang
k ...,_. tr/J e' thay
ip
Tieu they
ban nguyet dLreii

n nguyet tren
Khe phi,
\Ze
\411...
k \ \‘N 111.
,j

Thung king tieu nab

Hinh 47.7: Hinh the ngoezi cua tieu nao (mcit

319
 - They nhOng tigu nao tidu nao (lingula cerebelli), tidu they trung tam (lobulus
centralis), dinh (culmen), chdch (decline), la they nhOng (folium vermis), ea they nhOng (tuber
vermis), thap they nhOng (pyramis vermis), lutoi ga they nhOng (uvula vermis) va cue nao (nodolus).
- Ban cau tidu nao await chia lam:
• Cl mat tren có canh tidu they trung tam (ala lobuli centralis), tidu they vuOng (lobulus
quadrangularis), tigu thhy don (lobulus simplex) va tidu they ban nguydt tren (lobulus
semilunaris superior).
• di mat dadi có tigu they ban nguyet duesi (lobulus semilunaris inferior), tidu they hai
than (lobulus biventer), hanh nhan tidu nao (tonsilla cerebelli) Ara nhung nao (flocculus).
Nhung nao va cue nao nal vdi nhau qua cu6ng nhung nao (pendunculus flocculi). rot dati
nay, vd phia bung, hai ban call tidu nao khuydt sau tao thanh met thung lung (vallecula
cerebelli) ma day la be mat caa they nhOng.
- Mat truac cua tidu nao thro'c chia lam hai phan:
• Phan dudi nhti da mo tad mat cloth gem nhung nao, cue nao, cu6ng nhung nao va hanh
nhan tidu nao.
• Phan trend hai ben la ba cap cu6ng tieu nao tren gitla va duai va tang giva cac cueing
la dinh &la mai nao thA b6n dual ittai tidu nao.
1.4.2. Hinh thg trong (H.47.8)
Tiiu they trung tam
Luoi
Dinh -

VO tie-U nao

Khe chinh

Man lily tren

Chich

Cdu nao
Nap. that IV
Ld Tim ming
mach nao
Mit IV

Cu
Man tdy du'di
Ctic nao
Ludi ga
Thap

The tity (cay sing tiiu nao)

Hinh 47.8. Hinh the trong cad tieu nao (thiet cto clang doc)

Gio'ng nhu a dai nao, cau tao cua tigu nao g6m co:
- VO tigu lido (cortex cerebelli) la lap chit xam ben ngoai.

320
 - Chat trong a ben trong goi là thd thy (corpus medulla& toa ra cac la trang (laminae
albae) di vao va tidu nao trong giang raw canh cay. Hinh clang dac sac nay cila chat trong tidu
nao dude goi chung là cay song tidu nao (arbor vitae cerebelli).
- Cac nhan xam tidu nao nam chim trong thd ti.ty gam có: nhan rang (nucl. dentatus),
nhan mai (nucl. fastigii), nhan cau (nucl. globosus) va nhan mit (nucl. emboliformis).

2. TRUNG NAO (mesencephalon)

2.1. HINH THE NGOAI. Trung nao nam n6i hen gifia cau nao a dudi va gian nao a tren
g6m hai phan: phdn bung hay cueing dai nao va phan lung hay mai trung nao. No dude gidi
han ar dudi bai ranh cdu trung nao (cau cu6ng) va a tren bai bo tren cila chat thiing sau va dai
thi giac va sau la bd tren cila mai trung nao. Trung nao, cau nao va hanh nao nam tren mot
true va ddoc goi chung la than nao (H.47.1. va H.47.2.)
2.1.1. Cueing dai nao: (pedunculus cerebri) g6m hai bo chdt trong 1dn chay taa ra thanh
hinh chit V nen can &foe goi là tru dai nao (crus cerebri). gicia hai try la ha gian cuang
(fossa interpeduncularis) va chat thOng sau (substantia perforata posterior) duoc giai han hai
ben bai ranh trong tru dai nao (sulcus medialis cruris cerebri) not phat xuat ra day so III.
2.1.2. Mai trung nao (tectum mesencephali) gam có 4 1oi nao con goi là 4 cu nao sinh ta.
Hai 16i nao tren (colliculus superior) va hai 16i nao dudi (colliculus inferior) nam defi xang qua
clYdng giYa va phia ngoai not vdi cac the goi cila gian nao qua cac cdnh tay 16i nao tren va
dudi (brachium colliculi superioris et inferioris). Day so IV tach ra a ngay dudi hai 16i nao dudi
la day so duy nhat tach ra. a mat sau than nao.

Lai nao trot.?

Chgt xam trung tam
Cong nao
Nhan than kinh III
Bo doc trong
Canh tay loi nao du'di Liam trong

Hinh 47.9. Hinh the trong ctia trung nao

2.2. HINH THE TRONG (H.47.9.).

- Chtit xam: tren cac thie't do, cau tao cua trung nao kd tit sau ra trade gem::
321
 • Phan 16i nao difuc tao nen do cdc tang xdm 1oi nao tren (stratum griseum colliculi
superioris) va nhan loi nao du'ai (nucl. colliculi inferioris)
• Chat xdm trung tam (substatia grisea centralis) bao quanh tong nao (aqueductus cerebri),
nui thong nao that IV vdi nao that III.
• Phan tran (tegmentum) trai tit tong nao cho ddn chat den (substantia nigra), ben trong
chi1a cdc nhan xdm nhu nhan than kinh van nhan (nucl. n. oculomotorii), nhan than kinh rang
roc (nucl. trochlearis), cdc nhan tran (nuclei tegmenti), nhan. do (nucl. ruber), nhan 136 trung
nao than kinh sinh ba va cau tao lu'ai trung nao.
• Truck chat den là tru dai nao có nhan gian cuo-ng (nucl. interpeduncularis)
- Chet trdng :
• dr phan tran trung nao gom cdc 136 chat trang nhu : sui vO lu'di. (fibrae corticoreticulares),
be) tran trung tam (tr. tegmentis centralis), 136 trung nao cua than kinh sinh ba (tr. mesencephalicus
n. trigerhini), hai be) doc trong va lung, cdc lidm trong, ngoai, liem gai va trung nao. Ngoai ra
con cc!, them cdc bat cheo xay ra a trail trung nao nhu : cdc bat cheo tran (decussationes
tegmenti) gom bat cheo trail lung cila IA mai gai va bat cheo trail bung cua hai 136 dO gai va do
va bat cheo cuthig tidu nao tren (decussatio pedunculorum cerebellarium superiorum).
• dr phan try nao có bo thdp d doan gitia va 136 vO cau d hai ben.

CAU HOI TRAC NGHIEM

Chon cau tra 16i dung nhat

536. Tram nao gom :

a) flanh nao. d) a, b, c ddng.
b) Tidu nao. e) a, b, c sai.
c) CAu nao.

Dung bang tra ldi sau day de tra 1di cau 537 - 538 :
a) VI. d) VI, XII.
b) IX, X. e) XII.
c) IX, X, XI.

537. Day than kinh nao thodt rad phan gicia va ducli ranh ben trudc hanh nao :
(Xem them beti 27).

538. Day TK nao thoat ra a ranh ben sau hanh nao : (xem them bai 27)
322
539. Hanh nao có nhan cda cac day TK so :

a) VII, IX, X, XI, XII. d) IX, X, XI.

b) VIII, IX, X, XI. e) VIII, IX, X
c) IX, X, XI, XII. (Xem them bdi 27)
540. Cac day TK so thoat ra d ranh hanh can :
a) V, VI, VII. d) VI, VII, VII', VIII.
b) VII, VIII. e) VIII, IX, X.
c) IV, V, VI, VII. (Xem them bdi 27)
541. Cdu nao phat tridn tit :
a) Tay nao. d) Nan trade.
b) Nao sau. e) Trung nao.
c) Nao (Xem them bed 61)
542. Nhan cda than kinh nao KHONG ndm d eau nao :
a) X. d) VI.
b) VIII. e) V.
c) VII.
543. tidu nao, thd tay chInh la :
a) Cac nhan xam tidu nao. d) Nhan mai.
b) Cay song tidu nao e) Tgt ca d6u sai.
c) Nhan rang.
544. Cu6ng tidu nao gida thuo:c :
a) Trung nao.
b) Cau nao.
c) Hanh nao.
d) Tidu nao.
e) Gian nao.
545. Vay quanh nao thdt IV la :
a) Cdu n5.0.
b) Tidu nao.
c) Hanh nao.
d) Ca a, b, c.
e) Chi a va b.

323
546. Nao that IV thong vai :

a) Khoang dudi nhOn qua 16 gida va hai 16 ben.

b) ang nao.
c) Ong trung tam &la tily.
d) a, b, c ddu dung
e) Chi a va b dung.

547. Mai dia nao thgt IV g6m :

a) Man tly tren. d) a va c thing.

b) Man tily e) a va b dung.
c) Cu6ng tidu nao gilt&

548. Than nao g6m :

a) Cu
a nao, hanh nao.
b) Trung nao, cau nao.
c) Trung nao, cau nao, hanh nao.
d) Cau nao, hanh nao, tidu nao.
e) Trung nao, cau nao, hanh nao, tidu nao.

549. L6i nao (hay ca nao sink til) thuOc :

a) Gian nao. d) Tram nao.

b) Doan nao. e) Hanh nao.
c) Trung nao.

550. Noi ve tidu nao, cau nao SAI :

a) Nam d h6 so sau.
b) VO trAng a ngoai, cac nhan xam d trong.
c) Cac nhan Xam g6m : nhan rang, nhan cau, nhan nut va nhan mai.
d) G6m mot thily giun va hai ban call tidu nao.
e) N6i vdi than nao bai ba cap cueing tigu nao tren, glib. va duai.

324
 48 GIAN NAO

MUC TIEU BAI WANG

A. MUC TIEU IAT THUYET

1.MO to vi tri va cau tao ciia gian nao.
2. MO to dai thi, yang tren, sau va dudi dai va chdc nang &la Bing thanh phan.
3. MO to can tao cua vUng ha dai.
4. MO to cac thanh ctia nao that III.
5. Ve thigt do thing doc qua nao that III.

B. MUC TIEU THVC TAP

1. CM tren nao that, mo hinh, tieu ban, tranh Ire : hinh the ngoai, hinh the trong va lien
quan caa dai thi.
2. CM tren nao that, mo hinh, tieu ban, tranh ve cac yang tren, sau, dudi dai va viing ha
dai.
3. CM tren nao that, ma hinh va cac phucing tin thuc tap khac cac thanh &la nao that III.

Clung vdi doan flan (telencephalon), gian nao (diencephalon) la phan nao phat tridn tit nao
trade (prosencephalon). Gian nao nam viii or day gida hal ban cau dai nao (hemispherium) va
not lien hai ban cau vdi nhau.
Vi nhm sau nhu vay nen gian nao rat MI6 quan sat va mo ta. Phan nao nay gam co dai
nao va yang ha dai quay lay nao that ba.

1. Doi NAO (thalamencephalon).

Doi nao bao gam dai thi, NrUng tren dai, yang sau dai va NrUng dudi dai.
1.1. Doi THI.
Doi thi (thalamus) la mot khea chat xam hinh soan gi6ng qua trung chim ba cau gam bon

325
mat va hai dau. Dau sau to va cach xa duOng giita hun dau trade vi tryc ldn caa dai thi che-ch
ra trade va hci vao trong. Kich Ulu& cua dai thi khoang 25-40mm (ddi), 18-20mm (rOng) va
20-22mm (cao). Hai dai thi dole ngan each nhau bai nao that III.
1.1.1. Hinh the ngoai
Ban mat dia doi thi là:
- Mat trong lien quan a phan ba sau vdi mep sau (commisura posterior) va 16i nao tren
(colliculus superior), con 2/3 truck thi tao nen tang lung ciia thanh ben nao that ba (ventriculus
tertius) d sau cuong tuye'n tang. Co mep dinh gian dai. thi (adhesio interthalamica) not lien
mat trong cua hai dai thi vdi nhau. Mop nay doi khi khong c6 a nao ngutari (khodng 20-30%),
thuang c6 dang 136n canh 3mmx5mm. Doi thi phan each vdi vang ha dai bai ranh ha dai
(sulcus hypothalamicus), di tit 18 gian nao that (foramen interventriculare) chay che-ch xu6ng
dudi va ra sau tan lig a 18 tren cua c6ng nao (aqueductus cerebri) (H.48.1.)
- Mkit ngoai 16i, dinh lien vao ban eau dai nao cang ben, lien quan vdi nhan duoi
(nucleus caudatus) a tren va bao trong (capsula interna) 6 dudi (H.48.2).

Vach trong suat

Vom nao
Mep dinh gian d6i thi
The chai Van toy ddi thi
San íóí thi
L6 gian nao that Cu6ngteing
Ngach king
Map truec The tong
La tan cang Mop sau
Nhan canh nao that
L6i nao tren
tieing fru& thi Loi nao duel
Nhan tren thi C6ng nao
Ngach thi giac
Vting 6161 doi
Giao thi
Ngach, pheu Veing ha d6i
Tuyen yen
Nhan king trong The ye
Nhan sau bung trong
Nhan sau
Hinh 48.1. Thiet d6 clang doc qua gian nao

- Mat tren hinh tam giac ma dinh a trudc gidi han a phia ngoai bai ranh thi van va
trong bai cu6ng tuygn tang duuc chia lam hai phan bai ranh mach mac. Phan trong rang, la mat
dien ti do, pha bai mat ldp chat trdng mang goi là tang yang (stratum zonale). Phan ngoai
hep, gap phan tao thanh san cua nao that ben (ventriculus lateralis) &roc phu bai la dinh
(lamina affixa) la mat ldp to bao not toy (ependyma). Bei trong caa la nay la nui gdn cua tam
mach mac (tela choroidea) nao that ben goi la san doi thi (tenia thalami). Con hai canh ben caa
mat tren la hai b6 chat trdng gO'm van toy d6i thi (stria medullaris thalami) a trong va van

326
tan ding (stria terminalis) o ngoai. Van tay, gidi han mat tren va mat trong cua doi thi, di d6n
tan het a nhan cu6ng tung (nuel. habenulae).

Van toy dal thi

V6m nao (than)
The chai
Tgrn mach mac
NJ° thgt ben nao thgt ben
Nhan duo i
La dinh
Van tan cut-7g
Tang yang
La toy cloi thi
Nhan ben d5i thi La toy ngoai
Nhan trong ddi thi
Nhan tam trong
Bao trong
Nhan boo
VOng bdt dinh
Dai thi Nhan dudi dai
VOng ha dal Bao trong
B6 vu thi
Giao thi
Thin kinh thi Vorn nao
Nao thgt ba

Hinh 48.2 : Thie't clo clang ngang qua gian nao

Van tan ding chay trong ranh thi van phan each nha.n dual vdi dOi thi, la mat bo den caa
viing ha do'i (H.48.3).
— M4t difai lien tuc vdi yang ha dOi (hypothalamus) a phia tru'dc trong va vdi vUng du'di
doi (subthalamus) d phia sau ngoai.

The chai
Nao thdt ben
Van tan cOng Vach trong su6t
La dinh Vam nao
Nhan duOi
San doi thi
Bao trong
D6i thi
Nhan bOo
Mep cu6ng king Van toy d6i thi
The king Tgm mach mac
Canh tay lien hop du'ai nao thgt ben.
L5i nao tren
L5i nab dudi

Hinh 48.3 : Mcit tren gian nao.

327
 - Dau trudc d6i thi trim nh6, nho ra tao thanh cu tritdc d6i thi (tuberculum anterius
thalami) va gidi han vdi cot cua vom nao mot 16, 16 gian that. Dau sau 16i to goi la dai cham
(pulvinar). D6i cham hai ben n6i vdi nhau bdi mep sau (H.48.1). D6i cham lien quan d phia
doei vdi vilng sau d6i.
1.1.2. Hinh the trong
D6i thi duoc cau tao bai hai chat: chat trang va chat xam.
1.1.2.1. Cheit trung (substantia alba)
Chat trang cua d6i thi tap trung ch6 ygu e hai ndi, tang \Tung va cac la tuy d6i thi
(laminae medullares thalami) (H. 48.2, H. 48.4).
- Tang viing, nhu da not 6 tren, lOt din tkr do cila mat tren d6i thi, du6c eau tao b6i bó
thi va (fasciculus thalamocorticales).
- Cac la tuy d6i thi tao nen hinh chit Y, gam mot la sau va hai la trudc, chia mat lung d6i
thi ra lam ba 1(116i nhan xam ldn, cac nhan tru'dc, trong va ben. Ngoai ra con co la thy ngoai
la ldp chat trang nam a mat ngoai d6i thi, phan each d6i thi vdi bao trong.
1.1.2.2. Ch.& xdm (substantia grisea)
Dula vac chile nang sinh 1y than kinh, cac nhan xam d6i thi co thd phan ra lam hai nhom,
cac nhan chuyen bit va cac nhan khong chuyen bit cua dai thi:

Man bung trudc ben Cu trick doi thi

Nhan lu'di doi thi
Nhan bung trung gian Nhan trudc

Nhan ben king

— Mop dinh gian doi thi
Nhan bung sau trong

Nhan bung sau ben Nhan trong

Nhan sau Nhan chidnggiCia
La tuy d6i thi
The g6i ngoai
The g6i trong

Hinh 48.4 : Sa dd cac nhan xdm ctia clot thi

- Cac nhan chuyen bit c6a d6i thi g6m :

+ Cac nhan trudc dai thi (nucl. anteriores thalami) g6m cac nhan truck lung (nucl.
anterodorsalis), nhan trudc bung (nucl. anteroventralis) va nhan trudc trong (nucl. anteromedialis).
Cac nhan nay la tram trung gian cua cac the di tit yang clued dai len h6i dai (gyrus cinguli), CO vai
tat) trong cac xfic cam va su dap (rug not tang nhu di6u haa ho hap va dp huygt.
+ Nhan trong doi thi (nucl. medialis thalami) la tram trung gian cua cac thd yang dad d6i
- va trail trudc co vai tra trong to duy hinh thanh nhan cach.

328
 + Cac nhan ben dai thi (nucl. laterales thalami) g6m:
• Nhan bung truck ben (nucl. ventralis anterolateralis), nhan bung trung gian (nucl.
ventralis intermedius) la tram trung gian cda &Ong van deng ngoai thap.
• Nhan bung sau trong (nucl. ventralis posteromedialis), nhan bung sau ben (nucl.
ventralis posterolateralis) là tram thing cua cac duerng cam gide than the va net tang.
• Nhan ben hrng (nucl. lateralis dorsalis) ce chdc nang lien hqp cac nhan khac cua dal thi
voi ve thay dinh.
• Nhan sau (nucl. posterior) hay dei cham là nhan lien hqp cua cac du6ng thinh va thi gide.
Cac nhan khong chuyen biet cua dei thi g6m :
+ Nhan luccli dei thi (nucl. reticularis thalami) nam 6 giila ngoai va bao trong.
+ Cac nhan trong la (nucl. intralaminares) va nhan trong trung tam (nucl. medialis
centralis) thuec cac Id toy dai thi.
+ Ngoai ra con ce cac nhan du'Ong giura nam trong phan tren cua thanh ben nao that ba va
trong mep dinh gian dei thi. Cac nhan nay nao ngU6i hien dien met each so sai nhu'ng lai
&at tri6n manh 6 cac load Ong vat cap thap.
Khac veri cac .nhan chuyen biet cUa. &Si thi ma chile nang sinh ly va su dan truy6n than
kinh da duoc chuyen biet hoa, cac nhan khong chuyen biet thuec y6 h6 hkri kith hoat hurting
len, met thanh phan quan trong cUa eau tao lutri (forniatio reticularis), ce chile phan trong sit
danh thilc va tinh thdc cUa town be v6 dai nao.
Si' phan loci trail day chi' y6u dura theo danh phap giai phdu qu6c td, tuy nhien con rat
nhi6u quan niem khac trong viec phan loaf va dinh danh cac nhan cUa dei thi.
1.2. VUNG TREN D6I
Wing teen dei (epithalamus) chidm phan tren trong cua gian nao, g6m c6 thd tong (corpus
pineale) va tam giac cueing tong (trigonum habenulae) (H.48.3).
— Thd tong la met cat' tree hinh non, kith thuac : 5-8 mm, nam ngay tren 161 nao tren
mat sau trung nao (mesencephalon). Chile phan cua thd tong chug d►toc bidt re, ce le do la met
tuydn nei tidt co tac dung tic chd sur hoat Ong cUa tuydn sinh due. Sau 16 tu'6i, thd tong cua
ngti6i bat dau thodi hoa va thueng nhi6m voi, thay &lye tren phim X quang.
— Tam giac cu6ng, dinh truck va hai canh ben la cu'ding the tong (habenulae). Trong
cueing c6 chda cac nhan cuang tong trong va ngoai (nucl. habenulae medialis et lateralis). Cac
nhan nay, 6 hai ben not voi nhau qua mep cueing ding (commissura habenularum), va cho ther
di xu6ng tao thanh be phan chidu (fast. retroflexus) ddn nhan gian cu6ng (nucl. interpeduncularis)
6 mat trate cu6ng dai nao (pedunculus cerebri).
1.3. VUNG SAU DOI
Wing sau dei. (metathalamus) g6m b6n thd goi nam 6 mat sau dutri cUa dei cham. Hai th6
g6i ngoai (corpus geniculatum laterale) not lien voi 16i nao tren bai canh tay 16i nao tren
329
(brachium colliculi superioris) c6 chung mot chdc phan la trung khu nhin dried v6. Tirong ttt, hai
the g6i trong (corpus geniculatum mediale) n6i vai 16i nao du6i qua canh tay 16i nao dti6i
(brachium colliculi inferioris) la trung khu nghe du'ai v6 (H.48.3, H.48.4).

1.4. VUNG DWI D6I

Wing duai d6i (subthalamus) gan day duvc xem nhu' mot vOng nao rieng bidt, la thanh
phan sau ngoai cua d6i nao. O phia trojc trong &la vOng nay là vOng ha dai, ma du'Ong phan
cach la 136 sau ctia cot \Tom nao (columna fornicis) tan hdt a the vii (corpus mamillare). Vg mat
eau tao, chat trang cua yang dual di:3i la nhUng th6 hinh quai, quai beo (ansa lenticularis) va
quai cueing (ansa peduncularis), di xu6ng tir cam nhat (globus pallidus) qua cu6ng d6i thi clutri
(pedunculus thalami inferior) dd den d6i thi. Con chat xam tap trung chu ydu 6 yang bat dinh
(zona incerta) va nhan clued d6i (nucl. subthalamicus), la mot trong nhting tram dimg cila dating
van Ong ngoai thap dli6i vo c6 tac dung trong cac cit Ong long data lie van Ong di chuydn
(H.48.1, H.48.2).

2. VUNG HA DOI (hypothalamus).

Vimg ha deli la phan trttac nhat cua gian nao, nam d tang bung cua hai thanh ben nao
that III. Trong luvng tong cOng chi khoang 4g, chigm 0,3% trong lacing ctia toan thd nao bO,
"16n khOng bang ming tay cai", nhung vOng ha d6i là mot vOng rat quan trong va rat phic tap.

2.1. HINH THE NGOAI.

Wing ha d6i tao thanh san va thanh bung ben dia nao that III, 6 mat du& d6i thi, chidm
mot vOng tir rigay sau hai the vi cho ddn cyc tru'efc &la giao thi, bao g6m thd vti, cu xam (tuber
cinereum), phdu (infundibulum) va tuydn yen (hypophysis), (se duvc mo to o bai 60), dai thi
(tractus opticus), giao thi (chiasma opticus) va 1a tan ding (lamina terminalis) (H.48.5).

Giao thi
Phgu
Dal UV
Cu xam
Chgt thong trutfc
The vu

Chgt thong sau

Cugng dal nab

Cgu nao

Hinh 48.5: Mat du'ai yang ha dai

330
 2.2. HINH THE TRONG (H.48.1, H.48.2).
2.2.1. Chat trang. Chat trang la mot van de con Bang trong yang tiep tut khao sat, du'ac
cau tao bai cac bó den va bó di cua vang ha d8i.
—Cac bó den có the vam nao (fornix) den tit hai ma (hippocampus), van tan ding den
tit the hanh nhan (corpus amygdaloideum), bo nao truac trong den to cac yang khau cua they
bo deli thi ha deli, bó beo nhat ha deli...
—Cac bo di Om co cuaing the vu (pedunculus corporis mamillaris) vdi cac bo vu thi (fast.
mamillothalamicus) va bó vu trail (fast. mamillotegmentalis), cac the quanh nao that (fibrae
periventriculares), bo dot lung (fast. longitudinalis dorsalis), dai tren thi tuyen yen (tractus
supraopticohypophysialis)...
2.2.2. Chgt xam. GO'm cac nhan nam trong hai yang ha deli ngoai va trong ma ranh gidi
la mat phang doing doc di qua ba bó : the vom (c8t vom), 136 vii thi va 136 phan chieu. Chile
nang va phan loai caa cac nhan xam yang ha deli co the tom tat nhu sau :

PHAN LOAI CH eC NANG

Vitng ha deli trong

— Vang truck :
• Nhan tren thi (nucl. supraopticus)
• Nhan canh nao that (nucl. paraventricularis)
• Nhan truac thi trong va ngoai
— Wing ea :
• Nhan bung trong (nucl. ventromedialis).
• Nhan lung trong (nucl. dorsomedialis).
• Nhan San (nucl. posterior)
— Wing the vii
• Nhan the va (nucl. corporis mamillaris).
ngoai va trong
Wing ha cloq ngoai
• Cac nhan cu (nucl. tubercles).
Trung khu chi ph& dal giao cam
Trung khu -boa nhiet
Di8u haa not tiet tuyen yen
Trung khu chi ph6i giao cam
Trung khu bao ton va tao nhiet
Trung tam no va trung tam nu6i
Trung tam khat va diet' haa
Wong nude vao

Cac nhan cua yang tru'ac thi du rang la mat phan cau Goan nao nhung carig du'oc de cap a
day vi chting có sat lien he mat thiet vdi eau tao va chile riang cast vang ha dd.
Tom lai, yang ha deli la met trung khu than kinh cao cap chi phol moi haat Ong cilia he
than kinh ti chili (systema nervosum autonomicum) cilia ca the. Trong do cac chile nang diet'
haa than nhiet, dieu haa luting an vao, thang bang Wong nude cilia co the, dieu haa not tiet
tuyen yen buck dau da duoc xac dinh.
331
3. NAO THAT III (H. 48.1, H. 48.2)
Nao that ba (ventriculus tertius) la met khoang don, trong nhu met khe hep, nam thing doc
chinh giaa gian nao, c6 kich thutrc 2,4-4cm (deci) 0,5-1,0cm (rang) 2,5-3,0cm (cao). Thong vdi
nao that ben 6 tren bdi 16 gian nao that va vdi nao that bona dudi th6ng qua c6ng nao. Nao
that ba c6 dang hinh thap b6n canh ma mai d tren va dinh 6 dudi.
3.1. MAI NAO THAT hay thanh tren g6m ba phan: phan gliita la mang mai rat m6ng va
hai phan ben là hai cu6ng tong. O mat tren mang mai c6 tam mach mac nao that ba (tela
choroidea ventriculi tertii) lach vao. C1 dau truck, ngdy dual hai cot yam nao c6 16 gian nao
that thong thuong nao that ba vdi nao that ben.
3.2. HAI THANH BEN hoi chech xu6ng dudi va vao trong. Ranh ha dei chia thanh ben ra
lam hai tang: tang lung thuec del thi va tang bung thu6c vUng ha dei. 0 trade met phan ba
gicra cUa tang lung c6 mep dinh gian dei thi bang ngang nao that. Day là met mep lien ket gia
vi eau tao chit' yeu do cac to bao than kinh dem va cac soi phan chieu hinh m6c quay tra lai
ben xuat phat. 0 tang bung ch6 thap nhat la dinh cilia ngach pheu (recessus infundibuli) Wong
dug vdi dinh cua nao that ba.
3.3. THANH TRU'OC gar' nhu duing thing, ke tit tren xu6ng c6: cac cet cUa vOm nao, mep
truck, la ding va giao thi. Hai thanh phan sau nay hop thanh met tali ding, ngach thi giac
(recess us opticus).
3.4. THANH SAU DT OI chay chech xu6ng dudi va ra truck. Kd tit sau ra trade c6:
- The tang vdi day a truck bi phan thanh hai nep tren dudi bed ngach tong (recess us
pinealis). Nep tren hay mep trade cu6ng tong va nep dudi hay mep sau. C1 tren nep tren la
ngach tren the tong (resessus suprapinealis).
- Lo tren cua c6ng nao Wong ung vdi ci.tc sau cua nao that ba.
- Chat thUng sau (substantia perforata posterior) va cac thanh phan cua san nao that cilia
\rung dudi d6i.
3.5. DiNH cilia nao that ba ung vdi ngach pheu, cu6ng tuyen yen va tuyen yen. Tuyen yen
la met tuyen nei tiet than kinh dinh a mat cloth vimg ha dei c6 hai thug, thily sau, ngu6n g6c
than kinh, thUy trudc c6 ngu6n g6c tuyen. Tuyen yen nam trong h6 tuyen yen a nen so.
Hinh d6i chieu cua lido that ba len so, neu rihin tit tren xu6ng thi a chinh gill-a yam so;
neu nhin tit trudc thi hoi d teen u tran giita. Ngoai ra, dung thing dang qua khdp so doc giita va
dung lien ifing tai ngoai se gap nhau d met diem nam hoi truce tam diem dm nao that ba met it.
Ngudi to c6 the chup hinh nao that ba n6i rieng va he th6ng nao that not chung bang
each bum hoi hoac thu6c can quang vao de quan sat hinh dang, kich thudc ciAa nao that

CAU 1161 TRAC NGHIEs M

Chon cau tra 16i thing nhat

551. Thanh phan nao KHONG thuOc gian nao:

a) Doi thi. d) Cac the g6i trong va ngoai.
b) Nhan duoi. e) Tat ca cac thanh phan tren deu thuec gian nao.
c) The tang.
332
552. Di nã°:
a) La di thi.
b) Gm di thi va nhan duel.
c) Gm di thi va yang tren d6i.
d) Gam di thi, viing tren di, vUng sau dOi va yang dual d6i.
e) Tat ca deu sai.
553. Ranh giai giaa yang ha di va vUng dual di la :
a) La tan ding.
b) Ranh ha d6i.
c) Mat phang dung ngang di qua ngay sau hai th6 y(i.
d) Mat phang clang ngang di qua phia trade hai th6vu.
e) Tgt c du sai.
554. Vung ha di (hypothalamus).
a) Nam a trade trong cüa di thi.
b) Là trung khu cao cap cüa he TK
c) Hinh the' trong la cac nhan xam duac chia lam vfing ha d6i trong va ngoai.
d) Hinh the' ngoai gam the' vu, cü xam, giao thi, tuygn yen...
e) a, b, c, d dting.
555. Thanh trade cCa nao thgt III dirge tam nen hal :
a) Tru trade vôm nao. d) b va c thing.
b) Mep tru'ac. e) a, b, va c deu dung.
c) La tan ding va giao thi.
Dung hinh ye va bang tra ldi sau cho cac cau 556 cign 560.
a) D6i thi.
b) Vach trong sugt.
c) The' ding.
d) Wing dudi di (subthalamus).
e) Wing ha di (hypothalamus).
556. Chi ti6t so' (1) la :
557. Chi tigt s6 (2) la :
558. Chi tigt s6 (3) la :
559. Chi ti6t s6 (4) la :
560. Chi tigt s6 (5) la :

333
 49 DOAN N AO

MUC TIEU BAI GIANG

A. MUC TIEU LY THUYET

1.MO to hinh thd ngoai (cac ranh, cac thdy, cac h6i cti a ban cau dai nao).
2. Me to cac mop gian ban cau.
3. MO to hinh the trong ban eau dai nao.
4. MO to cac sling cua nao that ben.
5.Ve thidt d6 cat ngang va cat ditag ngang qua hal ban cau dai nao (thiet d6 Flechsig vs Charcot).
6. Ve hinh chidu cua nao that ben len so.

B. MUC TIEU TT-111C TAP

1.Chi tren nao that va me hinh cac mat cila ban cau dai nao.
2. CM tren nao that va me hinh cac ranh, cac thug, cac h6i dia ban cau dai nao.
3. CM tren tiou ban, mo hinh, tranh ye hinh thd trong ban eau dai nao ya cac mep gian
ban cau.
4. CM tren nao va mo hinh cac sung cua nao that ben.

Doan nao (telencephalon) g6m hai ban cau dai nao (hemispherium), la phan to nhat
va chidm trail 85% trong lddng el1'a than thd nao bO (encephalon). Doan nao nam trong
tang trade va tang gitia &la hOp so, a tang so sau thi nam de len leu tidu nao. Cac kich
diode trung binh cua doan nao la dai 16cm, Ong 14cm va cao 12cm. Can nang thay d6i
td 1000g ddn 2000g. Meng nao ngddi Viet Nam nang trung binh khoang 1322g ddn
1442,23g. Tuy nhien khOng thd data vao kich thu'dc, can nang dia nao dd danh gia tri the;
con ngdeti. Ve phdang diet' phat trian, doan nao dutqc chia ra lam hai phan : phan c4u
doan nao va phan tan doan nao. Phan cktu doan nao gam h6i nai. vien (thuft do nao cu),

334
khau nao va cac nhan n8n. (do nao cii) la nhang phan nao phdt sinh dau tien Ira da sam
thodi hoa. Trong khi do phan tan doan nao van tidp tyc phdt tridn, manh nhat là a chu vi
tao nen do nao (pallium) g6m chdt trong a ben trong va lap vO xdm dai nao (do nao mai) a ben
ngoai. cdc load Ong vat cap thap nhit loci laang the, bo sat... thi khiIu nao va cdc nhan nen
rat phat tridn trong khi a loci Ong vat cap cao, tang ti6n h6a bao nhieu thi phan tan doan
nao tang phdt tridn bay nhieu. Ve phu'ung dien giai phdu, doan nao dirge eau tao bai lap v6
xdm dai nao a ben ngoai, chat trang va cdc nao that a trong va cdc nhan nen a du6i.

1. HiNH THE NGOAI CUA DOAN NAO

Khe nao doc (fissura longitudinalis cerebri) phan doi chinh gala doan nao ra lam hai ban eau
dai nao phai va trdi. C1 phia truac va sau, ski phan deli nay hoar" than, nhung a phan giaa khe nay
chi d6n the chai. O mat phia sau doan nao n'am triim lap len d8i thi, trung nao va tidu nao.
Ngdn each doan nao vdi cdc cau true nay co khe'ndo ngang (fissusra transversa cerebri) dd cho cdc
tam mach mac (tela choroidea) caa hai nao that ben va ba ldch vao. Moi ban cau dai nao gom c6 ba
mat : mat tren ngoai, mat trong va mat du'ai, ngan each nhau bai ba bo : tren, dadi va trong. Cdc
mat dirge chia ra lam nhidu they nao (lobi cerebri), they lai dude chia ra lam nhigu h8i (gyri
cerebri)ho4 c tidu thug (lobuli cerebri) bai cdc ranh. nao (sulci cerebri).
1.1. MAT TREN NGOAI DAI NAO (facies superolateralis cerebri) (H.49.1).

Hoi Mt& trung to Hai sau trung tam

Trung tam dinh tren

Hai tran tren
Trung tam dinh du'di
r oc' r

Ranh dint? clidm

\Ntre
Hai tran gia'a
Hai chdm tren

kcea
Or Hot chdm dual
Hai tran dual Tr. Sc
Cid ddOn Cu'c chdm
Cy'c tran
Hai thai dung tren
Ranh ben
Cu'c thai &Icing TD attoi' H6i thai du'ang gia'a
Hai thai du'o'ng dddi

Hinh 49.1 : Mat tren ngoai ban cau dai nao

Day là mot mat 16i, nam dp sat van yam so, co hai ranh Wang doi c6 dinh, ranh trung
tam (sulcus centralis) di tit phan ba gicia ba tren bdn cau (margo superior) chay ch6ch xu6ng
dual va ra tru'ac, va ranh ben (sulcus lateralis) di tit ba dadi bdn cau (margo inferior) nai n6i
phan tit tritac vdi ba phan tit sau r6i chay ch6ch len tren va ra sau. Hai ranh nay ding vdi mot
ranh it c6 dinh han, ranh dinh cham ngoai (sulcus parietooccipitalis externus) rat ham .nam
thang g6c vdi phan ba sau ba tren ban eau, chia mat tren ngoai ra lam b6n thay nao : thay
they thai duang, thay chdm va thay dinh. Ngoai ra, a doan dau cua ranh ben sau nInt

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mot thung lung, c6 tach ra ba tre : tre trade (ramus anterior), tre len (ramus ascendens) va tre
sau (ramus posterior) gidi han nen ba nap : nap tram (operculum frontale), nap trd.n. dinh
(operculum frontoparietale) va nap thai clueing (operculum temporale) eaa thug dao, mot thUy
ma phdn ldn bi vui lap not ddy cua thung lung ben.

1.1.1. Thiry bran (lobus frontalis).

Thiry trail nam traffic ranh trung tam va tren ranh ben, e6 ddu track goi Id ate trdn (polus
frontalis). Ba ranh : trude trung tam (sulcus precentralis), tram tren (sulcus frontalis superior)
va tram dutch (sulcus frontalis inferior) chia mat ngodi cua thUy ra lam bon h6i : h6i trade trung
tam (gyrus percentralis), h6i tram tren (gyrus frontalis sup.), h6i trail gitia (gyrus frontalis
medius) va h6i trdn cludi (gyrus frontalis inferior).

1.1.2. Thiry thai dtidng (lob us temporalis).

Thiry thdi diking nam du'ai ranh ben, phia trudc ditty cham c6 dAu truck goi là cue thai
diking (polus temporalis). Hai ranh thdi duong tren va du'di (sulcus temporalis superior et
inferior) chia mat ngoai cua thily ra lam ba h6i thai throng tren, giita va cludi (gyri temporalis
superior, medius et inferior). Ngoai ra, nam d mat tren cilia they, thuOc thanh dad ranh ben co
nhi6u ranh thdi doting ngang (sulci temporales tranversi) gidi han nen cac h6i thai dudng
ngang (gyri temporales transversi).

1.1.3. Thiry chgin (lobus occipitalis).

Thiry cligni ma dau sau goi la cue chdm (polus occipitalis), CO gidi han trade la mot &Ong
thang n6i tit khuyeet tru'dc chdm (incisura preoccipitalis) den ranh dinh chdm ngoai. Ranh chdm
ngang (s. occipitalis transversus) chia mat ngoai they chdm ra lam hai nhom h6i chdm tren va
dudi (voi so lugng khong co dinh). Doi khi can thdy them ranh nguy'et (sulcus lunatus) nam
gar" cue cham va ddu sau cua ranh can (sulcus calcarinus). Neu co, ranh nay la gidi han cua
vUng thi gide d mat tren ngodi.
1.1.4. Thew dinh (lobus parietalis)
Thiry dinh nam dr tren va Om 16y ddu sau ranh ben : nam gala they tran phia truck va
they cham phia sau. Ranh sau trung tam (sulcus postcentralis) va ranh gian dinh (sulcus
interparietalis) chia they ra lam h6i sau trung tam (gyrus postcentralis) va hai tidu thily dinh
tren va cludi (lobuli parietalis superior et inferior). Ngoai rad ddu sau ranh ben, ngay dual tidu
thUy dinh dudi con c6 hai h6i nao khdc, da la h6i tren vin (gyrus supramarginalis) om lay dau
sau ranh ben va h6i g6c (gyrus angularis) yang quanh dau sau cua ranh thai duzing tren.
1.1.5. Thiry dao (insula) (H.49.2).
Cdc h6i oda thUy dao sap xe-p thanh hinh tam gidc ma dinh a track dtidi, not nay tao
thanh mot ne-p li6m n6i thily tram vdi cue thdi &tong goi la th6m thUy dao (limen insulae). CO
hai ranh : ranh trung tam dao (sulcus centralis insulae) chay tit dinh che-ch len tren sau, phan
each d trade ranh la cac h6i Tao ngan (gyri breves insulae) va d sau la mit hoi dao dai (gyrus
longus insulae). Ranh tha hai la ranh yang dao (sulcus circularis insulae) chay \Tong quanh cac
h6i, phan each cluing vai cac thily nao chung quanh.

336
 Nhan canh nao that
Nhan sau
Nhan king trong
Nhan Cu Ranh ha dOi
I.

Nhan tren thi

Giao thoa thi
Tuyen yen
Nhan bung trong -
Nhan the vu

Day van nh5n

Anh X_XXXV : Vang ha d"di (Thi& do dung doc)

337
 Cac hoi dao ngan

Ranh vOng dao

Nap tran dinh — Ranh tam dao

Nap tran
1-161 thai ducing ngang

Nep liam
(the'm the)), dao)
Nap thai &icing

Hinh 49.2 : Ccic it& dcio

1.2. MAT TRONG VA MAT DU'OI BAN CAU DAI NAO (facies medialis et facies inferior
hemispherii)

1.2.1. Mat trong nao gem c6 :

— Ranh the chai (sulcus corporis callosi) chay vien sat be tren the chai.
—Ranh dai (sulcus cinguli) gidi han mat lung cUa h6i dai, khi chay cl6n veng 16i the chai
thi quat len tren tao thanh tre vie'n tan h6t a be tren ban cal"
—Ranh diidi dinh (s. subparietalis) not tiep dau sau caa ranh dai. Hai ranh nay chia mat
trong nao, a veng trail dinh ra lam hai phan : phan du ai la h6i dai (gyrus cinguli) nam ngay
phia tren ranh the chai. Cl phia sau hai that lai tao thanh eo h6i dai (isthmus gyri cinguli).
Phan tren, ke tit trudc ra sau c6 :
* H6i trail trong (gyrus frontalis medialis) la mat trong &la h6i trail tren.
* Tien they canh trung tam (lobulus paracentralis) là phan nhe vao cua hai hai trade trung
tam va sau trung tam.
• H6i trudc them (precuneus) thu(ic tidu they dinh tren, hinh ban canh, canh trade la tre
ranh dai, canh tren la bar tren ban cau, canh dodi la ranh duel dinh va canh sau la
ranh dinh chain (sulcus parietooccipitalis).
* Phan them (cuneus) thuec they cham, hinh tam giac, dinh a trudc, c6 ba canh la be tier'
ban eau, ranh tufa va ranh dinh cham.
— Ranh dinh chain di tit be tren phan ba sau ban cat' chay chech xnang duai ra trust, tan
h6t khi ti6p not vdt ranh tufa.

338
 - Ranh hai ma (sulcus hippocampi) tie-p tuc ddu sau &la ranh the chai 'yang xuthig ditai phan
cach h6i rang (gyrus dentatus) a trong va h6i canh hai ma (gyrus parahippocampalis) a ngoai.

Ranh rung tam

Tre Wen TT. canh trung tam
Hdi tran trong
Hai tradc chem
Ranh dai
Ranh dadi dinh Ranh the chai
The chai
Ranh dinh chain
Vach trong su6t
Hoi chem
Von" nao
Dai xam
Ranh cija Map track
Ranh ben oily Hai thang
Wing dadi chai
Hoi la Hoi can/7 la tan cang
Hai Nei Eo hBi dai
La tan cung
Hoi canh hal ma The vu
M6c hal ma Ranh mai
Hoi thai daong chem Hai rang
Ranh hal ma

Hinh 49.3. MO trong ban cau dai nao

1.2.2. M4t dutdi nao g6m có hai phdn ngan each nhau be i phdn (Mu cua ranh ben a mat
ditai ban cau.
+ Phan thcii &tang chdm : có
- H6i canh hai ma (g. parahippocampalis) có ddu trade u6n lei thanh in& (uncus) va phdn
sau goi là h6i ktai (gyrus lingualis). Giai han a phia triidc cUa Ea& hai ma la ranh mai (sulcus
rhinalis) va a phia ngoai h6i la ranh ben phu (sulcus collateralis).
- H6i chdm thai du'ong trong va ngoai (gyrus occipitotemporalis medialis et tateralis) ngan
each nhau bai ranh chdm thai throng (sulcus occipitotemporalis). Hai hoi nay nem gifia h6i
canh hai ma a trong va bar dltdi ban cau d ngoai (H.49.4).
+ Phein o mdt cUa thUy tram bao g6m h6i thdng (gyrus rectus) d trong va cac h6i 6 mat
(gyri orbitales) a ngoai. Ngan each gala hai h6i nay co ranh khiru (sulcus olfactorius) va ngan
each giita cdc h6i 6 mat co cdc ranh 6 mat (sulci orbitales) dei khi xep thanh hinh chit H.
Ngoai ra, mot phdn cou doan nao cimg they du'oc a mat nay : do la ithitu nao (phdn ngoai bien)
g6m co hanh khilu (bulbus olfactorius), dai Multi (tractus olfactorius) va tam giac klatiu
arigonum olfactorium). Cau tao nen tam giac nay la ba van khitu (striae olfactoriae) giai han
trot ic cUa mot khoang co nhieu 16 thang de cho mach mau di vao goi la chat thing trade
(substantia perforate anterior). Lien tic ben trong cda du'ang lthitu giac a mat trong ban cau la
mot viing nao nem ngay chtdi mO the chai, do la \rung vach g6m co \Tang du'ai chai (area
subcallosa) va h6i canh tan ding (gyrus paraterminalis). H6i dai, h6i canh hal ma va vUng clitdri

339
chai tao thanh mot hdi ldn yang quanh cac mep gian ban cdu dai nao goi la hoi vi6n, ma cgu
tao va chic nang con clang chive ban cai (H.49.3).
CVc tran Khe nao doc

Ranh tran duel Ranh khdu

Cac h6i 6' mai Hanh khau
Cac ranh 6 mat broi thing
CVc thai dVdng Cu6ng khCiu
Tam giac khliu
Ranh mill Chgt thong fru&

Thung long ben Giao thi

M6c hai ma Co xam
H6i chgm thai dUdng trong The va
Trung nab (thigt do)
HOi chain thai &king ngoai
L6i nao
H6i thai duting du6i .0
Ranh thai du'ong duel - 'The g6i trong
U
Ranh chgm thai dicing Thg g6i ngoai
Ranh ben phy Loi thg chai
Khe nao ngang

CVc chgm
Khe nao doc
Hin,h 49.4 : Mat duoi ban cdu dai nao

Vann tia Ranh trung tam

Bao trong

Ranh dish chgm

Tia thi
Mep fru&
D ai thi giac
The g6i ngoai
Cat.' nao
Hanh nao
Tigu nao

Hinh 49.5 : TM tea thing oda ban cau dai nao

340
 Ngoai ra, nam a sat mat tren caa the chai con co mat hei nao c6 da can cot', do la h6i not
phan trung acing cila khiiu nao, gem co dai xam (indusium griseum) vdi hai van doc
trong va ngoai (stria longitudinalis, medialis et lateralis) lien tvc a phia sau dual vdi hei la
(gyrus fassiolaris), h6i rang (gyrus dentatus), hai ma (hyppocampus) Ira the hanh nhan (corpus
amygdaloideum).

Tho' trong vo
Soi cung

Bo cung
Bo doc dudi
Hinh 49.6. Cac tha lien hop doc clia ban ceiu dai tido

1.3. CAC MEP GIAN BAN CAU DAI NAO. DO la phan dinh lien hai ban cdu dad nao vdi
nhau gem:
1.3.1. The chai (corpus callosum) la m0t, manh chat trang, tren thiet de thing doc c6 kich
thaic dai 8cm, day lcm rang 1cm a phia tra6c va 2cm d phia sau. Th6' chai g6m co 4 phdn.:
tao
ma (rostrum), g6i (genu), than (truncus), va 161 the chai (splenium corporis callosi) &toe
nen bai cac soi ngang thuac v6 cac dai than kinh mep (tractus nervosi commisurales) n6i lien
hai va ban cdu dai nao vdi nhau. hai dau tra6c (g6i) va sau (16i) dia the chai, cac soi nay
u6n cong thanh hinh chit' U tao thanh hai kep, kep nhO (forceps minor) a trick va kep lan
(forceps major) a phia sau (H. 49.3 va H. 49.7).
1.3.2. VOin nao (fornix) la mat Om chit trdng hinh tam gide chay u6n quanh tren nhan
(columna fornicis)
duOi (nucleus caudatus) va dai thi, gem co mat than (corpus fornicis), hai cat
a truck va hai tru (crus fornicis)
a sau. Vom nao chtqc cdu tao bed cac soi di tit hai ma den the
vu (corpus mamillare)-caa \Tung ha del (hypothalamus). Ngodi ra gala hai tru sau co cac scri not
lien tao nen mep vom nao (commissura fornicis) (H.49.8). Giai han a track 18 gian nao that,.
th6ng nao that ba vdi nao that ben, có tam mach mac da mai nao that ba lien ket vdi tam
mach mac ctia nao that ben. Cot Ong xu6ng chresi tai tan the vu. Try vom nao quan xung
quanh cac sau dai thi chay yang xu6ng dudi va ra trade tai tan the hanh nhan.
341
 Cdc tha trong vo Tia the chai

The' chat

Kt p sau

86 tham chai Map truac

D6i thi

Sting sau nao taht ben

Sting (Alai nao trill' ben

Hinh 49.7. Cdu tao ea a the chai (cac the lien hap ngang)

1-16i rang Then vem nao

COt vOm nao

The vu

Mac hal ma
Hoi 0 Chan hai ma
Tort vOm nao Tua hai ma
Hai ma

Hinh 49.8. Cdu tao vela yam nao

1.3.3. Mep triidc (commissura anterior) thu6c thanh trade nao that ba
(ventriculus
tertius) duvc chia lam hai phdn: phdn trudc (pars anterior)
nha g6m cac thd n6i lien hai thanh
khdu NT& phan sau (pars posterior) ldn g6m cac sdi chat trong chay ngang qua la tan ding, n6i
lien hai hai thai duang gilla a hai ben ban cdu.
1.3.4. Vach trong start (septum pellucidum) g6m hai la (lamina septi pellucidi)
va mot 6
(cavum septi pellucidi) nam tren mat phang doc gia'a n6i lien tit th6 chai d6n vem nao tao nen
thanh trong cua hai nao that ben.

342
 2. NAO THAT BEN (ventriculus lateralis) (H. 49.13, H. 49.14, H. 49.15, H. 49.16).
M8i ban cau dai nao co mat nao that ben th6ng vdi nao that ba bai 18 gian nao that
(foramen interventriculare). D6 là met 16 h6ng dace lot bai met lap td bao nai toy (ependyma) c6
hinh mOng ngaa ma xuang dadi va ra trudc, u6n quanh mat kh6i g6m nhan dual va dai thi. Su
Win quanh nay chang to trong ph6i thai, nao trudc phat tridn dau tien ra trudc va len tren, v6
sau mdi phat tridn ra sau Ira xu6ng duai. Sit phat tridn nay da tao nen hinh clang chit C caa
nhieu cau talc trong ban cau dai nao tru'ang thanh nha nao that ben, dam r6i mach mac,
nhan duoi, thd chai va vbm nao. Vol hinh clang do chang co thd hien dien hai lan trong mat
thidt d6 nao (H.49.9 va H.49.10).

Khe di coa bao (tong

Phan trung tarn

Dau nhan duoi • m
Milliol Than nhan duoi nao thgt ben
Ranh thi van
Sting truoc
' os ,.;:.,
,

.0„. SCIng sau

Nhan hank nhan

Aiti Dud!
lik nhan Judi
Sang dcfc5i

Hinh 49.9. Su do cac nhan nen va lien h0 ngoai cda ndo theft ben

Nao th'dt ben g6m c6 phan trung tam (pars centralis) va ba sang: trade, sau va du'di
(cornu anterius, posterius et inferius).
- Sang trudc nam trong they trap, a sau g6i thd chai, dam sang each eye tram 3cm, c6 gidi
han sau la 16 gian nao that.
- Phan trung tam hay nga ba nao that ben la not gap nhau caa ba sang nao that nam a
curt sau dai thi.
- Sang sau nam trong they chdm, c6 chieu dai rat thay &a.
- Sang dual to tam giac ben u6n xu6ng dual va ra trudc di vao trong they thai daring. Dau
sang each cure thai duang khoang 2cm.
Hinh del chidu cua nao that nay len thanh ben caa hap so nam trong mat dien b6n canh:
canh dadi la duang each ngang song song tren mom g6 ma xu'o'ng thai duang 2cm, canh tren la
duang song song a phia tren caa canh duai 4cm, canh trade la duang thong clang qua dau trudc cilia
phan ngang mom go ma va canh sau la doing thong clang 4cm trade mat phang tram tidp
343
tuydn vai xuung cha'm (H.49.15). Ngoai ra, didm d6i chidu cua phan trung tam nao that, ch6 gap
nhau cua ba sirng, len so la mat diem nam each ddu u phia sau va troll 18 6ng tai ngoai 3cm.
B choc da, nao that ben, a tre can ba c6 the dam kim qua goc ben cua thOp truck dd di
van nao that. 0 nguai 16'n, phai dam qua 16 khoan caa so a xu'ung trail hoac xuang cham
(H.49.16). Thu thuat nay thuang thiic hien nham Gran luu dich nao tay trong cac twang bin tdc
16 gian nao that gay tang ap lu'c trong so, hoac dd bum thu6c can quang hay bum hai de chup
hinh cac nao that.

0 each trong sudt V6 xam dal nao

Bac) trong Chit treng

Boo sgm
Boo nhet
11 G67 the chai

Sting trudc nao that ben

Nhan tn/dc tu'dng Deu nhan du&

C6t vOm nao
va thuy deo Nao thit ba
D6i thi
Bad ngoai
Bao ngoai cling Duoi nhan dual
L6i the chai
G67 bao trong
Tia thi R5nh cora
Sting sau nap thit ben

Hinh 49.10A : Thie't d6 ngang caa ban cdu dai nao

V6 xam del nao

Chat treng

G67 the chai

Day nhan duoi yen cling That nao ba

Nhan beo
D6i thi
Mep dinh gian d6i thi
Dudi nhan cludi van cling Nhan trdac tilting
Mac hai ma
Sting duel nao thit ben

Hinh 49.10B : Thie't d6 clang ngang czia ban cdu dai nao

344
3. HiNH THE TRONG BAN cAo DAA NAO
3.1. CHAT TRANG. Chat trong dia ban cdu chiem tat ca nhirng khoang dam a giaa vo dai
nao, nao that ben va cdc nhan nen, gom ba loai b6.
3.1.1. Be tea thing (H.49.5) Om cdc sui den va di xudt phat tit tat ca cdc phdn cua va
nao di vao ben trong. day chiing taa. Ong tao thanh vanh tia (corona radiata), a ben dual
hOi to lai di gala nhan duoi va d6i thi a ben trong, nhan beo a ben ngoai, phdn nay goi là
bao trong (capsula interna). Tren thiet d6 nao ngang, bao trong co dang hinh chit V ma
dinh Inking vao trong goi là goi (genu capsulae internae) va hai canh goi la tru trade (crus
ant.) va tru sau (crus post.) dia bao trong. Tru truac nam giCia nhan beo (nucleus
lentiformis) va nhan dual, can tru sau thi nam Oita nhan beo va dUi thi. Phdn sau dudi dia
tru sau con chive chia ra lam hai phAn; phdn sau beo (pars retrolentiformis) ben trong c6
chda tia thi gide (radiatio optica) di tit the g6i ngoai den vo khe cu'a va phdn dudi beo (pars
sublentiformis) cUa bao trong ca chtl'a tia thinh gidc (radiatio acustica) di tt:i the goi trong den
va thai diking (H.49.10A).
3.1.2. Be lien hdp doc (H.49.6) phat trign rat manh a nao ngu'ai. B6 c6 the chi chay
trong lip v6 xam (thd trong vo), hoac vao trong chat trong dudi vc1). B6 dudi va chia
lam hai nham : nham sui ngthn hay sqi cung dai nao (fibrae arcuatae cerebri) n6i cdc phdn
nao ke can nhau trong ding mot thUy. Nh6m sui dai not cdc thily khdc nhau trong mot ban
cdu, nhut 136 mac (fasciculus uncinatus) not phdn. 6 mat thily tram vdi chic thai du'ung, 136 dai
(cingulum) di tit thily tram yang sat tren the chai tdi they thdi du'ung va b6 doc tren (fasc.
longitudinalis superius), 136 doc dudi (fasc. longitudinalis inferius) n6i thay tram, thUy chdm
vdi they thai duang.
Bao ngoai (capsula externa) va bao ngoai cling la hai ldp chat trong mang nam 6 mat
trong va ngoai nhan tru'dc Wang (claustrum) duqc c6u tao chit yeu bai cdc b6 lien ho nay.
3.1.3. Be lien hdp ngang thuOc v6 cdc mep gian ban cdu dai nao g6m co mop truac va
the chai. hai ben the chai, cdc thd toa rung tao thanh tia the chai (radiatio corporis callosi)
di den lchap cdc \Tung cilia va nao (}{.49.7).
3.2. CHAT XAM
Cali tao ben trong ctia doan nao duuc quan sat 1.6 nhat tren nhfing thiet do nao ddng
ngang va ngang (H.49.10). Chat xam tap trung chit yeu a hai nc/i, cac nhan nen va v6 dai
3.2.1 Cac nhan nen. Cdc nhan nen Om co the van, nhan trudc Wang va the hanh nhan.
3.2.1.1. The van (corpus striatum) Om co nhan duoi Ara nhan beo. Ddu trade hai nhan nay
dinh nhau, phdn sau tach rOi bai bao trong.
- Nhan clued (nucleus caudatus) la kh6i chat xam u6n tong hinh mang ngu:a cu6n quanh
doi thi gam ca ddu, than va duoi (caput, corpus, cauda nuclei caudati). Duoi nhan duoi tan het
a the hanh nhan (H.49.9).
- Nhan beo (nucleus lentiformis) tren cdc thiet do, ca hinh tam gidc, chia lam hai kh6i bed
la thy ngoai (lamina medullaris lateralis). Kh6i ngoai 16n goi la beo sdm (pulamen) va kh6i
trong nha goi la cdu nhat (glob us pallidus). Cdu nhat lai du'uc chia ra lam hai phdn nho han
345
 bai la tuy trong (lamina medullaris medialis). W phudng dien phat tridn, nhan duoi va beo
sam thuec ye the van mdi, beo nhat thuec the van ca va the hanh nhan thuc the van c6. The
van IA trung khu cua diking van Ong ngoai thap dual vo, trong do the van ca có chuic phan
kiem sok sac cu dng co va su phai hdp cua cac cur deng tu Ong dun gian nen khi bi ten thudng
se gay nen benh co cling co, gay bat &Ong hoac khong phol hdp dude cac cif clang (benh
Parkinson). The van mdi có nhi'em vu kiern soat the van Ca nen khi bi ton thuong, suit cudng
co bi giam, gay nen benh tit Ong r6i loan (bOnh mud van va =la gi(tt).
3.2.1.2. NM' n trudc twang (claustrum) la nhan tach ra tit vo thay dao, chile nang va lien
he chua ra.
3.2.1.3. TM hanh nhan (corpus amygdalloideum) na'm trong mac hai ma truck dual nhan
chuIc nang thuc ve &rang khaki gide.
3.2.2. VO dai nao (cortex cerebri).
Nhu da not d tren, vo dai nao hay do nao mdi là ldp vo xam bao pha than be mat ngoai
hai ban eau dai nao. Ldp vo xam nay la ncri tap trung &la cac car quan phan tIch co nhiem vu
phan tich cac kith thich d ngoai nOi canh du'a vao, tong hdp lai va bien cac kith thich do thanh
57 thuic. Nh6 co su lien he nhu' vay nen co the mdi co kha nang thich wing vdi ngoai canh.

VO dai nao khi phat tridn se phat sinh ra cac ranh nao. Dien tich caa vo dai nao la
2200 cm2 ma hai phan baa sau trong cac ranh, chi co met phan ba là to ra ngoai. Toan vó
xam dai nao co tat ca do midi ben ti to bao sap xep thanh 6 ldp. Tay tUng ch6, chieu day dia
vo dai nao thay dai tit 1,5mm den 4,5 mm va sau lap td- bao cang thay dai. Cac ranh tren mat
nao co loai c6 dinh va loai khong c6 dinh. Ranh khong c6 dinh co nhieu, nhO be va nhieu Wen
del nen scr sap xep hinh the cac h6i nao có the thay d6i thy theo ngudi.
Data vac, cac thi nghiem thuc nghiem, Brodmann chia nao ngutori ra lam 47 khu. Hien nay
ngudi to chia ra lam 52 khu, mai khu cua vo nao dam nhan met chile phan chd yeu khac nhan.
Su' dinh khu cua vo nao dudc tom tat nhu' sau (H.49.11).
I/Ong van deing ph6i hop Vung vo van dong chinh
(6) (4)
Trung khu vigt Wing cam giac than thg
(vdng 3, 1, 2)
Trung khu not

Vung vi giac
(43)

Wmg tie'n dinh Vung thi giac

(38) Wing thinh giac (17)
(41, 42)
Hinh 49.11A : Dinh khu dia vo nao (ndt ngodi bdn cdu)
346
 Vang vo van d'Ong chinh
(4)

Vang cam giac than the

(yang 3, 1, 2)

Vang thi giac

(17) Vang khau giac
(25, 34, 27)

Hinh 49.11B : Dinh khu cda vó nao (mat trong ban cdu)

—Cac vang va cam gide chinh : nhan cac sai thi v6 tit cac tram nhan ddc biet cua d6i thi
(xem bai Gian nao), g6m có :
+ Vang cam gide than the a h6i sau trung tam (vang 3, 1, 2 Brodmann).
+ Vang thi gide a hai ben khe caa (ming 17 Brod.).
+ Vang thinh giac a h6i thai &tang ngang (wing 41, 42 Brod.).
+ Vang vi gide du'ang nha a nap dinh tha6c h6i sau trong tam (vang 43 Brod.).
+ Vang khdu giac quanh the hanh nhan cua ink hai ma.
+ Wing tin dinh duang nhii a cue thai duang (yang 38 Brod.).
Nam k6 can cac yang cam gide chinh nay can có cac vang cam gide phu, then tich thuang
nho horn va n6u bi ton thaang chi gay ral loan cam gide nhe.
—Cac yang va van dung :
+ Vang va van dung chinh a h6i trade trung tam (vang 4 Brod.) cho ra dai v6 gai (tractus
corticospinalis) (bó thcip) dieu khi6n cac van dOng coy auk.
+ Vang v6 van dung phu va traac van d6ng (vang 6 Brod.) a ngay tau& va a mat trong cua
yang van dOng chinh co nhiem vu ph6i hap cac cii dung.
+ Ngoai ra con co cac sal v6 ly tam khang thuOc he thap (h0 ngoai thap) nha sai vo lath
(fibrae corticoreticulares), dai va cau (tr. corticopontini), sai v6 nhan (fibrae corticonucleares), bO
va thi (fast. corticothalamici)... xuat phat tii cac phan khde nhau &la va nao.
Vi tri doi chi6u cua cac yang cam giac va van Ong than the len tren vang cam giac va
van dung va nao ding da duac xdc dinh (H.49.12).

347
 Nao thit ben phai
Nao thit ben trai

Thiry Binh Sting truec nao that ben

Ngach tren tuygn tong

Ngach tang

Thiry chgm

Thiry tran
•L6 gian nao thgt

Ngach thi giac

Sting sau Ngach pheu
nao thgt ben Nao thgt ba
Ngach tigu nao Thiry thai clUdng
cu'a nao thgt b6n Sung duel mac, thgt b6n
Ceing nao
Tigu nao
Hanh nao
Nao thgt b6n
Ngach ben nao thgt b6n
Ong trung tam

Anh XXXXVI : Cac nao that chieu len mat tren ngoeti ban edit d i nao

348
Hinh 49.12 D6i chie'd cac yang than the len yang On cking vet cam gicic caa yo nao

Sang trudc Phgn trung tam

Nao thgt ba
Sting dtidi Sting tru'c3c
Sting sau

01111

111!"
Ngach tren
tuygn tang1
L6 gian nao thgt

Nao Ngach phju

thgt bgn 44 06,44? "4
Sting dudi
47 Ceing na o
Ngach ben
Sting sau

A B

Hinh 49.13. Nei() Mgt ben

A. Nhin tren. B. Nhin ben phcii.

349
 Dai thi
Duoi nhan duoi
(II)

Sang dtic3i nao thgt ben

Dam r6i mang mach
Mang hai ma
Tua hai ma
H6i rang Hai ma
\0
\0\%\\\\:\
\\\

" Ii„

A
Hoi thai ddang duel

Hinh 49.14 : Thiet dd qua hdi ma yet sang cladi nao thdt ben

Ranh trung tam

Ranh ben
Nga ba
Sang sau

Siing ddai

Hinh 49.15 : Hinh chie'u cda nao thdt ben len yam so

\Pe mat chic nang ctia vo nao, trade day ngudi to cho rang co hai trung khu di6u khign
tie-ng not va chit vie-t (he thong tin hieu thu nhdt va he thettg tin hieu thu hai cda locii ngu'eri)
nam o h6i trail du'ai va gida dm ban eau dai nao ben trai d6i vdi ngu'di thuan tay phai va
ngagc lai. Ban eau trai daqc goi la ban cau cha dOng. Nhung theo Paplov, cac trung dung phan
khu d v(5 nao chi co gia tri Wong doei, va that ra toan b0 v6 dai nao la 'Mit he th6ng lien hqp.
Chinh nhd sit lien hqp Ong rat c6 tinh chal lien v6 nay ma cdc kha nang tri tue, Y date, ldi
not va chat vie-t caa con ngudi mdi duac hinh thanh. D6 la nhang phan xa co dieu hen thu6c

350
- cac he th6ng tin, hieu tinh vi ma chi loaf ngiki mai c6. Trong qua trinh hinh thanh v6 nao cua
nguOi, chile phan da giii mot vai tro quyet dinh. O Ong vat ma b6n chi chug phan h6a, dien
tich cua v6 nao va s6 lacing to bao nao can it, viing v6 nao van dOng rat gan curt tran. Khi tie'n
ddn len loci ngudi, lao Ong trd nen coy thilc va muc dich, su phan ding than tay ra rang, thi
v6 nao troy nen rat Ong va philc tap hon tat ca cae loci vat khac. Nhu \ray co mot sit th6ng
nhdt giura chile phan vdi hinh thai va cau tao cUa v6 lido.
Tuy nhien, nhfing ding trinh gdn day nhdt cUa. Sperry (Nobel y hoc 1981) ve sir phan cach
hai ban cau dai nao bang each cat b6 the chai va cac mep gian ban eau d'a cho thdy chile nang
rieng biet cUa tUng phdn ban cau va rn6i lien h0 gida hai ban dm do cac sqi cUa the chai not
hai ban cau vdi nhau. Nhiing 110i chtIng xung dot gian ban cau va gian doan truyen tin gitla hai
ban cau da dirge nghien eau. Doi vdi nguOi. thuan tay phdi, ban cau trai duqc coi nha dee quyen
ve tin hieu lOi not va chit vie-t, can ban cau phai lai co uru the hon v6 viec the hien cac cam xilc
manh liet hon ban cau trai. Vdn de chile nang sinh l5r thdn kinh cua dai nao con can duqc
nghien eau tie'p tic.

Hinh 49.16 : Choc do nao thdt ben (mai ten chi ditang choc do vdo phdn trunk tam)

CAU 1161 'MAC NGHIEM

Chan cau tra loci diing nhdt

Dung bang tra loci chicil clay cho cac eau 561 +Mil 565.
a) Tiltiy ttan. d) Thuy thai duong.
b) Thuy dinh. e) Thi y trail va thuy dinh.
c) Thtiy
561. Hoi thdrig thuOc thily nao ?
562.116i goo thuOc thily nao ?
351
563. H6i tren vin thuOc thay nao ?
564. Tigu they canh trung tam thuQc they nao ?
565. H6i trudc chem thuQc thay nao ?
566. Nam tren h6 so sau
a) Mat dudi thay chdm.
b) Mat &add thay thai dadng.
c) Mat dual thay chdm va phan sau mat du'di thay thai du'dng.
d) Mat dudi va ca mat tren - ngoai ctia thay chdm.
e) Tat ca deu sai.
567. The van (corpus striatum) g6m :
a) Cac nhan xam dUdi v6 nao caa doan nao.
b) D6i thi, nhan dad., nhan beo.
c) Nhan duoi., nhan beo, nhan trade tudng.
d) Nhan dual, nhan beo.
e) Tat ca deu sai.
Dung hinh ye sau de tra ldi cac cau 568, 569, 570.

568. Ranh cya ar vi tri:

569. Van.g va nao giaa hai ranh (C) va (D)
a) H6i trade chem. d) Tigu thay canh trung tam.
b) H6i chem. e) H6i canh hai ma.
c) H6i
570. Vang v6 nao gnia hai ranh (D) va (E) la:
a) H6i tradc chem. d) Tieu thay canh trung tam.
b) H6i chem. e) H6i canh hai
c) H6i

352
Dung hinh ye sau cle tra Rh cac cau 571 de'n 575 (Tra'c nghiOm dien khuygt).

Seing tru'c5(c
•
nao thgt ben •
• (5)

Gtri the chai

Nhan beo (4)

(1)
Nhan tn/dc ttfang Doi thi

Ldi the chai

(3)
571. Chi tit s6 (1) Pa :
572. Chi tiet s6 (2) la : (2)

573. Chi tigt s6 (3) là :

574. CIA tigt s6 (4) la :
575. Chi ti'gt s6 (5) là :
Dung hinh ye sau d tra loci cac cau 576, 577, 578.

576. Cha (A) tu'ong trung cho :

a) Ranh trung tam. d) Ranh tran dudi.
b) Ranh trueic trung tam. e) Nganh ben cUa ranh ben.
c) Ranh ben.

353
577. Chit (B) tu'ong trung cho :
a) Ranh sau trung tam. d) Ranh gian dinh.
b) Ranh dudi dinh. e) Tat ca d6u sai.
c) Ranh dinh tren.

578. Chia' (C) tucing trung cho :

a) H6i dinh du'di. d) Tidu thily dinh dudi.
b) H6i g6c. e) Tat ca d6u sai.
c) H6i tren vidn.

354
 50 HE THAN KINH TLJ CHCJ

MUC TIEU BAI GIANG

A. MUC TIEU T.A7 THUYgT
1.Neu cac tinh chat, dac diem va chiIc nang cilia he thdn kinh to chi.
2. Ma to cac trung khu, cac hach, cac soi trade va sau hach cua phan giao cam.
3. MO td cac trung khu, cac hach, cac soi trade va sau hach cilia phan doi giao cam.
4. Kg ten cac dam rai than kinh to chi'.
5. Ve so do chi ph6i cua phan than kinh giao cam va phan than kinh dai giao cam.
B. MUC TIEU THIIC TAP
1.Chi tren xac va mo hinh, cac hach than kinh giao cam va dai giao cam.
2. CM met s6 dam rai than kinh tit chu thay duqc tren xac.

1. DAI CIXING
He than kinh tki chu (systema nervosum autonomicum) con goi la than kinh thiic vat bao
gom cac soi than kinh di tit he than kinh trung uong tai cac co tron (cac tuyen, cac tang vd cac
mach mciu) va co tim.
He than kinh to chili duoc chia lam hai phan : phan giao cam (pars sympathica) va phan
dai giao cam (pars parasympathica) hoat dOng theo nguyen -cage d6i lap nhau. Vi du kich thich
phan giao cam cua tim thi lam tim dap nhanh con kich thich phan dai giao cam (thdn kinh
lang thang) thi lam tim dap cham lai, hoac kich thich than kinh giao cam lam giam co b6p 6ng
tieu hoa va kich thich than kinh doi giao cam thi c6 tac dung ngucrc
Tuy goi la than kinh to chil, nhung van chiu sit chi huy cua vo nao.
He than kinh tit chili gom nhung phan sau day
— Trung khu than kinh chit : gom cac nhan than kinh nhm trong nal° hoac ttly.

355
 —Cac scli than kinh tit cac nhan trung aong di ra ngoai Wen gom hai loci : sod triteic hach
tit nhan tdi cac hach va scti sau hach tit hach tdi cac co' quan.
— Cac hach thin kinh tai chii gom ba loai : hach canh s6ng nam doc hai ben cot s6ng, hach
track tang va hach tan cimg d ngay gan cac co quan.
—Cac dam r6i than kinh ti cha : do la cac mang ladri sqi than kinh giao cam va d6i giao
cam dan nhau chang chit trade khi di vas) mot cc quan. Day la bang cluing caa dang than kinh
hinh lu'Oi xuat hien rat sdm trong qua trinh pilot sinh Chung loci cua he then kinh.

2. PHAN DOI GIAO CAM (pars parasympathica).

Go'm co hai phan : phan trung aong va phan ngoai Wen (H.50.1)

Mat.„,. Hach mi Trung nao

T.K. van nhan Hanh nao
Hach Chan budm khiu cal
Tuygn 10 T.K. as ra
Tuygn va mach
niem mac mCii Co I
(‘q
Tuygn dudi ham - -----
Tuygn mang la'
hiic
Co tim
uan Ngvc I

Cd phg quan

--Da day

Rudt non - ------

Rudt gia Thgt king I

Nigu quan
Day cuang
Bang quang
TrVc trang Cang II

' Co quan sinh duc

Hinh 50.1 : Pha'n ddi giao cam caa he than kinh tit chil

356
 Hoch mi
Tuyan la
Than kinh van nhan
Hach chan bildm - khau cai
Than kinh trung gian
Hach tai
Than kinh thief hau
Than kinh tang thang Tuye'n nuPc bgt dudi IUdi
Tuye-n nuPc bQt mang tai Hoch dual ham
Tuye'n mkt bpt dudi ham
Hoch c6 tren
DPng mach canh chung
Than kinh canh trong
Tuye'n giap
Than kinh tim co tren
ThVc quart
Than kinh tim co tren, trong, dudi
Than kinh gian sten Than kinh tim co fret-)
Ph6i phai
Tim

Nhanh gian hoch

Gan
Dpng mach chi,
' Do day
Than kinh tong Ion Dam r6i tang
Thy
Than kinh tang be
Dam nooi mac treo trang tren
Cac nhanh n6i Ke't trang
RuPt non

Dam r6i mac treo trang dudi

Dam rai ha vi
Dam r6i cung

Ti! cung
Bang quang
Than kinh chau hOng
Am ciao
Trvc trang

Anh XXXXVII : HO than kinh t chic'

357
 2.1. TRUNG VONG. G6m cac nhan a nao va a thy.
- nao b6 (trung nao, cdu nao, hcinh nao) : gom c6 nhan phu (n. accessorius) cUa day van
nhan a trung nao, nhan nu'O'c bot tren va dadi (n. salivatorius superior et inferior) dia day mat
cd u ndo) va day thiet hau va nhan lang (n. dorsalis) cUa day than kinh lang thang a hanh
nao.
- C1 doan thy cling (cling 2-4) gam cot nhan trung gian ngoai (n. intermedius lateralis)
thu6c sung ben chat xam thy gai. Gan day ca mot s6 tac gia con cho rang trung tam doi giao
cam con ca a doan thy ngi,tc - that lung.

2.2. NGOAI BIEN. Gam cac soi va cac hach sau day :
2.2.1. Cac sqi truldc hach cua phan trung ticing thuOc nao b0 mu'on &rang cha cac
day than kinh so sau day de den cac hach.
- Day than kinh van nhan den hach mi (ganglion ciliare).
- Day than kinh mat den hach char' Warn khau cal (ganglion pterygopalatinum) va hach
dual. ham (gl. submandibulare).
- Day than kinh thiet hau d6n hach tai (gl. oticum).
- Day than kinh lang thang d'6n cac tang truck tang 6 ngu'c va bung. Cac sal sau hach tit
cac hach tren di tai co tran cUa cac tuyen, cac mach mau va cac tang.
2.2.2. Cac sqi triidc hach oda phAn trung tking or doan tuy cling di ra theo r6 truck
day gai song, r6i theo cac day cu'o'ng den cac hach chau hong (ganglia pelvina), tit do cac sqi
sau hach di den bang quang, cac tang sinh due va trktc trang.

3. PHAN GIAO CAM (pars sympathica).

3.1. TRUNG TIONG tit nhan trung gian ngodi (nucleus intermediolateralis) a doan thy
ngtic that lung (tit ngitc I den thdt lang II) (H.50.3).

3.2. NGOAI BIEN gam cac sai va cac hach sau day :
3.2.1. so triforc hach theo re tat& cac day than kinh gai song vao nhanh th8ng (rami
communicantes) d6n cac hach giao cam 6 canh cot sting. Cac sai sau hach mu'qn dung cac day
gai song qua cac nhanh thong de d6n co quan bang cac dam r6i tut chil (plexus autonomici).
3.2.2. Hai chuili hach giao cam (ganglia trunci sympathici) nam hai ben cot sting, mOi
chu6i ca 23 hach not tiep nhau bang cac nhanh gian hach (rami interganglionares).
Chu6i hach giao cam not vai day than kinh gai song bang cac nhanh thong trung va xam
(11.50.2)

4. CAC PHAN CUA THAN KINH TI CHU

H6 than kinh t4 chti duvc chia lam cac phan sau : phan dau c6, phan ngu'c, phan bung va
chau hong.

358
 4.1. PHAN DAU VA CO (pars cephalica et cervicalis systematis autonomici). Creim có cac
hach va cac soi sau day.
4.1.1. Hach c6 tren (ganglion cervicale superius) la hach c6 Min nhdt, nam gitia gong
mach va tinh mach canh trong ngay (lath nen so, phia trudc mom ngang d6t song c6 II III.

Hach gai
Nhanh king than kinh
gai song

, r••
Re tru'ac than kinh gai sang

Nhanh byng than kinh Nhanh gian hach

gai sang
Nhanh thong tning

Nhanh thong xam

Than kinh tang

Hach giao cam canh song Hach tang

Rut non

Hinh 50.2 : Cdc hach giao cam canh song vet cac nhdnh thong.

N6i vori hach có cac day than kinh sau day : clay than kinh tinh mach canh (n. jugularis),
day than kinh dung mach canh trong (n. caroticus internus), day than kinh tim c6 tren (n.
cardiacus superior), cac day than kinh dOng mach canh ngoai (nn. carotici externi) va cac dam

359
r6i canh trong (plexus caroticus internus), dam r6i canh ngoai (plexus caroticus externus) va
dam rol canh chung (plexus caroticus communis).
4.1.2. Hach c6 giaa (g. cervicale medium) nam ngang mac sun nha'n, phia trudc ch6 be
gap caa &Ong mach giap ditch. Tit cue (Judi hach, cd cac nhanh di phia truck va sau dOng mach
cludi don tao nen quai clued dim (ansa subclavia). Tit quai cd cad nhanh di den hach c6
Ngoai ra can cd day than kinh tim c6 giita (n. cardiacus cervicalis medius).
4.1.3. Hach co clad (g. cervicale inferius) nam sau trong nen c6, phia sau dOng mach d6t
song. Doi khi dinh li6n vdi hach nguc 1 tao nen hach c6 ng-uc hay hach sao (g.
cervicothoracicum or g. stellatum). Tit hach cd nhanh n6i vdi hach c6 giita tao thanh quai Judi
don va c6 day than kinh tim c6 ditch (n. cardiacus cervicalis inferior).

Dam rai canh

Mat ---C)
Tuygn le Cac nhanh cho tuygn, car trdn
va van mach a dau
Tuygn mang tai lJ
Cac nhanh cho tuygn
Tuyen dual ham cd trdn va van mac
h a c6

Tim --
• Hach c6 ken
Hach c6 gi0a
Pha quan • Hach sao
I •,^
Than

Da day --
Toy --
Cac nhanh cho tuygn,
van mach va
Ruat non __-
cd trdn a than
Hach tong -----
Tuygn thudng --
than
That
lung II
RuOt gia
Hach mac -' Cac nhanh cho tuygn,
treo trang tren Hach
van mach va cd trdn
mac
(
a phan du'di than va
Bang quang treo chi dudi
niOu quan trang
dual
Cd quan sinh duc

Hinh 50.3 : Phdn giao cdm czia he thein kinh tic* chd.
4.1.4. Ngoai ra con cd cac hach mi, hach than Wain khan cal, hach &lei ham,
hach tai da not d phan 2.2.

360
 4.2. PHAN NGLIC (pars thoracica systematis autonomici) có to 10 - 11 hach ngu.c (ganglia
thoracica) va cac day than kinh sau day :
Cdc day than kinh tim nguc (nn. cardiaci thoracici), day than kinh tang ldn (n.
splanchnicus major) va hach tang (g. splanchnicum), day than kinh tang be (n. splanchnicus
minor), day than kinh tang dudi (n. splanchnicus imus) di vao than nen can goi là nhanh than
(ramus renalis). Ngoai ra co cac dam r6i nhu dam roi tim (plexus cardiacus) nam phia dudi
Ong mach cha va hach tim (g. cardiacum) nam phia ben phai dm day chang dung mach, dam
r6i cha nguc (plexus aorticus thoracicus) va dam roi ph6i (plexus pulmonalis) nam phia tru'dc
ch6 phan dui cua khi
4.3. PHAN BUNG VA CHAU (pars abdominalis et pelvina systematis autonomici) (H.50.3).
G6m co 3 dgn 8 hach that lung (ganglia lumbalis), 4 hach ding (ganglia sacralia) va 1 hach le
(ganglion impar). Trong phan nay có cac dam roi chinh la :
— Dam roi tang (plexus celiacus) con goi la dam r6i &fang vdi hach tang (ganglion
celiacum) va hach cha than (g. aorticorenalia). Dam roi mac treo trang tren. (plexus mesentericus
superior) va hach mac treo trang tren (g. mesentericum superius), dam r6i mac treo trang dual
(plexus mesentericus inferior) va hach mac treo trang dudi (g. mesentericum inferius), dam r6i
lien mac treo trang (plexus intermesentericus), cac dam r6i gan (plexus hepaticus), lach (plexus
lienalis), vi (plexus gastrici), tuy (plexus pancreaticus), thuang than (plexus suprarenalis), than
(plexus renalis), dam roi nieu quan (plexus uretericus), tinh hoan (plexus testicularis), bung trang
(plexus ovaricus), dam r6i trang (plexus entericus), dam r6i ha vi (plexus hypogastricus), dam roi
truc trang (plexus rectales) va dam roi tit cung am dao (plexus uterovaginalis).

CAU HoI TRAC NGHIEM

Chun can tra loci dLing nhat

579. He than kinh tu cha :

a) Duac goi nhu thg vi hoax' toan khong chiu ski chi huy cua v6 nao.
b) Chi tac dOng tren ca tran cua cac tuye'n, cac tang va cac mach mau.
c) G6m met trung khu TK tu cha va cac sal TK W trung khu nay den cac co quan.
d) CO hai chu6i hach dui giao cam a hai ben OA song.
e) a, b, c, d deu
(Xem them beci 61)
580. Chun cau clang :
a) Trung khu phan giao cam a than nao.
b) Trung khu phan d6i giao cam a sang ben tidy song tit d6t tidy c6 VIII den d6t tidy
that lung II.
c) Trung khu phan giao cam d doan tuy ding.
d) Trung khu cao nhat nam a v6 nao.
e) a, b, c, d deu sai.
361
581. TK so nao dadi day KHONG có cac soi TK cua he d6i giao cam mu'c,in doOng :
a) III. d) IX.
b) V. e) X
c) VII. Xem them bed 27)
582. Trong cac TK docli day (clia he TK to' chti), TK nao bao g6m cac soi trade hach :
a) TK van nhan. d) TK tim c6
b) TK tim c6 tren. e) TK tang Ian va tang be.
c) TK tim c6 gida (Xem them bed 27)

362
 51 MANG NAO TUY

MUC TIEU BAI GIANG

A. MUC TIEU LY THUYET

1. Mo to cac mang nao thy va cac tat" cha mang nao et-Mg.
2. Ve sa do cac lap mang nao thy.
3. So sanh cac mang va cac khoang a nao vai a thy.
4. Ice ten cac tam mach mac va cac be dudi nhen.
5. MO to nai tiet, nai chi a va nai tieu thodt cda dich nao tdy va nhfing (trig dung benh IY.
6. Neu cac vi tri choc do nuac nao thy.
B. MUC TIEU THLIC TAP
1. CM tren nao that, ma hinh va cac phitang tien thuc tap khac cac lap cda mang nao
cac tit" cha mang nao cling va cac tam mach mac.
2. Xac dinh m6c choc do nude nao thy tren co the ngitai

1. CAC MANG NAO TUY (meninges).

1.1. DAI CUONG. Tay gai vet nao bo$ di/ye ngdn each vai thanh xoang Ong song, h'Op so)
bang cac mang nao thy. Co tat ca ba mang Oak xuat chh ye'u tit ngdn g6c trung bi : mang
citng, mang nhen va mang mem (H.51.1) va (H.51.2).

1.1.1. Mang clitng (dura mater) dai, khong dan h6i. Day 0,3 - 1mm. Mat ngoai xu xi, dinh
vao mang )(Long a vai ch6 nhu' quanh 16 cha'm va hOp so. Mat trong lang bao lay cac xoang tinh
mach cda h'Op so va du'ac not mac bao phd. Mat ngoai có nhieu mach mau.

Mang cuing each thanh xoang bang khoang ngodi mang cuing (cavum epidurale). Phia
trong, mang cling each vdi mang nhen bang khoang trong mang cuing.

363
 Mang mem

Mang nhen
Mang cling

Bao than kinh

11)_. Re day than kinh

D6t song

Khoang dtidi nhen

Hinh 51.1 : Sa cid ccic mang tiiy.

Xoang tTnh mach

doc tren
-Mb mach lien lac --
Xdong so-
Mang ding
Tihh mach mang nao Khoang dudi mang ct7ng
Mang nhen
Tihh mach nao
Khoang dtToi nhen
Mang mem

Hinh 51.2: So, cid ccic mang nao.

Xoang tinh mach mang cuing là not mang cang tach ra hai la, tao thanh cac 6ng dan mau,
du'ac lot ben trong met lap net me de chaa va clan lull mau tinh mach.
364
 1.1.2. Mang nhOn (arachnoidea) mang, trong suat. G6m hai la ap sat vao nhau tao nen
mot khoang do.
Mang nhen bac cau qua cac ranh ban cau dai nao ma khong lath vao nhu mang mem.
Giita mang nhen va mang mem c6 mot khoang goi la khoang dual nhen chda day dich nao
Qua khoang dad nhen c6 nhilng be manh lien ket not mang nhen vdi mang mem.
Khoang dudi nhen (cavum subarachnoideale) thay clot kith thole thy ch6, co nhfing nui
gian Ong lam thanh cac 136 chita dual nhen (cisternae subarachnoideales). Khoang dudi nhen
thong thuong vdi he th6ng nao that qua cac 16 gida Ira 16 ben mai nao that IV, va lien ldt vdi
xoang tinh mach mang cuing bang cac hat mang nhen (granulationes arachnoideales). Hat
mang nhen c6 tac dung tieu thoat dich nao toy (H.51.6).
1.1.3. Mang mem (pia mater) cau tao bang ma' lien ket long leo, chda nhieu vi mach de
nuoi diking nao 130 va toy gai cho nen con ducat goi la mang nuoi. Mang mem a trong ding, bao
pha toan b0 mat ngoai va len 16i sau vao cac ranh ban cau dai nao. COng vdi cac to bao than
kinh dem c6 vai tro nang de? va nuoi du Ong cac not roil, mang mem tao nen mang nuoi-dem,
hinh thanh cac khodng quanh mach mau cUa cac tidu thing mach va tidu tinh mach. Do do, the
khodng quanh mach mau thuOc khoang dudi mang nhen va ding chda dich nao thy (H.51.3).
Mang nuoi - dem la co set vat chat dia hang rho mau - dich nao
Theo quan niem hien nay, cac khoang dudi nhen chinh 1a cac mat lurdi coa mang nuoi-dem.

Mang cuing

Mang nhOn

Khoang dual mang nhOn

Mang mem

KhoAng quanh mach mau

Hinh 51.3 : Khodng quanh mach mciu.

1.2. CAC MANG TOY GAI

1.2.1. Mang cling (dura mater spinal,is). CI thy gai mang cuing tao nen tali mang cuing, keo
dai tit quanh 16 cham clan ngang &at sang ding II.

365
 TIE mang cung cach vdi 6ng song bang khoang ngoai cung, chda mO and va dam rol tinh
mach cot sting.
Tit day tai mang ming ngang d6t song ding II, mang cung bao quanh day cung tao nen day
mang cung (filum durae matris spinalis) va dinh vao mat sau xuang cut, có cac day chang cung
- mang cung (Trolard) tang cuang. Co the gay to ngoai mang cung a viing nay (H.51.4).
Cac Ong mach dtit sting, gian soon, that lung va cung phan nhanh den mang cung va
xuyen qua cac mang -UV gai vao nu6i dung toy gai.

1.2.2. Mang nhOn (arachnoidea spinalis). La ngoai dinh vao mat trong mang cuing. La
trong xuting tan day tOi mang cung. Ghia hai la là khoang nhen; co cac dai lien 1dt, day chang
rang, r6 than kinh gai sting va mach mau xuyen qua.
Khoang Judi nhen &la toy gai (cavum subarachnoideale) có hai ch6 gian reng. Do la be dudi
nhen tigu hanh nao (cisterna cerebellomedullaris) ar quanh hanh nao va tidu nao va be bay gai
chda dad ngua a day tai mang cuing. Choc do that lung de lay nude nao toy a be nay (H.51.4).

1.2.3. Mang mem (pia mater spinalis)

Mang mem toy gai d m6i ben tech ra mot tre là day chang rang.
Day chang rang (lig. denticulatum) not mat ngoai mang mem vdi mang nao cuing o hai
ben theo mat phang ding ngang keo dai tit 16 lan xu'ang them den non ding -bay gai. G6m
khoang 17-18 rang. Gina cac rang la cac khe de cho r6 truck va re sau coa than kinh gai song
n6i vao nhau. Day chang rang chia tuii mang ding lam hai phong: truck va sau, thong nhau
qua cac cung rang (H.51.5).

Tay
That Icing I

Nddc nao toy

Khoang ngoai cling

Ch6c d6 that king

That king V

Xdong cung
Day cling

Gay to ngoai
Xdang cut
mang cuing

Hinh 51.4 : Ccic mang toy a pita' n dudi o'ng song.

366
 Cac tinh mach nao tren
Xoang da tren trai
Xoang da dudi
Lem nao
Tit-7h mach nao Ion

Khuye't 14u tieu nao

Xoang doc tren
Xoang tinh mach theng -1
Xoang doc dudi
Pheu tuyen yen
Ddng mach canh trong
Than kinh thi giac
Hdi kfu tinh mach

Xoang ngang
Cac tinh mach nao dudi
Leu tieu nao -1
Mao ga
Xoang sigma
- - Xoang fien hang
Tinh mach canh trong
Xoang bu'dm dinh
Xoang da tren phai
Dam 1-(51 nen Tinh mach nab trong nong
Xoang hang
Hoanh yen
Xoang gian hang
Lung yen

Anh XXXXVIII : Ccic tre mang nao tang

367
 Hanh khCfu

Thiry tran

Than kinh thi giac

Be giao thoa
DOng mach canh trong
Mang mem nao

Thiry thai &icing

Tuygn yen
Mang nhan nao
DM thong sau
Thg vu
T.K. van nhan Be gian cu6ng
DOng mach nen
DM nao sau

Than kinh sinh ba

Cau nao
TM tigu nao du6i
Than kinh ha thiet
DM d6t song
Tigu nao
Hanh nao

Be tieb nao hanh nao

Anh XXXXIX : Mang nh'On nao vet yang thing mach tido.

368
 Lo mang cling cac day than kinh song

Mang cing

Day chang rang

Fro sau (6 sau D/c rang) Day than kinh

gai song
R4 truec .j

Hinh 51.5 : Day dieing rang

1.2.4. Cac mang nao tay a day thAn kinh so va day thAn kinh gai song.
Noi cac day so va day gai song chui ra khOi cac 16 xu'ung có cac phan caa mang nao bao
boc. Doi vdi cac day gai sang, mang cting lien tac boc lay bao ngoai day than kinh (epinerium)
caa phan xa hach gai.
Mang nhen cang tao thanh bao, phan cach Ca hai r6 va tan ding d phdn gan hach gai.
Mang mem tao nen ldp trong cang quanh moi re thdri kinh gai sang, keo dai clan tan 16 gian
dot song va hoa 16n vao bao ngoai day than kinh (H.51.1).
D6i vdi cac day so ding tu'ong tai nhu' tren, ngoai trii day thi gide, day mat va day van nhan.

1.3. CAC MANG NAO

1.3.1. Mang ming nao (dura mater encephali).

Mang cling nao bb khac vdi mang cang tay gai a nlifing diem sau day
—Sat vao thanh xu'ung, va khong có khoang ngoai mang
— Mat trong cho cac tre (tient dai nao, liem tieu nao, leu tieu nao vet hoanh yen).
—Tao nen cac xoang tinh mach mang cang (11.51.6).
369
 TM mach lien lac

Hat mang nhen Xoang tinh mach doc tren

Hinh 51.6 : Hat mang nhen va xoang tinh mach mang cling

Lim nao
Xoang tinh mach doc fret?

Xoang tinh mach

doc dadi

Xoang tinh
mach tang

..
, ..........
.............„., ..............
Lou tieu nao
Vang nho

Hinh 51.7: Cc c tre caa mang cling (nhin ben)

370
 Mang cling barn chac vao an so lion a Om so. Wing de bac tach (Gerard Marchant) tif bd
sau canh nh6 )(Long budm ddn u chain that ra khOng phai duy nhat vi cdc mdu to ngodi mang
ming do ton thudng cac mach mdu mang nao c6 thd ldch vao gida mang cling va thanh xudng
Om so ya mot phan nen so.
Cdc tre c6a mang cuing (H.51.7 va H.51.8) gam :
— Liem dai nao (falx cerebri). Hinh luiori Hem, dinh vao toan b0 vOm so doc theo dudng giiia
va di vao khe doc gida hai ban cdu dai nao, tao nen mot vach sdi. Dau tru'dc gan va bac lay
mad ga )(dung sang. Bd tren lien tuc ra sau r6i tan cimg a u cham trong. Bd duai, tu do chay
cong theo mat tren cua the chai.

Hoanh yen

VOng nho

Vang Ian

Hinh 51.8 : Cac tre mang cling (nhin tren).

Ngay sau 16i the chai, Hem nao dinh chat vao mat lung leu tidu nao doc theo dudng gida.
Bic duai liem dai nao chda xoang tinh mach doc clued, lien tuc ra sau d6 v6 xoang tinh
mach thang (nam trong phan dinh cua hem dai nao vdi ldu tidu nao).
Bic tren hem dai nao chda xoang tinh mach doc trent
— L6u tidu nao (tentorium cerebelli) tao nen mot mai tren h6 so sau, ngan each mat
tren tigu nao vdi they cham caa ban cdu dai nao. Leu c6 hai bd : bd trong hay yang nhO, tti
do, nhd, lOm sau, hqp vdi yen xtiong budm tao thanh khuydt leu tidu nao (incisura tentorii),
va la gidi han tren cua trung nao. Bar ngoai la yang ldn dinh vac) xacing chilm doc theo mot
ranh chda xoang tinh mach ngang r6i theo cdc mep ctia mot ranh di doc mat tren phan da
xoang thdi duang, tao nen xoang tinh mach da tren. L6u ti'du nao tidp tuc ra phia tru'qc gdn
vao mom yen sau.

371
 Thoat vi me nao thu'dng xay ra tai khuydt 16u tidu nao hoac tit tren xu6ng (thocit vi thdi
duang), hoac tit dudi len (thodt vi they nh'ang tren).
- Lim tidu nao (falx cerebelli). La met phdn nho cua mang cuing a ngay dudi u chdm
trong. sau dinh vao mat trong xudng chdm va chda xoang firth mach chdm. Bcs trade hu'dng
vao trong lath gida hai ban eau tidu nao.
- Hohnh yen (diaphragma sellae). Hinh tO gide tao thanh mai h6 yen, dd thUng met to
nho a trung tam goi la to hoanh yen dd cho phan phdu cua tuydn yen di qua (H.51.9).

"‘•
• 00 • .0
0 0 • 0 • 0 0 0 0 0414

C • .
I." 6

Hinh 51.9 : Xoang hang va hoanh yen

Deng mach cap mau cho mang tang cua nao la : dOng mach mang nao giaa, nhanh ctia
d6ng mach ham va d6ng mach mang nao sau, nhanh cUa Ong mach d6t sting.
Tinh mach la cac tinh mach mang nao di theo hai he th6ng : he th6ng sau vdi cac ho mau
Tro-la (Trolard) va he th6ng nong vdi xoang tinh mach doc tren va dam r6i tinh mach than
biidm, dam bac, thong n6i 116 tinh mach not so Ira ngoai so.
Than kinh ctia mang nao la cac nhanh mang nao dia day sinh ba.
1.3.2. Mang nh'01 nao (arachnoidea encephali). Nhii a toy gai, cac khoang dudi nhen a so
gian thanh cac bd chila nhu :
—B'd tidu - hanh nao (cisterna cerebellomedullaris).
—Bd h6 ben dai nao (cisterna fossae lateralis cerebri).
—Bd giao thoa (cisterna chiasmatis).
— Be lien cu6ng nao (cisterna interpeduncularis) (H.51.10).
Dich nao tuy theo cac dudng (ling vdi ranh), ddn cac lath (Ong vdi ranh ldn) ve cac dong
(Ong vdi khe nao). Cac dong h6i to vd cac bd chda.
Khi thodt hdt dich nao tUy (ma mang cang dicing han), mang nhen Ai) sat vao mang mem.
Lac do chi phan biet &roc mang nao tang va mang nao mem.
372
 • Be CLAW nhen lien cu6ng nao
Be dudi nhen tie'u nao - hanh nao

Hinh 51.10 : Cdc be du'di nhen

Khoang du'di nhen thong vdi he thong nao that qua cac 16 mai nao that IV va thOng vdi
tinh mach qua cac hat mang nhen.
1.3.3. Mang mem nao (pia mater encephali).
Mang mem có cac mach mau phan nhanh di vao nao; phan phan chiau cua mang mem
theo cac mach mau tao nen cac khe hinh chop, ma thanh khe la hai la cua mang mem. Cac
khe nay goi la cac khoing quanh mach mau, chda dich nao -UV (H.51.3).
Cdc dam rai mang mach (plexus choroideus) là thanh phan cilia mang mem nao, g6m co :
—Dam rai mang mach nao that IV (plexus choroideus ventriculi quarti) va tam mang
mach nao that IV (tela choroidea ventriculi quarti) a gia'a hanh nao va tidu nao.
—Dam rai mang mach nao that III (plexus choroideus ventriculi tertii) lien tuc vdi dam rai
mang mach nao that ben (plexus choroideus lateralis) tai 16 gian nao that. Ca hai dam r6i nay
deu thu6c v6 tam mang mach nao that III (tela choroidea ventriculi tertii).

2. DICH NAO TUY (liquor cerebrospinalis). Dich nao tuy chiia trong cac nao that va trong
khoang dudi nhen.
2.1. NGUON GOC : Dich dive tidt ra chu yau tit cac dam r6i mang mach trong - cac nao that.
Dam r6i mach mac twang Cmg vdi met vimg cl:ac Met do cac cuOn mao mach duvc mang nei tuy
mang vao cac that nao, d'a'y 16i han vao trong cac phan ming (mang mai) cilia cac that Tido de tiat
ra dich nao tily.
Khi he thong nao that be tac, huyat Wong tit cac mach mau trong khoang nhen tao
ra dich nao tily qua cac khoang quanh mach mau. DO la ngulin g6c th( hai ngoai dam rai mang
mach cilia dich nao

373
 Vey dich nao toy la chat tiet ciia cac dam r6i mang mach nao that choan day trong he
th6ng nao that va khoang dudi nhen nao be Ira toy gai.
Dich trong su6t, khOng mau, thanh phan sinh hoa có khac vdi huye't tuong (it protein, it
glucoza, nhieu C1 va K1). Trong co the, chi có loc dich cau then, thay dich o nhan cat.' va not
dich tai trong la có dee tinh Wang tai.
Dung lacing 80 - 200cc, dude dei mdi 4 - 5 lan/24

2.2. NM CHIYA. Dich nao tay chda trong 2 ngan thong nhau :
—Ngan trong la he th6ng nao that, con goi la he th6ng tao thanh dudc lot nei m6.
—Ngan ngoai hay he th6ng hap thu g6m khoang dudi nhen vdi cac be chda. Be chda to
nil& la be chaa tidu - hanh nao.
Rieng 6ng trung tam thy gai khong chaa dich nao toy vi long 6ng qua nil&
Cac ch6 thong gida hal ngan la 16 gifra (16 magendie) va hal 16 ben (15 luschka) a mai nao
that IV.
2.3. SIJr LI.TU THONG DICH NAO TOY
Tit dam r6i mang mach nao that ben, dich nao toy qua 16 gian nao that tdi nao that III va
qua tong nao tdi nao that IV. Sau khi haa Ian vdi dich cac nao that nay, dich nao toy tit ngan
trong ra ngan ngoai qua mai nao that IV. L6 gifia va hal 16 ben mai nao that IV ma' ra be dudi
nhen tidu hanh nao. CO the vao be bang each choc do dudi 16 ldn xucrng chain. Tit be dudi nhen
tidu - hanh nao, dich nao toy xu6ng dgn be dudi nhen a quanh toy gal. CO the lay dich nao toy
a day bang each choc do that lung dudi d6t song that lung II.
Tit khoang dudi nhen, dich nao toy thoat di qua cac hat mang nhen de sau ding d6 vao cac
xoang tinh mach so.
Trong cac ngan, dich nao toy luu thong cham chem tang kh6i met. Trong he nao toy
khOng có van nen moi lac nghen deu la benh
Ldi dung si luu thOng nay to CO the tham do he nao toy bang each cho thu6c vao sau choc
do nude nao thy.

CAU HOI TRAC NGHIEM

Chon cau tra dung nhat

583. Chon cau dung :

a) Khoang ngoai mang cang CO d so.
b) Khoang ngoai mang cling có a toy.
c)6 day TK sinh ba la met the cua mang nhen.
d) Mang nhen thy xu6ng ten d6t that lung II.
e) Mang toy cling tdi d6t that lung II, bao quanh day cang tao nen day mang

374
DAng bang tra ldi sau day cho cac eau 584, 585, 586.
a) Cac hat mang nhen.
b) Dam r6i mang mach a cac nao that.
c) Cac xoang TM trong so.
d) Cac DM mang nao (tru'ac, gilta, sau).
e) Ta't ca deu sai.

584. Dich nao by chi ye-u ddoc tao ra tit :

585. Dich nao by du'oc hap thu a :

586. Mang cdng a nao, ddoc nuoi dating bai :

587. Trong mai-1g nao My, dich nao tuy nhm

a) Ngohi mang et:mg vh mai-1g nhen.
b) Giaa hai ld mang nhen
c) Giira mang nhen va mang mem.
d) Gifra mang mem vh \To nao.
e) b, c dung.

375
 52 MACH NAO TUY

MUC TIEU BAI GIANG

A. MUC TIEU THUYgT

1.M6 to cac dOng mach &la thy.
2. M6 to dir6c cac loai dOng mach, tinh mach cilia nao, cac xoang mang cling va cac tinh
mach lien lac.
3. Ve so d6 yang dOng mach nao.
4. Ve cac dOng mach v6 nao 6 cac mat bdn cau dai nao.

B. MUC TIEU THLIC TAP

1.Chi tren nao that va cac phu'ong tien thgc tap khdc cac mach nao tily.
2. CM tren xuzing so cac xoang mang citng.
3. CM tren phim X quang c6 chuan bi cac dOng mach ctia v6 nao.

9
1. MACH CUA TUY.

1.1. BONG MACH. DOng mach cila thy la cac nhanh gai (rami spinales) bAt ngu6n tit dOng
mach d6t s6ng va cac nhdnh cua dOng mach gian s66n, that lung va c6ng a doc cot song. Cdc
dOng mach nay cho ba loai nlidnh de vao thy. D6 là cac dung mach gai tru'6c, cac Ong mach
gai sau va cac dOng mach. re hay cac citing mach gai ben (H.52.1).

1.1.1. Doug mach gai trate (a. spinalis anterior) tdch ra tii d'Ong mach d6t s6ng gan than
nen harp lai thanh mot than chung di doc xu6ng theo dutrng gida, tru'ac khe giira trade

1.1.2. Wong mach gai sau (a. spinalis posterior). Co 2 Ong mach gai sau tdch tit dOng mach
d6t song hoac d6ng mach tieu nao dasi a ngang miic mat ben hanh nao, r6i di doc xu6ng
chia lam 2 nhanh nho di phia track (re truac) va phia sau cua re sau yeti Ong mach gai sau.

376
 Deing mach gai truec

DOng mach gai sau

962ng mach gai truific

DOng mach gai ben

Hinh 52.1 : Ccic dOng mach clia

DOng mach gai sau

DOng mach r5nh

Ludi mach vanh

DOng mach gai truec

Tinh mach gai trudc

DOng mach re

Mang nhen

Mang cling

Dam r67 tTnh mach

cr6t song trong

Hinh 52.2 : Cdc ctOng mach re czia tety.

377
 1.1.3. Cac dOng mach r6' can goi la dOng mach gai ben torch ra tit cac d6ng mach gian
swan, that long va cang a doc hai ben cot song. Cac dung mach nay chui vao 6ng song qua 16
gian clot song va chia hai nganh di theo hai r6 ciia than kinh gai song r6i cho cac nhanh len va
xua'ng dg not vdi dOng mach gai trade va d6ng mach gai sau (H.52.2).
Cac Ong mach tren torch ra cac nhanh ranh de di vao khe gida tru'ac bay gai va cac nhanh
ngang de tao nen a diteri mang mam cua tuy mang ludt dOng mach vanh (vasacorona). Tit mang
nay ca cac nhanh di vao nuoi
1.2. TINH MACH. Not chung theo dOng mach va d6 vao mang tinh mach mang mem
caa tory.

2. MACH CUA NAO.

2.1. BONG MACH. DOng mach ciia nao bat ngu6n tit hai dOng mach là difing mach clot
song vb. Ong mach canh trong.

DOng mach thong tn/dc DOng mach nao tn/dc

DOng mach tieu nao trot?

DOng mach nao gitia

DOng mach thong sau

DOng mach tieu nao

duel trade DOng mach nao sau

Hinh 52.3 : Vong clang mach nao a mat dziai nao

378
 Hai d6ng mach daft s6ng (a. vertebralis) sau khi qua 16 lan xu'cing cham vao so thi hop lai 6
trade ranh nen ciia eau nao thanh dOng mach nen (a. basilaris). Sau khi cho cac nhanh vao cau
nao (rami ad pontem) va tieu nao, clang mach nen chia hai nganh ding là dang mach nao sau
(a. cerebri posterior).
Con (tang mach canh trong sau khi tad xoang tinh mach hang 6 trong so den mom yen
truac thi chia thanh 4 nganh cling la : dOng mach nao tru'ac (a. cerebri anterior), dang mach
thong sau (a. communicans posterior), thing mach mach mac trade (a. choroidea anterior) va
&Ong mach nao gitia. (a. cerebri media).
M6t s6 lan cac nhanh cita 2 ngu6n d6ng mach cl6t s6ng va &Ong mach canh trong not nhau
6 mat ditai nao xung quanh yen btidm de tao thanh yang dOng mach nao.

2.1.1. Vong dOng mach nao (circulus arteriosus cerebri) con goi la da gidc Willis. Wong
gem 6 den 7 d6ng mach n6i nhau. D6 IA cac cap Ong mach nao troac, th6ng sau va nao sau.
Doi khi c6 mot nhanh tha bay not hai dOng mach nao trade vdi nhau goi la d6ng mach thong
trade (a. communicans anterior) (H.52.3).

2.1.2. DOng mach cua tram nao.

Hanh nao nhan man tit cac dang mach da song, phan tren cua cac d6ng mach gai tru'ac
va gai sau. Cdu nao nhAn mdu troc tiep tit d6ng mach nen hoac -Ur dOng mach tieu nao dual
trade va tieu nao tren.
Can tieu nao du.ac cap huye't lath ba cap Ong mach la : d6ng mach tieu nao cloth sau (a.
cerebelli inf post.) tach tit dung mach d6t song, d6ng mach tieu nao doai truarc (a. cerebelli inf
ant.) tach tit dOng mach nen va dung mach tieu nao tren (a. cerebelli sup.) tach tit dau tren &la
Tang mach nen.

2.1.3. DOng mach cua trung nao.

Trung nao du'oc cap huye-t bai cac nhanh tach tit dOng mach nen va dOng mach nao sau.

2.1.4. DO'ng mach ctia gian nao va doan nao.

Cdc d6ng mach cap huye't cho nao trade (gian nao va doan nao) dooc chia lam hai loai
chinh : dOng mach v6 va dung mach trung uang. Ngoai ra con co cac d6ng mach mach mac tao
nen cac ddm r6i mach mac.
2.1.4.1. Cetc thing mach vo.
Cac Ong mach a va nao xuat phat tit 3 d6ng mach: nao trade, nao giita va nao sau.
* D'Ong mach nao trutdc (a. cerebri anterior) (H.52.4) sau khi tach tit d6ng mach canh
trong di trong than kinh thi giac vao khe gian ban cau de tai mat trong ban cau dai nao bang
each yang theo g6i va chu vi the chai. DOng mach nao trilac cap huyet cho mat trong ban cau
dai nao (phia trztac reinh dinh cheim trong) mat ngoai cua hai h6i tram tren va tram giaa Ira
nth trong cua h6i 6 mat cila mat dual they tram Cdc nhanh va (rami cortical es) cua dung
mach nao tru'ac la: cac nhanh 6 mat (rami orbitales), cac nhanh tran (rami frontales) va cac
nhanh dinh (rami parietales).

379
 Nhanh dinh

Cac nhanh tran

Nhanh chgm

Nhanh 6 mgt
Ddng mach ago sau Ddng mach nao tnhdc
r. r

7.

Hinh 52.4: Ddng mach a mat trong ndo.

Cac nhanh
Ddng m?ch thai du'dng
nao giu'a
Nhanh 6 mat

Ddng m?ch d6t song

Hinh 52.5 : Ddng mach a mat ngodi ndo

380
 * DOng mach nao ghla (a. cerebri media) (H.52.5) con °bloc goi la Ong mach Sylvius,
tach tit Ong mach canh trong, di cheo khoang gian cuo-ng nao vao ranh ben a mat ngoai ban
cdu dai nao, bo tren mat they dao va tan ding a do. Vang cap huy6t a vo nao dia. Ong mach
nao gia'a la dai bo phan mat ngoai ban cdu dai nao Wit hai h6i trcin tren vd giz.2a ctia cldng
mach nao truck vet mot phein thdy chdm caa ddng mach nao sau) va naa ngoai cua ho'i 6 mat
dia mat dadi they tram. Cac nhanh vo (rami corticales) caa Ong mach nao gida. la : cac nhanh
6 mat (rami orbitales), cac nhanh tran (rami frontales), cac nhanh dinh (rami parietales) va cac
nhanh thai throng (rami temporales).

Nhan du&
Doi thi

Nhan beo
Ddng mach van trong

Cac nhanh clOng mach

mach mac sau
Ddng mach van ngoai
Ding mach
mach mac tru'oc DOng mach thong sau
DOng mach nao sau

DOng mach canh trong

Hinh 52.6 : Cdc ddng mach trung dung.

* DOng mach nao sau (a. cerebri posterior) (H.52.3) la nhanh ding &la O'ng mach n6n,
htan ra ngoai a mat du'ai cuo-ng dai nao r6i cap huy6t, cho mat dad ci.ia they thai du'ong chdm
va mat trong va ngoai cua they chdm. Cac nhanh vo (rami corticales) &la dOng mach nao sau
la: cac nhanh thai du'ong (rami temporales), cac nhanh chdm (rami occipitales) va cac nhanh
dinh chdm (rami parietoocipitales).
2.1.4.2. Cdc ddng mach trung dong (H.52.6) cap huy6t, cho cac nhan n6n (nhan xcim chtdi
vO) ciia nao nha nhan duoi, nhan beo, nhan tradc cho gian nao va thanh dadi cua nao
that III. Cac nhanh trung acing nay (rami centrales) Tett tach tit ba dOng mach nao track, nao
gala va nao sau. Rieng cac nhanh tach tit Ong mach nao gala du'oc goi la cac nhanh van (rami
striati). Thutng xay ra xiat, huy6t, nao a cac Ong mach nay.
2.1.4.3. Cdc ddng mach mach mac : Cdp huy6t cho cac Valli mach mac cila cac that nao. CO
hai Ong mach mach mac : dOng mach mach mac trade (a. choroidea anterior) tach tit Ong
mach canh trong va nhanh mach mac (ramus choroideus) tach tit Ong mach nao sau.
Cl ngutd Viet Nam, O'ng mach canh trong a doan sau c6 ham caa xaong ham dadi CO

381
duting kinh là 4,13 nun 6 ben trai va 3,88 mm d ben phai. Khi vao trong so thi 6 ben trai con
2,86 mm va ben phai can 2,61 mm. Dieing kinh cua dOng mach nao giCia ben trai là 2,41 mm,
va ben phai là 2,29 mm, cua Ong mach nao tru'dc ben trai la 1,89 mm va ben phai la
1,79 mm, cua dOng mach nao sau la 1,72 mm (ben trdi) la 1,57 mm (ben phcii), caa Ong mach
thOng sau la 1 mm (ben trdi) va 0,95 mm (ben phcii), caa dOng mach than nen la 2,8 mm, caa
Ong mach thong tru6c la 1,17 mm. CO 5 dang caa yang dOn.g mach nao trong do dang din
hinh chiam 68,8% dale biet co 4,4% killing co yang thing mach nao (do khong c6 hai clang mach
thong sau) a dang nay thong n6i k6m rat bat 16i khi bi tai bian hep hay ta'c mot ben.
2.2. TINH MACH.
2.2.1. Cac tinh mach caa tram nao Va trung nao tao nen cac mang tinh mach Wang
Ling de cu6i ding do vac, cac xoang mang cdng. Cac tinh mach cua tidu nao thi g6m hai loai :
tinh mach ti6u nao tren (vv. cerebelli superiores) va tinh mach ti6u nao duth (vv. cerebelli
inferiores). Cac tinh mach nay d6 vao tinh mach nao Mn.
2.2.2. Tinh mach cila nao. Bac diem caa tinh mach nao la khong co van va khong di
kem theo &Ong mach ma tao thanh mot mang chay trong mang mem r6i qua khoang dutti nhOn
de d6 vao cac xoang mang cang. Chung ta se Fan luvt didm qua cac tinh mach nao va sau do la
cac xoang mang cling.

Cac tinh mach nao tren

Tinh mach not tren (Trolard)

Cac tinh mach

nao tren

Tinh mach no'i du'di

(Labbe)

Cac tinh mach

nao dudi
Tinh mach nao giCia nong

Hinh 52.7: Cdc tinh mach vO nao.

2.2.2.1. Cdc tinh mach nao. Giang nlw dOng mach, ta có the chia cac tinh mach nao
thanh hai nh6m : cac tinh mach v6 (hay tinh mach nong) va cac tinh mach trung acing (hay
tinh mach sau).

382
 * Cac tinh mach voi nam tren mat v6 nao trong cac ranh va di crc chia lam hai nhOm :
nh6m tren Ira nh6m du6i.
+ Cac tinh mach nao tren (vu. cerebri superiores) (H.52.7) g6m c6 td 4 d6n 6 tinh mach
m6i ben, nhan mau d mat trong va mat ngoai cila ban cau dai nao.
+ Cac tinh mach nao diidi (vv. cerebri inferiores) nhan mau 6 mat diidi va phan dtidi cua
mat ngoai ban cau dai nao r6i d6 vao cac xoang mang cling d nen so.
+ Tinh mach nao Oda nong (v. cerebri media superficialis) bat dau tit mat ngoai ban cau
dai nao chay trong ranh ben xu6ng mat diidi va d6 vao xoang tinh mach hang. Tinh mach n6i
tren (v. anastomotica superior) (Trolard) n6i tinh mach nao gida 'long vdi xoang dot tren con
tinh mach n6i diidi (v. anastomotica inferior) (Labbe) n6i tinh mach giia nong vdi xoang ngang.

TTnh mach thi van

Tinh mach mach mac

TM mach nao trong

77nh mach nen

Tinh mach nao On

Hinh 52.8 : Ccic tinh mach trung nong clic" nao.

* Cac tinh mach trung Ltong (H.52.8) nhan mau tit cac phan sau cna nao (gian nao va trung
nao) d6 tap trung d6 ve tinh mach nao lan (v. cerebri magna) de sau dung lai d6 v6 xoang thang.
Tinh mach nao lan do hai tinh mach nao trong (vv. cerebri internae) tit khe nao ngang d ngay mitt
16i chai di ra h6p thanh. Tinh mach nao trong 14i nhan tinh mach mach mac (v. choroidea),
tinh mach thi van (v. thalamostriata) va tinh mach nen (v. basalts). Ngoai ra tinh mach nao
16n con nhan them cac tinh mach ti6u nao tren va ti6u nao diidi nhu da trinh bay 6 phan ti6u nao.
2.2.2.2. Cac xoang mang tang (sinus durae matris). Cac xoang mang ding la cac khoang
chila mau tinh mach duoc gidi han bai lap ngoai cot mac xuong so va mang nao ding. Phia

383
trong c6 lit mot lap not mo. Cac xoang c6 tic dung nhii mot con kenh din lu'u mau tit nao va
hOp so ra cac tinh mach a c6 va cat song. Co hai loaf xoang : Cac xoang le (chi có mot xoang a
gida) nhii xoang doc tren, xoang doc dual, xoang thing, xoang chdm, hOi hiu cac xoang, dam ro'i
nen va cac xoang chin (co hai xoang a hai ben) nllit xoang ngang, xoang xich ma, xoang da
tren, xoang da duai, xoang hang va xoang biidm dinh (H.52.9).

Xoang doc tren

Xoang doc du'di

Xoang de tren
Tinh mach mat

Xoang thing
Hdi Iciu cac xoang
Xoang hang

Xoang xich ma
Xoang de du'di

Tinh mach lien lac clam

Tinh mach canh trong

Hinh 52.9 : Cdc xoang 'ming cdng

Xoang doc tren (sinus sagittalis superior) nam doc a duang glad. tit 16' tit track mao ga
—

xuang sang tai u chdm trong gala Om so va bar tren li6m

—Xoang doc dutdi (sinus sagittalis inferior) nam a bar tit do (ba chtai) cua liem dai nao va
n6i a phia sau vdi xoang thing.
—Xoang thing (sinus rectus) nam a ch6 giap nhau giita liem dai nao va 16u tidu nab. D6
vao xoang thing c6 xoang doc du'di va tinh mach nao lan. Xoang thing a phia sau d6 vao hai
luu xoang.
—Xoang chthn (sinus occipitalis) nam a phdn trai xoang chdm tit ba sau 16 lan tai hai ltru
xoang.
—HOi hiu cac xoang (confluens sinuum) nam d u clidm trong la nai hOi to cua cac xoang
doc tren, xoang thing, xoang chdm va hai xoang ngang.

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 —Dam rai nen (plexus basilaris) la mot dam reci filh mach có tinh chdt flint xoang mang
cling nam a mom nen 'along chdm va phdn sau than xuang budm &an luu mau Oita xoang hang
va xoang da dudi.
—Xoang ngang (sinus transversus) la mot xoang ldn nam trong ranh ngang ar phdn trai
xurang chdm tit 11.0i lulu cac xoang tai xoang xich ma.
— Xoang xich ma (sinus sigmoideus) lien tiep vdi xoang ngang tii phdn nen xuang da tdi
16 tinh mach canh a nen so d6 ti6p n6i vdi tinh mach canh trong. Xoang ngang va phdn ldn
xoang xich ma ducrc gidi han bai phan trai xu'ong chdm va bar yang ldn cua ldu tidu ndo.
—Xoang di teen (sinus petrosus superior) nam o bar tren phdn da xurang thai &tang.
Xoang nay n6i xoang hang d phia trong vdi ch8 n6i giaa xoang ngang va xoang xich mad phia
ngoai.
—Xoang da dudi (sinus petrosus inferior) nam doc theo khe da chdm n6i tit xoang hang
tdi (Mu tren tinh mach canh trong.
—Xoang hang (sinus cavernosus) nam d thanh ben than xuang budm, (Mu trudc tai khe 6
mat tren va ddu sau tdi dinh xoang da. Thanh ngoai va thanh tren caa xoang là tre mang ndo
cuing (H.52.10). Phia trade, xoang nhan tinh mach mat tren va dudi. Phia sau, xoang clan mau
di nhO xoang da tren va dual.
— Xoang bitdm dinh (sinus sphenoparietalis) di theo mot rdnh 0 canh nha xuang budm va
d6 vao xoang hang.
Tom lai, ve mat dinh khu, có th6 chia cac xoang mang cling thanh hai nhom :
—Nhom sau teen. Cac xoang thu6c nhom nay là xoang doc tren, thang, doc dudi, chdm,
ngang va xich ma. Tdt ca deu d6 vd h0i luu cac xoang.

Thgn kinh van nhan

Thanh ngoai xoang hang

Tuygn yen — Xoang hang

DOng mach canh trong

Thin kinh yin nhan ngoai
Thgn kinh mgt
Xoang xurtng bu'am

Thgn kinh ham tren

Hinh 52.10: Thie't d6 ding ngang qua xoang hang.

385
 — Nh6m trUdc ditari. G6m cac xoang bu'am dinh, cid tren, des du'ai Ira cac tinh mach mat
va tat ca ddu d6 vd xoang hang.
2.2.2.3. Ccic tinh mach lien lac (vv. emissariae). Do la cac tinh mach n6i gida cac xoang
mang cling a trong so voi cac tinh mach a ngodi so de cho mau co thd thOng thuang theo moi
chieu. Thuang cac tinh mach lien lac d nen so 16n lion a yam so. Cac tinh mach lien lac chui
qua cac 16 rieng ctia xuang so va mang ten cac 16 a )(dung do. NhOrng tinh mach thuang gap
nhat la tinh mach lien lac dinh (v. emissarie parietalis), tinh mach lien lac chum (v. emissaria
mastoidea), tinh mach lien lac chdra (v. emissaria occipitalis), tinh mach lien lac 16i cat' (v.
emissaria condylaris).
Ngoai ra con cac dam r6i tinh mach ctia Ong mach canh trong (plexus venosus caroticus
internus), dam ro'i 16 bau duc (plexus venosus foramina ovalis) va dam r6i tinh mach 6ng than
kinh ha thiet (plexus venosus canalis hypoglossi).

CAU HoI TRAC NGHIE: M

Chon cau tra lai thing nhat

588. DOng mach nao KHONG cung cap mdu cho mat ngoai ban cau dai nao :
a) DM nao trade. d) DM mang mach trade.
b) DM nao gida. e) Ca a, b, d ddu thing. a
c) DM nao sau.
Dung hinh ve sau de tra ldi cac cau 589, 590, 591.

So' cid mach nao - Da gicic willis

589. DM nao trudc a vi tri :

590. DM thong sau a vi tri :
591. DM nao nuOi dung cho pilau ldn mat tren - ngoai vó ban cau dai nao :
592. Ch6n cau thing : Cac xoang TM a Om va nen so chit yetu d6 vac) :
a) Xoang hang. d) Tat ca deu
b) HOi li.tu cac xoang (hai lu'u Herophile). e) Chi có a, b dting.
c) Xoang TM ngang.

386
 PHAN VIII - GI 'AI PHAU DAI CU'ONG

53 HE XIJdNG
MUC TIEU BAI GIANG
1. Neu cdc chdc nang cilia he xdong lien quan den c'au tao &la chung.
2. Phan loai xdong theo hinh the va cau
3. MO to sq cot h6a.
4. Neu cdc quy luat tang trd&ng xdong va cdc yeu to anh hdang tai sy tang tru'ang.
5. MO to dac diem &la xdong dai tren phim X quang.

I. DAI CthJNG VE HE XUCING

1.1. CAU TAO.
BO xdong ngutri c6 : 206 xdong, da s6 là xu'ong chdn, gom :
+ Cac Yoking true :
—Xu'ong so va xdong mat (ossa cranii, ossa faciei) 23 xu'ong.
—COt song (columna vertebralis) 26 xdong.
— Xdong lOng ngiic (thorax) 25 xdong.
+ Cac phu, :
—Xdong chi tren (ossa metnbri superioris) 64 xdong.
— Xdong chi du'ai (ossa membri inferioris) 62 xuzing.
—Xu'ong nhi (ossicula auditus) 6 'along.

387
 Ngoai ra can mot s6 xu'ung viing a trong cac gan ca va nhang xdong bat the ang khac.

1.2. CHLiC NANG.

Xiang có b6n nhiem vu chinh.

+ Nang dd. Ca thd cua cac Ong vat s6ng duti ntidc dote nang der bdi lite ddy Archimede,
can d6i vdi cac dung vat sting tren can he xuang phai du yang chac de nang dor toan bo cod the.
Han the nita, a nguti, mu6n dat dote tu' the thing thgng, nhiem vu nang dd cua he xdung trd
thanh rat quan trong. Nha co he xuang ma cc( the ngu'ai co mot hinh clang va vi tri nhat dinh
trong khong gian.
+ Bao vg. CI mot s6 dung vat, he xuang bao boc ben ngoai cc; thd, bao ye cho ca the (cua,
tom, rim). C1 ngdai, 1-10p so va cot song bao boc lay he than kinh; long ngdc che cher cho tim
ph6i va cac mach mau ldn quan trong; khung chau che cher cho mot s6 tang thuOc he nieu dyc.
+ Van clang. Xuang la nai ca den barn nen dote coi nhu' mot he clan by ma didm tda là
cac khdp xu'ung. Nhu' vay, he xu'ung long mot vai tro thy Ong trong b0 may van d'Ong.
+ To mau va trao dui chat. Ngoai ba chile nang tren, he xdung can lam nhiem vu tao
mau va trao do). chat. Tay xdung la nai tao ra hang eau, bath cau va tidu cau. Tay xuang cang
la nai dd tri cac chat md. Ngoai ra xdung cling la nai du trd cac mu6i khoang, dgc biet la
photpho va canxi
Bat cd mot sit khiem khuyet nao caa he xuang cang se it nhieu anh hitting den cac chile
nang ke tren.
Thi du :
- Bat thdang cua cot sang do barn sinh hay mac phai se gay ga veo cot s6ng va lam anh
hating den hinh clang (chile nang nang da).
- Khiem khuyet cua cac xuang so trong twang hap thai vo so se lam cho he than kinh
khong dutc bao ye.
- Gay )(dung hay khdp gia se lam anh hdang den he don bay dm sit di chuydn.
- TOn thuzing cua tay xticing do hoa chat hay phong xa có the gay ra cac benh y6 mau v.v...

2. CAI TAO CUA HE XVCING

2.1. PHAN LOAI.

2.1.1. ve phiidng din hinh clang co thd chia xuang thanh cac loci sau :
- Xu'o'ng tai (os longum) nhu' xiiang try, xdung canh tay.
- Xu'ung ngan (os breve) nhd xdung c6 tay, co than.
- Xttang det (os planum) nhu' xu'cing vai, xuang urc, xu'ung vam so.
- Xu'ung hinh bat dinh oho' xuang ham tren, xdung thai dutng, xdang sang.

388
 — Xuang va'ng (ossa sesamoidea) là cac xuong ham trong gan at hay bao khap nhu xu'crng
banh che.
2.1.2. ye pinking din mo hoc : data vao each tao xuong, co thd chia he xuang lam
hai loai :
— )(acing c6t mac hay xuong mAng do mang xu'o'ng tao ra.
— )(acing Havers hay xuong sun do toy tao c6t to ra. CO hai loaf xuang Havers :
* Xuang Havers dac duqc cau tao bai nhang he thong Havers. DO là nhCing kh6i xuang
hinh tru tao thanh bai nhimg la xuong clang tam quay quanh mot 6ng goi la 6ng Havers, 6ng
Havers là clueing di dm mach mdu trong xuong (H.53.1).
Xiang Havers x6p là xucrng co nhirng h6c try lan thong vai nhau, ngdn each nhau khong
hoan than bai mot it la. =mg.

2.2. HINH THE NGOAI.

M8i xuang c6 mot hinh the ngodi rieng biet ma data vao do to c6 the xdc dinh duoc thong
d8 clang. Tren cac xuong thuang c6 nhiing ch6 16i lOm. 0 xurang tre em va phkt nit cac nai 16i
lam nay khong ro rang bang a nam, nhaa là so vdi nhfing nguti. lao &Ong than tay va thuting
xuyen ren luyen than thd. Cdc ch6 16i lOm nay cluac chia lam hai loai :

Ong Havers

O xu'o'ng
To' bao xddng

La )(doing

Hinh 53.1 : He thong Havers

—Loai tidp khdp (diO'n khop, facies articularis). Loai tiep khap lOm deuce goi là 6 chg.() hay
6 cea; loai 16i là thorn, 16i cau hay rang roc. Cac dien khap duoc phti be i skin khdp (cartilago
articularis) con dot is goi IA sun boc.
—Loai khong tidp khdp. Ch6 16i goi 1A. 16i, mom, u, gai, Ch6 lOm lA h6, ranh, khe,
6ng, khuydt...
Noi 16i thuang la ch8 ca bam, nai lOm là do gan ca, mach mdu hay than kinh tao nen khi
di sat xurcrng. Ngoai ra a mot s6 xuan.g so mat, c6 cac h6c xoang goi là xoang hay hang. Cdc heic

389
xdong nay lam cho ddu nhe bat va la horn Ong hitting c16 ti6ng not yang xa.

2.3. CAU TRUC DAT THE.

2.3.1. Cgu true xticing

Cgu true xuang dai not chung g6m mot than )(dung (diaphysis) hinh 6ng va hai ddu phinh
to ra goi la Tall xtrung (epiphysis) (H.53.2).

Bao khdp

tin khdp

Chat Along xeip

Ddng mach ming xu'o'ng

Mang Wong
Buong tely

Chat xudng dac

D'Ong mach nudi xudng—

sl

Hinh 53.2 : So dO cdu tao mot xuang

390
 2.3.1.1. Than xuang.
Than xuang duac eau tao bdi chat xuang dac (substantia compactor) du'ac bac trong mang
xuang (periosteum), a gida c6 met h6c goi la bu6ng toy (cavum medullare). Cat ngang than
xuang thong to thay lan loot cac lap sau (H.53.3).

Lap trung gian

Mang xtio'ng

Lap giCia
(ire thong Havers

HO thong
HO thong ca ban ngoai
cd ban trong

aging toy

Hinh 53.3 : Cdu tao vi the met doan xuang dai.

—Mang xuang day khong qua 2mm, g6m c6 hai lap : lap ngoai lam nhiem vu the cha chda
cac dau tan tong cUa than kinh cam giac nen khi bi cham thuang se gay dau; lap trong
norm sat xuang va bam chat vao xuang; c6 chda cac td bao c6 kha nang sinh )(dung (tao cot
bao). Day la lap quan trong cho sit phat tridn va tai tao )(dung. Ca hai lap 'deli c6 18 cho mach
man di qua.
—He Hang ca bdn ngoai (lop ngoai) cUa chat xuang dac g6m nhiing la xuang cat mac d6ng
tam ma true thi trung vai truc than xuang.
—Lap giaa cUa chat xuang dac cau tao cho yau bdi xuang Havers dac xen ke vai nhting
mau he thong Havers trung gian va he thong cat mac trung gian.
—HO thdng ca bdn trong (lop trong) cua chit xuang dac g6m met it IA xuang &Mg tam ma
true trung vai truc than xuang do toy tao cat tao ra.
— BuOng toy chda toy )(dung.

391
 Ve phuung dien chic nang c6 bon loai tay xuung.
+ Tay tao cot la mo lien kat c6 chtla nhang tao c6t bao va hay c6t bao di lam nhiem vu
xay thing xuung hay phd hay sun, xuung.
+Tuy tau huyet tao ra cdc dung lidng can, cdc (long bath cau da nhan va tidu cau.
+Ttiy ma chtla cdc to bao ma, la not du' trii ma quan trong caa co thd.
+Tay xo c6 trong 6ng tay cua nguai gia.
Vd mat hinh thai ngtiori to chia lam hai loai tay : tay do (medulla ossium rubra) Wong ling
vdi -bay tao c6t va bay tao huyet; tay yang (medulla ossium (lava) Wong tay me va tay xu.
2.3.1.2. Deiu xuang.
Phan trung tam dau xu'ung rat day, la xuung Havers x6p, phan ngoai vi mang, la xuang
c6t mac. Tai dien khdp : xu'ung c6t mac duuc thay bang sun khop. Dau xuang cung ductc boc
trong mang xucing trif a dien 'chap.
2.3.2. Cgu trtic xxicfng ngAn.
Tu'ung ti nhu cau trac dau xuung dai.
2.3.3. Cgu trot xticing dct va xutdng kho dinh hinh.
Cdc xucing Om so ducic eau tao bdi hai lap xu'ung dac goi là ban (diploe), a gida hai lap la
xuung Havers x6p. Mang xuung chi phii a m'a't ngoai caa ban ngoai.
MOt s6 xucing kh6 dinh hinh c6 nhang xoang (sinus) hay hang khong khi (antrum) nen con
&rue goi la xu'ung c6 h6c khi (os pneumaticum).

2.4. CAU TRUC VI THE.

MO xucing cau tao bai ba thanh phdn chinh.
2.4.1. Chgt can bin tao thanh cdc Id xu'crng. Gida cdc la xuang ca, nhang h6c nho goi la 6
xuang, chtla t6 bao xuung.
2.4.2. Cac phan tii sqi xap theo mot hudng nhat dinh trong cdc chit can ban nhu' nhang
loi sat trong mot tam betOng, c6 tac dung ch6ng su gang co.
2.4.3. Cac to bao xtving nam trong 6 xucing.

2.5. MACH MAU VA THAN KINH.

2.5.1. Mach mau.

Cac mach mdu nuoi xucing sau khi chui qua to nuoi xu'o'ng (foramen nutricium) se clan cdc
hip caa )(dung. Co ba loai clOng mach nuoi xucing (H.53.2).
—DOng mach mang xu'ung clan nuoi chat xuung dac.
—Wing mach dau xuung thuang xuat phat tit cdc dung mach nuoi khap, sau khi xuyen qua
chat xucing dac se clan nuoi xuung x6p va tay dau xu'ung. Day la do, ng mach nuoi duang cho \Tung
tang twang &la xuang nen bat thuang a Ong mach nay se gay bat thuang vg tang truang xuong.

392
 —Deng mach nuoi xdung di qua chat xdung dac, chia nhanh nuoi tay va chat xdung (lac.
Deng mach nay di trong cac 6ng nuoi (canalis nutricius) hiking vd dau it tang twang caa xuang
dai nghia. la. "di vd phia khdp khuSru Ira di xa khdp g6i".
2.5.2. Than kinh.
Cac than kinh di theo cac mach mau nuoi xu'ung (sqi van mach), con cac sqi cam gidc se
clang laid mang xu'ung. Vi vay to c6 the gay to a quanh mang xu'ung khi xdung bi gdy hay khi
can lam cac phau thuat. Ngoai cam gidc dau, cac sui than kinh a mang xu'ung con cho cam gide
vo i ap ldc.

2.6. THANH PHAN HOA HOC.

Thanh phan cua xu'ung gom c6 :
—Chat hau co' (12,40%) du'uc goi dual ten ossein hay osseomucoit la h6n hup gem protein
va mucopolysaccarit.
— Chat vo cc! (21,85%) chili yeu la photphat canxi va cacbonat canxi.
— Ma (15,75%).
—Ntrac (50%).
Trd mc1 va nti6rc, ti 10 chat hal car trong xuccng la 1/3 va chat vo ccc IA 2/3.
Cac chat hilu car gidp cho xdung c6 met de dai nhat dinh. Khi ngam xdung vao dung dich
HC1 hay HNO3, chat vo ccc se bi hoa tan, xdung gift hinh dang nhung mat ye ming chat c6 the
be tong de dang.
Ngdgc lai, chat vo ccc lam cho 'arcing ran chat. Khi d6t xdang, thanh phan hau cct chay het,
)(dung mat de dai trot thanh don, de vd.
NhO c6 thanh phdn nhti tren ma xuccng vita dai vita cling. )(dung c6 the chiu ap ldc
15kg/mm2 trong khi sac chiu cua gach nung chi khoang 0,5 kg/mm2. Xuung c6 the chiu met hic
keo va lixc op xap xi hoac horn met naa ldc keo va ldc ep cilia deng, horn han lure keo va chiu
sac ep cilia nhang loci g6 ding nhat (go soi).

3. S11 TANG TRU'oNG VA PHAT TRIEN Ct' . A HE XISdNG

3.1. SLJ COT HOA.

3.1.1. NIning nguyen tAc chung cua qua trinh cat h6a.
— Xdcrng du'uc hinh thanh tit hai cach :
+ C6t h6a trdc tiep : chat can ban cilia mo lien k6t ngam Ca va bien thanh mo )(dung. Cdc
xuccng nay goi la xu'crng mang nhu' xdung Om so va phan 16n xdung dau mat.
+ C6t h6a nha sun : chat can ban cilia mo lien k6t ngam cartilagen thanh sun. Sun nay bi tieu
di O. clduc thay the bang mo lien ket non clan clan bien thanh xdung (xuong Havers, xdong sun).
— Trong qua trinh c6t h6a 'Lion luon c6 hai hien tu'ung d6i ngduc nhung xay ra song song.
Hien tagng pha hay )(acing do hay c6t bao va hien tuung tao xuccng do tao c6t bao.

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 — Trong qua trinh cot h6a c6 hai giai doan c6t boa lien tiep nhau : c6t h6a nguyen phat
hay giai doan xay dung xuong va c6t hoa this phat hay giai doan sd'a sang lai xuong.

3.1.2. Cot hoa trip tigp.

3.1.2.1. Cat hda nguyen phdt.
Hien tu'ong nay xay ra chu y6u trong giai doan phoi thai. Van khoang tudn that 9, xoung c6
dang met mang lien k6t, gom t6 bao trung mo va it soi tao keo, bat dau c6 cac trung tam c6t
h6a. Tai trung tam c6t h6a cac soi nhiL len, day t6 bao trung mo ra xa. T6 bao trung m6 sau
do thanh tao cot bao. Mang xu'o'ng thanh ma dang xu'ung gom c6 chat can ban, sal va tao c6t
bao. Sau do co hien Wang ngam voi va tao c6t ban thanh t6 bao xtiong. Tit trung tam cat Ma
nhCing be xu'cing lan ra moi hu'ong thanh met mang xoang va mo dang xu'ang thanh ma )(dung.
M6 mil:mg tang twang theo chi'6u Ong do so c6t hoa lan ra dan va tang tru'ang theo chi6u
day do mat ngoai mo xu'o'ng thanh mang xuong. Cac tao c6t bao a mat trong mang xu'o'ng tao
thanh cac là xuong nhin chOng nhau. La xu'ang xudt hien sam nhat se na'm sau nhal.

3.1.2.2. Cdt hoa thu phdt.

Khi mai sanh, xu'ang yam so la met m6 xuong dac d'eing nh'at. Sau khi sanh, lap gida cua
vain so bi pha huy thanh nhiing h6c chda thy tao huy6t va lap gicra thanh )(dung Havers x6p
&foe boc trong hai ban ngoai va trong.

3.1.3. Cat Ma qua sun (Hinh 53.4).

3.1.3.1. COet hoa nguyen phdt.
+ than xoung.

Sun d6u )(dung

Ddng mach

Bu6ng tay

Hinh 53.4 : Sa ciao su c6t hoa nguyen phdt qua sun.

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 Trong giai doan thai, xuang chi la ma sun duac boc bdi mang sun. Mang sun thanh mang
xdong bao quanh sun tri hai dau. Cac mach mau cl6n than mang theo mo lien kel. MO lien k6t
thanh hay cot bao va pha hay sun de tao thanh tay xu'ong. Mach mau ti6n v6 hai dau than
xaang lam hep dan sun, Ong dan tay. Nai Oda dau va than xaang se c6 yang cat hoa hay
trung tam c6t h6a. Sun vimg nay nhiexm canxi thanh xdong. Trong khi do mang xuang tieep tuc
ddp nhiing la xuang lam thanh xaang day len.
+ CI dau xu'o'ng.
Su' c6t h6a nguyen phat ar ddu xu'ang xay ra muen horn, thurang a giai doan sau sinh. Su' cat
Ma nay cling bdt dau tit viec mach mau den sun, mang theo hay c6t bao lam pha va 6 sun, d6
thanh thy. Phan sun bao quanh tay nhi6m canxi thanh xttang. Gina dau xuang va than xdong
con chita lai met bang sun, goi la sun dau xaang (cartilago epiphysialis) hay sun ti6p va se bi6n
mat khi trdang thanh. Chi khi nao sun dau xuang mat di thi mang xaang a dau xu'ong mai bi
c6t h6a.

3.1.3.2. Co't hoa tha phat.

eithan xuang sit cot h6a nay nham tao he xu'ang Havers. Trong khi mang xuang tao
thanh nhang la xaang a mat ngoai, thi tit thy cac mach man mang theo hay c6t bao dao nhieu
diking ham doc theo than xdong, cac duang ham nay not nhau. Clung vdi hay cat bao la tao col
bao d6n lam thanh nhang là xuang deng tam va lam hep long duang ham lai thanh cac 6ng
Havers. Nha vay he thong Havers duac thanh lap. Sau met thai gian, than xdong duac c'au tao
bai xaang Havers clac. Chen vao giaa he thong Havers toan ven mdi &lac tao ra là nhang he
th6ng Havers duac tao ra tit truac va bi hay met plan thong Havers trung gian). Khi nao
toy kheing to nita thi tao cot bao caa tay mai tao cac 14 xaang caa he th6ng ca ban trong.
dau xuang tay tao c6t trong cac h6c xu'ong trong sun se dan dan tao ra cac vach xuang
thanh xuang Havers )(op.

3.2. S15 TANG TRTJONG.

3.2.1. Tang traing theo chi6u dai.
Xuang tang truang theo chieu dai là nha sun dau xuang n6i Oita than va clan. Xdong tieep
tuc tang trdang cho tdi lac day thi. Cac t6 bao sun mdi sinh ra se lien tuc bi hay cot bao pha
hay va tao c6t bao den de tao thanh xuang mdi. Nha vay s un dau xdang khong day len ma
xaang va toy van dai ra.
Trung binh khoang 20 tu6i sun d'Au xuang bi c6t hoa hoan toan va xu'o'ng ngang tang
truang.

3.2.2. Tang trxid'ng theo chi6u day.

Do tao c6t bao a mat trong mang xuang lien tuc tao ra la xaang mdi va cac hay c6t bao
luon 'Lion tao ra nhang he th6ng Havers mdi.

3.2.3. Cac quy luat tang trurdng

— Trong hai sun dau xdong a hai dau than xdang dai co met sun tang trdang nhanh hon :

395
do la sun gan g6i, xa khuSru. Vi vay xuang chi tren tang twang theo chieu xa khdp khuYu va
xuang chi &Jai tang twang theo chieu huang ye g6i (H.53.5).
- )(dung tang truang chieu dai va chieu day khOng deng be.
- Doi vai hai xuang canh nhau (xuang cdng tay, xuang cdng chdn), thi chung thay phien
nhau tang twang ve chieu dai.
- Xuang nao hoat Ong nhieu han se tang twang manh han va t6c de tang twang thy giai
doan truang thanh cua ca the.

Hinh 53.5: Huang tang truang cua cac xuang dai a chi.

3.2.4. Cac ygu to anh huang dgn stf tang trtaing

Ngoai nhang yeu to anh huang truc tiep den be may di truye'n, su c6t h6a va sy tang
twang cua xuang chiu anh huang bai :
- Giai doan tang truang cua ca the. d tre em hien Wang tai tao manh han hien tuang pha
hay. VI vay thanh phan ca"u tao xuang tre em cling khac thanh phdn xuang nguai lan tu6i.
Xdong tre em it chgt vo ca, giau chA hal ca han xuang nguari lan. Do vay gay xuang cua tre em
là loai "gay cay xanh" do chap thuang va rat de lanh; trong khi xuang nguai lan tu6i de gay,
thuang là gAy benh, khO lamb.
- Tinh trang thieu dinh dung a me mang thai, a tre dang ldn (lac biet la thieu canxi,
vitamin D se anh huang den sd c6t h6a va sy tang truang. Cac benh not tiet nhu benh cua
tuyen can giap lam anh huang den ski hal) the cac mu6i khoang cang lam anh huang den he
xuang.
- Trong khi van Ong, xuang thuang phai chiu met trong ba luc sau : lure keo, lure tip va ldc
ma sat do treat (Thi du : khi to xcich vat ndng, chi tren se chiu lee keo; chi du'ai, cot song phcii

396
chiu luc ep, cac ddu xuang chiu luc ma sat n'eu khap chuyen ddng). Cac lac nay deli lam anh
haang den du to &la he xuang. Ngaai to &a." nhan tidy tren X quang cac dau xuang ngon than
caa cac nghe si maa ba le (thu'ang hay clang tren mui chdn) day ban len. Ngutc lai nau ca yau
di (trong b'enh bai lift) hay chi bi bat Ong lac gay xuang, xuang cling teo di.
Vi vay luyen tap than thd clang each la met dung lac cho sa phat tridn he xuang.
Ngoai ra trong cling la met lac 6p len he xuang. Met ca thd c6 be xuang chaa phat
tridn day du nau song trong moi tru'ang kheng trong lute (trong cac con tau vu tru) c6 sa tang
traang khac vdi he xuang chiu lac hat dia qua dat.

3.3. SU. TAI TAO

Khi xuang gay, gala nai gay se hinh thanh kh6i- to chac lien ket do mang )(dung, can, cc,
mach mau tay )(acing, he thong Havers. TO chic lien kat nay se ngdm vei theo kidu cot hoa
trac dap (cdt hda mang) va lam lanh xutang. VI vay khi m6 ket hap xuang, khong dutc ldy di
mang xuang va cac to chac xuang van, vi xuang van se là ngu6n cung cap canxi dd tao slit cot
h6a. Ngutc lai khi cat xuang phai nao mang xuang de tranh hien tutng tai tao xuang.

3.4. SI/ PHAT TRIEN.

Trong qua trinh phat tridn chang loci, he van Ong phat tridn dan tit thap den cao, tii dan
gian clan phdc tap, thay dui v6 lacing va chat.
He van clang lac dau chi la nhang taii da ca hay co than minh can vao day song (hinh thdi
sa khdi cua cot song). DO la sa van Ong bang than a met s6 loci ca. Sau do, met s6 lodi bat
dgu CO su' van Ong bang chi.
Hinh thdi chi sa khai la cac vay lung, vay duoi, vay ngac a mot s6 lodi ca hay a nong noc,
cu6i ding phat tridn thanh chi trudc va chi sau vdi cac dai chi a cac Ong vat tren can.
Qua trinh tian h6a nay hien hien tuan theo quy luat sa thay dui cau tao phai phi hap \rai
sa thay d6i chdc nang. Nhang ca the nao thay dui cdu tao khong phi hap chac nang se bi dao
thai.
Track dui hai phai thay del chile nang di chuydn tit ben char' sang hai than, sa tian hoa
he xuang cua loci wan nguti thanh loci ngaai co nhang net thay d6i ldn sau day :
— Kh6i xuang mat nho bat, kh6i xuang so ldn len, xuang ham nho lai. Co sa xuat hien cac
xoang a xuang s9 mat lam kh6i so mat nhe bat.
— Chieu cong cot song tit hinh vanh cung thanh bon doan cong lei lem.
—Xuang 16ng nguc phat tri6n theo chiu ngang thay vi chieu trudc sau de thay &Si trong
tam dia ca tha pha hccp vdi to the thing thang.
— Khung chau rang ra dung thai c6 xuang dui cling dai len lam tang dien tich than de khi
di lai bang hai chan.
- -Sit biet hoa chile phan caa chi trudc va chi sau (chi trade thanh chi tren chi de cam ndm;
chi sau thanh chi duai chi de van chuyen) lam cho chi tren ngan lai. Cang tay co them Ong
tac xap ngda„ nein tay cai lam dutc Ong tac d6i chiau. Chi &lti chiu sac nang cilia toan be co'

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the nen yang chac hon va c6 sit hinh thanh yam gan chan trong va vein gan chan ngoai giap
de clang trong khi di chuyen.

4. HiNH ANH X QUANG CUA HE XISdNG

MO xuang do có nhieu mu6i khoang nen rat can quang va cho hinh anh X quang rat ri5
rang.
Tren phim X quang chit xuang dac dirge thi.y na.'m d ngoai hien dutri clang mot dai sang
dOng nhit. mot s6 yang chit )(along dac nay bi mOng lai de tao thanh chit vi5 (substantia
corticalis). Trong khi do chit xuang x6p &roc thy d gala hay d hai dau than xuang dai dtidi
Bang mot lifori sang met. Tay xu'ong khong can quang nen mO. VO xuang khong phan bit du'oc
tren hinh anh X quang (H.53.6, H.53.7 va H.53.8).

1. Dau du'di 'airing quay 2. Xdong thuyen.

3. Xiang the 4. Xtiong thang
5. Along tieing 6. Xtfdng moo
7. )(thing Ca 8. )(Yang thap
9. Xdong dau 10. Airing nguyet
11. Dgu dudi xuang tru.

Hinh 53.6 : Hinh anh X quang ctia xuang ban tay ngudi ldn (mat tru'dc)

5. HE XUdNG TRONG PHAP Y HOC VA NHAN CHUNG HOC

He xuang clang mot vai trO rat quan trong trong Phap Y Hoc va Nhan Chang Hoc. Data
vao hinh thai ngoai va cac kich thu'orc do dac, ngutri ta có the xac dinh du'oc gidi tinh caa xurong.
Rieng hinh thai ngodi xuang so, có the cho phep xac dinh du'oc gidi tinh vdi skt chinh xac lan
horn 80%. Du'a vao do dac xuang va nhit la dtta vao hinh thai rang ngutri ta cang xac dinh dirge
tu6i, chiing tOc cua cac xuang, rang.

398
 1. Dau miring try 2. Syn deu Wang (sun tieP)
3. Dau Wang quay 4. Syn dau miring
5. )(Yong thuyen 6. )(Yong nguyet
7. )(tieing thap 8. Xticing thang
9. XUdng the 10. XuPng ca

f3 11. Xticrng mac 12. Dau xu'ong cleft ban I

13. Dau cac xticing dot ban 14. Dau dot ngon ggn

15. flat' dot ng6n giria 16. Dau dot ngon xa

Hinh 53.7 : Hinh dnh X quang cda Juicing

ban tay tre em 9 tit& (mat sau)

1. XuPng suen XII 2. D6t song that king

3. Than dot song 4. Vanh th5n dot song

5. G6c dot song 6. Cung crdt song

7 Mom gai 8. Mom ngang
9. Mom khdp tren 10. Morn khdp dtiai

Hinh 53.8 : Hinh dnh X quang phoin thdt

lung ctia cot song (nhin sau)

399
 Ngay nay vdi sit tie'n be cua nganh hoa mo va mien dich hoc, nguOi ta c6 the xac dinh
chinh xac xucing cua moi noki data vao cac khang nguyen nam trong cac mgu vun xuung.
Ngoai ra do dac tinh khong bi th6i rila, he xuung la di tich con 141 cu6i cimg va duy nhat
cua cac clang vat c6 xu'a, nen xu'ung ding la met d6i Wong quan trong &la nganh co sinh vat
hoc. Data vao be xuung nguyen ven, nguoi ta c6 the tai tao lai hinh anh cac deng vat da bi diet
vong.
Tom lai, he xu'ung clang met vai tro quan trong trong he th6ng nang de Ira van clung. He
=mg la met 10 thong song Arai cac qua trinh trao del chat va chiu tac dung cua nhieu yeu to
ben ngoai. He xtiong là d6i Wong khao sat dia nhieu nganh hoc khac nhau.

CAU 1161 TRA C NGHIEM

Chun cau tra 16i d6ng nhat

593. Cac xurong dia chi tren va chi du'di la :

a) Xuong cha-n. d) a va c
b) )(dung true. e) a va b thing.
c) Xuung phu.

594. Xuung co chirc nang :

a) Nang de va bao ye. d) a Ira b dung.

b) Van Ong va tao mau. e) a, b, c thing.
c) Du tre' me va

595. Cau tao phan trung tam &la dau xuung dai la :

a) Xu'ong c6t mac. d) Sun.

b) Xuccng Havers dac. e) nay.
c) Xuang Havers x6p.

596. Cac xuccng Om so là :

a) Xu'ong det. d) a va b dung.

b) Xuung c6t h6a true tie-p. e) a va c dung.
c) Xuung c6t hoa qua sun.

400
 Dung hlnh ye sau c16 tra 141 cac cau tit 597 sten 602 (trdc nghiOm din lehuye't)

597. Chi tie't s6 (1) IA ...

598. Chi tigt s6 (2) la ...
599. Chi 661 s6 (3) la ...
600. Chi tigt s6 (4) la ...
601. Chi tiet s6 (5) la ...
602. Chi ti6t s6 (6) la ...

401
 54 HE KHOP

MUC TIEU BAI GIANG

1.Vdt sa d6 phan loai khdp.
2. Phan biet khdp bat dOng, ban thing va thing.
3. Kd cac thanh phan tha Inert khdp dOng.
4. Phan loai khdp dung theo thing tac va theo hinh thd.

1. DAT CISCING

CI nhang loai thing vat cap thap song trong nu'ac, cac )(tong lien kelt vdi nhau nha cac mo
lien kelt va sau do mai la nhang ma son. Nhang hinh thac do han cld nhiau cac thing tac hoat
Khi Ong vat tidn h6a horn, mo lien kat (ngudn g6"c ti trung mo) d giaa cac xuang hinh
thanh 1 khe (6' khdp). Do do da mat hien 1 kidu lien kelt mai. Nha 6 khdp, cac doan 'arcing
thkic hien dive nhang thing tac Ong horn, dac biet la do-i vdi nhang Ong vat c6 cuOc song tren
mat dat. Nhu' vay trong qua trinh ti6n hoa da xuat hien hai kidu lien kelt xuang. Kidu dau la
lien kelt bat ging. Cac doan xitang dinh Ira lien tut vdi nhau. Kieu sau va lien kelt &Ong. Cac
doan xuang khong lien toe va giaa cluing la 6 khdp (H. 54.1).
Nhn vay, theo qua trinh ph& tridn, cac kidu lien kelt xtrang (hay cac khdp) c6 the chia
thanh hai nhom ldn (H.54.2) :
- Khdp bat dOng (synarthrosis) : kidu nay khong co 6 khdp, bat dOng hoac it dOng ve m'a't
ethic nang.
Khdp dOng (diarthrosis) : co day du cac thanh phan cau tao tha khdp nhu' bao khdp, bao
hoat dich v.v... va hoat Ong v6 mat eh& nang.
- Gina hai dang tren can có dang chuydn tie-p goi la khdp ban dOng (amphiarthrosis) : loai
nay tuy co bao khdp sai nhang 'thong co bao hoat dich.
402
 Sun _4

Xu'cing

To' chdc sdi 6 khdp

day chng
Bao khdp

Hinh 54.1 : Su coo sit ph& trien ccic lout khdp

Loai bgt cldng Loai ddng

Hinh 54.2 : Ccic clang khdp

403
 Si phan loai khdp co thd torn tat theo so d6 sau :

SO DO PHAN LOAI KHOP

KHOP BAT BONG KHOP BAN BONG KHOP BONG

Z\
Sqi Xoong Sun Sun so Sun trong 1 true 2 true Nhidu true

Tam thdi Vinh vin Tru Rang roc Soan L6i eau Yen ChOm Phang

Day chang Mang Dodng khdp

Rang Vay Nhip Mao

2. KHOP BAT BONG

CO ba loai.
2.1. KHOP BAT DONG SOT (junctura fibrosa) là kidu khdp lien kdt cac xuong mot each
lien tue nhd mO lien ket. Tay theo tinh chat cila mo lien kdt, nguti ta chia ra :
2.1.1. Khdp bat dOng day chang. MO lien ltdt giCra hai xuang la nhang nhom soi co tinh
dan h6i goi là nhang day chang. Vi du : Day chang yang gida cac sung dot song.
2.1.2. Khdp bat dung mang. MO lien ket gala hai xuong thu6c loai mang. Vi du : Mang
gian cot gida xuang chay - xoong mac, mang gian cot gala xuang try - xuong quay.
2.1.3. Theo hinh clang &Ring kheip nguai ta con phan bit(H.54.3) :
- Khdp rang (sutura serrata) (H.54.3A) : cac xuong cai vao nhau nhu' hinh rang cu 'a, loai
khdp nay có a cac khdp yam so.
- Khdp vay (sutura squamosa) : cac xuong ch6ng len nhau nhd vay ca. Vi du : Khdp thai
duang - dinh (H.54.3B).
- Khdp nhip (sutura plana) (H.54.3C) : hai xuong lap ddu dan, an nhip vdi nhau theo
dodng thong. Vi du : Khdp gida hai xocrng mai.

404
 O Khdp rang Khdp vay

mo o lili1111111

OC Khdp nhip 0 Khdp mao

Hinh 54.3 : Cac clang khdp bat Wing sqi

— Khdp mao (H.54.3D) : mao cua mot xuang lap vao khe cud. mot 'axing khdc. Vi du : khdp
buam - Ld mia.

2.2. KHOP BAT DONG SUN (junctura cartilaginea) (H.54.4). Logi khdp nay ca mot sun
dinh chat hai dau xuang vao nhau, a ngoai thi lien tiep vai cot mac. Do tinh chat dan hoi &la
sun nen kidu khdp bat Ong sun khong chat than bang kieu khdp bat Ong xuang. Vi du :
Khdp gida xuang saran va sun satin. Tay theo mite do phat trign, khdp bat dung sun can chia
lam hai loaf :

XuZing Cic

4///) (000
Sun Wan

Hinh 54.4: Khdp bit ddng sun

405
 —Loai tam thdi : to chile sun chi ton tai cho den mot lila tuOi nhat dinh, sau do se thay
bang to chile xu'ung.,Vi du : Cac khdp xodng d nen so, khdp gida &du va than xdang dai hodc
khdp gida xdang ding va xudng chdu.
—Loai vinh vin : to chile sun UM tai suott, ddi. Vi du : Cac khdp giita cac xdang akin va
xudng dc (H.54.4), khdp gala xu'ung da va xuang bd.:3m hoac giita xdung da va xu'o'ng them.
2.3. KHdP BAT DONG XU'ONG (synostosis).
NhCing to chile sun hoc sdi gida cac xdang dude thay the bdi cac mo xdang lam cho cac
xu'ang do dinh lai thanh mot khOi viing chdc. Vi du : Cac khdp yam sod ngudi gia.

3. KHdP BAN BONG (amphiarthrosis).

Neu d gida cac )(Yang co khe khdp va bao khdp sdi nhung trong bao khdp sal khOng có bao
hoat dich thi sit lien ke't nhii vay là su' chuyen tie-p giirta dung va bat Ong goi la khdp ban
d6ng. Tay theo tinh chat sun then gala khe khdp ma ngddi to chia ra hai loaf :
Khdp sun sa (symphysis). Vi du : Khdp gida than dot song, khdp mu (H.54.5) va khdp sun
trong (synchondrosis). Vi du : khdp gida can de va than xu'ang
Khdp ban dOng can cod the tao bed sit chuyen ngudc tit d6ng sang bat d6ng do thoai hoa
khdp. Vi du : Khi bi thoai h6a cac dOt song, 6 khdp chi con lai mot khe nh6 gida the than dot
song.

4. KHdP BONG HAY KHdP HOAX DICH (junctura synouialis) la nhiing khdp co tit d6ng
nhieu, gia 2 xdo'ng co 6 khdp Ira bao hoat dich.

4.1. CAU TAO KHOP DONG.

M6i khdp Ong g6m CO cac thanh phan nhir : mat khdp, bao khdp sal, bao hoat dich, cac
sun khdp (sun boc) va cac day chang tham gia gilt khdp v.v...
4.1.1. M4t khorp (facies articularis) co hinh clang khac nhau thy theo (icing tae va thudng
thigh ang vdi nhau, mat nay 16i thi mat kia lOm v.v... Be mat khdp dude phti bdi mot ldp sun
boc day 0,2-0,5mm goi. la sun khdp (cartilago articularis). NM tinh dan h6i va nhdn cUa sun
khdp nen mat khdp d6 clang trudt len nhau va chiu dung du'ac lite nen (H.54.6).

Hinh 54.5: Khap ban d"Ong

406
 Ho ham dudi
O khdp

/ Bao khdp (mang sdi)

Tai cung hogt dich
Mang )(acing
Mom gd ma
&Icing thai du'o'ng

Sun khdp

__Sun chem

Chum xu'o'ng
Bao khdp ham du'di
(Mang hogt dich)

Hinh 54.6: Sc do cdu tao khdp dcmg

A. Khop dOsng gida hai ddu xdong dai. B. Khop thai &tang - ham du'oi.

Trong khdp ch6m, rigu chain to ma h6m khdp nong va hep thi vie'n xung quanh hOm con
có mOt vAnh sun goi là sun vien lAm cho hOm khdp rung va sau hun (xem bai Khap vai). Neu
hai dien khdp khong thich t ng nhau hohn than, cang 16i nhu khdp goi, khdp thai. duong - hAm,
hoc cang lem nhu' mat khdp gala hai than di-it song thi xen \TA.° gian mat khdp con co sun dia
khdp (sun chem) (discus articularis) (H.54.6B).
4.1.2. Bao kheip (capsula articularis) gum hai mang : mang sgi va mang boat dich. Mang
soi (membrana fibrosa) hay bao soi IA mOt bao to chic lien ke/t soi barn xung quanh mat khdp
not lien hai clan xucing vao nhau va lien tuc vdi mang xtiong (H.54.6A). Bao khdp co nhitng ch6
dAy mang khac nhau, ch6 dAy se lai thAnh nhting day chang (day chang gCin), ngoAi ra con c6
nhiing day chang a ngoai. bao khdp (day chang xa), cdc gan cu (day chang chzi dOng) v.v... a
xung quanh bao khdp, lam :tang cuting khd nang, not khdp (xem bai Khop vai). COng có nhang
day chang di trong mang soi goi là day chang trong bao khdp (lig. intracapsularia).
Mang hoat dich (membrana synovialis) hay bao hoat dich IA mOt bao thanh mac 16t a ben
trong bao khdp. Bao hoat dich dinh quanh vi6n sun khdp a hai dam xu'ung tao thAnh mOt 6
khdp (H.54.6A). Khi c6 gan co hoc day chang di vAo trong khdp de barn vAo dau xuung, bao
hoat dich se boc quanh cdc gan va day chang. Do d6 cac gan va day chang nay tuy a trong bao
khdp soi nhung lai rim ngoAi bao hoat dich (xem bai Khop vai). Thanh mac di tir sun khdp tdi
bao khdp thu'Ong hay co nhilng ne-p gap tao nen nhang tai cang hoat dich hod'c 16.ch va.o khe
dueli cdc gan co tao nen nhting till bit. Trong 6 khdp va cdc ttii co chi a mOt chat nhan goi IA
chat boat dich (synovia) giap khdp cii dOng de clang Ira giam ma sat dia gan, co.
4.1.3. O khdp (cavum articulare). Là mOt khoang kin duvc gidi han Uri mat khdp va bao
float dich. O khdp chda chat hoat dich va co dip luc am (nho bon ap lu'c khi quyen) vi vay bi dp

407
lift khi quy6n tac dung lam cac mat khdp luon sat vao nhau ch'Ong lai cac dOng tac c6 xu haing
lam gian khdp. Di6U nay c6 the giai thich ve sit nhay cam dia khdp dui vdi sit thay d6i dp
khong khi va nhung ngudi viem khdp man tinh c6 th6 du' down trade dude thdi ti6t dang thay dal
4.2. CAC LOAI KHdP DONG.
Co nhidu each phan loci khdp dung, hoac theo s6 true quay, hoac theo s6 lacing din khdp.
4.2.1. Phan 1041 khdp theo so truc quay.
- Loai khdp mot true : khdp quay quanh mot truc. Loai nay có hai kidu : Ki6u try
(articulatio trochoidea) (H.54.78) va kidu rang roc (articulatio trochlea) (H.54.7A).

Chigu cd dOng
(ggp dueii)
Chiou ca' Ong
(sip ngeia)
Tnic

0 KIEU BONG ROC C) Kiel.) TRU

Hinh 54.7: Khap mot true

— Khdp 2 true : CO ba kieu. Ki6u soan (articulatio ellipsoidea) nhu khdp c6 tay - tang tay
ma Tang tac theo hai chieu : gap dui va nghieng hai ben (H.54.8A). Ki6u 16i eau (articulatio
condylaris) nhu khdp dot ban - new. tay (H.54.8B) hoac kigu yen (articulatio sellaris) (H.54.8C)
nhu khdp d6t ban ng6n cai - xudng thang.
Khdp nhieu true : loai nay Ong tac rat phong ph6 : gap - du6i, khep clang va khi pheii
hdp la Ong tac quay yang. Khdp nhieu truc c6 hai ki'eu : Kidu chain (articulatio spheroidea)
(H.54.9A) nhu khdp vai hay khdp hong va ki6u phang (articulatio plana) (H.54.9B) nhu' khdp
cang vai - don.

408
 1•

Dot ban ngon I

Xu'ang
/thang

Nhin nghieng

A. KIEU SOAN B. KIEU LO! CAU C. KIEU YEN

Hinh 54.8 : Khop hai truc

A. KIEU CHoM B. Kiel.) PHANG

Hinh 54.9 : Khop nhieu truc

4.2.2. Theo s6 hiving din khdp, ngtiori to chia lam bon loai.
- Khdp thin (articulatio simplex) : chi c6 hai mat khdp tie/p xdc nhau.
- Khdp kep (articulatio composite) : c6 h6n hai mat khdp ti6p xdc nhau. Vi du : Khdp
khOu.
409
 —Khdp phiIc hap (articulatio complexa) : chen vao gala hai mat khdp khong toting urng
nhau c6 mot sun chem lam cho khdp tra thanh hai khdp. VI du : Khdp g6i, khdp thdi duang -
ham (H.54.6B).
—KhUp lien hap : khi hai khdp hoat dOng ph6i hap vai nhau. Vi du : Hai khdp thdi &rang -
ham.

5. CHIC NANG CUA KHOP

5.1. CO SINH HOC CUA KHOP.

Trong co the ngutii song, cac khdp c6 ba chile nang quan trong :
—H8 tra cho stt on dink vi tri cila co the.
—Tham gia vao viec di •dOng cac phan co the va Wang h8 lan nhau.
—dluyen Ong ca the de di chuydn trong khong gian.
5.2. HOAT DONG CUA KHOP.
Bac diem hoat dOng caa cac khdp la do hinh dang cac mat khdp quyel dinh. Milc di) dOng
tac phu thui)c vao de) lan caa mat khdp. VI. du : Ngu hOm khdp la mot cung 140° con 16i cdu IA
210° thi •cung ehuyen dung se IA bleu s6 cua hai sof do We IA 70°. Hieu s6 cang ldn thi cung
chuyen Ong cang lan va nguac lai. Ngoai ra hoat Ong khdp con bi han chg bed -cac eau true
"ham" khac nha cac day chang, mom )(Yang a chung quanh v.v... Khi khdp phai chiu thing life
nang, keo dai va lap lai nhie'u han, nhirng tdc dOng vat V se anh huang den sit phdt trien cac
thanh phan ca, day chang quanh khdp v.v... lam han the hoat Ong cua khdp. Cj mot s6 van
(Ring vien, nguai ta nhan dO hoat gong cac khdp con phu thuOc vao cac dang the thao. Vi
du : Khdp vai co bien do hoat Ong Mn a van dOng vien the duc ty do va nhO han a van dung
vien cif ta v.v...
Khi bao khdp, bao hoat dich bi viem, thanh caa no bi day len va bi dinh, chat hoat dich
khong con tinh chat nhan nguyen thay niia lam ca thing khdp bi han the va dau clan. Cdc &Ong
tdc the duc, xoa b6p co anh hiking rat t6t d6i v(ii 6 khdp, gan va day chang, lam cho su' cung
cap mdu den khdp dome t6t horn, gia tang qua trinh hinh thanh hoat dich va lam cho day chang
va bao khdp hien gift vting tinh dan hoi caa no.

TOM LAI

Cdc klieg) daqc phan chia theo chile nang van &Ong khdp va theo cau taa caa chting. Khdp
bat dOng la khdp khong c6 bao khdp, khdp bdn dung c6 mang xa, nhung khong co mang hoat
dich, can khdp citing la khdp vim co bao khdp scri d ngoai va mang hoat dich chaa chat hoat
dich a trong.

410
 CAU HoI TRAC NGHIEM
Chon cau tra ldi thing nhat

603. d tre so sinh, khdp giuia cac xucing yam so la :

a) Khdp bgt d6ng sdi. d) Khdp ban thing.
b) Khdp bgt thing sun. e) Khdp dOng.
c) Khdp bat d6ng xu'ong.

604. Khdp ban d6ng khac vdi khdp dung a cho :

a) Khong c6 khe khdp. d) Khong c6 bao xo.
b) KhOng c6 day chang. e) Khong cat d6ng du'dc.
c) KhOng co bao hoat dich.

605. Cac thanh pilau cda mot khdp d6ng la :

a) Dien khdp c6 sun khdp.
b) Bao khdp vdi hai mang : mang sdi va mang hoat dich.
c) Cac day chang.
d) a, b, c deu dting.
e) a, b, c, deu sai.

606. Khdp vai la mot khdp :

a) Ban d6ng. d)M0t true.
b) L6i eau. e) Chain.
c) Hai true (xem them bdi 2)

607. Sun them :

a) Boc cac mat khdp.
b) Co cac khdp phuic hdp.
c) Cod cac khdp ma hai mat khdp ding 16i hoac ding lOm.
d) b va c
e) a, b, c deu dung.

411
 55 He co
MVC TIRU BAI GIANG
1. MO td sit phdt trign va cau tan cua ca van.
2. Kg ten va neu cdc tac dung cdc phan phu thuOc cua ca nhu mac, bao hoat dich, tui hoat
dich, bao sai.
3. Neu cdc quy luat phan b6 cua ca.
4. Gidi thich cdc dOng tdc cda car theo nguyen tdc don by.

Ca (musculus) la mot trong cdc ma quan trong cua ca thg. Tinh chat ciia ca la sit co nit. CO
hai loaf ca :
1. Ca van hay ca barn xdang hoat Ong theo y mu6n do than kinh dOng vat chi ph6i va
chigm tai 2/5 trong lu'ang ca the. T6ng s6 cc cua ca thg là khodng 500.
2. Ca trap (trong do bao g-Om ca ca tim la loci ca dcic bift) do than kinh tit chi' chi phol,
boat dOng it nhieu ngoai muon va la ca cua cdc tang, cdc tuygn va thanh mach mdu.
Trong phan dai Wang nay chi not chi' ygu vd co van.

1. SV PHAT TRIEN CUA

1.1. CAC CO O THAN
Cdc ca a than phdt trign tit cdc hoan tigt tdc la cdc doan a lung cua trung bi phOi nam hai
ben day nguyen song (chorda) va 6ng than kinh.
Phan ben sau cua cdc hoan tigt goi la cdc nguyen ca sau nay se phat tridn thanh cdc ca
van. Khi ph& tridn, cac co' se chia ra phan lung va phan bung. Phan lung g6m cdc ca canh song
do cdc nganh sau cua than kinh gai song chi ph6i con phan bung g6m cdc co dr track ben dm

412
than va do cac nganh trade than kinh gai song van Ong. Cac nguyen ca hic dau daac ngan
cach nhau bdi cac vach to chdc lien ke't (H.55.1), vd sau mat clan di, chi can de' lai in6t, vai di
tich nhu cac ca gian such, cac tre gan trung gian cua cc thang bung. Si phan dot nay con ro
cac Ong vat thap.

1.2. CAC COO TLS CHI.

Cac ca 6 ta chi phat tridn tit cac ca a phia truck caa than do dO cling du'ac van dOng bai
cac nganh track caa than kinh gai song nhu- dam r6i canh tay, dam r6i thai lung va dam r6i
ding. Mot s6 cad tut chi phat tridn vd phia than nhu cc ngyc to, ca ngyc be, ca lung rOng va
ngu'ac lai mot s6 co 6 than hoac a dau phat tridn ra W chi, nhu ca tram, ca vai mong, co thang,
ca tic don chum v.v...

1.3. CAC CO O DAU.

Cdc cod dau phat sinh tit cac hohn ti6t, dau tien a phdn &du ctia phoi (H.55.1).

Cac nguyen co Cac nguyen ca

c5a ago c5a gay

Cac nguyen cd
-""..
---...____
""•••■•■....000.
cua than

Hinh 55.1 : Cdc nguyen co' clia cac haul tie't a dew va than caa thai nhi

2. OW TAO Ctik Cc

Doi vdi cac co van thi don vi cat' tao ctia co la sqi co. Sai cc dai khoang 12 cm va co
diking kinh tit 10-1000 micron. M6i sqi co g6m có nguyen sinh chat va mot s6 nhan. Nguyen
sinh chat co nhieu to co. M6i to co g6m co nhiing dia sang va dia toi xen ke nhau. Khi co co,
cac dia t,61 thu ngdn lai va phinh to ra : khi du6i, cac dia sang keo dai va nh6 14i. T6 chac lien
kgt thua n6i lien cac scri cc vdi nhau thanh Bing b6 nh6 tap hap dan thanh cac bo lan va cu6i

413
 ding thank ca. M6i ca &roc van clang bai mat hay nhieu nhanh than kinh tii cac day than kinh
so hoac gai song. Than kinh vao co c6 cac soi cam gidc va soi van clang theo ty le khoang
40/60. Can nhanh than kinh van ca qua bao ca (perimysium) theo hai each : ngu la ca dai thi than
kinh thbang song song vdi cac the car con neu la ca rang thi than kinh thudng thang g6c vdi cac
the ca. Da ldn cua than kinh khong phu thuac vao do ldn ctia co' ma vao cac hoat clang pink
tap da ca. Car tang c6 nhieu hoat clang phirc tap cang co than kinh to hon. Mach cap huyet cho
ca finking di vao co ding vdi than kinh, nhung ding c6 nhfing twang hop mach khong di vao
ding ch6. Cac mach caa co thating it not ti'ep vdi cac ca quan lan can. M6i co c6 the dude cap
huyet, bai mat den nhieu nhanh tit nhieu ngu6n khdc nhau. Su n6i ti'ep gala cac nhanh trong cc
cling thay d6i tiny loai co (nhi& a ca ngqc to, ca delta, trung binh a ca may, ca thdng ddi va rat
it a ca thon, ca tam ddu ccing chdn v.v...). N6i chung cung giong nhu' doi vdi than kinh, cac
mach cap huyet cho co va n6t nhau trong ca nhieu hay it phu thuac vao hoat clang dm co pink
tap hay khong.
Ve dai the m6i ca duvc cau tao bai hai phan : phan thit va phan gan.
— Phan thit tao nen than ca hay bung co g6m cac thd thit dinh vao gan song song vdi true
ciia co hoac barn chech vao mat phla gan (ca ban long chim) hoac vao hai phia ga'n. (ca long
chim). Cac ca co clang tac rang nhung co yeti c6 thd thit dai, song song va lien tiep vdi cac thd
gan con cac cc co manh nhung bien do di chuyen nh6 se c6 cac thd thit barn chech vao gan.
— Phan gan g6m nhirng thd trAng, chat than thing a dam barn vao xudng ctia co. Cac thd
gan c6 the song song (a gdn ngdn va det) hoac xoay troll 6c (a gan ddi hinh tru). Nha cau true
xoay ma gan c6 the dan h6i giam &roc cac va cham manh ma van co khoe. Doi vdi cac gan det
cua cac cc rang, ngudi ta thbang goi la can (aponeurosis).

3. PHAN LOAI CO VA TEN GQI Cd

Tay theo s6 lu ng, hinh the va chilc nang cua phan thit va phan gan ma ngudi ta phan ra.
Theo hinh the c6 136n loai : ca dai (cac ca a chi), co rOng (cac ca rOng bung), cc ngan (cac
ca vuong) va ca yang (cac ca thcit cac to tu nhien).
Cung co the thy theo s6 luring than va gan cc ma ngudi ta chia ra : co nhi than (hai bung),
ca nhi dau, co tam clan, co of dau v.v...
Tby theo hinh the ngudi ta goi ca vuong, cc tam gide, cc thap, ca trbn, cc denta, ca rang v.v...
Thytheo huidng cua thd co, ta goi la ca thang, co cheo, cc ngang.
Tby theo chiic nan.g, nguti. ta chia ra cc gap, cc du6i, ca dang, ca khep, co sap, cc ngrita v.v...

4. CAC PHAN PHU THUOC CUA Cd

Cd dttoc mat s6 cac ba phan phu nha cac mac, bao hoat dich, bao soi, tui hoat dich . tro laic
cho hoat Tang cua co.
4.1. MAC
Mac (fascia) la mat mang me lien ket bao boc 157y co hoac mot nh6m ccr.

414
 Co ba loai : mac boc ca, mac sau va mac nong.
— Mae boc ca : c6 tac dung bao ye va tao dieu kien cho mai co co bop rieng re theo chdc
nang rieng caa minh. Neu mac bi rach, ca se lei ra ngoai.
— Mac sau : bao boc met nhom cc va ngan each nhom co do vdi nh6m khac hoac vdi cac ca
quan lan can. Doi khi no ngan each ca met yang ca va doge goi la vach gian co (septa
intermuscularia).
— Mac ming nam ngay dudi da co lien quan chat the vdi to chdc to bao dual da va c6 tac
dung dam bao tinh clan h6i cho da.
4.2. BAO HOAT DICH CUA GAN (vagina synovialis tendinus) la cac bao thanh mac boc
xung quanh gan g6m hai la : la trong boc sat gan Ira là ngoai dinh sat vao bao soi (H.55.2). Hai
la lien tiep nhau a hai Tau bao quay lay met.khoang kin trong co chat hoat dich lam cho gan
ca' deng de" clang khong bi co sat vao )(dung. Doc theo hai canh cua gan, hai la ding lien tiap
nhau tao nen mac treo gan (mesotendineum).
4.3. BAO SOT Ct A GAN (vagina fibrosa tendinus) bao boc cac gan va cot gan vdi )(acing
de tao nen met eing xuang soi lam cho gan t5r vao xtrung tao dieu kien cho gan hoat clang. 0
nhieu vang nhu c6 tay va c6 than cac bao nay day len va rat chat tao thanh cac mac gill' cac
gan (retinacula tendinum). Co nai no tao thanh met rang roc (trochlea) gift cho gan d6i hudng
de tang bp keo cho gan.

Bao hoat dich Khoang haat dich

Hinh 55.2 : Bao hoat dich va bao sqi czia gan ca

4.4. Tin HOAT DICH (bursa synovialis) la met tai kin trong chda hoat dich gi6ng nhu
met cai g6i hoac cai dem nam gifia. 2 ca hoac gala ca va xuang hoac gan va xu'ong a an ch6 ca
barn vao xuang. Met s6 tai a gan bao khdp c6 the thong vdi bao hoat dich ciia khdp.

415
5. CAC QUY LUAT PHAN BO

S4 sap xep ming nhu cau true caa cac co tuan theo mot s6 quy lust sau day :
5.1. Ca sap xe-p tang cap d6i ming qua truc giUa ca thd.
5.2. Ca gift dau vet cua sit phan d6t (vi du : ca gian wan, ca thdng bung).
5.3. Ca barn bang hai dau a hai xdong khac nhau theo con diking ngAn nhat va thuang
duac goi la nguyen ay va barn tan. Khi ti vao didm no thi keo a didm kia. Bidt dome hai didm
bam do, to se biet duac Ong tac caa ca.
5.4. Cac the/ ca du'ac sap xe-p thang goc vdi truc quay dia. khdp. Neu truc quay caa khdp là
true ngang thi cac thd ca se nam doc sinh ra dong tac gap va due"i. Neu true quay caa khdp la
trudc - sau thi ca se nam thang goc hoac cheo d hai ben truc do dd thiic hien Ong tac dang va
khep. Neu truc quay caa khdp la thang clang thi ca nam ngang thang gOc vdi truc do de thuc
hien &Ong tac xoay trong hay sap va xoay ngoai hay ngila. Do do bie-t du'ac true quay caa khdp
•se bidt du'ac each sap xe-p cac ca quanh khdp do va ngutri thOy thu6c co the bie-t each chinh
hinh met Ong tac cho khdp nha sap xdp lai ca khi co ca khac bi liot.

6. CHT:IC NANG CUA CCi

Dac tinh ca ban caa ca la slit co rat. Khi co rut, ca tao nen moi su hoat dong cho ca the nhu
di chuydn, hoat citing caa moi he th6ng ca quan trong ca thd, bidu le tinh cam Ira tidng noi.
Ca hoat Ong theo nguyen tac don bay, nghia la c6 met didm tua, met lu'c can va met lure
tac Ong. Trong ca hoc, co 3 loai don bay :
6.1. LOAI I. Didm tua T nam gicia lite can D va laic tac Ong L. Vi du nhu trong Ong tac
ngOa &du, didm tua la khdp chdm - doi, didm dong the la lite can la trong lacing caa dau va hie
tac do", ng la cac ca gay (H.55.3A).
6.2. LOAI II. Diem tura T nam a met ben, lute tac dong Lis met ben va lite can D nam d giaa.
Twang hqp nay rat it gap a ngu'ai. Co thd lay m6t, vi du nhu' &Ong tac king got chan (H.55.3B).
6.3. LOAI III. Didm tu'a nam a mot ben, hie can a mot ben va lure tac Ong nam a giita. Vi
du flint d(ing tac gap du6i quanh khdp khuSru (H.55.3C).

7. ANH WAGING CtA NGOAI CANH DOI VdI CCi

Co hoat clOng sinh ra nang Mang va ca mu6n phat tridn can nhigu chat dinh du'ang dila
vao do mau. Vi vay, tang cuing van Ong ca va dinh duang day &I se lam ca phat tridn. Did'u
nay &lac nhan thay rat re a nhang nguai lao dong chan tay hoac luyen tap than the nhieu.
Can chu y a mot s6 nghe nghie‘p lao dong chan tay hoac thd due thd thao chi chil trong tai met
s6 ca nh.6t dinh thi se lam cho ca thd phat tridn lOch ve cac ca do. Do do, can chd 3-7 luyen tap
the due dd lam cho tat ca cac ca phat tridn deu clan, lam cho ca thd duo'c can d6i han.

416
 A
T T

0
Hinh 55.3 : Ccic hoot dOng clia co. then nguyen tdc don bdy
A : Logi I B : Logi II C : Loai III
T : Diem taa D : Lztc can L : Lvc hie dOng

CAU HOI TRAC NGHIEM

Chon cau tra 16i dung nh'at
608. Cac co barn xnung la :
a) Co troll.. d) a, c dung.

b) Co van. e) b, c thing.

c) Do TK tit cha chi phol.

609. Trong hai hinh ve sau day, chu thich nao sai :

(a) Gan co

(c) Bao hoot dich

(b) Bao sdi

(d)6 hoot dich

(e) Mgc giu7 On

417
610. Cu tam dau canh tay hoat &Ong theo nguyen Mc don bay :
a) Loai I. d) Khong thuOc loai nao.
b) Loai II. e) Thigic ca 3 loai.
c) Loai III. (xem them beci 4)

611. Cu eh& bung ngoai. IA :

a) Ca Ong. d) a, b thing.
b) Cu cheo. e) a, b, c thing.
c) Co khep. (xem them bat 29)

612. Chon cau dung :

a) Can là gan det cua mot co rOng.
b) Can là mac day len.
c) Can IA mai-1g mo lien kgt boc lay mot co Ong.
d) Can là mang mo lien Icgt ngan hai nhom ca.
e) Tat ca d.du dung.

418
 56 HE TIM MACH

MUC TIEU BAI GIANG

1.MO to sy phat trien plied thai tim de giai thich cac di tat barn sinh cua tim.
2. Ve sa d6 tuan hoax' ph8i thai de giai thich cac hien tut ng va nguyen nhan cua sit khdc
nhau gala:than hoan sau sinh vdi than hoar' phOi. thai.
3. Ke ten cac loci Ong mach va tinh mach.
4. Phan biet Ong mach vdi tinh mach ve mat giai phau, can tao va chtic nang.
5. MO to cac thanh phan caa he bach huyet.
6. MO to cau tao cua thanh mach.

1. DAI CU'CiNG N

Cdc co quan Wan hoan tao nen mot he thOng van chuyen cac chat hitu ca trong co the
sang. Man than hoan mang theo chat dinh &tang hap thy tit co quan tieu .hda den nuOi cac
pilau cila ca the. D6ng th6i, mdu cling mang oxy tit phOi den cac m6 dia co the va mang cac
chat ba 'Dien throng tit nhthig mo nay den cac co quan bai tie't va khi carbonic a phOi. Tim chi'
yeti la met cdi bom cau tao bai co, vdi mot he thOng bung tim va van. tim dtrqc sap x6p rat
tinh vi. Tim day mdu vao cac dOng mach. Cau trac caa thanh dOng mach thich LYng vdi viec
chtla mdu lyc cao va dao dOng do tim ddy vao. Ngoai ldp not ma là mot dac trong chung
dia tat ca cac mach mdu - thanh Ong mach duvc tang clittng \rang chat bai ca tron va mo lien
kat dan h6i quan thanh nhang ldp d6ng tam rat chat che. Cdc mo dan h6i dam bao tinh co
gian caa thanh mach. Co trcrn, hoat dung dtibri sy kiem sodt caa than kinh van mach caa he
gido cam, dieu hanh khau kinh cua mach Mau.
Khi tiep can cac ca quan, dOng mach chia nh6 dan de di vao .tat ca cac mo cila co quan.
Phan nha nhat caa cac mach mdu nay oi la mao mach, tao nen mot mang lath g6m cac 6ng
not nhau, quan ho chat the vdi cac don vi to bao caa co quan. Chinh trong mang Mori mao mach
nay ma cac chat cila he tuan hoan cluvc van chuyen. Thanh mao mach rat mong, chi g6m
' •
419
nhung 6ng n6i mo 'ming, de tham cac chat hoa tan trong mau va oxy tit mau ddn m6 va cac
chdt ba dinh dui:mg tii cac mo vao mau. Khi da di qua mang lath mao mach, mau d6 vao trong
cac tinh mach lan dan va trd vd tim. Mdu tinh mach a du'di dp 14c Wang d6i thap hone d(ing
mach. Khali kinh tinh mach lan han va thAnh mang han dOng mach a trong ding mot vOng ca
the. Tinh mach ding có it mo dan h6i va ca tran hon.
Ngadi to nhan thy rang ski' sap xep Chung caa cac mach mau chii ydu dia. he Wan hoan a
bat dr dOng vat nao ding ddu pha hap \rad vi tri dia cac ca quan thqc hien cac chic nang
chuydn hoa chii ydu. Vi du : de phan ph6i oxy ddn cac ma, mau can phai di qua mot ca quan
chuydn hoa than hoan trade khi chive phan ph6i cho town ca thd. O Ong vat ca xaang s6ng the
bang mang, mau nhan oxy lac qua mang r6i mai di ddn cac m6. \Tong kin nay thiic hien bai hai
mang lath mao mach, mote mang va mot a cac ca quan va cac m6. 0 bAo thai &la dOng vat ca
nhau thai la ca quan hO hap va mot he th6ng mach mau dac biet tam thai, "n6i tat" tit
nhau ddu tim thai va tit day mau &lac bam di khdp ca the. O ngu'ai twang thAnh ding nhu' d
cac Ong vat ca xudng s6ng cao cap khdc, ph6i dam nhan eh& nang cda mang. Sau khi da
nhan oxy tit ph6i, mau dttoc dua tra lai tim trade khi tai phan ph6i khap ca thd. Nhu vay,
ngutii ca hai he th6ng mach mau rieng biet. Wit di qua ph'6i, goi IA tuan hoAn ph6i hay vOng
tuan hoan nhO va mot di khap cac phan khdc cda ca thd goi là tuan hoan he th6ng hay yang
tuan hoan ban. M6i he có Ong mach, mao mach va tinh mach rieng biet. Tim ding dirge chia
doc thanh hai nda phai va trai dd hai giong mau di vao hoan than each biet nhau. Mau di vao
ben trdi bat ngu6n tii tuan hoan ph6i va se du'ac dan vao tuan hoan he th6ng. Mdu di vao ben
phai bat ngu6n tit than hoar' he thong va se dlicic dua trd lai phai.
Mao than kinh
Xoang noi phoi
*Atli DOng mach
4tio chi king
,C•
1

Te" bao ngoai

1-6 bac tim ca tim
nguyen they
Ong tim
NOi bi

Rucit trade

Xoang quanh tim

Ong tim

Mac treo byng

Hinh 56.1 : Sa coo tcto thdnh 6ng tim

420
2. PHOI THAI HOC
2.1. PHOI THAI TIM
2.1.1. Rti hinh thanh va gap khtic cua Cing tim nguyen duly.
d nguai, tim xua-t hien a cuoi tun le thd 3 ciia phei kk. Luc do, dia phei lan rung ra ben
tren tai noan hoang (H.56.1).
Cc dOng mach tinh mach
Mac treo king

Mang ngoai caa Mang tim

Xoang mang bao quanh
Cing tim A
tim tin mach
Xoang ngang

Xoang
chgch

DOng mach phdi

Deing mach cha
Xoang ngang

Tinh mach pho7 trai Tinh mach chi) tren

Tinh mach phdi phai

Xoang chgch
Tinh mach cha dddi

Hinh 56.2 : Srt thcinh lap xoang che'ch vet xoang ngang.
A : Qtc ctang mach va ca'c tinh mach trong mang tim. B va C : Cdt ngang.
D vet E : Ong tim gap lai hinh thcinh xoang che-ch vet xoang ngang.
F : Xoang che"ch va xoang ngang cta hinh thetnh.

421
 Si thanh lap tim xay ra a phan (tau tha dia phoi, gliiia trung bi tang va nOi bi cua tuii noan
hoang. ei day, cac to bao tao tim xuat hiOn thanh nhiing chuck va day, xe-p .thanh hinh chit U
phia tru'ac bung tam than kinh va a hai ben phoi, trudrc khi hoan tigt Tau den xu6t hiOn. Khi
phan dam cud phoi torch khai tut noan hoang ve phia tru'dc va plied to gap lai hai ben, thi cac
day va chu6i to bao nay tign den gain nhau ye phia trade.
MOt phan cac t6 bao nay tao thanh 6ng tim. Do thanh tha phoi g'dp lai lien tuc then chidu
doc a hai ben, nen co hai 6ng tim. Hai 6ng tim ti6n den gain nhau a du'ang gtita va hop lai
thanh mot 6ng tim duy What theo chid(' doc. Trong laic do, nOi bi tang bao quanh 6ng tim nay
tao nen lap ca ngoai tim, lap trong thi mang hon 16rp ngodi. Chinh tit lap trong nay cac van tim
du'qc thanh lap. Lap ngoai se tra nen ca tim va mang ngodi tim tang). LtIc nay, thanh phoi
sau khi gap lai, lam torch bit mot phan xoang nOi phoi chung quanh 6ng tim, goi là xoang
quanh tim. Ltic dau, tim durac treo trong xoang nay bang mac treo bung va mac treo lung. Mac
treo bung mat di rat sopa, con mac treo lung thi ddn giai doan 16 hoan tiel mai mat di. Nilo
vay, mang ngoai tim chi dinh veil Ong tim a hai cut : cut Ong mach va coc tinh mach (H.56.2).
Do thd tich cua xoang quanh tim c6 dinh it phdt trien nen 6ng tim phai gap khdc trong
xoang. Khi ifing tim tiep tvc phdt trien dui ra thi curt dOng mach va curt tinh mach tiefn dgn gain
nhau : tett tinh mach tru'at ra phia sau va di ve phia dau (H.56.3).
Ngay tit dau, 6ng tim dtioc chia lam nhieu phan. Tit clued len dau g6m có :
(1) Xoang tinh mach, thanh rang, co nhieu tinh mach a vao.
(2) Tam nhi nguyen they, thanh cung mang.
(3) Tam that nguyen they, lan horn va thanh day.
(4) Hanh tim, la phan thon nha n6i tam that nguyen thily vai cac cung dOng mach chti.
Khi gdp khtic, 6ng tim be gnat a hai ch6 : tao thanh hinh char N. Xoang tinh mach va tam
nhi nguyen they a curt duoi nhu'ng loch ve phia phai. Tam that nguyen they di chuydn ve phia
dau va bung. Con hanh tim hay hanh &Ong mach thi di ve phia dau va hori lOch trai. Tam nhi
nguyen they, bat dau di len phia sau tam that nguyen they, keo theo xoang tinh mach. Xoang
tinh mach dan dan di len phia sau tam nhi nguyen they. Tam nhi nguyen they phinh ra thanh
hai hai ben hanh tim, do là lien than cea tam nhi phai va trai. Cting hic do, tam that
nguyen they phut trien ve kith thoac va. car. CO mot ranh ben ngoai chia tam that nguyen they
thanh tam that phai va tam that trai, con hanh tim thi n6i vdi ben phai.
Hanh tim la phan tao nen bai nganh len tha otng tim va not Arat cac re cua cac cung &Ong
mach chit. Khi phoi doge 4-5 tuan (5mm) hanh tim g6m co ba phan : phan gain, n6i vao phan
be cua tam that phai, phan gifia goi là non tim (ve sau thank non ctc.ng mach hay ph-eu)
phan xa goi la than dOng mach se torch doi thanh &ling mach chi' va than Ong mach ph6i.
Xoang tinh mach dan dan chuydn sang tam nhi phai. Qua trinh phan chia tim thanh hai ben
phai va trai thuc hiOn bai mot vdch doc di tit coc nay den clic kia, qua hanh tim, tam - that va
tam nhi nguyen they. Su phan chia nay xay ra trong 6ng tim gap goc nhidu ch6, cho nen rat
kho mo to va a lam lain. Vi vay, khi ma tai, chung to de tim dung 'Ong nguyen they cea no
(H.56.4).

422
Xoang mang
tim

Ranh hanh Nhi trai

tam thgt

Xoang tinh mach

A PhOi 8 hoan tiet B Phoi 11 hoan tiet C Phoi 16 hoan tiet

Than d6ng mach

Nhi phai

Nhi" trai
Non tim

Phan ba
that phai R5nh gian thgt

0 Ph6i 28 ngay (5 mm)

0 PhOi 28 ngay (nhin trti6c)

Hinh 56.3 : Szt tien trien va bien ct6i hinh the cad Eng tim (nhin ben).
A : Phoi 8 todn tiet D : Phoi 28 ngdy (5mm)
B : Phoi 11 hodn tiet E : Gierng nhu D, nhin tru'ac
C : PhOi 16 hodn tiet
Xoang tinh mach bao g6m mot phan ngang va hai sling phai va trai. M6i sling nhan ba
tinh mach :
a) Tinh mach tim chinh g6c, nhan hai tinh mach tim chinh trade va sau, lan lu'dt clan lieu
man d phan clan va dual cna phOi.
b) Tinh mach noan hoang, clan luu mau tit tui noan hoang.
c) Tinh mach r6n, Oak xuat tit nhau thai va mang mau có oxy va chat dinh daang dgn
phOi. Tinh mach r6n phai mat di rat grin, khi gan thanh lap hO tinh mach cda. Khi tuan hoan
nhau thai gia tang va mot tinh mach chn dadi phat trign tit mot s6 tinh mach a phoi, thi tinh
mach r6n trai thanh lap mat nhanh n6i tryc tie-p vdi tinh mach cha &raj; nhm trong nhu mo
gan. VO sau, phan tinh mach r6n trai n6i vdi xoang tinh mach cung mat di. Tinh mach noan
423
hoang cling bi gian doan bai sit phat trien cua gan. Phan xa cua tinh mach nay phat trien
thanh he tinh mach cda gan, con phan On van no/t vai xoang tinh mach. Nhang khi sang trai
cua xoang tinh mach thoth h6a, thi tinh mach noan hoang trai cang bidn mat theo. Phan gan
cua tinh mach noan hoang phai tra thanh phan tren gan cua tinh mach cha da6i, mat phan
cua mach mau nay xuyen qua gan de cli vao tim phai. Nhii vay, xoang tinh mach da mat 3
trong s6 6 tinh mach cua no.

L41, DOng mach

— chi) xudng
Vach hanh DOng mach
phOi Ong Ong mach
DOng mach
DOng mach, DOng mach chO len
Hanh dOng phdi chi') len Van ban nguyet
mach Vach gian
that
Tam that
Chdi trong L5 ball duc Day gan
tim
Tam nhi Vach I
Vach I Van tinh mach
Trnh mach tim Xoang chi) dUdi
tim Vach II
chInh gdc (P)
mach Trnh mach Tinh mach
ron (P) chi tren i--
L phdi
Van xoang
(TM tim chInh 1 Xoang tinh mach
Tinh mach noan gdc phai) firth mach vanh
hoang (P) Trnh mach chd vanh (TM tim
dUdi (TM. noan chinh gdc trai)
hoang phai)

O O O

Hinh 56.4 : SiC phcit trien cua 6ng tim (de 6ng tim thdng).
A. Cdc tinh mach bi gach cheo se tieu di.
B. Ccic vach tim beit dau thanh lap, xoang tinh mach lech phdi, ccic tinh mach ph6i xudt hien.
C.Su phan chia tim hocin thanh.
2.1.2. Silt phan chia ang tim, stf phat trien cua tam nhi va suf hinh thanh vach
gian nhi.
Khi thanh dia tam that va tam nhi nguyen thay day len, mat vach du'ac thanh lap de
chia tim thanh bon ngan. Vach tao nen tit nhieu phan not nhau. 0 tam nhi., c6 hai vach
nam ben trai cua xoang tinh mach. Vach nguyen phat (vdch I) phat trien trong xoang tam
nhi nguyen thtly, tit thanh sau tren cidn 6ng nhi that nguyen thay. Trade khi chia han
xoang tam nhi thanh hai phan rieng biat, vach I tieu di a phan giaa tao nen mat 16 trong.
Taung tit nhi vay, vach that phat (vdch II) phat trien a ben phai vach I va 16 trong cua
vach II daoc goi la 16 bau due. Do vach I ch6ng len vach II tac dung nhi mat van, goi la
van 16 bau due nen khi tam nhi co b6p, vach I ddy vg ben phai the 16 trong cua vach II,
'thong cho mau chay vao tam nhi phai. Khi tam nhi na ra, giOng mau cua tinh mach chit
duai day vach I 176 ben trai, lam 16 bau duc ma ra.
424
 Tinh mach chd tren là dau vet cua tinh mach tim chinh g6c phdi. Phan gan cua tinh mach
noun hoang phai thi troy thanh phan tren cua tinh mach chd duai. VI cac mach mau nay tao
nen a ben phai nen tat ca mau W nhau va plied deu d6 vao ben phai xoang tinh mach. Do da,
sting trai xoang tinh mach thoai h6a di Ira chi co mot phan nh6 mau di vao sting nay. Phan
gan cua tinh mach tim chinh g6c trai teo lai dam va trd thanh xoang tinh mach vanh, can phan
xa thi trd thanh tinh mach tim chgch Marshal. Cac tinh mach phOi not vdi tam nhi trai khong
phai do cac tinh mach tim tao nen, ma hoan than là cac tinh mach mai thanh lap khi plied
phut tridn.
Luc dau, tinh mach chd tren va tinh mach chd clued ding d6 "vao sting phai.cila xoang tinh
mach. Oh vao &la sting nay c6 hai la van : Van cda xoang tinh mach phai va trai. Cac van nay
c6 chdc nOng hudng giang mau tit cac. tinh mach vao 16 bad ddc. Vao cu6i thang this 2 dia phoi,
tam nhi phdi lan nhanh lam cho sting phai bi xep va trd nen Emit phan cua vach tam nhi va
xoang tinh mach haa Ian vao tam nhi phai. Tinh mach chit tren va dual ding bi qua trinh nay
chi ph6i. Si' phut tridn manh cua vach tam nhi phai da phan each chting va cac tinh mach trai
nay phai d6 vao cac 16' rieng biet. Van cda xoang tinh mach thoai h6a, haa lan vac vach II.
Van cua xoang tinh mach phai teo lai va trd thanh mao ding, van cda tinh mach chil cloth va
van cda xoang tinh mach vanh. Cdc cau true nay hoan -Loan vo dung sau khi sinh.
2.1.3. Siki ph& trign cua tam that, sot hinh thanh vach gian that va sot chia dal
cua hanh cling mach.
Tam nhi va tam that nguyen thdy thong nhau bdi mot loan hep. Ong nay chicle chia thanh
hai nita phai va trai bdi hai ch6i trong tim lung va bung (H.56.5). Hai ch6i nay gdp nhau d giva
va ngan each hai 6ng nhi that phai va trai. Cac 18 dm. 6ng nay throe bao bac bdi nhu mo se trd
thanh cac van nhi that 6 tam that, thanh ca bdt dau rang runt, cho nen cac van nguyen thtly
hinh nhu (lucre neo vao thanh tam that bdi cac day co tuvng d6i day. Cac day ca nay thoai h6a
thanh mo lien ke't va tao thanh day gan. Phan xa cua cac day gan n6i vai phan hinh non cda
co tao ra do ski hoa rang cda thanh tam that, goi la co nhd (H.55.6).

Ong nhi" thgt

chung Ch6i trong tim king Ong nhi thgt (P)

Ong nhi thgt (T)

Ch6i trong tim bung

Hinh 56.5 : Sit tao thcinh vach gian thdt

425
 Nhu mo
Van MIT thgt

Day gan

Ca nhO

Hinh 56.6 : Su tao thcinh van nhi thdt, day On vet ca nha
Ben trong hanh dOng mach ciing phat tridn hai goy doc (Wang tif nhu' chi trong tim) dinh
vao nhau a gliaa tao thanh vach thanh.N.hung qua trinh dinh nhau khong theo dung thong
ma theo dung xoan 6c, lam cho dOng mach chti Ira than dung mach ph6i xoan vao nhau. DOng
mach phei bat cheo phia trudc dOng mach chti. DOng mach plied ma vao tam that'phai va Ong
mach chit ma vao tam that trai (H.56.7).
O tren cluing to da not tai ranh ngoai cua vach gian that. Vach nay phat xugt tit nen tam
that nguyen thew. Vach gian that hinh liem Oat tridn len cao a thanh bung va thanh lung dm
tam thgt de tie'p xtic vori chi trong tim. Nhung plign gifta ctia vach nay lai khong len den chi
trong tim va do do de lai mot l6 gian that. L6 nay duoc gidi han bai vach gian that, phan gan
caa vach hanh Ara phan gifia cua cac ch6i trong tim. L6 nay duoc dong lai vao tugn 1e tha 7 ctia
piled kY, do sit phat trien &la nhu mo tit ba tau trac ke tren, tao nen phgn mang cda vach gian
that. Con vach gian that nguyen thtly se troy thanh phan co cua vach gian that.

DOng mach chti

DOng mach pho7

Phan On caa
vach hanh

Lo nhi thgt (P)

Vach gian that

Hinh 56.7: Su phan chia ctia hanh tim (cdt clang ngang qua ccic tam that).
2.2. PHOI THAI CUA CAC MACH MAU LON.
Tit ofng tim nguyen thay, Ong mach cho bung nguyen thily phat xuat tit hanh tim va chia
426
lam hai nhanh phai va trai. Can hai dOng mach chit lung thi tigp n6i vdi hai dOng mach ron.
Khi cac cung mang (cung hdu) phat trien, m6i cung co mot thing mach n6i dOng mach chit lung
va Ong mach chit bung vdi nhau. Nhut vay, to c6 6 cung thing mach chit (11.56.8). Cung dOng
mach 1 va 2 mat di rat sdm, dau vet cita chiing con lai & ngu'ai tru'ang thanh là thing mach
ham va Ong mach ban dap (ictmus stapedius). Cung thing mach thd 5 thi bign mat hoan toan.
Cung dOng mach tint 3 tao thanh mot phan dung mach canh trong. Cung dOng mach thd 4 ben
phai tao thanh Ong mach duai don, ben trai tao thanh cung dOng mach chili. Luc cung Ong
mach thd 6 xuat hiOn thi hanh tim da thanh lap vach hanh (vetch xodn) va tao nen Ong mach
cha va dOng mach ph6i. DOng mach ph6i n6i vdi phan bung cila cung dOng mach thd 6. Phan
king cua cung thd 6 mat di a ben pMi, nhung ben trai van can ton tai va tao thanh 6ng Ong
mach, not dOng mach ph6i trai vdi `cung dOng mach chil (11.56.9). Thing mach chi' lung tit cung
thing mach this 3 dgn thi 4 bign mat d ca 2 ben. Ben trai, Ong mach chit' long tit cung dOng
mach that 4 tra xuaeng se tao thanh &Ong mach chit xitheng. Can ben phai, Ong mach chil lung
tigp n6i vdi cung &Ong mach thd tit tao thanh dOng mach du'ai don phai.
Hun bat cd he thong nao trong co thg, he mach mau c6 rat nhi6u di dang Digu nay cung
de higu khi nhin lai qua trinh tao thanh cac dang mach mau : Phoi gifting nhin mot dam bot
bin vdi mot mang lath rat nhigu tinh mach phdc tap. Cac &Ong mach thi luOn "dam chiii", cai
mai thay the cai eft, trong khi cac tinh mach du'ac tao nen do sit thodi h6a hau hgt mang lutoi
tinh mach trong phOi.

DOng mach ca'nh trong

DOng mach chu king

ElOng mach D'Ong mach chti bung

c'anh ngoai

Mang ngoai tim

Hinh 56.8 : Bon cung dOng mach ddu tien nhin tit' ben trdi
427
 Than kinh X

Hinh 56.9: Sic phdt trien clia cac cung dOng mach
S6 1, 2...6 : S6 the try cung dOng mach
X : Tha'n kinh lang thang vet qudt nguac thanh quan.

Met quy lust khdc la ve s6 phan cac mach mau cua met co quan khi no di chuyen xa khOi
vi tri nguyen thug cda no. CO truting hop, cac mach mau nay ton tdi va keo dai theo ca quan.
VI du nhti cac deng mach sinh duc.
O trudng hop khdc, mot boat cac mach mau khdc xuat hien, thay the cho cac mach mau ea
khi cac quan di chuyen. Vi du nhir then. Than phat trign to Wing chau h8ng du'oc cap mau bed
&Ong mach ding giita. Khi than di chuyen len thanh bung sau, du'oc cap mau Ian 'dot bdi dung
mach chat' trong, chat' g6c va Ong mach chili bung. Met hay nhieu nlidnh nay co the ton tdi
nhu la cac dOng mach than "bat thtfOng".

2.3. TUAN HOAN PHOI THAI

O thari kS7 phoi thai, thai song nho' mau tit nhau thai tdi, cho nen dung mach va tinh
mach r6n quan trong hon nhieu so vdi Ong mach va tinh mach ph6i. O thdi kST nay, ph6i
data host dung cho nen chi co it mau v6 tam nhi tral. Vi vay, kh6i Wong mau ve tam nhi
phai qua cac tinh mach chit ldn horn nhieu. Tinh mach r6n data mau tit nhau thai tdi d6 vao
tinh mach dill du'di qua Ong tinh mach d mat tang cua gan (vi gan chua haat crOng) cid ve
tam nhi phai. Van ciia tinh mach chii dudi d trong tam nhi phai hidng clan hau het mau co
nhieu oxy tit nhau thai qua 18' bau duc de vao tam nhi trai r6i xu6ng tam that tral de ra
&Ong mach chti di nuoi co the thai. Tam nhi trdi chi nhan met s6 it mau del tit ph6i. Mdu
tut tinh mach chit tren va tinh mach chit dudi it haa ban trong tam nhi phai de bac dam Wan
hoan he th6ng va phoi (thai) khong bi thieu oxy cung cap cho phan ddu ca the quan trong
vi c6 nao be. Trong khi do, giang mau tit tinh mach chtl tren se huzing vd to nhi that phai
xu6ng tam that phai r6i vac, clang mach ph6i. Chi co met it mau di vao ph6i (lac nay chita
host dOng) con hau het mau deu di vao cdu not tat la Ong Ong mach, del Ong mach chti
xu6ng had. Ian vdi mau tit tam that trdi ra de di nuoi cac phan con lai ctia thai va fru v6
nhau thai qua cac Ong mach r6n (H.56.10).
428
 L6 bgu duc Phdi

Thgt trai

--- That phai

Ong tinh mach

Tinh mach rgn
DOng mach chi.) bung
Gan
Tinh mach cila Tinh mach cha duel

DOng mach ro'n

Nhau
Bang quang

Hinh 56.10: Tudn hoan phoi thai

Nhu vay mdu có nhigu oxy nhat sau khi dgn tim trai, &rue bum vao Ong mach cha len va
cung Ong mach cha dd cap mdu cho phan tren cua phoi nui có cdc t6 bao thin kinh cua nao a
phoi. Cdc phan con lai cua cci thg' phoi &Plc cung cap mail it oxy va chat dinh Mang hen, vi
mdu vao dung mach chti xugng bi pha nhigu bai mdu tinh mach tit gng Ong mach di ra.
Ngay tru'ac khi dgn tim, mdu tit tinh mach rgn da bi pha loang bai mdu tit gan va tinh
mach chit duOi. Dg giam thigu tinh trang nay, tinh mach ran can mot cau not Vat, this nhat la
6ng tinh mach. CuA n6i tat thd 2 la. 16 bau duc, dg pha lOang vori mdu tit tinh mach ph6i. Su
pha bang nhigu nhat la a Ong mach chil xugng, sau khi di qua du not tat did 3 la gng Ong
mach.
Sau khi sinh, Ong mach ran bi cot lam ngu'ng lulu thong mall ti nhau thai va tdc ang
tinh mach. Oxy khong dgn duqc thai lam tang lacing CO2, thay d6i pH mdu, lam kich thich
trung tam ho hap a hanh nao. Do do, ho hap bang ph6i bat dau hoat Ong do data tre khoc lac
ra dOi.
Lacing mdu a tam nhi phai giam xugng khi cdc mach mdu ran bi tdc. Ph6i hoat Ong, cdc
mao mach ph6i mar ra, nhan nhigu mdu. Do do, dp luc da tim phai giam xuong, ap laic tim trai
gia tang, day vdch I vao vdch II, lam clang 16 bau due lai. C1 cho va thO, c6 cdc van hinh vanh
429
thing oeng clang mach lai, d citu c6 co yang co that thing 6ng (tang mach vai phut sau khi that.
Ong dong mach a nguai khong c6 van va co vOng, cang se thing lai sau vai tuan hoac vai thang.
Co the chu'a ro. Neu khong clang lai, se tao nen di tat con 6ng clang mach.
Tom lai, tuan hohn phoi thai co call tao khac titan hoan sau khi sinh la a ch6 mau trong
phoi khong hoan toan do do pha trail nhieu Ian (phdri ddu &lye nuoi mew dd nhat, cac phan
than va chi cludi it lion). Sur di nhu vay vi phoi &toe dinh duang nha nhau thai nen phoi va he
tieu hoa chua hoat dOng do do ten tai met s6 cau n6i tat gilia he th6ng man do va mau den.
3. CAC LOAI MACH MAU
3.1. DONG MACH.
Deng mach (arteria) mau yang nhat hoac xam xanh a ngtotai song, (lac trang bdi nhip dap.
Dua vao cau trac, clang mach dole chia lam :
(1)Deng mach 16n (chin MO.
(2)D'eng mach phan ph6i (co.)
(3)Tidu Tang mach
3.1.1. DOng mach flan horii bao g6m thing mach chi', than tay dau, dong mach canh
chung va clang mach du'ai don. Tinh dan hoi thanh clang mach chu cho phdp Ong mach
nay gian ra nhieu va c6 tac dung nhu la met ben chtla, bidn doi luting mau glen doan tit tim
thanh giong mau lien tuc. Tinh dan hei nay guy& dinh huy& ap tam thu, ddy mau di trong ky
tam tritang, clang van dOng mach chii va day mau vao cac thing mach vanh. Cac clang mach
ph6i ding thuec loai clang mach dan hei, tuy vay, thanh cua no rat it de khang vai giong mau.
Ap luc cua fling mach phoi chi bang 1/6 cila clang mach chi' (20mm Hg).
3.1.2. DOng mach cd la cac nhanh cua dung mach dan hei. Thanh mach chola it mo dan
hei va nhieu cc; trail. Hau hdt cac dOng mach ciia co thd deu thuec loai nay. Cac nhanh phat
xuat tit cac than thing mach 16n tao thanh met g6c nhon (clang mach mac treo trang tren), g6c
vuOng (dOng mach than) hoac g6c to (cac dOng mach qudt nguqc). Giong mau trong cac g6c
vuong va gOc to thuang ydu bon la a goc nhon. Cac thay &Si benh ly nhu xu Ong mach
finking xay ra a gan ch6 phat xu'at cua cac nhanh.
3.1.3. Tigu dung mach (arteriole) la cac nhanh nho nhat cua clang mach, dung kinh 100
microns, thanh mach bao gem hau het la co trap. Tidu clang mach de khang manh nhat d6i vai
giong mau, CO tac dung lam giam ap lvc mach mau tritac khi di vao mao mach. Ap laic tieu
dung mach khoang tit 50 dgn 60 mm Hg.
3.1.4. Mao mach (vas capillare) bao gem met mang htai mach mau ph6c tap gan yeti cac
tieu clang mach. Thanh mach c6 tac dung ban them, cho phep di qua cac chat nhu nude, tinh
thd va met vai protein huye't tu'ung, nhu'ng khOng cho qua cac phan tit 16n. Oxy va cac chat
dinh dung di qua thanh cua mao mach clang mach de vao mo. Cac chat ba va CO2 tii mo trot
vao mau qua thanh cua mao tinh mach. Mao mach co nhieu o cac mo hoat clang nhu co, tuygn
gan, than, phOi. Mao mach it hon a cac mo it hoat Ong nhu' gan, day chang. Giac mac mat,
430
thdong bi da va sun trong thi khong c6 mao mach. Khi di qua mang laidi mao mach, mau c6 the
chi di qua 111'0 vai mao mach, goi là mao mach du the.
3.1.5. Mach clang xoang rung hurl va u6n kink nhieu han mao mach. Chung thay the cho
mao mach a gan, lath, tally xdung, tidu the canh, va thdang than, tuydn can giap, tim. Khong
giong nhd mao mach, to bao nei mo dia mach dang xoang c6 the thuc bao va duuc nang da bai
mo 'add.
3.1.6. Mo hang dung de chi cac khoang clida day mau trong vat hang va vat x6p cUa
deicing vat va vat hang ctia am vat. Nei mo cua cac khoang nay thi giong nhu' mao mach. Mo
hang cang hien dien a not mo 6
Tor cac mang liege mao mach, mau tra v6 tinh mach tang ngay tang loin clan len.
3.2. TINH MACH.
Tinh mach (vena) mau xanh sam d ngutii s6ng. Thdang khong dap. Khi chay mau thi
kliiing ban thanh tia. Tinh mach c6 nhieu horn Ong mach, thanh Irking hon va khau kinh
thdang ldn han dOng mach Wong ing.
Till met vai ngoai le, cac tinh mach sau thuang di kern vdi dOng mach va mang ding ten.
Cdc tinh mach a phia ddai khuSr'u va g6i va mot vi tri khdc thuang c6 met, cap. Cdc cap tinh
mach nay deist goi là tinh mach di kern va thdang n6i vdi nhau theo su6t doe 10 trinh. Cdc tinh
mach n8ng (vena cutanea) thing khong di kern vdi dOng mach.
Mac dU hau het maxi co the deu tra v6 tem qua duang tinh mach chili, mau c6 the di theo 10
trinh xen. ke. LO trinh nay khong di kem Ong mach, Om he tinh mach dan, he tinh mach
s6ng va he tinh mach cita. Ca hai he nay thong n6i vai nhau va he nao cling c6 the tao thanh
10 trinh chu ydu khi cac he khdc bi tdc nghen met phan hoac hoan toan.
He dia là mot he ma trong do mau sau khi da ra khai mot he th6ng mao mach, lai di qua
met he thong gi6ng mao mach khdc, trdac khi tra v6 than hoan he thong. Vi du, mau tit mao
mach da day, rust, tuy, ldch, ttli mat, duuc dan vao tinh mach cira den gan qua cac mach clang
xoang truck khi vao tinh mach chi' du'ai qua cac tinh mach gan.
Cdc van hien dien a 'nhieu tinh mach. Khi clang lai, van killing cho giong mau di nguqc lai.
Van tinh mach (valvula venosa) tao nen do sir xdp nep cUa lap nei bi va thdang c6 hai la , dui
khi c6 ba. Bar tu do cita la van hiking v6 phia tim. Chu vi da tinh mach thualig ldn hon a vi tri
cUa. van. Cdc van thu'ang hien dien a gan ch6 ma no d6 vao met tinh mach khd.c. Cac van c6
nhieu a cac chi, khong co d than (id cd h0 tinh mach cda va he tinh mach song). Cdc van
thdang khong hien dien d cac tinh mach gan tim nhd cac tinh mach canh trong, duai din va
tinh mach dui. Tuy vay c6 the c6 vai van a tinh mach chau ngoai ya chau chung. Cdc van dimg
de ngarr man di ngduc ding a dau va chi khi ap luc trong ngdc va bung gia tang.
3.3. CAC MACH NOT (vas anastomoticum).
(3 met vai vi tri, cac Ong mach n6i nhau. Vi du : Ban tay, ban than, ddy nao, gan runt,
quanh khap, trong tim v.v... Khi met trong cac dung mach nay hi tac hoc that lai, mach bang
431
4' (vas collateral e) có the thanh lap qua cac mach n6i.

Tuan hoan bang 110 dal khi tao nen qua mao mach, dac biOt la a ngu'ai tre. Do có nhieu mo
trong thanh mach, mOt, mao mach có the bign d6i thanh mOt, dOng mach hoac mOt tinh mach.

Mau khong phai luon luon di qua mao mach, ma có the di Ur tidu d6ng mach den tinh
mach nhO (venula) qua cac mach n6i dOng - tinh mach (anastomosis arteriovenosa). Thanh cua
cac mach n6i tat nay day han mao mach va khong cho phep trao d6i chat. Mach n6i Ong -
tinh mach hi6n din a da mui, mai, mi mat, long ban tay, &du lctdi, runt. Nhieu mach n6i khdc
rat phdc tap va có thd là ca quan tan ding than kinh - mach man. Cac mach n6i khac khi ma
ra, mau ddcfc clan "di tat" khong qua mao mach. Do do, vdng duvc phan ph6i bai cac mao mach
nay thi khong có mat" den. Khi trdi lanh, cac mach n6i nay gidp gilt nhiet qua da. runt, cac
mach n6i "bac cau", qua cac mao mach, ngoai tra' hie tieu hoa.
3.4.. CAC DONG MACH TAN.

MOt s6 Ong mach cap mau cho mOt vdng giai han cda mo hoac co quan, khong nai vai. cac
Ong mach khdc lan can goi la &Ong mach tan giai phau. VI du &Ong mach cap mau cho vOng
mac mat, khi bi tac thi cran d6n mu mat. MOt &Ong mach có nai vai mOt Ong mach lan can
nhu'ng van khong dd duy tri tuan hoan sau khi bi bit the goi la d6ng mach tan chile nang. Cac
dOng mach tan chilc nang hiOn din a nao, than, lach, runt.

4. CAU TRUC MACH MAU.

DOng mach g6m ba lap : lap trong, giita va ngoai.

4.1. LOP TRONG (tunica intima) lot bai noi mo, difac Jiang bai mOt s6 mo lien ke't long
leo, ditqc giai han ben ngoai bai mOt ang me dan h6i (mcing dan 11,64 trong).
4.2. LOP GILDA (tunica media) day nhat, g6m nhi6u sgi dan h6i, la thanh phan chil yeu
cua cac clOng mach ldn. Khi cac dOng mach nhO clan, luvng mo dan h6i giam 'Yang ca tran
tang len. Cac sai ca tran sap xep theo yang trail hoac xoan 6c. Mang dan h6i ngoai, khong ro
bang mang dan h6i trong, ngan each lap gala vai lap ngoai.
4.3. LOP NGOAI (tunica externa) manh nhat, g6m nhieu sai dan h6i va seri keo, gitip de
phOng tui ph6ng dOng mach a cac mach mau khong có hoac thi6u ca tran. Loai nay chda cac
mach mau nhO goi la mach cila mach (vasa vasorum) doi khi xuyen vao den lap giCia.

Cac tidu dung mach lan co cau true gi6ng nhit tren. CI cac tidu &Ong mach nhO han thi ba
lap tren dan dan khong rO nita. Cac tidu dOng mach nho nhat chi bao g6m mOt, lap nOi mo boc
quanh bai mOt lap ca tran. Mao mach chi co mOt, lap nOi mo. Tinh mach nhO gem mOt lap nOi
mo diiac nang dor bai mOt s6 it chat keo. 0 cac tinh mach lan han, co them mOt vai sai ca tran.

Tinh mach ming có ba lap nhu'ng so Arai &Ong mach lap giaa mOng han nhieu, thanh chi a
it ca trail va m6 dan h6i han. Ca trail (Iliac xe-p theo &Ong trop, doc hoac xoan. Su x6p theo
vOng tron tao nen tac dung gi6ng nhit ca \Tong va lam cham giong mau chay.
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5. HE BACH HUYET

Bao g6m cac mach bach huy6t (vas lymphaticum), cac ma bach huy6t hoac clang bach
huy6t. MO bach huy6t hien dien O' mat vai co quan nhu' runt va tao thanh cac co quan khdc, nhu'
hach bach huy6t (nodus lymphaticus).
5.1. CAC MACH BACH HUYET.
Cdc chat dinh &Ong lien tut di qua thanh mao mach vao ma. Hau het cac chat nay deu troy
vao cac mao mach, nhung phan ldn cac phan tit protein lan thi khong. Cdc mach bach huy6t tdc
dung nhu' mat co ch6 biet hoa dd clan cac phan tit nay trot ve mau. Vi cht-ing lien he chat the Arai cac
mo bach huy6t, chung cling data cac t6 bao lympho van mau. Chit dich du'oc van chuydn trong mach
bach huy6t goi la dich lympho aympha). Ca.0 mach bach huy6t bao gam :
(1) Mao mach là cac Ong not bi.
(2) Cdc mach gop, la cac Ong not bi c6 them cac co troll. Ira mo sqi lien Icel...
(3) Cdc than bach huy6t ma thanh chda nhieu m6 lien ket va co troll.
Mao mach bach huy6t mang Ara trong su6t, long mach luon ma do gan vdi cac mo chung
quanh. Cdc mach nay ldn hon va khong deu clan so vdi mao mach mau va c6 dang mang latori
chung chit, thong n6i tai do. Mao mach bach huy6t c6 it van nhurng cac mach g6p co nhieu van.
Cdc van (valvula lymphatica)) thadng c6 hai la, de gidp cho giong bach huy6t chi chdy theo mot
chieu. Cdc mach g6p hep lai a vi tri cac van. Cdc mach gap thu'Ong hop thanh ding nhom va di
chung vdi tinh mach.
Mao mach bach huyet thuang hien dien ar nai c6 mao mach mau. Co nhieu a da va them
mac va quanh cac 16 tar nhien, nhu mieng va hau mon. Mao mach bach huy6t a niem mac runt
non van chuydn duang chap tao nen do qud trinh tieu h6a.
Cdc mach bach huy6t co a mang trong tim, mang ngoai tim va a mang ph6i, khdi dau a
cac ph6 nang ph6i, di ye ron phoi vdi cac &Ong mach va tinh mach ph6i. Mach bach huy6t cling
co d mang hoat dich va vo 'awing, a va va be ciia cac tuyen.
Mach bach huy6t khong co a than kinh trung u'ong, co van (chi co a mo lien ke't bao quanh
cling), toy xunng, cac cau triic vo mach nhu sun trong, mang, toe.
5.2. CAC MO BACH HUYET HOAC DANG BACH HUYET.
Bao g6m cac t6 bao lympho, du'oc nang dor hal cac to bao ltidi va cac soi co trap, sal keo va
soi clan hai. Cdc mo nay co a : Hach bach huy6t, niem mac, tuyen de, ld.ch va toy xuang.
MO bach huy6t a niem mac chi ca mach di. Cdc mo nay to lai thanh cac hanh nhan
khan cdi, hanh nhan hau, hanh nhan luroi va cac nang bach huy6t a ru6t, (folliculis
lymphaticus).
Tuyen dc co cac mo bach huy6t x6p thanh nhieu thUy.
Lach co nhieu mo bach huy6t, nhu'ng duvc sap xep de" loc mau bon la bach huy6t.
433
 5.3. CAC HACH BACH HUYET.
Cac hach bach huyet (nodus lymphaticus) c6 hinh dang, mau sac va kith tha6'c thay d6i.
Ding . kinh khodng 1 - 20 mm. Cac hach clan luu bach huyet tit gan thaeng men nau, tit phai
thaang mau den, tit ruet non thaang mau trang stla. Cac hach thifting nam rieng re, doc theo 10
trinh cila mach mau va 6ng tieu h6a. Cac hach d vang ben c6 thd se thay daoc. Con d cac vang
khac chi c6 thd se thay khi bi phi dai. MOt hach bach huyet dole bao boc bdi met bao xo, ben
trong bao g6m nhieu be. Mach bach huyet vao qua bao xo ya ra qua rein &Ong mach.

6. CH& NANG HE TUAN HOAN.

He than hoan dua mau tit tim qua he thong mach mau den cac co quan r6i lai dura man va
tim. Cac mach mau daoc kidm soat bdi yeu to than kinh va the dich. Kim soat than kinh thuc
hien qua trung gian co the phan xa. Cac tan tang than kinh phong thich Norepinephrine vao
thanh cac Ong mach va mao mach. Con kiem soat thd dich thi qua trung gian Epinephrine do
tay tuyen thaong than tiet ra. Tac dung caa 2 chat nay deli gay that co tro'n.
Vi mau a tinh mach chdy cham hon trong &Ong mach, nen khau kinh finking ldn hon dOng
mach Wong 'Mg (lY do thdy dOng hoc). Cling ding ly do nay, cac tinh mach thaang co hai di
kem theo mot dung mach, nhu cac tinh mach di kern a cac chi. O phan gam cua chi, cac tinh
mach di kem thaang d6 vao met tinh mach ldn duy nhat (tinh mach ndch, tinh mach kheo).
Cac tinh mach ldn thaang co met "khodng trong" ldn quanh chung, cho phep tinh mach gian
t6i da khi giang mau tang len.
O ngudi khOe manh binh thadng, chile nang cho ygu cila co quan va me bach huyet là tao
nen to bao lympho va hay diet cac hang cau. Te bao lympho c6 vai tro quan trong tao khong
the va phdn Ling mien nhigm. Chung co the di chuydn, nhung khong time bao, c6 chaa vai
enzyme lam tan protein. Cdc m6 lympho con c6 vai tro gan loc tac nhan benh 1y, co vai tro
quan trong trong co the bdo ve co the. Cac phan tit bat hoat nhu carbon, daoc gift lai phan ldn
d mo lympho. Vi trung, sidu vi trung, to bao ung thu ding bi giur lai. Tuy vay hang rao bdo ye
nay chi cO gia tri mile de. Cac mach xuat cO the lam lan tran cac nhan t6 gay nhigm trong va
ung tha clan cac mo va co quan khac va sur Ian truyen benh ly nay khong nhat thi6t phai theo
10 trinh giai pilau. No co the lan truy6n "tat" do qua trinh benh 131-. Neu mach bach huyet bi
tac, cac van co thd du'ac tach rori ra va giong bach huyet co the chdy ngruve lai. Bach huyet co
thd thong not to do vdi cac tinh mach a nhieu not tren co the. Ong nguc of) th6 bi cut ma chung
nguy hai gi vi bach huyet se di theo cac mach ngoei bier' khac.
7. MAI PHAU X QUANG TIM VA MACH MAU LON.

Tim binh thaang co rat nhieu dang : Tim. ngang, tim doc, tim cheo. Tim doc cc') the thdy d
ngii6i co 16ng ngife hep va co hoanh thap. Tim ngang thay d ngutri beo va to ngang. CO nhieu
dang khac co the thay &Plc thy thuOc tu6i, to the, khung than thd, thei ky ho hap. Nhin chung,
bang tim tren phim X quang chup thong a ben phai c6 hai cung : cung tinh mach chi' tren va
cung tam nhi phdi; va a ben trai c6 ba cung la cung clOng mach cho, cung dOng mach phai va
cung tam that trai (H.56.11). Ngoai ra d6i vdi dOng mach c6 thd chup sau khi born chat can
quang vao nguai. sting (H.56.12) hoec vao tieu ban lay d xac tacii chu'a trap (H.56.13).
434
 DOng mach duel dem trai

Cung thing mach chO

Tinh mach chO tren

DOng mach ph6i

Tigu nhi" trai

Tam nn Tphai
Tam thgt trai

Tinh mach chO du'oi

Hinh 56.11 : Gicii pita u X quang tim va mach mau 16.n (chup sau tru'ac).

Hinh 56.12 : Chip ctOng mach than tren nguai song Hinh 56.13 : Hinh dnh X quang caa d'Ong
1. DOng mach than 2. &Ong mach clic tren than mach vanh tim (born chat can quang tren
3. DOng mach giUa 4. DOng mach cvc dadi ngu'ai che't).
5. Ccic clOng mach gian thay.
435
 CAU HoI TRAC NGHIleM
Chun cau tra lai dung nhat.

613. Sy' tan tai 16 thong lien nhi la do :

a) Sy' tieu di cila phan gifia vach that phat.
b) Sy' tieu di dia phan gifia vach nguyen phat.
c) Sat phat tridn khong day du cua vach thd phat.
d) a, b dung.
e) a, b, c deu dung.

614. Sy tan tai 16 thOng lien that thu'ang :

a) Cl phan mang vach gian that.
b) C1 phan ca vach gian that.
c)Do si.r phat trign khong day do cila vach gian that nguyen thug, phan gan cua vach harsh,
phan giCra cua choi trong tim.
d) a, c thing.
e) b, c dung.

615. Mau cua thai :

a) TrOn Ian gliira mau dO va mau den nhieu Ian.
b) DO nhat d phan dau caa thai.
c) Trao d6i khi or nhau thai.
d) a, b, c dung.
e) a, b thing.

616. Cac khoang chda mau trong vat hang va vat x6p throng vat la :
a) Mao mach. d) MO hang.
b) Tidu dung mach. e) Mach dang xoang.
c) Tidu tinh mach.

436
 Dung hinh sau cle tra ldi cau 617 - 618,
Tren hinh X quang caa tim.

617. Cung tam nhi phai nhm a vi tri :

618. Cung dOng mach ph6i nam a vi tri :

437
 57 HE TIED HOA

MUC TIEU BAI GIANG

1.Ic6 ten cac ca quan thuec hq tieu hoa.

2. Ve so' d6 cdu tao chung cua 'Ong tieu h6a.
3. MO to ca the cac clang tac tieu hoa thile an tit 6 mieng qua hdu, xuong tilde quan tdi da
day, runt non va met gia.
4. MO to hinh anh X quang caa tang doan dia. Ong tieu hoa.

1. DAI CU'CiNG
BO may tieu Ma. (apparatus digestorius) hay he tieu hod. (systema digestorium) la met he
thong dam nhdn viec the hien cac thac an v6 mat ca hoc va h6a hoc d6 ca th6 hgp thu va bai
tie-t, dam boo sit dinh &fang can thi6t.
He tieu hoa g6m c6 mieng va can frac phu nhu' moi, ma, khdu cai, lath, rang, hdu, 'Ong tieu
h6a va cac tuyen tieu h6a la gan, tuy ya cac tuyen nudc bot. Ong tieu h6a du'o'c chia thanh
nhieu phdn co kith thuac va chile nang khac nhau g6m c6 thiic quan, da day, runt non va met
gid.

2. SCi LUOC VE CAU TAO

2.1. CAU TAO TONG QUAT COA ONG TIEU HOA (H.57.1)
Ong tieu hoa la met tang r6ng, thanh 6ng c6 nhie'u lap khi cat ngang tit trong ra ngodi c6
cac lap sau :
2.1.1. Ldp niem mac (tunica mucosa) lot a mat trong cua Ong tieu h6a.
O m6i phdn caa 'Ong, thaong ma co hinh dang khac nhau. CI mieng, thaang inO co nhi6u
tang. da day va ruet la thuang mo met tang. Hinh thai cua cac t'6 boo thuang mo cang khac
nhau. 0 6 mieng la thuang m6 det, a met non la thuang mo tru d6 thich Ling vii cac chic nang
Wang ling.
438
 Mac treo runt

La tang (thanh mac)

Lap co doc

- Lop co wing

Dam r6i than kinh

Tam cludi niem mac

Lop co niem mac

Tuyen du al Worn mac

Nang bach huygt

Hinh 57.1: Thie't clo cat ngang runt non cho thdy cdc lap cau tao nen thanh 6ng tieu hoa.

2.1.2. Tgm tidal niem mac (tela submucosa) là to chile lien kdt xor, trong do co cac mach
mau, cac sal than kinh va cac mach bach huy6t.
Gina lap niem mac va tam du'di niem mac la met lap mong cac sai cc trail tao thanh
manh cc niem mac (lamina muscularis mucosae). Khi co nit, cc niem mac co the lam cho lap
niem mac gap lai thAnh cac ndp.
Trong cac t6 bao thu'ang mo cua niem mac con co thuang m6 biet hoa thanh cac tuye-n tidt
ra dich tieu h6a de vAo long met qua the 6ng tiet. Co cac tuye-n den gian IA tuy6n met to bAo,
co cac tuydn pink tap hen gam c6 nhieu td bao hoac co phan nhanh thanh nhieu 6ng tuydn.
Cac dam to chile lympho nam trong lap niem mac g6m mat to chile lu'ai ma trong cac mat
lath c6 t6 bao lympho sinh san tai ch6. 0 met s6 nal , to chile nay hap thanh cac hach goi là
nang thu'ang nam trong tam dudi niem mac, hoac cac nang to lai thanh dam goi IA mang to
chile lympho (co nhieu a hOi trong).
2.1.3. Lap cd trail (tunica muscularis) chia thanh hai tang, tang ngoai g6m cac sai cc doc
va tang trong la cac sai cc yang. Trong phan tren tha thuc quan co cac sai cc van phis hap vai
chile nang co that that nhanh a phan tren tha thuc wan khi nu6t. Tit da day ddn met non,
tang co yang va cc tren IA met lap lien tut. 0 runt giA, cac sai cc doc tap trung thanh ba dai c6
thd nhin tidy khi quan sat dai thd.
Ngoai ra, trong da day can c6 lap cc tran thd ba là lap cc cheo.
2.1.4. rgm &Jai thanh mac (tela subserosa) la to chile lien ket theta nam Oda lap ca ben
trong va lap thanh mac ben ngoa.i. Nha lap nay ma c6 thd bac thanh mac dd clang ra khoi cac
cau true ben du'ai.
439
 2.1.5. Lep thanh mac (tunica serosa) tao bai thuang mo det caa phdc mac. Mat tut do dia
thanh mac c6 chat thanh dich lam cho cac tang truat len nhau de dang. Thanh mac co hai
phan, la pha thanh 6 bung goi la pink mac thanh, la phi' cac tang goi la phac mac tang.
2.2. CAU TAO TONG QUAT CliT'A GAN VA TUY.
Dan vi cau true cua gan la cac tieu they c6 hinh lang try, m6i tieu they cau tao bai nhung
be gan xe-p theo hinh nan hoa t6a ra tit tinh mach trung tam. Cdc be gan hyp bai hai day to
bao thuang mo. GiUa hai day nay c6 mao quan mat. Chat tilt di qua mao quan mat vac cac
&Ong dan mat, chay giaa cac tieu they (16 d6 vao cac tieu quan mat r6i tap hap lai thanh 2
6ng gan di ra kh6i gan.
Ve cau true, tidy tang thuOc ve nhorn cac tuyen tai phac tap. Ong tilt caa tidy dO chung vao
mot 6ng cang vdi 6ng mat chi'', can mot 6ng tilt phu khac d6 rieng biet vao long to trang. Dac
diem caa tidy tang la can c6 cac yeti to tuyen khong lien quan gi vdi cac 6ng tilt, do la cac ciao
tidy tac la phan not tilt caa tidy tang.

3. Sii PHAT TRIEN CtA ONG TIEU HOA.

Da trinh bay a bai Pink mac. O day chi xin nhac lai van tat.
thai trong (nOi bi) (entoderm.e) xugt hiOn a ngay that 8 cua bao thai, phdt trien nhanh
. -ch6ng thanh phoi 2 la (lecithocele) hai phan :
- Phan ngoai phOi : Wen mat or thang that 3.,
- Phan not phoi : la nguOn g66 cua 6ng tieu hoa va cac tuyen •phy nhac gan, tyy.
Luc dau eing tieu hoa dive clang bed hai mang :.mang hau va. mang o nhdp.
Mang hau bien mat vao tuan that 4. Mang6 nhdp ma ra vao tuan that 9.
Sy phat tri6nclia 6ng tieuh6a:c6 the torn vao-baqud trinh song song :
- Sy phdt trien v6 phia truck &la phan hau.
- Sy keo dai ra cua phan. giaa (phan bung).
- Sy phan chia thanh he tieu h6a va he nieu duc a phan tan cling.

4. GIAI. PHAU CHIJC NANG CI:TA HE TIEU HOA.

4.1. CO CHE CUA. SLf NHAI. Truck tien thdc an duqc data vao 6 IniOng, doan dau tien
caa 6ng tieu hoa. di day xay ra qud trinh tieu h6a dau tien nha ca the nhai, nghia là thac
an ducic nghien nat va tr0n vdi nude but tilt ra bai cac tuyln nude but. Sy xe va nghien
tMc an la do rang. Rang ca'a xe thuc an nha Ong tdc nang va ha xuang ham dudi do cac
ca nhai tdc thing, con rang c6i nghien nat thac an nha dung tdc dua ham sang hai ben chid
ye-u do cac ca than budm ngoai tdc gong. Lath Ara ma co vai tra quan trong trong viec dua
fink an vao vi tri cho rang nghien va trong viec trOn deu thac an vdi nude but. Nude bot,
chat tilt dia cac tuyln nude bot co tdc dung hoa tan, lam mem, lam tram va tie(' h6a mot
phan thac an do men ptyaline.
440
 4.2. CO CHE CUA STj NUOT. Sau khi nhai, thdc an se duac vao hau de chudn his xu6ng
thuc quan. ei day xay ra deng tdc quan trong goi là nu6t.
Nu6t la deng tdc dua thdc an tii mieng xu6ng thuc quan ductc thuc hien u trong hau. Car chg
nu6t g6m ba giai doan kg tigp nhau : giai doan mieng, giai doan hau va giai doan thuc quan.
— Giai doan mieng : Meng dong lai, thdc an da duac nhai va tam nude bot se duac mat
tren lutei ep len yam khau cdi va duac day tori eo hong nghia la gida. hai cung khau cal - piaci
cda man hau. Giai doan nay con goi la giai doan luai vi loran giii mot vai tro quan trong. Hai ca
cam Mei nang dau ludi len con cdc ccr tram luOi, mong ltiori va itrai tren thi lam mat tren lciei
lOm xueing thanh ranh va day thdc an ra sau. D6ng than, man hau nang len ap sat vao thanh
sau hau ngan cach hau mieng vai hau mai. Man hau &I've nang len do tdc dung ctia ca nang
man hau (H.57.2).

Co nang man hau

Co Itidi tren

Co tram OW
Cuc thdc an
CO mong hidi

Hinh 57.2: Giai doan mieng cua dOng tcic nu6t.

— Giai doan hdu : Sau khi thdc an qua eo hong, lath day tang dot cho thdc an vao.
hau. Eo hong hi hep lai do co hau - man hau co lam 2 cung khau cal - hau gan lai. Thank ..
quan clang lai do sun nap thanh mon day xu6ng thanh mon. D'Ong tdc nay thuc hien duqc
nha thanh quan &P lc nang len ma to cif) the quan sat duvc ngay dudi da c6. Trong giai doan'
nay mieng phai hoan toan clang kin va xuang ham dudi bat Ong nhO cdc cc; a san mieng..
Thdc an se ludt xu6ng theo hai ngach hinh le a hai ben hdu (vi vciy ocuong- hoc thudng mac
lai d ngdch hinh le). LLic nay có sut tham gia cua cdc ca khit hau (H.57.3).
441
 Co nhi than

Co tram mOng

Cuc thdc an

Hinh 37.3 : Giai doan Mu cda cking tdc nu6t.

— Giai doan thuc quan. Day là giai doan cuai cang. Ming thuc quan hic do van clang lai
do mot co that, nay dttac ma ra de cho thdc An di vao thuc quan. Cac song nhu d6ng caa cac co
thuc quan a sau ban sun nhan bat dau hoat dang. Trong khi do tat ca. cac ID() phan khac
thanh quan, luai, man hau, nap thanh mon trd lai vi tri ban dau va ming lai co thd ma ra
(H.57.4).
4.3. SAU DONG TAC NUOT, thdc an ddo'c nhu do, ng cua thdc quan day xuang da day. Tai
day sit co b6p caa da day lam thdc an tr6n vdi dich vi cua da day tidt ra, thanh mot chat long
s6n set goi la dnang trap. MOt s6 thdc an ran chua tieu hoa kip co thd con d lai da day trong
vai gia.
Cac song nhu dung td gala da day xuang mon vi day &fang trap vao to trang. Trung binh
mai phut c6 ba dot song nhu d6ng, m6i dot khoang 20 giay. Khi song nhu dung cham ca
that mon vi, lap tdc ca ma ra va thdc an du'ac day qua. Thiic An tiep tuc di chuydn xuang hang -
hai trang cling nha cac nhu d6ng cua runt non. O day tidp tuc xay ra qua trinh tieu boa thdc An
nha cac dich cua runt, mat cua gan va dich tuy, (icing thai xay ra qua trinh hap thu cac chat
dinh duang. Sau do tai runt gia. Van hai manh trang co tac dung ngan khong cho thic An di
ng-dgc trot lai td manh trang ve h6i trang. Cl phan dau cua runt gia, nuac duqc hap thu trot lai,
sau do phan dan dan du'oc hinh thanh va di chuydn xuang kdt trang xich-ma dd ddgc dui trd va
thai ra ngoai.
442
 Co' c;tn

Co cam mong

Hinh 57.4 : Giai doan thvc quern caa dOng tdc nudt.

5. HINH ANH X QUANG CU' A ONG TIEU HOA.

Thuc quern c6 hinh ang vdi vai ch6 hep sinh 1Y. Da day hinh chit J, hai bar Wan song song
treo d,iii ccr hoanh trai, xueing thang phia hcri chgch ve ben phai (H.57.5). RuOt non, ve
phuzing dien X quang, hai doan h6ng trang va h6i trang khdc nhau rO ret ve cau trot niem mac
va dating kinh. O h8ng trang, niem mac c6 hinh long chim, d h6i trang hinh nay rat theta Ira
mat clan. O runt gia, hinh khung kat trang thg hien bang mot &di dam, trail bet c6 nhiing ngan
ram vao rat sau, hinh khong lien tuc, gian doan, cat ra tang kluic do co b6p cua thanh met gia
va cdc dai co d9c (H.57.6).
443
 Hinh 57.5 : Hinh dnh X quang cda da ddy Hinh 57.6 : Hinit cinh X quang clia runt gia
sau khi udng dung dich thudc can quang baryt. sau khi bum thudc can quang baryt.
1. Manh trang 2. Ket trang len
3. Goc kdt trcing phdi 4. Kdt tretng ngang
5. Goc ke't trang trdi 6. Kdt trang xudng
7. Kdt trang xiclt ma 8. Truc trdng.

CAU HoI TRAC NGHIEM

Chon cau tra.16i. thing nhat.

619. Gan va tuy la hai tang :

a) Thuec 6ng tieu hcia.
b) Thuec he lieu hoa.
c) Vita nOi tiet vita ngoai tiet.
d) a, c thing.
e) b, c clung.
444
620. Di)ng tac nu6t gm:

a) Giai doan ming, giai doan hdu va giai doan thqc quan.
b) Hoat ding theo 3'7 mu6n.
c) Hoat dOng theo phan xa.
d) a, b, c (ing.
e) a, b dung.

Dung hlnh ye sau de tra 16i cac cau 621 de-n 626 (trAc nghiOm (lien khuye-t).

621. Chi ti6t s6 (1) la :

622. Chi ti6t s6 (2) la :
623. Chi tigt s6 (3) la :
624. Chi ti6t s6 (4) la :
625. Chi tiet s6 (5) la :
626. Chi ti6t s6 (6) la :

445
 58 HE HO HAP

MUC TIEU BAI GIANG

1. Kd ten cac cc quan thuec he ho hap.

2. MO to su phat trien phoi thai cua he ho hap.
3. Neu met s6 dac diem giai pilau chiic nang he ho hip.
4. Ire so d6 hinh anh X quang ph6i chup thang.

Sii ho hap duceri hinh thdc nay hay hinh thiic khac la met dac tru'ng cc ban dia vat chat
song.
O loci dun bao, khi oxy daa vao hoac khi carbonic thai ra du cc trao d6i truc ti6p giira t6
bao va moi true mg song (khong khi hoac ndac).
O Tang vat cao nhu cac dung vat c6 xu'ang song thi qua trinh ho hap g6m hai clang tac co
ban, su hit vao sit than ra. Khi hit vao cc the nhan oxy tit khong khi cua khi quydn va thai ra
khi quydn khi cacbonic tao thanh do su' oxy hoa cac chit cacbon a trong cac mo cUa cc the.
Qua trinh trao d6i khi nay ducc thuc hien met cach gian tigp qua maxi cila co the va do do
he ho hap g6m nhieu co quan duce hinh thanh.
He ho hap (systema respiratorium) a ngutri g6m mot he th6ng 6ng dan khi va met he
th6ng trao d6i khi gida mdu va khong khi. He thong 6ng dan khi gum mui, hau, thanh
khi quan, va phe" quan. Con he thong trao d6i khi la be phan quan trong nhat g6m ph6i trong
co rat nhi6u tdi va h6c nhO goi la cac phe nang la not xay ra su trao d6i khi gida mau va
khong khi (Xem bai

1. SI; PHAT TRIEN CUA HE HO HAP.

1.1. SI1 PHAT TRIE7N CTTTA

Mid phat trien tit ngoai bi bat dau bang met tam day len a ngay phia tren tam mieng.
446
I1

Trung tam caa nhang tam nay bat ddu lOm vao ar tun that 5 dm dbri song bao thai tao nen cac
h6c mai nguyen thay. Ngay sau do cac h6c mai nguyen thily ma thong vao 6 mieng nguyen
thay. Can mai ngoai thi phat tridn rat &am ding vai ski phat trign cua yang mat. Si phdt tridn
cila mom khdu cdi cua xaang ham tren va xaang khdu cdi sau do se ngan cdch 6 mai vai 6
mieng va sit teo bat khol trung mo a giCta. 6 mai se hinh thanh nen vdch mai va hal 16 mai sau
(H. 58.1).

1.2. PHAT TRIgN CUA KHI PHE QUAN VA PHOI.

Mdm caa khi phg quan va phOi bat ddu co ta' tun thi ba &la diii song bac) thai. NO la
mot ngdch 16i ra a thanh traac cua doan ddu caa runt nguyen thay. Nha vay laidc vai mai
co ngu6n g6c ngoai bi, cac phAn con lai dia he ho hdp có ngu6n g6c tut trung bi va net bi.
Ddu tran cua ngach se phdt trien thanh thanh qudn con ddu dual tit tai va chia ngay thanh
hai phdn ben : mdm phOi phai va mdm ph& trai (H.58.1). Mdm ph6i phai lai phinh ra thanh
ba bong va mdm trai thanh hai bong. Cac bong nay se troy thanh cac they ph6i sau nay. M6i
bong they ph6i lai chia thanh nhCing bong nha horn va cur chia ddn mai cho tai cu6i ding
thanh cac tui phe nang (H.58.2). Nai bi cua runt ddu se thanh thu'ang mo caa niem mac khi
phe- wan, can trung m6 a xung quanh se phat tridn thanh cac mo lien kgt, cac sun, cac day
chang tang nhu' car cua cay ph6 quan.

H6c mai nguyen thug

Mgm khi qujn

Mgm phdi

Hinh 58.1 : Phoi thai cda he ha hap

447
 4

Hinh 58.2: Phcit trien phoi thai cfia phoi

I. Mdm khi qudn
2. Mdm phe qudn
3. Cac- bong phdi trcii
4. Cac bong phdi phdi

2. GIAI PHAU CHIC NANG CfJA HE HO HAP

2.1. LIIgNG KHONG KHI QUA MCI VA HAU

Nhu da trinh bay trong bai mui, khOng khi vao 6 mui theo hai darting : ducting ho hdp hay
dating tha va ducting khiiu giac hay darting ngiti. Dai b0 phan khong khi di theo ducting tha a
phia duai xuang xoan tren duac suai dem, loc bkii va lam dm nhi cac dac didm cua niem mac a
mai dia. \Tung thd, de qua hdu vao khi phd quan.

2.2. DONG TAC CUA CAY PHE QUAN

Khi the binh thaang, cac chuydn dOng cua cay phd quan khong thay d6i rO ret nhang khi
hit hdt siic thi cu6ng ph6i chuydn Ong xu6ng duai va ra tru'ac. Khi quan va phd quan chinh
ding di chuydn xu6ng dual lam cho phan sau cua ph6i nor ra. Bat ca stir c6 nao lam can tray
ski di chuydn ra truac va xu6ng dttai cua cay phd quan se lam han chd ski gian nor phdn sau cua
ph6i.

2.3. DONG TAC CUA PHOI

Chic nang cha ydu cua ph6i la chaa khong khi de trao d6i khi giita mau va khOng khi. S6
'Yang khong khi trong phoi gOm c6 :
- Khong khi lu'u thong la hiong khong khi hit vao va tha ra hic binh thuang (khodng
500m1).
448
 —Khong khi da tra la luting khong khi daqc tong ra them khi tha ra het stic (khocing
1.500m1).
—KhOng khi phi them IA lurorng khong khi dutc dila them vao khi hit hat stic (khocing
1.500m1).
—Khong khi can IA khong khi van can lai trong ph6i du da tha ra het sac (khodng
1.500m1).
TOng so lacing khong khi nhu' tren ma pheii cif) the clola dutc goi la dung tich ph6i (khocing
5000m1). Dung tich ph6i tit di lutng khong khi can goi la host lutng ph6i (khodng 3500m1
notai ion khde manh).
S6 Ian that trung binh trong mot phut a ngaqi lon la khoang 15 va a tre so sinh IA khoang
40. Tan s6 nay thay doi thy theo hic lao dOng nang hoac trong cac trung hqp b'enh
DOng tdc thei cua ph6i dacic that hien nhei ski thay ded the tich cua king ngac do tac dOng
cua cac ca, da'c biet la ca hoanh. Ph6i gian na dutc la do tinh dan h6i va x6p &la nhu mo ph6i•
cOng them mot dac diem rat quan trong la mang ph6i tang va mang ph6i thanh luon luon ap
sat vao nhau va twat len nhau de dang nh.6 dp lac am trong 6 mang ph6i va sit hien dien mot
chat nhin gift hai mat mang ph6i ap nhau. Trong tweing hqp .co dich (tran dich mango. WO
hoac co khong khi (tran khi ?Ong pita trong o mang ph6i thi ph6i se kilo hoac khong gian nei
dutc, gay kilo the'.
Tweing hqp ngat tha dO tai han nha dien gist hoac chat du6i thi co the lam ho hap
nhan tao bang each th6i. khong khi qua main hoac. mui nan •nhan. CO the cat be mot ph6i
hoac hai thay. cua hai ph6i ma. khong anh tiding tai tinh mang vi phan ph6i con lai se dan ra
de bu lai.

3. HINH ANTI X WANG QUA HE HO HAP

• CM.' tao dm' cac ca quan cila•he.ho hap .da 'dace m6 ta.ltST 0 cac bai Wang ang nhu'
hau, thanh quan, khi quan va ph6i. O day, chi xin trinh bay ve hinh anh X quang cua ph6i
. (H.58.4). •
Tut the thating chap hoac roi ph6i là W the nhin tit phia trade. Tren 'phim, chOng to se
nhin that' hai ben la hinh trong sang dia phoi quay lgy bong, mar cua tim o giiia. Ph6i sang vi
ph6i chaa nhieu khong khi nen it can tia X han tim. O gan phia Binh ph6i co bong xutng don
cat ngang chia thanh hai phan : phan tren don va phan 'dad den. O phan clued don con co
bong &la cac xu'ang siiarn. Dac bit d hai ben bong tim trong khoang tit xu'ang stiOn II dan
'along satin V co hai ddm mo sam, do la r6n ph6i. Bong r6n ph6i trdi be han, hep han va cao
hoe bong then ph6i phai. VI rein ph6i tea ra xung quanh cac vat- mei dan, do la cac thanh phan
pha . quan, mach di vao r6n ph6i r6i tOa nhO dan trong phoi. O hai ben phia ngoai ddy ph6i c6
hinh mot goc nhon, do la nge.ch sutn hoanh cua mang ph6i (H.58.3). Neu mat DSc nhon nay tac
la trieu chang Cita tran dich mang phoi. Cdc hach bath huyat &la ph6i thliOng khong nhin ro
tren phim X quang, tra cac tradng hqp benh 13 hach to ra hoac hach bi voi hoa.
449
 Phan ph6i tren )(acing dOn
Cung ddng mach cha

Xudng don
Cung cidng mach phdi

Cung tint; mach chit tren

Rein ph6i

Phan ph6i dtidi don

Cung tam that trai

Venn hoanh
Cung tam nhi pha'i

Ngach soon hoanh

Hinh 58.3 : Hinh dnh X quang ctia phdi (sa coo)

Hinh 58.4 : Hinh cinh X quang ctia tim va phdi

1. Rdn phdi 2. Phdi 3. Tim 4. Vzing dinh phdi
5. Co. hocinh 6. Ngcich sdan hoanh

450
 CAU H6I TRAC NGHIEM
Chon cau tra 16i dung nhgt

.627. Hoat luvng phifii là :

a) Luvng khong khi luu thong.
b) Lu'ong khong khi du' frit.
c) arcing khong khi phu them.
d) Layng khong khi can.
e) Tgt ca deu sai.

628. Thanh phdn nao sau day KHONG thu'Oc he th6ng ddn khi cua he ho hgp :
a) Mui, hdu. d) Ph6 quan.
b) Khi quan. e) Phe nang.
c) Thanh quan.

451
 59 HE NI E U SINH DUG

MIX TIEU BAI GIANG

1.Ve set dd he tigt nieu, he sinh duc nam va he sinh due nil.
2. MO to qua trinh phat trien phoi thai cua he sinh duc nam va he sinh due nil de giai
thich cdc di tat bem sinh.
3. Xem va giai thich hinh anh X quang cUa he sinh due.

Ca quan tigt nieu va sinh due lien quan mat thigt voi nhau ve pinking dien giai phAu va
phat tridn nen thudng duac goi chung la he nieu sinh due. ca hai gidi, he tigt nieu bao gom
hai than, hai nieu quan, bang quang va nieu dao. He sinh duc bao gem hai tuygn sinh due (tinh
hocin hoc budng trang), met he th6ng 6ng da'n cdc td bao sinh due (tinh tretng hodc noari) va
ca quan sinh due ngoai. Cf nam, tinh trUng ra ngoai qua &tang nieu dao, chung vdi he tigt nieu.
nit he tidt nieu va sinh duc tach bi'et nhau.

HE TIET NIEU

1. THAN VA NIEU QUAN

Cl ca hai gidi, then va nieu quail khong CO sit khdc nhau quan trong. Then nam d wing
bung, sau pink mac. Nieu quail dan nude tidu of bd than xu6ng tich clnia a bang quang nam
trong van.g chau (H.59.1).
Nurdc tidu dive thanh lap a than tit luau. Khi mdu di qua cdc tidu thd. than, a viing vo then,
dich lac se thgm qua cdc tieu the than vao trong he dieing 6ng Wan, tai day tiep tuc eel met qua
trinh tai hap thu va bai tigt met s6 chgt, sau do dich lot se di qua he th6ng eing thu thap d vimg
bay than va sau ding dO qua ede dai then vao be than; d day dich lac mdi tra thanh nude tieu•that
sii va duac nieu quan &an ye bang quang nha tee Ong co that nhu clang cua nieu quan..
Khi nieu quan bi tac nghen, hie den than van tip tuc san xua't nude tidu. Sau do dgn khi
dp lye trong he th6ng 6ng sinh nieu tang len (do tdc nghen ben ditoi) dgn tau hay nhu mo
452
then thi kha nang ch6 ti6t nude ti6u se khang can. NgLiai ta co thd sting du'oc n6u bi 14 di met
then. Nhung khi mat ca hai then thi khang thd song duac vi cac ccs quan co chile nang bai ti6t
khac nhu' da, phoi, gan, ket trang Ichang thd lam thay chile nang &la then duoc.

2. BANG QUANG VA NIEU DAO

Bang quang IA met tdi co' rang, nhen nude ti6u tit then qua hai nieu quan va tich chila
nude ti6u trong thai gian gida hai 16.'n di ti6u. Khi rang, bang quang nam hoan toan trong vimg
cheu. C1 nam, bang quang nem trudc trip trang. O MI, bang quang nam trudc tit cung va am
dao. Khi bang quang chda met Wong nude ti6u tit 200 ml trot len thi nguai ta co cam gide mac
tidu va khi do, co trail caa bang quang se co that dd tong nude tidu qua nieu ciao ra ngoai.

Tinh mach chi') dddi

Than phai

Alrau quan phai

Bang quang

L6 nieu quan

Alrau ciao

Hinh 59.1 : So' dd he tiet nieu

C1 nit, nieu dao ngan, nam dinh vao thanh truck am ciao va de ra a tin dinh am he. Cl
nam, ngay ta' c6 bang quang, nieu dao throe bao boc bai tuy6n tin liet. Khi tuy6n phi dai CO
thd gay ti6u lihO hay bi ti6u hoan toan. Tai doan tin liet nay, nieu dao ding nhen hai eng
phang tinh (cda chteing clan tinh) va tit day dating ti6t nieu va sinh duc hop Chung vdi nhau. Ra
khoi tuy6n tin het, nieu dao di xuyen qua met vach caa day cheu rai vao duang vet va ten
ding a quy Tau duang vet.
453
3. HINH ANH X QUANG DU'ONG TIET NIEU
Ngudi ta co the they dupe hinh clang caa than, dai be than va nieu quan bang each chup X
quang than vdi thu6c can quang barn qua clueing tinh mach. Phuang phap nay cOn cho ta bik
chic nang bai tiet caa. then (H.59.6).
Hinh a'.nh &la cac dai then, be then ding nhu nieu wan cOn du'qc nhan dien bdi phudng
phap chup X quang he nieu ngu'qc deng vdi thu6c can quang barn nguqc tit dudi len qua met 6ng
thong cho qua 16 nieu (pan.
Hinh anh cda nieu dao va bang quang duc nhan dien bdi phu'ung phap chap nieu quan
bang quang ngu'qc dOng.
Vdi cac phuang phap nay, ngudi ta c6 the than doan du'qc met s6 benh cua he tie-t nieu.

HE SINH DUC

Lac phOi thai, cu quan sinh duc nam va nit deu Oat sinh tit trung than, v sinh due, 6ng
trung then va 6ng can trung then.
Trung then cling nhu' then la hai tang nam trong vOng that lung, sau pink mac, doc hai
ben cot song. Trong trung then c6 nhieu 6ng, cac 6ng nay sau d6 tap trung vao met 6ng chung
la 6ng trung than. 1J sinh duc nam d phia trong va phia tren trung than va dinh vao vOng ben
bdi day chang biu (gubernaculum testis). O phia ngoai trung then là 6ng can trung than thong
vdi 6 pinic mac d phia tren (H.59.2).

Trung than
Ong can trung than
Nieu qugn

Ong trung than

Nia u nang

Tajo trang

,
0 nhdp

Hinh 59.2 : Ca quan nieu-duc luc phoi thai

Hai 6ng trung than va can trung than phia dudi de vao 6 nhdp. Sau nay trong qua trinh
phat trien, d nam u sinh duc se trq thanh tinh hoan, 6ng trung than se bio'n thanh mao tinh
va cac 6ng tinh; 6ng can trung than se thodi hoa; d nil v sinh duc phat tri6n thanh bueng
thing, trung than va 6ng trung than se thodi h6a, 6ng can trung than se phat trign thanh vOi
tit cung, tit cung va am dao.
454
1. St! HINH THANH Ci QUAN SINH DUC NAM

Ong can trung than U sinh dyc

Trung than

Ong Lung than

Day chang biu

Thanh bung

Ong tti cung am ciao

Tdi tinh

Ong clan tinh Toi bit tuygn tin fiat

Mao tinh

Ong mao tinh

Md'u phy mao tinh

Tinh hoan

Hinh 59.3 : Sa do su' phat trien ca quan sinh duc nam

455
 U sixth due phat tridn thanh tinh hoar'. Trung than va 6n.g trung than troy thanh mao tinh
va 6ng dan tinh. Ong can trung than teo di va de" lai hai di tich, met a dau tren là mau phu
tinh hohn nam d dau mao tinh va met a dau duoi la ttli bit (tdi bdu due) tuyefn tien liet Wong
to nhu am dao va tit cung d lid (H.59.3).
Tinh hoan, trong qud trinh phat tridn cung di chuyen tit 6 bung xu6ng biu. Su di chuyen
nay xdy ra la do su phdt tridn qua nhanh va khang dengdeu cUa cue tren so vdi cue du'cli cua
deng theci có the do tdc dung cUa day chang biu. Khi tinh hoan di xu6ng biu, met tdi phtic
mac cung song song di ding va sau do thanh 6ng phlic tinh mac. Ong nay ve sau se bit tdc a
loan trong thong tinh de ngan each 6 phdc mac a tren vdi 6 tinh mac a duai. Trong tru'ang
hqp bat thuang, tinh hoan có th6 khong di chuyen xu6ng biu hay di chuyen dd dang gay ra tinh
trang tinh hohn an hay tinh hoan lac ch6. Ong pthic mac tinh n6u khang bit tdc lai se gay ra
thoat vi ben barn sinh (H.59.4).

Thanh bung

Tinh hoan 6 phdc mac

Phew mac

Day chang biu

Biu

Ong phOc tinh Khoang tinh

mac mac

Hinh 59.4 : Sa d6 sz phdt trien cua tinh hodn

2. K' HINH THANH co QUAN SINH DUC Nij

di nit, trung than se teo di va de lai hai di tich là vat tren bung trung (epoophoron) va
6ng canh bung trying (paroophoron). Ong trung than mat han, có khi can d6 lai met mau phu.
Ong can trung than hai ben se phdt tridn va hap lai a duai thanh met eing chung la 6ng tit
456
cung - am dao, sau nay se phat tri6n thanh tit cung va am dao. Phan tren cua 6ng can trung
than (doan khong dinh nhau) se tra thanh voi tit cung. Day keo bu'Ong (gubernaculum)
m'Ot, phan troy thanh day chang trim, mot phan thanh day chang rieng buong trdng (11.59.5).

if sinh duc

Ong can trung than

Trung then

Ong trung than

Ong tU cung am d?o

1) sinh dyc

Trung then

Ong can trung than

VOi tit cung

Vat tren buong trang

Buong thing
Ong c?nh buong trang
TU cung
Day chang tr6n

Hinh 59.5 : Sa de; sr phdt trien ca quan sinh duc niZ

3. HINH ANH X QUANG HE SINH DVC NU
Co the chup hinh the trong cua tit cung va voi tit cung bhng cach bum cac chat can quang
vao 6ng c6 tit cung, bu6ng tit cung va voi tit cung de ch6n doan cac benh cua tit cung nhu u xci
hoc cac benh cua voi tit cung nhii tac voi v.v... (H.59.7).
457
 Hinh 59.6: Hinh cinh X quang cda &tang Hinh 59.7: Hinh cinh X quang cda tzt cung vet vett
• bed tie't nark tieu ttl cung sau khi burn thuo/c can quang
1. Ddi nho. 2. Ddi lon .1. Budng tit cung. 2. Ong co tti cung.
3. Be thdn. 4. Ni@t quern .3. Lo tti cung czia voi. 4. VOi tit cung.

CAU HoI TRAC NGHIEM

Chon cau tra lqi 'Ring nhat

629. Nude tidu duvc hinh thanh that sui tit :

a) Tigu thg' than. d) Ong thu nhap.
b) Ong luqn. e) Dai than.
c) Quai Henle.
Dung bang tra 1 i sau d tra 1di cau 630 den cau 636.
a) Dating dan trUng.
b) Tinh hoan.
c) DuOng dan tinh.
d) Phan 6ng can trung than bi thodi hoa.
e) Phan 6ng trung than bi thodi hOa.
458
Ghep cac phan có lien quan with nhau.
630. U sinh due :
631. Phan khong thoai hoa cila (ing trung than :
632. Phan 'thong thoai hda cda Ifing can trung than :
633.Tdi bit (tali bau duc) tuye'n lien lilt :
634.Am dao :
635. Ong tinh va tdi tinh :
636. Ong canh bang thing :
(xem them beti 42, 43)

459
 60 H E NOI TIEPT

MIX TIEU BAI GIANG

1.Neu dac didm cua cac tuydn nei tidt.
2. Kd ten cac tuydn nei. tik.
3. MO to cau tao va chile nang ciia ding tuydn nOi tidt.

He nOi tik gom cac tuydn nOi tik tik ra cac nOi tidt to (hocmon) dd tham gia vao sit didu
hoa cac hoat dOng cua td bao va diet' khidn cac hoat &Ong chuydn hoa. cua co the.
W mat giai pilau hoc, khong gi6ng cac he khac go'm nhiing ca quan ldn lien quan mat
thidt vdi nhau, he nei tidt chi Om mot s6 tuydn nhO nam rai rae a nhidu yang khac nhau
trong cu the va khong lien quan vdi nhau vd mat giai pha."u nhung lai lien quan chat the vdi
nhau vd mat sinh ly.
Cac tuygn nei tidt, có nhung dac didm co' ban sau day : met là cac chat tidt cua cluing dO
thang vao mau ma khOng qua met Ong tik nao cho nen cluing con dutc goi là "tuydn khong có
Ong tide (glandulae sine ductibus), hai la cac chat tik cda chting goi là hocmon hay nei tik t6
là nhung chat hoa hoc vii s6 lutng tik rat nhO nhung lai có tac dung rat lin trong six chuydn
hoa, sit phat tridn cua co thd va sir sinh san, ba là tuy kick thu'dc tuyen thutng la nhO nhung
lai có rat nhieu mach mau cap huydt.
He nei tidt g6m nhieu loai tuydn. CO nhung tuydn ban than la met co quan rieng biet nhu
tuydn yen, tuydn giap trang, co nhung tuydn chi IA nhung dam to bao tap trung trong mot cct
quan khac nhu cac dao tuy (ddo Langerhans) a trong tuy hoac cac td bao ke (te bao Leydig) a
trong tinh ham, lai c6 nhung cor quan cung lam chile nang nOi tik nhu gan, than, runt va sau
ding có nhung ca quan cittqc goi la nOi tidt nhu tuydn bung va tuydn sic nhung elide nang nOi
tit chua dutc bidt mot each ro rang (H.60.1).
460
1. TUYEN YEN.

Tuyen yen (hypophysis hoac glandula pituitaria) nhu cla ma to a bai Gian nao nam a san
nao that III trong h6 yen ctia than xu'o'ng bu'am.

Tuygn tang
Tuygn yen

Tuygn giap trang

Tuygn tic

Gan
Tuy
Tuygn thdcing than
Than

Budng trang

Tinh hoan

Hinh 60.1 : Sa dó ccic tuye'n not tie't chinh cua co. the

Tuyan yen du'oc c6u tao bdi hai thUy có ngu6n g6c khac nhau. Thiry truck (lob us anterior) con
goi la tuyan yen tuy6n (adenohypophysis) co ngu6n g6c tii ngoai bi & thanh tren cua hau. Thiry
tru'Oc duoc chia thanh ba phan : phan ph'eu (pars infundibularis), phan trung gian (pars intermedia)
va phAn xa (pars distalis) con goi là phan hall (pars pharyngea). Thiry sau (lobus posterior) con goi
la tuyan yen than kinh (neurohypophysis) có nguein g6c tii ngoai bi than kinh (H.60.2).
CO num va

Ngach thi giac

CO phe'u
Giao thoa thi giac
Ngach phgu

Phan ph'eu
Hoanh yen

Theiy tru'cic
Phan
Thely sau b
0 trung gian
0 0 0 6 0o b
00 0
0 0
00 Phan hau
t 0 0

Hinh 60.2 : Ulu tao ctict tuye'n yen

461
 Thiry sau tuyen yen tiet ra hai hocmon chinh la : vasopressine c6 tac dung thong lqi nieu
va oxytocine co tac dung lAm co b6p cc trail. cung.
Thiry trutc tuyen yen c6 tinh chat la met tuyen thuc sit va tiet ra rat nhieu loci hocmon
ma cho tai nay nguti ta con chca biet het. N6i chung cac hocmon cud thily truck tuyen yen
tham gia vao rat nhieu hoat clang quan trong nhu quyet dinh sir' tang trutng cila cc thg not
chung, six tang trcang va phat trign cac tuyen sinh duc v.v... Dac Wet cac hocmon cua they
truck tuyen yen c6 tac clang qua lai vdi Mu het cac tuyen not tiet khdc dac biet là tuyen giap
trang va tuyen thccing than, vi vay nguti ta goi tuyen yen IA nhac twang trong dAn nhac he
cac tuyen nal tiet.
Bang thuc nghi'em va tren lam sang, nguti ta thy neu thieu hocmon tang truang cua thily
trudc tuyen yen se gay nen neing tang tru'ang a &Ong vat hoac tre em va ngu'oc lai net' thda
hocmon tang twang se gay nen phat trign qua mtic thanh benh ngudi kh6ng 16 hoac nguOi• to
dau va chi.
2. TUYEN GIAP.
Tuyen giap (glandula thyroidea) nhc da mo td d bail 23 là met tuyen na'm a trade phan
tren khi quan gem hai thily va met eo tuyen. Tuyen giap mAu nau dO duce cau tao a ngoAi bdi
met bao xo, trong là cac tai duce vay quanh bdi cac to bac thutng mo. \Pe mat phat trien,
tuyen giap xuat hien a than le that tu cua bao thai nhu met tai ar thanh trutc dm Mu gia cung
mang thd nhat va cung mang thd hai. Di tich con lai cua tai nay lA 18 tit (foramen cecum)
dinh ranh chit V ctia mat tren luti. Doi khi con ten tai met 6ng not gida lutori va tuyen giap goi
là 6ng giap - (ductus thyroglossus).
Hocmon cUa tuyen giap c6 chola i6t. Vi vay khau phan c6 chda i6t rat can thiet cho viec
tan ra hocmon giap trang. Neu Ichau phan thieu i6t, tuyen giap phdi tiet nhieu hocmon de bn
vao, do do se phinh to ra tao thAnh phinh giap. 0 nhieu nitric tren the gidi ding nhu met s6
\rung o nuac ta c6 nhieu nguti bi phinh gidp là do trong nude an u6ng thieu chat i6t.
Tdc dung chi' yeu &la hocmon tuyen giap là tham gia vao viec gift chuygn h6a co bdn.
Thigu nang tuyen giap a nguai lan se lam giam chuygn h6a cc ban, than nhiet ha, mach cham,
mat phi va ngutti dor clan, cham chap do thigu nang tam than. 0 tre em, thieu hocmon giap
trang se dnh huang den sot phat trign ca ve hinh thdi Ian tam than gay nen chdng lun va clan
don. Ngutc lai, neu cut ng tuyen giap qud nhieu hocmon gidp twig) se lAm tang chuygn
Ma cc ban, gay, mach nhanh, de bi kith Ong va 16i mat (bOnh Basedow).
3. TUYEN CAN GIAP.
Tuyen can giap (glandula parathyroidea) thutng c6 Mn tuyen : hai tren va hai dual, nh6
bang hat gao nap nam a ngay mat sau cua tuyen gidp nhang lai khac tuyen giap ca va nguo'n
g6c fan sinh 13'r. Chung xuat hien tit not bi cua thAnh tai mang thd ba va thd tu va sau do mai
gan lai tuyen giap.
Hocmon cua tuyen can giap tham gia van viec chuyen h6a chat canxi trong cc the.
Neu thieu se lam gidm canxi trong mdu gay r6i loan hoat dung cua cc va than kinh trong
Mnh tetani, lam co quip bAn tay. VI vay trong phau thuat cat ba tuyen OAT can chd
462
gill lai tuye'n can giap. Nguoc lai, ndu thira hocmon tuygn can gidp (14 du trong tru'ang h,ap u
tuye'n can giap) thi tS'T la canxi trong mdu se tang len do canxi tit xttong chuydn vao, kdt qua
lam xoang de bi gay.

4. TUYEN TH1UVNG THAN.

Tuydn thuong than (glandula suprarenalis) da dugc ma to trong bai Than, la hai tuydn ram a
talc tren dia. than. Tuydn gam nhiau thitng to ban finking mo vai rat nhieu mao mach gida. cac
thitng do. Tuydn du'oc chia lam hai phan rat ro rat là phan vo va phan tuy. Giotng nhu hai thily cUa
tuydn yen, hai phan v6 va tuy cua tuydn thuong than rat khdc nhau ca ve nguan g6c Ian sink 13.
Phan tuy bat ngu6n tut nhung t'6 bao ngoai bi cUa mao than kinh gio/ng nhu nguan g6c cda
cdc hach giao cam canh song. Con phan \To thi lai xuat phdt tit lap thuong mo cua xoang ca thd
gi6ng nhu tinh hoan va bungthing.
Phan tuy tidt ra epinephrine va norepinephrine tdc dung len car trim gifing nhu than kinh
giao cam, con phan va thi sinh ra hai hoac ba hocmon loci steroit nhu aldosterone,
corticosterone va hydrocorticosterone tham gia vao su chuydn h6a &tang va cdc chat dian gidi.
Thoth h6a tuydn thuang than se gay nen banh addison lam banh nhan bi den xam. da, 6i
mita, suy nhucic ca. Nguoc lai qud san hoac u cua v6 thu'ang than lam san sinh qud n.hieu
hocmon steroit gay nen day thi sam a tre em va thay d6i giori tinh or nguai loin v.v...

5. TUYEN ec.
Tuydn tic (thymus) da du'oc ma to a ph.dn trung that g6m hai thily phai va trdi narn. or
trung that tren va trung that trade. Tuydn tic rat ldn a tre em, dat kith thudc tai da 10c 13, 14
tudi va thodi hoa sau hie day thi.
Tuydn tic c6 ngu6n g6c tit phan bung caa tai hau this tu, xuat hian vao tuan le th.0 tu cua
bao thai, canh tuydn can gidp this ba.
V'e chile nang, tuygn tic gi6ng nhu cdc mo lympho, phat ,trien manh a nguai tre. Tuy ntnen
tinh chat not tidt dm no con chuar6 rang va clang ban ca.i. 0 dOng vat, tuydn dc rat can cho sit
phdt tridn td bao lympho trong cdc mo lympho va la ngu6n cung cap cdc td/ bao co chi c nang
tao ra khang the, do do clang vai tra quan trong trong ha th6ng mien dich.

6. TUYEN TUNG.
Tuydn tong hay thd ding (corpus pineale) da duoc not tdi d phan gian nao la mot vat hinn
qua tong to bang hat bap.
Tuydn du oc boc bed mat bao to chtic lien kdt xd, trong la cdc to ban thuong mo ca ngu6n
geCc tit cdc to bao mang nao that III.
Tuydn ti ng xuat hian vao thdng thd hai cua dai song bao thai. Co ba ttii phat tridn a
mai cua dai nao gan trung nao. CI nguai, hai tdi trade thodi hoa con till sau phat, tridn
thanh tuydn tang.
Cung gieing tuydn dc, tuydn bung tuy duct coi la mat tuydn nai tidt nhttng chdc nang chun
ro rang. Nguai to da phan lap cluoc mat chat h6a hoc goi la melatonin trong tuydn bung. Chat
463
nay co tac dung lam co chat melamin (scic to den) trong to ban sac to. Con ski phat duc sam do
ton thuang tuy6n tong thi c6 le do cc!, sir' lien he yeti cac trung khu a viing clued thi.

7. CAC PHAN NO! TIET cua tuy, tinh hoan, bung trilng va mot s6 cac tang khac da &roc
mO to a cac co quan Wong ling.

8. CAC TIEU THE CANH (glomus caroticum), TIEU THE CHU (glomus aorticum), TIEU
THE CUT (glomus coccygeum) cling co th6 x6p vao he not tigt vi co cau tao Ira chile nang
gi6ng nhu phan tuy ctia tuy6n throng than Om nhieu mo u'a chrome.

CAU HOI TRAC NGHIEM

Chon cau tra dung nhdt

637. Dac diem cua cac tuy6n not tigt là :

a) KhOng c6 Ong ti6t. d) a, b, c d6u
b) Chat ti6t la hormon. e) Chi c6 a, b dung.
c) CO nhieu mach cap huy6t.

638. Thiry sau tuygn yen :

a) CO nguOn g6c tit ngoai bi cua
b) Co ngu6n g6c tit ngoai bi than kinh.
c) Tigt ra vasopressine va oxytocine.
d) a va c dung.
e) b va c thing.

639. Thanh phan nao sau day KHONG thuOc he not ti6t :
a) Tuy6n dc, tuy6n tUng.
b) Cac ti6u th6 canh, chi'', cut.
c) Tuy6n nhay a mieng hau.
d) Tuy6n thu'ong than.
e) Tat ca deu sai.

464
 61 HE THAN KINH

WIC TIEU BAI GIANG

1.M6 to ca.0 tao cila met noron.
2. M6 to sit phat sinh chi ng loci va phat tridn plied thai caa he than kinh.
3. Ke ten cac phan caa he than kinh trung acing va than kinh ngoai hien.
4. Ve sa do cung phan xa don gian dd giai thich ca sa hoat Ong cUa he than kinh.
5. Mo to cac du'Ong dan truyen than kinh 16n.

1. DAI CthJNG
He than kinh (systema nervosum) thqc hien sit th6ng nhat gitla ca the va mei trtOng ben
ngoai va dieu pho-i hoat dung tat ca cac co quan va mei tru'ang ben trong ca the nha tinh cam
img, met trong nhitng tinh chat can ban cUa chat song. Kich thich thu nhan tit cac gide quan
va cac cam thu quan doge phan ang tra lai (lam ca co, /dm tuye'n bat cac cau tao than
kinh trong tiing ca quan den tan cac mo.
He than kinh c6 cau tao tien h6a nhat va cao cap nhat. Do do ca the phan anh met each
tinh to va dap ling thich hap nhat d6i vdi moi kith thich ben ngoai hoac nhi-mg Nen d6i nei
mei trutng, bang du'ang chat dich (mad, bath huye't, dich mo ke).
He than kinh gum he than kinh trung acing (ndo b6 vex tay gai) va he than kinh ngoai
bier' (cac day so, day gai vdi cac hach va cac re, ke cd cac ddu tan sung cam gicic va van ctOng).
Dan vi giai phdu ciia he than kinh la naron.
Hoat Ong ciia he than kinh dip tren cung phan xa (XOsendp va Pcip-ap) va Ong phan xa
(Anokhin). Dila vao chile nang, he than kinh con dutc phan biet thanh he than kinh bar chi
(symtema nervosum autonomicum) con dutc goi bang nhCing danh tit khac (thltc vat, tang, not
tang, ca quan, khong ta He tit chi nay phi trach haat dung cua cac tang, tuyen, mach
mau, qua trinh trao d6i chat va hoat Ong ngoai y mu6n.
465
2. S1V PHAT THAN CU' A HE THAN KINH TRUNG

2.1. Vk PH-LSO-NG DIEN GIAI PHAU HOC SO SANH (cluing loci phat sinh) (H.61.1.).
DOng vat don bdo khong c6 he than kinh rieng, kith thich ben ngoai tac Ong ngay len
bao Wong phia ngoai. DOng vat da bcio cap thdp c6 vai to bao biet h6a goi la te bao than kinh
cam thy, tit do hinh thanh mot he than kinh phan tan vdi nhdng te bao rai rac n6i nhau bang
cac nhanh hdp lai thanh lath : ludi than kinh they tztc). Cf ngLtat, eau to lath a cac dam reii
than kinh cda tang (cac mang lath than kinh d thanh runt) là bang cluing caa giai doan so khai
nay. d cac &Ong vat nhu loci giun cac te bao va nhanh than kinh hdp lai thanh chu6i
(g dm hack vd day thdn kinh). Do do co hien trung giam nhanh &la to bao than kinh va sap
xep theo hiking nhat dinh. Hach do than to bao nhap lai va day do cac nhanh hdp thanh. Giun
c6 cau tao phan d6t nen a m8i dot, day than kinh c6 hai phan : doan ngang not lien cac hach
tong mat dot co the; doan doc lien tut vdi nhdng hach ctia cdc dot lidn nhau. Trong hai chuji
hach than kink cua giun, cac hach a de dot phia dau phat trien nhat, la main cda nao a dc
loci tien h6a hon. Di tich cda than kinh hach nay con thay a chugi hach giao cam a ngoai. Cf
loci san day da co mot hach a dal' va hai day than kinh bung. Tien hoa hon la a ddng vat có
ddy song (chordata) he than kinh CO hach tren tra thanh 6ng than kinh (a ca Luang ti'em) co
phan bong nao va toy gai, tien than eaa nao va thy.
Cac to bao van &Ong xuat hien muOn hon cdc to bao cam giAc va cac cam thy quail. Do 06
cac trung khu va day than kinh van dung cang dude thanh lap cham hon. Cac to bao than kinh
tiep tyc biet hoa vdi sit phan b6 khong deu va tap trung a nhfing digm nhat dinh. }Tang vat co
xaang sting va ngoai co thy gai la phan than cua 6ng than kinh phat tridn thanh. Trong toy
gai cac te bac than kinh tap trung lai thanh lap nhan, nhan nay hinh thanh nen cac dao chat
xAm nam trong chat trang, do sqi than kinh tau thanh. Sit hinh thanh toy gai c6 tac dOng den
qua trinh hoan thien co quan van dung (he co. xuang). Sau da nao bO ducic hinh thanh theo sit
hoan thien cdc cam thy quail. CA luting tiem chi co cam thy quan anh sang va khdu gide, cac
giac quan khac se phdt tridn them a &Ong vat c6 xuking sting. nao 130, cac than te bao than
kinh hinh thanh lap chat xam boc ngoai chat trang : vO nao. MOt s6 nai cua nao bO lai co mot
so to bao sap xep 'thong deu trong chat xAm hay ch6ng choo nhau trong chat trang goi la to
chdc ludi. Mat s6 to bac tap hqp thanh cac nhan xdm a nen nao phi trach cac hoat d'Ong ban
nang, trong khi vO nao phat trign manh tra thanh trung tam dieu khidn cac hoat dOng tap
tinh. VO nao xuat hien a lap 'Ong the, bo sat va a dOng vat co vu thi phat trign cao c10. Ci
ngutri, vO nao tien h6a nhat.
Tom lai quA trinh tien h6a cua he than kinh phat tridn tit don gian den phdc tap, W phan
tan den tap trung. dOng vat co xuang song, he than kinh co cau trot tang (gem cdc thanh
phdn cda cdc giai doan chiing loci phdt sinh khdc nhau). CAc cau true nay phu thu0c nhau lien
he nhau nhac 14i tinh chat phan d6t cda co thg thanh cac dot than thg. He than kinh ding co
sot phan dot, m6i dot than kinh Wang Ling vai mat Mt than thd (hocin tiet). Thi du : m6i re
trade dm day than kinh phan nhanh de van do, ng cac co co cling ngu'On geic volt no tit mat dot
co nhat dinh (myotome) va mgi re sau cling cam gide IT* d6t bi da Wong dug. Do da be mat da
va he co duqc phan Wet thanh nhieu doan cluing len nhau Wang Ling vai pham vi phan b6 cac
re trade va re sau cua day than kinh gai sting va day so.
466
 Khdu nao

Nao thi

O
A Dang &al th5n kinh
(COELENTERES)
Dang phan cleft (SERPULA)
(HO than kinh d phia bung 0 Dang hach giong nao
da biet h6a (NEREIS)
va chua co xoang)

HO than kinh phia bung

(ENTEROPNEUSTE)

HO than kinh phia king

(AMPHIOXUS)
Tut nao
0 Dang c6 hach gieing nao
(CONVOLUTA)
Co quan
khdu giac
Day song

Ru6t

Hinh 61.1 : Cluing loci phcit sinh he thein kinh : Ccic clang caa h0 than kinh
467
 Tay gai là trung tam phan xa than the va nal tang, bidu hien cu the &la su' dap Ling vdi
chdc na.ng dm ca the phan d6t. Do do kham lam sang td mat doan than the co the nhan biat
tinh trang &la doan tay Wong dng.
Than rid() có ngu6n g6c tit tram nao va nao gida (giai doan 3 bong nao) vita là trung tam
van clang cac clang tac tut Tang (di chay) vita là trung tam die'u hoa cac hoat clang not tang quan
trong cho doi song (ha hdp, tim mach...) dam bao co the thich nghi tot nhat vdi mai trtiOng.
Dieu nay vo ding quan trong a loci ca, hidng the, ba sat, loci chim vi co mat to chtic rat
quan trong a trung nao (nao gi0a, mesencephalon).
Ti'du nao phat trier' thy theo stt van clang caa clang vat co )(dung song. CI loci ca,miang
trail (vien khdu) chi là the' nhi (auricula) se tie-n hoa thAnh they (flocculus) ye sau. 0 ca CO
vay boi, tidu nao co them they nhang (vermis). Ban cdu tidu nao xuat hien sau cang a clang vat
co xu'ong song trail can. Ban cdu tidu nao dac bit phat trim a ngadi lien quan vai tir the citing
thang va chuyen bit hoat clang chi trail. Do do tidu nao co ba phan tidu nao mai
(neocerebellum) g6m phdn lan ban cdu tieu nao, tidu nao ca (paleocerebellum) là they nhang va
tidu nao co (archeocerebellum) IA the nhi.

lap ca

Moo

Tho
Hinh 61.2A : Tie'n hoa town the cac bong nao tit cldng vat có xuang sang cap thdp tai nguai
468
 Nao tru'dc co eau trdc tang d giai doan 3 bong nao se phat trien thanh gian nao
(diencephalon) va cac ban cau nao, quan trong dan tit lop 136 sat, chim va dung vat c6 vu. VO
nao &roo cau tao hai phan a hai tiled ky goi la do nao nguyen thdy nhan bigt mai vi (khttu nao,
rhinencephalon) phat trien ddn trong &Ong vat c6 vu. Sau dO thodi h6a clan va giCi vai tro trong
sinh ly cac nhu cau (an uo'ng), ban nang (sinh sdn) va not chung la tap tinh hanh vi ca the
cac Ong vat co vu cap cao va a ngutti. 0 nguti dO la phan thodi hoa d mat &Ai ban cat' dal
nao. Ao nao mdi (neencephalon) va vo nao mdi (neocortex) 141 phat trien chic dud Ong vat c6
vu cap cao, dac biet d nguti, phti len tat ca cac phan can 14i ctia nao bu (H.61.2A). Ao nao mdi
là co sa dm host Ong coy tilde theo y mu6n, co ca tinh va host Ong tam than nghIa la cac
hoat Ong than kinh cao cap d nguti (H.61.2B).

Ngudi

Hau nhu

•• • BO sat
••
I
I
••
; Lu'Ong the

1 •

• "Pr
'!10
Ca

Ca
Ladng the
elor
BO sat
HCiu nhO

Ngu'ai

Hinh 61.2B : Tibing quan dung luang nao bd, ckic bift la doan nao va
hcinh khriu a cdc d'Ong vat có xu'ang song

Qua trinh phat trien cda nao va cac hoat Ong than kinh cao cap nhu vay da din bign
trong hang trieu nam, da tie-n h6a tai mac loci nguti.
Con ngudi da nhan thdc du'oc chinh ban than va the gidi trong ski thich nghi vdi ngoai
canh. Su' hoc tap, huan luyen thd nuoi thuc chat là sit tao nen nhung phan xa mdi de cang
thich nghi hon vdi mei trutng, phat hien cac quy lust dm the gidi va cang tao moi died kien
thuan loi cho sit phat trien khong ngimg dui song xa hei.
469
 Ngogi phoi bi

Tim thin kinh

Mao thin kinh

Mang than kinh

Ngogi phoi bi

Mao thin kinh

Ong thin kinh

Hinh 61.3 :

Phdt trien phoi thai he than kinh.

Srt hinh thdnh otng than kinh
(phoi 20 ngdy den 24 ngdy tudi).
Hach

Tay

470
 2.2. VP PHIATING DIEN PHOI THAI HOC (ca the phcit sinh).
HO than kinh có ngu6n g6c ngoai piled bi, dau tien là tam than kinh a mat lung phoi, sau
do lam xu6ng thanh mang r6i hai ba mang gdn lai lam thanh Ong them kinh. Phan track ong
phat tridn rat to thanh nao, phdn can lai it thay d6i troy thanh tuy gai (H.61.3).
1■15o giaa
Doan nao
Alao trtidc N5o
Gian nao 12

Alao giCia Trung nao 3 Than nao

Tram nao chinh thilc
Tram nao I Tlniong nao 4 va
Tay nao 5 tieu nao

Doan nao (1)

Ilinh 61.4 : So, d6 phdt trien tett bong nao.

A. Giai doan 3 bong- B vet C. Giai doan 5 bong.

471
 Ong than kinh có 16 tradc va 18 sau &mg lai clan. N6u 16 truck khOng dOng se" sinh tat nao
torch deli (cranium bifidum), tii do ma c6 thoat vi mang nao va thoat vi nao qua 16 h6ng (thuang
a khap sang-trdn, dinh, chdm).
Tat gai sting the dOi. (spina bifida) la do 16 sau khong (long kin kern theo thoat vi mang
nao tily that lung-cling. CO twang hqp chi có mit kin xudng ding (spina bifida occulta) thudng
phat hien tinh coy khi chup X quang cot song that lung-cling.
Su phat trign phOi thai hoc ctia 6ng than kinh theo hai hudng :
—Theo chieu reing : clan de-n sit biet hoa chile nang va he than kinh ngoai bien. Thanh
bung cUa 6ng la ngu6n g6c cac to chic van dung. Thanh ben (trung gian) se cho cac phan than
kinh to chu. Thanh mai là ngu6n g6c cam giac. CO mho hach d phia sau eing than kinh tao nen
hai chu8i hach d m6i ben : chu6i hach so va chu6i hach giao cam.
—Theo chi& deti g6m cac hien tudng phan loan, uon cong, tang twang va day cac kh6i.
Phan dudi cUa 6ng than kinh thay doi it, noi di ra cac day than kinh cUa chi tren \Ta dudi tao
thanh phinh c6 va phinh that lung. Phan tren hay nao hic dau g6m ba bong nao tru'Oc,
sau (giai (loan 3 bong). Khi bong nao tru'dc va sau torch doi them tan nt a, nao co norm bong

Dinh
U6n
cong
Gay -4

U6n
cong

Hinh 61.5. Phcit trien phdi thai he than kinh. Su phan (loan vet cac udn conga nao.

472
(giai doan 5 bong). Day la hien Wong phan doan (H.61.4). Hien -Wong u6n cong d nao la do bi.
hOp so giai han : u6n cong a nao gitla ma g6c ra tru'dc, uon cong gay gala toy gai va hanh nao
cang ma goc ra track, va u6n cong cau d nao sau ma gee ra sau. Hien Wong tang truing va day
cac khol la do sit phat trign to lan cua nao gem mot loat cac dOng tic tachia doi, cu6n troll lai,
day va phti (de yeti gian nao va mot phan nao giaa hay ban cau tie'u nao the mat sau hanh
nao) va dinh lien lai, chang han hai mep gian ban eau (the chai va yam o) (H.61.5).

3. CAC PHAN CUA HE THAN KINH

He than kinh a ngaai g6m c6 110 than kinh trung dung va 110 than kinh ngoai bien. Ngoai
ra con c6 he than kinh ta cha ma trung uang va ngoai bien nam xen ke yeti 110 than kinh trung
u'ong va he than kinh ngoai bien.
3.1. HE THAN KINH TRUNG TIONG
Gem nao b0 va tuy gai
3.1.1. Nao bq g6m c6 :
—Doan nao (telencephalon) tic la hai ban eau dai nao va cac nhan xam nen nao c6 ngu6n
g6c tit phan trade dia bong nao trade (prosencephalon). Trong c6 nao that ben.
—Gian nao (diencephalon) gem c6 d6i thi, yang ha doi va tuyan yen (they sau) c6 ngu6n
g6c tit phan sau cua bong nao traerc. Trong c6 nao that ba.
—Trung nao (mesencephalon) gem cu6ng nao va cac 16i nao c6 ngu6n g6c tit bong nao gala.
Trong c6 tong nao.
—Cau nao (pons) va tidu nao (cerebellum) c6 ngu6n g6c tit phan trade (metencephalon) caa
bong nao sau va hanh nao (medulla oblongata) c6 ngu6n g6c tit tay nao (myelencephalon) tic la
phan du'di cila bong nao sau. Trong c6 nao that IV. Tat ca tao thanh tram nao (rhombencephalon).
Rieng trung nao, cau nao va hanh nao tao nen than nao va nha vay b0 nao se gem ba phan :
than nao, tieu nao va dai nao.
3.1.2. Tuy gai (medulla spinalis) do 6ng than kinh sinh ra. Trong toy gai c6 6ng trung
tam.
Than kinh trung arcing throe boc bai cac ming nao tay c6 chaa dich nao -bay (xem bai Mang
nao tily).
Sau day la bang tom tat cac phan va ngu6n g6c cac phan cua 110 than kinh trung dung.

473
 Caephan nao va tay. PhAn bung (nen) Phgn hing (mai) Cac khoang Ngtuin goc

Doan nao (1) Ban can dai nao Cac nao

(Telencephdon) Cac nhan xam nen lido that ben
Cac mep gian ban eau
Nao trade
p6i thi Mang mai (Prosencephalon)

Gian nao (2) Vung ha dill

(Diencephalon) Tuye'n yen 'TuYgn thug Nao that III
(phdn sau)

Trung nao (3) Cu6ng nao Cac 18i nao CO-ng nao Nao gilia
(Mesencephalon) (Mesencephalon)

Tien nao (4) Cau nao Tidu nao (Nao sau)

(Metencephalon) Tram nao
Nao that IV (Rhombencephalon)

Tuy nao (5) Ranh nao Mang mai

(Myelencephalon)

Tuy gai Phan truccc Phan sau Ong trung Ong than kinh
(Medulla spinalis) tam

3.2. HE THAN KINH NGOAI BIEN

G6m cac re, hach va cac day than kinh ngoai bien g6m 12 deli day than kinh so va 31 &eli
than kinh gai. Cac hach cua than kinh gai la hach gai nam u gall toy con cac hach caa than
kinh so da duoc mo ta trong phan nguyen uy cam gide cua cac day than kinh so. Cac re cua
thAn kinh gai la re track van Ong va re sau cam giac, con cac r6 van do, ng va cam gidc cua
than kinh so da ductc ma ta trong cac day than kinh so Wang iing. Khong ke vung nguc g6m
cac than kinh gian wan, ha.'u het cac than kinh gai con lai a co va to chi tao 'thank cac dam nil
than kinh (dam reii co, dam rot canh tay, dam roi thdt lung va dam refi cung) trade khi• chic
thanh cac nhanh ben va cac nhanh ding de di vao cac vUng Wang thig. Ve c‘u tao, m6i day
'than kinh duvc boc bed mot Mang tren than kinh (epineurium). Trong mang la cac be) than
kinh daac boc bai mang quanh than kinh (perineurium). M8i bo than kinh duac cau tao bai rat
nhieu sari la cac nhanh cua narOn, m6i soi duccc boc bth mot mang goi la mang trong than kinh
(endoneurium) (H.61.6).
474
4. TE BAO THAN KINH DEM
Là met be phan cau tao ph6 bign trong he than kinh, khong co tac dung ddn truyen xung
&Ong nhung rat quan trong trong ski nuoi dung va ho tro. Co hai loci la t6 bao dem 16n va to
bao dem nh6.
Tg bao than kinh dem lan c6 ngu6n go'c chung veld to bao than kinh; gem ba loai la : to
bao dem mang eing nei tuy (ependyma), dem sao (astroglia) va dem it canh (oligodendroglia).
Cac t6 bao dem mang O'ng nei tuy c6 nhanh lam nen dem mo than kinh tao chuyen h.tu dich
nao tuy nh6 long chuyen va tham gia chg ti6t dich nao tuy. Tg bao dem sao lath nen va c6
quan he Mil qua trinh trao dei cholesterin va chg tigt. Te bao dem it canh nuoi &ging, dieu
tigt noron Ira lien quan vdi qua trinh trao del nudc cua dich nao
— Tg bao than kinh dem nh6 g6m nhfing to bao rieng re trong he than kinh goi la than
kinh dem nh6 (microgolicyte) phat sinh tit chat gian bao va lam nhiem vu bao ye. Khong c6
naron nao thigu than kinh dem trong he than kinh.

5. CO Sa GUI PHAU CU A HE THAN KINH

Don vi giai phdu caa he than kinh la naron hay to bao than kinh gem ba loai, data tren so
'Yong nhanh dm than naron la noron don curt, naron Wang chic (hinh T) va naron da cu'c.
M8i naron chi c6 met nhanh true va cac nhanh con lai la nhanh canh. NorOn thay del chil
ygu la 6 nhanh canh; khong c6 nhanh canh (naron don eve), met nhanh canh (naron kid ng eve)
va nhi6u nhanh canh (naron da cite).
Sit phat sinh ciia to bao than kinh theo so do sau :

Thuvng mo thAn kinh

Nguyen bao than kinh Nguy8n bao x6p

Nguyen bao xo'p di cu

•
No ran Tg bao dem it canh Te bao dem sao Tg bao dem' O'ng nei

475
 Mang tron than kinh
(Epinorium)

Hach gai
Mang quanh than kinh Day than
Noron cam giac (Perinorium) kinh
(Hiking tam) ngagi bien
Mang trong than kinh
(Encloncirium)
B6

Dau tan cOng

Miran van clang cam giac
(Ly tam)

Eo Ranvie

Nhanh tryc
Dau tan cep-7g
Soi Bao myelin
van clang
Bao Schwann
(No-ra-lem)

Hinh 61.6 : Sd dd cac thanh phdn czia mot day thdri kinh ngoai bien.

5.1. NHANH CUA CAC NCI RON. Gom hai loaf : nhanh khong có myelin (s0 trdn) va
nhanh có myelin (sqi boc).
— Nhdnh khong co myelin : la nhanh cac noron trong nui tang. ThdOng có 7 - 12 nhanh
true khong có myelin dia nhieu noron hop lai, di trong mot kh6i cac to bao Om it canh (te bao
Schwann). Xung dOng than kinh di cham va do khong co vo boc nen khudch tan trail lam
— Nib:17th có myelin : a ngoai bier' than kinh trung hang va phan gidi han gida nao bu va
tuy gai. DAn truy6n nhanh, chinh xac (60-120m I gidy), co vO boc myelin va ngoai ding la bao
Schwann. Co nhiing ch6 that lai, goi la eo Ranvier. Dating kinh sot có myelin to hon soi khong
co myelin (H.61.6). Dau nhan cam la dau nhanh canh cUa noron cam giac, con dau van Ong la
dau tan ding cUa nhanh true cua noron van Ong.
5.2. XI NAP
Xi nap la ch6 giao tie-p cua nhitng noron. CO hang van xi nap d than mot noron cern thy gai.
Xi nap quygt dinh hiking clan truygn mot chieu cua xung dung. Xi nap dan truy6n xung Ong td
noron cam giac sang noron van Ong. Nhdng neu nhung xung &Ong do ngdcfc chidu thi bi tic che-
tai day. \re hinh thai, xi nap co cau true phan curt dd dam bao sit dan truy6n theo mot hiking.
Xi nap co hai cite : chic thd nhat la dio tan ding cua nhanh true chda nhieu tidu vat va tao
476
thanh chat trung gian (symphatine hay axetyleholin). Chat trung gian chia trong cac bong nha
duOng kinh d = 200 - 500A goi la b6ng xi nap (H.61.7). Cuc this nhat each noron 2 bang mang
trout xi nap. Ckic thit hai co mang sau xi nap do mang noron 2 to thanh. Quang trong o gilra
la quang gian xi nap. Hinh thai chung cua ca hai cue xi nap co thd a nhieu clang : boc quanh t6
bao hoac xep xoay trOn 6c tren north). 2 hoac cult thd nhat lOm sau vao than noron hai.

Mang tnfdc xi nap

Ty the
Nat xi nap ci'm cac
norem khac

Mang sau Phgn keo dai sdi truc

xi nap (no'ron (noron 1)
Bong xi nap

Quang gian xi nap

Hinh 61.7: A. So* coo kieu xi nap dien hinh.

B. Cdu true sieu hien vi mot xi nap.

Xi nap cluoc phan lam nhieu loai : xi nap true-than, xi nap truc-canh, xi nap truc-truc va
xi nap canh-canh.
Xi nap co thd ch6 tiet ra mot s6 chat, nhat là gian chat. Gan day dal chting minh du'oe cac
chat ch6 tiet cila Doren, duqc tong hop tit than va dan ra theo nhanh true cl6n tan tong nhanh
true r6i sang mao quan. Bay giO chat tiet tra thanh cac kith to hoat haa di khdp cc the, khOng
tac Ong len noron 2 ma len cab() phan hay cc quan (dieu tiet sm?a, nu& tieu).

6. S11 DAN TRUYEN VA TAI SINH MO THAN KINII

6.1. SI). DAN TRUYE'N.
Cac xung d6ng than kinh tit than noron di ra nhanh truc theo kidu lan song, cac song
xung Ong chia nh6 va cac nhanh va truyen theo tot d6 khac nhau.
Hien tu'ong dan truy6n than kinh kha phdc tap. Qua trinh dan truy6n xung Ong tieu hao
nang luong lan va phai dew h6i phut. Do do qua trinh dan truyen khong ngat quang va c6
tinh chu ky. Nhung su phut hai nay doi hai phai nhanh (1110-11100 gidy) Ara teCc d6 hai phut
can toy loai noron. CI nhanh to, to-c do dan truyen nhanh, nhanh nha to/c d6 cham va su h6i
phut nang lacing a nhanh nh6 cham hen. N6u xung dOng manh va lien tut d6n cac nhanh nh6
se khong cluoc dan truy6n kip than va xung Ong bi tic ch6 a day. Do do khong phai moi xung
d6ng clew &roc lan truyen toan b6 he than kinh tuy rang clning lien lac nhau chat che.
477
 6.2. TAI SINH.
Truck kia, do noron da biet hoa cao, ngotri ta van coi nhii noron khong the sinh san du'qc
va dng vat van gill nguyen s6 loong noron da c6 tit giai doan phoi thai. Quan niem nay khOng
can phi' hop mita vi s6 luting noron a co the tru'ang thanh nhidu hon s6 lacing noron trong giai
doan phoi thai. Do de, rtgo6i ta cho rang cac no ron mai dooc phdt sinh bang each Weil to bao
than kinh dem thanh no ron than kinh chinh thdc hoac do phan chia moron chinh thdc bang
tate tiep hay gidn phan. Nhung van dd nay van chua re.
Con tai sinh soi than kinh thi sao ? Thuc nghiem cho thay sy tai sinh soi than kinh lien
quan chat the veri cueing dO cat huy. Sau cat, ca hai dau co lai xa nhau va qud trinh viem xay ra
a ch6 cat. Ngu cac dau cat khOng xa nhau lam va ch6 viem khong co mu, nhanh true tram se di
qua filling Bunge do ta bao Schwann bin thanh trong so thodi h6a ctia dau kia vdi t6c de
2-4 mm/24 giet. Sau do nhei ta bao Schwann no se not lai nhu cu. Ngu ten thdang nang, ch6 cat
thanh seo va Tau tren phai di xodn 6c tao met khei cau Win gay dau nhdc lam din bian xau
qud trinh tai sinh soi than kinh. VI vay trong didu tri ngoai khoa can tao didu kien tot cho
nhanh true than kinh phdt, trign a vac vat thuong.

7. CAC DIJdNG DAN TRUYEN THAN KINH.

Chdc nang chu ye-u cila he than kinh la dan truy6n cac hung phan tit met kith thich cila
moi tru'Ong va dan truygn cac hong phan ddp dng tra lai. Toan be qua trinh do thuc hien nhel
cac cha'ng noron not tiep nhau goi là cac doting dan truy6n than kinh.
Met doting dan truy6n nao cung thureing g6m ba loai chang no ron not tiep nhau :
1. Noron cam gide, hoeing tam nhan kith thich tit rnoi. troOng. Than noron thuOng nam a
met hach than kinh ngoai bier' (hach gai a than kinh gai song hoc cac hach cam gide caa cac
than kinh so).
2. Cdc noron lien hop hay trung gian lien tiep vdi cac noron cam gidc dd chuygn cac hung
phan than kinh cho cac wren van Tang.
3. Noron van &Ong, ly tam tiep vdi cac moron lien hop tit trung u'o'ng ra cac co quan hieu
dng de? van Ong, tit dich hoO'c ddp ling met hoat Ong tam than.
Trong co thd co hai lo4f hoot deng : hoat dung phan xa don gian khong len v6 nao va thyc
hien nher clueing dan truydn phan xa hay cung phan xa don gian va hoot.Tang phan xa phdc tap
thyc hien nhet cac dung dan truy6n than kinh lan.
7.1. DIXING DAN TRUYEN VA CUNG PHAN XA DON GIAN.
G6m ba noron.
— Noron cam gidc, hoeing tam ma than nam a hach gai Ira cac nhanh canh tho ra tan cac
co quan cam gidc a ngoai. Wen, can cac nhanh true di vao toy qua rd sau ctla day than kinh gai
song.
478
 — Nuron lien hop ma than na'm a sing sau tuy gai va nhanh true tan het a sang trade. Co
triRdng hop kh6ng c6 noron lien hop nen no rem cam gide se not ti6p ngay vai noron van d6ng.
—Nor6n van dung, ly tam ma than nam a sling trade thy va cac nhanh true theo re truck
ctia than kinh gai song ra tai cac co quan hieu ling (co, tuy'en v. v...) (H.61.8).

Alaron cam giac

Hinh 61.8 : Su d mot cung phan xa don gian.

Hau het cac hoat dOng ciia cac tang, Cac tuy6n, mach mau va mot s6 it .gan co van thu6c
loci dan truy'en phan xa nay.
7.2. CAC DVONG DAN TRUYEN LON
Cac during dan truy6n ldn hay phiic tap thi khdc vdi cac cung phan xa don gian a ch6
cac chang cam giac, van dOng hoac lien hop khong chi g6m mot noron ma g6m nhieu noron k6
ti6p nhau, vi \ay ngu'di ta phan chia ra lam ba loai dudng dan truyen : cam gide, van &Ong va
lien hop.
Thy theo tinh chat dia dan truy6n, ngn6i ta chia ra :
Cac &Yang cam gide on) :
—Dudng cam giac nong ttic la cam giac a da bao g6m cam gide sd m6 (oak gicic) va cam
gide th6ng nhiet. (dau don, nong lanh)..
—During cam giac sau coy thilc a xuang, khdp, gan co va cac to chile sau dual da.
thilc g6m cac cam giac philc tap a co, mach va cac tang.
—During cam giac sau khong coy
* Cac &tang van dung gom :
Dutrng van dung coy thilc cho cac co van.
479
 —Diking van clang khong coy thiic cho skt wing co va cac mach hoac tang.
Thy theo dinh khu, nguti ta phan ra cac diking dan truy6n a Tau mat va cac diking clan
truy6n a c6, than va ta chi.
—Cac diking clan truyen cam giac a Tau mat thuang la cac diking gide quan nhtt dutng
khdu gide, datng thi gide, dutng thinh giac va thang bang, &rang vi gide v.v... hoac cac dutng
cam giac chung a dau mat. Cac diking van clang a dau mat truy6n di theo b6 goi a trong trung
mug va cac day than kinh so a ngoai bien. Cac &rang dan truy6n a dau mat da &toe trinh bay
mat phan a bai Cac day than kinh so.
—Cac outing dan truy6n a c6 than va to chi g6m có cac dung cam gide va cac &king van
dOng, coy that va khong Y that. Sau day chung ta se minh hoa mat s6 diking cam giac va van
Bang a c6 than va ta chi.
7.1.1. Cac &Ring cam giac d co, than va tiY chi.
Cac diking nay thirang gam ba chang 'loran lien ti6p nhau.
—Chang dau can goi la chang ngoai bien gam cac noron hinh chit T ma than naron nam a
hach gai cua cac than kinh gai song. Cac nhanh canh bat dau tit co quan cam tho va cac nhanh
truc theo re sau than kinh gai song di vao tan het a sting sau tay (cac chiemg cam gicic nong vd
cdc du'ang cam gidc sau khong có y thdc) ho4c a dau duti hanh nao (cdc &tang cam gidc sew có
thiic) tao thanh b6 thon Ira 136 them a thirng sau cua tay (H.61.9).

Ch4ng 3

ChOng 2

B6 thon va b6 them

Ch4ng 1

Hinh 61.9 : Du'ang cam gicic sau coy Hu& a co, than va chi.
480
 — Chang that hai la chang trung u'ang g6m cac naren ma than nam a sung sau tuy gai (cac
du'ang cam gicic 'long vd cac twang cam gide sau khong coy thitc) ho4e dau &rai hanh nao (cac
nhcin thon vd nhan chem czia ddang cam gidc sew co y Hide) va cac nhanh true tao thanh cac
boa ttiy gai nhir b6 gai thi trikirc va ben (cam gidc nong) (H.61.11) hoac b6 gai tidu nao trade va
gai tidu nao sau (cam gide sau vo y tilde) hoac bat cheo tao thanh bat cheo cam giac (decussatio
sensoria) hay bat cheo hem (decussatio lemniscorum) (cIdang cam gicic sau coy did& (H.61.10).
Tat ca d'eu bat cheo sang ben d6i dien de' tan het a d6i thi.
— Chang that ba ding la chang trung acing g6m cac n.0 ran ma than nam a d6i thi va cac
nhanh true tao thanh mot phan bao trong va tan het a vo nao dia h6i dinh sau trung tam.
Rieng d6i vdi cac ding cam gide sau khong COthdc
coy thi cac chang this ba va c6 the' thii td,
thd nam deu qua tidu nao va co the hoac khong len tdi v6 nao (H.61.10).
7.2.2. Cac ding van dung d co, than va td chi.
NhAr tren da noi, cac dikrng van Ong a dau mat di theo b6 g6i va cac day than kinh so
(H.61.11), can cac clueing van dOng co Y thtic a c6 than va tit chi truy6n di theo hai chang :

Chang 3
Ch4ng 4

BO gai tieu nao fru&

86 gai tieu nao sau

Hinh 61.10 : Duang cam gicic sau khong co .3i auk.

481
 — Chang cidu hay chang trung uong gem cac ncc ron ma than nam a vti h6i tram tru'ac trung
tam va cac nhanh troc theo bao trong xueing trung nao, cdu nao, hanh nao, tao thanh b6 thap.
Tai ddu datari hanh nao, 2/3 b6 thap bat cheo sang ben del dien de tao thanh b6 thap ben d thy
gai va tan het a sung truck tay gai. Met plian ba con lai tiep tuc di xuting cot track thy de tao
thanh b6 thap trade va sau ding ding bat cheo sang ben del dien va ding tan het a sang track
tay gai (H.61.12).
— Chang thu hai 14 chang ngoai bien gem cac no ron ma than nam a sang fru& thy va cac
nhanh troc di theo re truck caa cac than kinh gai sting de tan het a cac co.
Con cac daring clan truyen van dung khong c6 3'r thac se truy6n di theo cac 136 rieng goi la
cac dating ngoai thap gem cac dating van citing phu va cac &fang van dung du6'i va.
Bac diem quan trong cua cac &rang d'an truy6n la tren cac ch4ng tit trung u'o'ng den ngoai
bienbao gia ding c6 met tan bat cheo sang ben del dien, do do bat ca met ten thu'cing nao a va
nao met ben se gay to va het nira ngtfai ben d'oi dien.

Chpg 3

ChOng 2
(Bó gai thi)

Chang 1

Hinh 61.11 : Dtteing cam gidc nong (xlic gidc vet th6ng nhi0t).
482
 Chang 1

BO gdi

Cac day
than kinh so
,Bo thap van dOng

BO thap ben
Bo thap tnidc

Chang 2

Hinh 61.12 : Ccic du'ang van d'Ong coy thdc.

CAU HOI TRAC NGHIEM

Chun cau thing nhdt

640. Than kinh tit chil Wang ang vdi :

a) Dang than kinh hach. d) a, b, c dung.

b) Dang than kinh hinh 6ng. e) a, c dung. (xem them bai 50)

c) Dang than kinh hinh

483
641. Gian nao c6 nguen g6c tit :
a) Ong than kinh. d) Phan sau bong nao truerc.
b) Bong nao sau. e) Phan truck bong nao truerc.
c) Bong nao gida. (xem them bdi 48)

642. Than kinh ngoai Wen gam :

a) Cac r6, hach va day TK ngoai TK trung u'crng.
b) Cdc day than kinh so.
c) Cdc day than kinh gai
d) a, b, c thing.
e) a, c dUng.

Dung cac chi tigt sau cle tra loci cau 643.
1)Hanh nao. 3) Trung nao.
2) Cau nao. 4) Tidu nao.

643. Than nao gam :

a) 1, 2. d) 1, 2, 3.
b) 1, 2, 4. e) 1, 2, 3, 4.
c) 2, 3, 4. (xem them bdi 49)
644. Du6ng dan truyen xuc gidc a c6, than, to chi gam :
a) M6t chdng ngoai Wen ma than natron a hach gai.
b) MOt chang trung uong ma than naron tao nen nhan thon va nhan them a hanh nao duet
• c) MOt chang trung u'o'ng ma than norOn a d6i thi.
d) a, b, c deu dung.
e) a, c dung.

645. Du'ang clan truy6n van dOng coy thdc a c6, than, W chi gem :
a) MOt chang trung acing ma than noron nam a hai trade trung tam.
b) Met chang ngoai Men ma than 'wren nam a sung trade tily song.
c) 9/10 bat cheo a dam clued hanh nao de tao thanh b6 thdp ben.
d) b va c dung.
e) a, b, c deu dung.

484
 62 He Ac QUAN
IG

MUC TIEU BAI GIANG

1. Phan biet the loai giac quan.
2. MO to cac Idp thuong bi, bi, long, meng, cac tuy6n caa da.
3. Ve so de eau tao cac lap cua da.

1. DAI C1J€$NG
He gide quan gem cac car quan cam gide (organa sensuum) co vai tra cdc ky quan trong
trong viec giao tiep gitia co the vai mei tradng xung quanh. Nha cac gidc quan ma co the nhan
duoc cac kich thich tit mei twang xung quanh de dila len than kinh trung acing va ddp ctng lai.
Mei gidc quan bao gem ba phan :
1.Be phan nhan cam bi6n cac nang luong kich thich thanh cac hong phan than kinh.
2. Be phan dan truyen dan cac hung phan than kinh.
3. Be phan phan tich a va nao chuyen cac hung phan thanh cam giac.
Be phan nhan cam IA dac trung cho mei giac quan. NO chi nhan cac kich thich rieng cua
no nhu cc7 quan thinh giac nhan song am thanh, co quan khdu gide va ca quan vi gide nhan the
chat hOa hoc haa tan, da nhan cac kich thich ming lanh, so' me, ap ldc v.v... Be phan nhan cam
gem cac Tau tan cang cua cac soi than kinh cam giac k6t hop vai met s6 t6 bao dac trung cho
Bing loai gide quan. Cdc to bao nay thu'ang khong phai là t6 bao than kinh. Vi du nhu' to bao
non hoac que a mat, to bao Corti a tai v.v... CO nhiing be phan nhan cam tit xa nhan cac kich
thich tit xa nhu' nghe, nhin, ngdi va CO nhdng be phan nhan cam trdc tip nhu sar mO va thang
bang. CO nInIng "be phan nhan cam hda hoc" nhu ngdi, nem vi thong nhan cac kich thich la
cac chat Ilea hoc.
485
 Nguari ta cling can chia ra :
1. Loai "be phan nhan cam ngoai the" (exteroceptor) nhan cdc hung phan Ur ben ngoai co
the nhu da, tai, mat, mid, luai.
2. Loai "be phan nhan cam ban the" (proprioceptor) nhan cde hung phan ban the nhu cam
gide 6 ca va khap.
3. Loai "be phan nhan cam not the" (interoceptor) nhan cdc hung phan a trong ca the nhu
cdc tang va mach mdu.
BO phan nhan cam cua da tuung d6i dun gian nhat. N6 gom nhiing nhanh tran cua cdc sui
than kinh hoac &flue boc bai hip mo lien kat. D6i vai cc quan khau gide va vi giac, thi c6 them
mot s6 to bao nhan cam dac Wet, con tai va mat thi be phan nhan cam co cau talk rat phde
tap. Co ca met be phan rieng de nhan cdc kith thich ta' ben ngoai.
Rieng v6 cac gidc quan thi ngoai ta co the chia lam hai loci :
1.Da, nhan cam gide chung ve sa ma, ming lanh, dau dan, ap lure.
2. Cdc gidc quan chuyen biet gom khau gide, vi gide, thi gide, thinh gide va thang bang.
Cac gide quan chuyen Wet da dooc mo ta ky phan Dail mat co ao.V. C3 day chung ta
chi not them ve da.

2. DA.
Da hay v6 boc chung (integumentum commune) ciia co the bao gam ca da, to chile duai da,
long t6c, m6ng va vu. Vu da duve mo to a bai Ca quan sinh due nit. Da co chile nang bao ye co
the nhu la met hip v6 khong ngam nude, co chic nang bai tit ma hell VA digu Ilea than nhiet
va dac biet la co quan )(tic gid.c. Dien tich da trung binh la. khoang 2m2, tuang d6i lin han ar
ngoai xa ming de t6a nhiet nhanh. D6i vii y hoc, da la nai c6 nhieu benh 157. Trong dieu tri
bong rat can big vg tSr le va cau tao cua da. Be day cua da tit 0,5mm tell 8mm, day a phan lung
va phgn dui cua co the han phan bung va phan gap, mong han o tre em va nguari giA.
Da g6m hai lap : hip thu'ung bi a &mg va lap bi a sau.

2.1. THLIONG BI.

Thuung bi (epidermis) IA hip thuung mo vay lat tang xuat phdt true tiep ta' be mat hip
ngoai bi cua phoi, .day chiing 20 dark 1400 micron va khong co mach mdu. Lap nay day nhat
gan chan va gan tay va gam nam tang tit nong vao sau la : tang sung (stratum corneum); tang
trong (stratum lucidum), tang. hat (stratum granulosum), tang gai (stratum spinosum) IA tang
day (stratum basale) (H.62.1).
Tang sung la mot hip mang . cac ta bao' bdn trong, chgc va dan hai co tae dung nhu dap
Clign nude, can tang sau nhat la tang day con goi la tang tru (stratum cylindricum) là tang
Binh san de thuang xuyen- phut hai lai lap thucing bi bi bong ra. Sac to melamin thuang dong
ngay tren tang ddy nay de can ede tia cite tim cua anh sang mat trati khong cho xuyen qua da.
486
 Tang sang
Tang trong
Tang hat
Tang gal
Tang day
Tuyen mo hoi

Hinh 62.1 : Sa d6 lap thuzing bi

2.2. Bi.
Bi (dermis) ho4c (corium) nam ngay clitai ldp thuung hi va chda cac mao mach ding nhu
hau h6t cac tan cUng cUa cac sal than kinh cam gide. Tang nong nhdt, la tAng nlui (stratum
papillare) c6 nhung niud (papilla& hudng 176 phia thuung bit. sau hen va day han la tAng lttdi
(stratum reticular& Om nhi6u sqi keo an sau xu6ng tam da (tela subcutanea). Trong lap
nay doff khi c6 ca troll d mot s6 vung nhu biu, du'ung vat, num vu v.v... Tiem du'61 da ttic IA tiem
vao ldp (ROI da.

Dau tan cOng tq do

Oval mach mau Tieu the Meckel
Co dung long
trong nhO da
Tieu the xac giac
Meissner

Tang nhO
••
• •
• • Tang
•

I I
/

I /
/

f
,
I I
t%
• ,
soi cam giac
•
• '
• %• , %••
•,•.• . _

Soi chi]
Tuyen m6 hoi Tieu the 0 (Pacini)
Hinh 62.2 : Sa de phan 1)6 cac lap da
1,2,3 : thaang bi, bi va ha bi (mo dual da)
487
 Tram tr6 vao da tiic la cham mot chat Ilea hoc nhu cacbon vao lap bi. Trong ldp bi ce cac
tidu the than kinh tan chug (corpuscula nervosa terminalia) nhu tidu thd hanh (corpuscula
bulboidea) (Krause) tidu the la (corpuscula lamellosa) (Pacini), tidu thd xtic gide (Meissner)
(corpuscula tactus), tidu the sinh duc (corpuscula genitalia) va tidu thd khdp (corpuscula
articularia) (H.62.3). Cac the tidu nay ce tac dung nhan cac cam gide a da.
2.3. LONG.
LOng (pili) IA dac dim caa loci ce va, ce tac dung bao ve va dieu hea than nhiOt, lam d6
thoat m6 hoi va can ce tac dung nhur mOt, gide quan. Thy luc va thy ch6 ma long mang cac ten
khac nhau. O bac thai la. long to (lanugo), a TALI goi là tee (capilli), a tren mat goi la long may
(supercilia), a mi mat goi la long mi (cilia), a mep va cam goi là rau (barba), a nach goi la long
nach (hirci), a tai goi là long tai (tragi), a midi goi la long mai (vibrissae) va a mu goi la long
mu (pubes).

Tieu the Meckel

flgu tan ceing

ti/ do (dau)

Tieu the Krause

Thilong bi (lanh)

Bi
Tieu the Meissner
(xlic giac)

Ha bi
Tieu the Ruffni
Tieu the Golgi (tieing)

Tieu the la
(Pacini)

Ap hip NhiOt Sd va dau

Hinh 62.3 : Sa cto phan bef cdc loci dciu kin cling cdm gicic cila da dCiu ngon tay

Ve cau tao, long ce mot than long hay r6 (radix) nam trong mot 6ng goi IA nang long
(folliculus pili). Nang phinh ra a phan dual goi là hanh long (bulbus pili). Thuang ce mot be co
488
tron goi la ca dung long (mm. arrectores pilorum) barn -di mat da vao gdn chan lOng. Khi co co
lam long dung len (ndi da ga) trong lac so hai hoac lanh (H.62.4).
2.4. MONG
Mang (unguis) la nhang 130 phan cling sang hoa cUa thaang bi nam d mat mu caa cac ngon
chan va ngon tay. Chang co tac dung ba'o ye dam cac ng6n va de cao va gai. Mang tay c6 phan
than (corpus unguis) va phan re (radix unguis) nam sau dual da. Gina da va re CO mot ranh goi
la lap sung tren mong (eponychium). 0 ngay phia track co mot vung tra'ng duc hinh ban nguyet
(lunula). O dau xa phia dual mong ding co mot Wing da bi sang hoa goi là lap sang da6i. ming
(hyponychium) con a hai bar riving goi la lap sang quanh ming (perionyx) (H.62.5). Cac chdm
trang thdy a mong la do qua trinh sang hoa chua day

Ha nh long

Hinh 62.4 : Sa do mot nang long

2.5. CAC TUYEN CUA DA

Cac tuyen dia da (glandulae cutis) gom cac tuygn ba (gll. sebaceae) (H.62.4) d6 vao nang
long, tuyen mo hoi (gll. sudoriferae) (H.62.2) d6 ra da, tuyen quanh hau mon (gll. circumanales)
va tuyen day tai (gll. ceruminosae).
489
 Re
Lop sang tren truing han

Lap sang
•.• duel mong

Hinh 62.5: Sa de cdt doc qua m6ng tay

CAU HOI TRAC NGHIEM

Chon cau tra ldi dung nhat

646. BO phan nhan cam ctia mot gide quan có thd gom :
a) MOt s6 t6 bao dlac tning cho timg giac quan.
b) Cac dau tan ding cua cac sal day than kinh cam gide.
c) Cac than noron.
d) a, b, ching.
e) a, b, c dung.

647. Chile nang cua da là :

a) Bao vO ca thd.
b) Bai tidt mO hoi va didu hba than nhidt.
c) Co quan 2alc giac.
d) HO hap.
e) Tat ca dgu dung.

490
Dung hinh ve sau d tra ldi cau 648 - 650.

648. Chi tiet s6 (1) la :

649. Chi ti6t s6 (2) là :

650. Chi ti6t s6 (3) la :

3

491
 PHU LUC
DE THI TRAC NGHIt' M MON MAI PH:A
x U HOC
(De thi hoc phan I — Y 2008)

651. Ranh TK tru hien di'en

a. Chi:5m xuang canh tay.
b. Chom )(dung tru.
c. Mom tram tru.
d. Khuye't tru.
e. Lei eau trong xu'cing canh tay.
652. Khi not ve 6 mieng, chi tigt nao sau day SAI:
a. Duac chia lam 2 phan bdi cung rang lai.
b. Phan tien dinh mieng chi thong vdi 6 mieng chinh khi ha mieng.
c. Cl tien dinh mieng co O-ng tieet tuyen mang tai do vao.
d. Phia truck tien dinh mieng thong vdi ben ngoai qua khe mieng.
e. Thanh ben caa tien dinh mieng la ma.
653. Co nao sau day dive coi la mice ca chu ygu caa vang co:
a. Co ham mong.
b. Cu tram ming.
c. Co Lk riing.
d. Co bac thang trudc.
e. Tat ca cl6u sai.
654. Met TM nong caa c6 co lien quan vai TK ngang c6 va TK tren vai IA:
a. TM canh trade.
b. TM tai sau.
c. TM canh trong.
d. TM canh ngoai.
e. Cung TM canh.
655. Chi tie-t nao sau day KHONG lien quan vai phia trade caa DM dual clan trai:
a. TK vat nguoc.
b. Ong
c. Quai clued don.
d. TK hoanh.
e. TK lang thang.
656. Khi di vao yang mang tai, DM canh ngoai:
a. Di ngang qua mat ngoai tuygn mang tai.
492
 b. Di ngang qua mat sau tuyen mang tai.
c. Di doc then bo tru'dc tuyen mang tai.
d. Di qua phan sau tuyen mang tai.
e. Ca a, b, c, d deu sai.
657. 1\16i v6 DM canh trong, chi tiet nao sau day SAI:
a. Thuang bat dau a bar tren sun giap.
b. Chay met doan trong met eng xuang a mat dad )(dung da.
c. Xuyen qua 18 rach de vac) hep so.
d. Co met doan lien he mat thiat vdi TK van nhan ngoai.
e. Cho cac nhanh tan sau khi rdi khoi xoang TM hang.
658. Eo tuyen OAT bat eh& qua cau trot nao sau day:
a. Xucing m6ng.
b. Sun khi quail 1.2.
c. Sun nhan.
d. Sun giap.
e. Tat ca deu sai.
659. Chi tiet nao sau day KHONG phai la dien khdp cua khdp thai &tang ham:
a. Cu khdp cua xudng thai &tang.
b. H6 ham cila xitang thai daring.
c. Chem xudng ham chtdi.
d. Mat tren dia khdp.
e. Mat dad dia khdp.
660. Chi tiet nao sau day KHONG thing vdi ang ca khep:
a. Bat dau tit dinh tam giac dui va tan tong a yang gan ca khep.
b. Co gidi han trurdc trong la ca may Ira mac rang khep.
c. Chita DM did, TM dui, TK hien va nhanh TK dui cac ca rang.
d. Trong eng ca khep, DM did bat cheo phia tru'dc de di vac) trong TM did.
e. TK hien di ra Ming a khoang 1/3 duai eng ca khep.
661. M'enh de nhan qua. Chon:
a. Ne'u (A) dung, (B) dung; (A) va (B) co lien quan nhan qua.
b. Neu (A) thing, (B) dung; (A) vet (B) khong lien quan nhan quci.
c. Ne'u (A) dung, (B) sai.
d. Neu (A) sal, (B) thing.
e. Neu (A) sai, (B) sai.
(A). Ngutri to co the thing DM did lam mac de choc do TM dui a ngay dctdi day chang ben, Vi
(B). DM din nam sat ngay ben trong TM did.

493
662. Chon cau SAT : O xu'o'ng chay va xu'o'ng mac:
a. Mat ca. ngoai 16i lion mat ca trong.
b. Mat ca ngoai sau ham mat ca trong.
c. Mat ca ngoai thap hon mat ca trong khoang 1cm.
d. Mat ca trong nam sau TM hidn Ian.
e. Mat ca ngoai nam sau TM hidn be.
663. Menh de nhan qua. Chon:
a. Neu (A) clang, (B) dung; (A) va (B) co lien quan nhein qua.
b. Ne'u (A) clang, (B) clang; (A) vet (B) /thong lien quan nhan quci.
c. Neu (A) clang, (B) sai.
d. IV& (A) sai, (B) ching.
e. NO"u (A) sai, (B) sai.
(A). Khi ton thurong TK giita, thi tat ca cac co ciia Wing cang tay track bi liet, VI
(B). TK giOra cho nhanh van Ong ddn tat ca cac co vOng cang tay trade.
664. Day chang nao ngan su trat khap len tren cila xurcifig canh tay:
a. Day chang qua ding vai d. Day chang qua-don
b. Day chang Ong e. Day chang ding vai don
c. Day chang qua canh tay
665. Chi tie-t nao sau day SAT khi n6i v6 than kinh tru:
a. Chay mot loan trong 6ng canh tay.
b. Choc qua vach gian co trong a 1/3 tren canh tay.
c. D6ng hanh vai DM ben tru tren.
d. Di xu'ong cang tay qua met ranh nam gida mom khuSru va mom tren 16i cAu trong
'Wang canh tay.
e. Khong cho nhanh ben a canh tay.
666. Than gaita cila dam roi TK canh tay dirge tao bdi:
a. Nhanh tru'ac TK gai c6 VI.
b. Nhanh taxi& TK gai c6
c. Nhanh sau TK gai c6 VII.
d. Nhanh tru'ac TK gai c6 VI va VII.
e. Nhanh tai& TK gai c6 VII va VIII.
667. Bac tinh cila co chi tren:
a. Co nam phia tilt& la co du6i.
b. Nhom ca nam 6 bar quay canh tay là nhom co' trade.
c. Nh6m co cila cang tay tru'ac c6 chic nang du6i c6 tay va cac ng6n.
d. Nh6m ca vung cang tay frit& c6 chdc nang sap cang tay.

494
 e. Nhom co viing tang tay sau có chic nang gap c6 tay va cac ngon.
668. Thanh phan nao sau day KHONG gap phan tao nen tran 6 mai:
a. Manh xoang tran.
b. Than xuang bu'arn.
c. Canh 'arcing la mia.
d. MOrn budm xuang khdu cai.
e. Me dao sang.
669. Chon:
a. Neu 1,2,3 thing. d. .1\16"u chi CO 4 thing.
b. Neu 1,3 thing. e. Ne'u 1,2,3,4 thing.
c. Neu 2,4 thing.
1. Ong not dich di trong tong tin dinh me dao )(acing.
2. Ong ngoai dich di trong ding 6c tai ciia 6c tai me dao
3. Ong not dich tan ding bang tai not dich nam dadi mang cling mat sau phan (la
xuang thai duang.
4. Ong ngoai dich thong ngoai dich vdi mat duai phan da xuang thai d1ang.
670. Chon cau DUNG:
a. GO thap nam d thanh chum cua hOm nhi.
b. Cita s6 tin dinh co mang nhi phu day.
c. Thanh tru'ac hom nhi lien quan \raj tinh mach.
d. TK nhi là nhanh cua TK mat.
e. 'Mt ca deu sai.
671. Thi dich di ac tai hap thu a:
a. M6ng mat.
b. Xoang tinh mach.
c. Tinh mach mi.
d. Mom mi.
e. acing mach ineing mat.
672. Ngach mai tren ding có cac 18 d6 cUa:
a. Xoang tran, xoang sang trate.
b. Xoang tran, xoang balm.
c. Xoang balm, xoang sang sau.
d. Xoang sang sau, 6ng le mai.
e. Tat ca deu sai.
673. Than kinh nao raj khoi xuong thai &rang 0 phan da bang khe da nhi:
a. TK lu'ai.

495
 b. TK mieng.
c. TK ha thiet.
d. Thitng nhi.
e. TK huyOt rang
674. Nuac mat thiia duvc clan hal xu6ng mai lan lust qua cac thanh phan sau day:
a. Till 10, tidu quan 10, ngach mai dui.
b. Tigu quan le, 6ng 10 mui, ngach mud du'di.
c. Tidu quail 10, tin 10, 6ng le mui, ngach mui
d. Tidu quail 10, tuydn 10, 6ng 10 mai, ngach mai
e. Tigu quan 10, tdi 10, 6ng 10 mai, ngach mai gida.
675. Cam giac vi gide 2/3 tru'dc lath do than kinh nao dual day chi ph6i:
a. TK mat.
b. TK
c. TK trung gian.
d. TK thiet hau.
e. TK ha thiOt.
676. Chon cau DUNG. Xu'ung don:
a. COng Arai 'awing vai va cac )(tong chi tren tao thanh dai vai.
b. Co mot than va hai dau, dau dep haing vao trong.
c. Mat chidi có ranh don de dOng mach dual clan di qua.
d. CO hai 136, 136 tru'dc lOm a phan trong.
e. Ca a,b,c,d dgu
677. DM nao sau day phat sinh tit DM canh ngoai & ngang mac sang loin caa )(Long mOng:
a. DM thanh quan tren.
b. DM ham.
c. DM giap tren.
d. DM tai sau.
e. DM hau len.
678. Chon cau SAT. Tinh mach canh trong:
a. Bat dau a 6ng canh.
b. La sit tiep n6i &la xoang TM sigma.
c. N6i vdi TM chiai don tao thanh TM tay dau.
d. CO 2 ch6 phin.h, tao thanh hanh TM tren va dual.
e. Cl cg, nam trong bao canh.

496
Dung cac chi tie't sau trd Uri cac cau 679, 680
1. DM gian su'an tren cang 4. DM tren vai
2. DM gicip dadi 5. DM ngang co
3. DM co salt
679. Than c6 wan bao gem cac nhanh:
a. 1, 3. d. 1, 3, 4.
b. 1, 5. e. 1, 4, 5.
c. 1, 3, 5.
680. Than giap c6 bao g6m cac nhanh:
a. 1, 2, 3. d. 3, 4, 5.
b. 2, 3, 4. e. 2, 3, 4, 5.
c. 2, 4, 5.
681. Than kinh hoanh xua't hien a bb ngoai co nao:
a. Ca ac don chum.
b. Ca thOng dau truac.
c. Ca dai c6.
d. Ca thOng dau ben.
e. Ca bac thang truac.
682. Cu can barn tit cung go ma den mat ngoai goc ham, nen se lam dong tac:
a. Nang ham du'ai len.
b. Keo ham duai ra sau.
c. Du'a ham du'6'i ra truac.
d. Ha ham du'6'i xu6ng.
e. Ha cung go ma.
683. M'enh de nhan qua. Chon:
a. Neu (A) dung, (B) dung; (A) va (B) có lien quan nhein qud
b. IV& (A) dung, (B) thing; (A) va (B) khong lien quan nhd n qud
c. Ne'u (A) dung, (B) sai
d. Neu (A) sai, (B) dung
e. Neu (A) sai, (B) sai
(A). Khi gay 1/3 gicia 'along canh tay c6 nguy ca ton thu'ung TK giu'a nhieu nhat Vi
(B). Than kinh giira di trade xdong canh tay va tang tay.
684. Chon cau DUNG:
a. H6 so trurac va h6 so sau du'o'c gidi han bed giao thoa thi va bar sau canh nha )(dung
bodm.
b. H6 so trade du'ac cau tao bai xu'ang tram va xaang Warn (canh nh6).
497
 c. H6 so sau duac cau tao chu y6u bai xuang chain, met pilau )(acing badm va xu'ang thai
du'ang.
d. H6 so giiia va h6 so sau la bir tren xuang da va phan tradc )(acing cham.
e. H6 so gifla có 4 mom yen budin va khe 6 mat duai.
685. D6u hieu ban tay ra la do:
a. Liet TK tru.
b. Liet TK gala.
c. Liet TK quay.
d. Teat khap ea tay.
e. 'Mt Ca deu sai.
686. TK gan chan ngoai
a. Cac nhanh ding cua TK tru d gan tay.
b. Cac nhanh ding cda TK gida a gan tay.
c. Nhanh ciing sau cua TK tru.
d. Nhanh cUng 'long cua TK tru.
e. Nhanh ding caa TK quay.
687. O vong gan ccc khep, co thanh phan nao sau day di qua:
a. DM kheo.
b. TM did.
c. Met nhanh cUa TK bit.
d. TK hien.
e. TM hien.
688. Hach bach huy6t ming a viing ben KHONG co dac diem nao sau day:
a. Nam trong ldp mO ma dath da a Wang tam gide did.
b. G6m 12 d6n 20 hach.
c. Nhom hach narn thAng nhan bach huy6t, tit chi dudi.
d. Nhom hach nam ngang nhan bach huy6t tit Wing day chau, hau mon, sinh duc, mOng
va bung.
e. Hach 2 khu tren nhan bach huy6t, a mong va bung, va 2 khu dudi nhan tit day chau
va hau mon.
689. Thanh phan nao sau day KHONG di qua khuygt ng6i
a. Cu hinh le.
b. DM mOng tren.
c. TK then.
d. DM then trong.
e. DM then ngoai.

498
690. Cau nao sau day SAI:
a. Co xu'ung dui có mot phan nam ngoai bao khdp.
b. Day chang chau dui la day chang khoe nhat cua khdp hOng.
c. Toan 136 chom xdo'ng dui la mat khdp va khdp vdi 6 c6i.
d. Bien d6 hoat thing cua khdp hong it hun khdp vai.
e. Khdp hong it trat ham khdp vai.
691. Dirt TK giita a 6ng co tay
a. KhOng gdp ducic ngon cai.
b. Khong dai dutdc ngon cai.
c. Khong dang dude ngon cai.
d. Khong gdp du'dc cac ngon 2,3.
e. KhOng gap va d6i du ac ngon cai.
692. Cau nao sau day SAI:
a. DM ben quay la nhanh trade dia. DM canh tay sau.
b. DM ben giiia la nhanh sau caa DM canh tay sau.
c. DM ben tru dddi la nhanh dia. DM canh tay.
d. DM quat ngt.tdc quay la nhanh caa DM gian cot.
e. DM gian cot tach tit Ong mach tru.
693. Than kinh tru co dac didm, NGOAI TRth
a. Xuat phat tit bo trong dam r6i than kinh canh tay.
b. Tai Wing khayu, di phia sau mom tren 16i eau trong xnang canh tay.
c. O co tay, di phia ngoai miring dau.
d. O cang tay, van Ong cho nita trong co gap cac ngon nOng va co gdp c6 tay try.
e. Khong cho nhanh cam gide a cang tay.
694. Chon cau SAI. V6 nguyen uy dm ca:
a. Cu nhi dau co dau dai di qua ranh gian
b. Ca gap c6 tay tru có dau tru va &du canh tay.
c. Ca sap trOn ding co &du tru va dau canh tay.
d. Ca gap cac neon nong co dau tru va dau quay.
e. Cd khep nein cai có dau Cheo va dau ngang.
695. Cau nao sau day KHONG clang vdi )(acing tru:
a. Lan Won dai hdn xurong quay ding ben.
b: Khi khuku du6i, mom khOu nam trong h6 khuSru )(dung canh tay.
c. Khuyet rung roc khdp vai rang roc 'awing canh tay.
d. Khuyet quay a mot trong mom vet, khdp vdi vanh xiking quay.
e. Khuydt tru nam a dau du-di xnang tru.

499
696. Mat sau )(Yung canh tay co:
a. H6 mom khOu va h6 vet.
b. H6 vet va h6 quay.
c. H6 quay Ara ranh than kinh quay.
d. Ranh than kinh quay va h6 mom khuSTu.
e. H6 mom kh4u va 16i ca delta.
697. Chon cau DUNG:
a. Xu'ung chau do ba xu'ung tao thanh: xu'ung canh chau d tren, )(acing ng6i d trade dudi
va xu'ung mud sau dudi.
b. Mat trong xacrng chau có h6 chau nano phia &rch dui:mg cung.
c. Mat ngoai 3atung chau co 6 col de' ti6p khdp vdi chrim xu'ung
d. Du'ang cung la dadng cong xu6ng dudi va ra sau d mat trong xuang chau.
e. Tat ca deu sai.
698. Than kinh van nhan (III) van dOng cho cac car sau day, NGOAI TRU:
a. Car thong tren.
b. Cu thang trong.
c. Ca thang ngoai.
d. Ca nang mi tren.
e. Ca cheo
699. Trong vom ngang cua ban char', xu'ung nao du'uc coi nhu la dinh cua vOm:
a, Xu'o'ng ghe.
b. Xu'crng chem giffa.
c. Xuang chem trong.
d. Nen xu'ung ban chan III.
e. Nen xu'ung ban chasm IV.
700. DM ma dui ngoai di gala:
a. Cu may va cc cang mac dui.
b. Cu may va ca rOng ngoai.
c. Ca may, ca thang dal va ca that lung chau.
d. Ca loge, cc, thang dui va ca cang mac dui.
e. Cu hruc, ca that lung chau va ca may.
701. \Tong dui du'qc gidi han
a. Day chang ben, day chang khuy6t, day chang phan chi6u.
b. Day chang ben, day chang phan chi6u, mao loge )(dung mu.
c. Day chang ben, day chang khuy6t, mao luac xacing mu.
d. Cung chau lu'uc, day chang ben, day chang khuy6t.

500
 e. Cung chau lilac, day chang khuyet, day chang phan chieu.
702. DOng tac dui co tay khong the thyc hien cluac khi bi ton thu'ung TK nao sau day:
a. TK gida.
b. TK try.
c. TK quay.
d. TK ca bi.
e. TK bi tang tay trong.
703. Chi tiet nao sau day KHONG lien quan vai mat sau tuyen mang tai:
a. Nen mom tram.
b. BO trade ca dc don chum.
c. Phan nhi xnang thai du'ang.
d. Ca tram kith.
e. Ca tram m6ng.
704. DOng mach cham di qua:
a. Tam gide canh.
b. Tam gide vai don.
c. Tam gide c6.
d. Tam giac du'di don.
e. Tam gide c6 sau.
705. Khi di vao yang mang tai, DM canh ngoai:
a. Di ngang qua mat ngoai tuyen mang tai.
b. Di ngang qua mat sau tuyen mang tai.
c. Di dot theo bar truac tuyen mang tai.
d. Di qua phan sau tuyen mang tai.
e. Ca a,b,c,d deu sai.
706. Nhanh nOng TK try van Ong coi chute nang van dOng cho:
a. Ca gan tay dai.
b. Ca gan tay ngan.
c. Ca dOi nem cai.
d. Ca giun 3 va 4.
e. Tat ca deu
707. Than kinh giita van &Ong cho cac ca sau, NGOAI TRT21:
a. Ca dang ngen cai ngan.
b. Ca gap nem cai ngan.
c. Co khep nem cal.
d. Ca d6i ngen
501
 e. Co giun 1 va. 2.
708. Trat khdp co chan, ban char' thildng bi 'at theo chi6u :
a. Hiking ra phia ngoai.
b. Hadng vao trong.
c. Hiking phia trodc.
d. HYdrig phia sau.
e. Tat ca deu thing.
Dung hinh ye d tra 1 i can 709, 710
709. Chi tidt s6 (2) tren hinh ye là:
a. Co chay trudc.
b. Co mac dai.
c. Co mac nga'n.
d. Ca du6i ngon cai dai.
e. Co du6i cac ngon char). dai.
710. Chi tidt d vi tri s6 (5) se do than kinh:
a. TK chay.
b. TK mac Ming.
c. TK mac sau.
d. TK hidn.
e. Tgt ca ddu sai.
Thigt d6 ngang cang chan

DE THI TRAC NGHIEM MON MAI PHAU HOC

(Dd thi hoc phan I — Y 2009)

711.Cgu trdc nao sau day KHONG tham gia gidi han 16 mai sau:
a. Than xiiong bu'dm.
b. Canh xu'ung la mia.
c. Bd sau khdu cai
d. Ma'.nh trong mom chan bitdm.
e. Than xurong ham tren.
7.12. Cau nhan qua. Chon:
a. Neu (A) dung, (B) dung; (A) va (B) co lien quan nhdn qua.
b. Neu (A) dung, (B) dung; (A) va (B) khong lien quan nhdn qud.
c. Aqu (A) dung, (B) sai.
d. Neu (A) sai, (B) thing.
e. Ne'u (A) sai, (B) sai.

502
(A) Viem nhi'em yang hau, hong a tre con co the gay r6i loan thinh gide, VI
(B) C1 tre con, co nhieu me bach huye't quanh 16 hall vai tai, khi viem co the bit 16 nay.
713. Hanh nhan khau cai:
a. Là mot to chile bach huye't nam d eo hong.
b. Co 2 clic tru'dc sau.
c. Mat trong co cac hOm hanh nhan va h6c hanh nhan.
d. Mat ngoai dinh vao mac ma hau va tie-p xtic vdi ca khit hau tren.
e. Dive cung cap mau cha ye-u bdi Ong mach mat.
714.Re tren quai c6:
a. Phat xuat tit quai n6i II.
b. Co the di vao bao TK thi'et
c. Chay phia trong DM canh.
d. N6i vdi re duai a ngang mdc sun nhOn.
e. Co khi di vao bao than kinh lang thang.
715.Nhanh Ong mach nao sau day KHONG co ngu6n g6c tit than giap c6:
a. DM c6
b. DM 04 duai.
c. DM vai xu6ng.
d. DM tren vai.
e. DM c6 sau.
716.0 doan co, phan sau co bac thang, clang mach dudi don KHONG lien quan phia trirdc vdi:
a. Co bac thang trade.
b. Than kinh ngkrc dai.
c. Than kinh hoanh.
d. DM ngang c6.
e. DM tren vai.
717.Du'ang thang ngang sau a mat du'di xitung so (qua 2 mom chiim) KHONG di ngang qua:
a. L6 rach. d. Khe nhi chum.
b. L6 tram chum. e. Bar sau 16 TM canh.
c. Ong TK ha thiet.
718.Thanh phan nao sau day KHONG lien quan vdi bar truac co can:
a. TK mat.
b. Ong tiet tuyen nude bot mang tai.
c. DM mat.
d. Mach ham duai.
e. Mach ma.

503
719.Noi v6 DM did sau, chi tigt nao sau day SAI:
a. Nam truac co that lung chdu. d. Nam sau co khep ngdn.
b. Nam tritac co lucre. e. Nam trade co kilo') lan.
c. Nam sau co khep dai.
720. Chi tigt nao sau day KHONG dung vai 6ng co khep :
a. Co gieri han trade trong la co may va mac Ong khep.
b. Clula DM dui, TM did, TK hign va nhanh TK cho cac co Ong
c. Trong 6ng co khep, DM did bat cheo phia trade dg di vao trong TM
d. TK hign di ra nong d khoang 1/3 du'di 6ng co khep.
e. Bat Tau tit Binh tarn giac did va tan ding a yang gan co khep.
721.Chi tigt nao sau day KHONG diing khi not ve mac gift gan gdp:
a. GUT cho mu c6 tay 16i theo chigu ngang va sau
b. Ciing vdi cac xu'ong c6 tay tao nen 6ng c6 tay
c. O phia trong barn vao 'co:mg Tau va mac xu'o'ng mac
d. d phia ngoai, bam vao cu xtrong thuygn va cu minng thang
e. Che mat trade cua cac gan gap, TK gala, DM quay, DM try
722. Cau nhan qua. Chon :
a. Neu (A) dung, (B) dung; (A) va (B) co lien quan nhan quci.
b. Neu (A) dung, (B) thing; (A) va (B) Oiling lien quan nluin qud.
c. Neu (A) thing, (B) sai.
d. Neu (A) sai, (B) dung.
e. Neu (A) sai, (B) sai.
(A) Nhigm trung bao hoat dich ngon ut bao giac cang lan dgn bao boat dich ngon cai, VI
(B) Bao boat dich ng6n tit thirang thOng n6i vdi bao hoat dich ngon cai a c6 tay.
723.Noi vd cu gap cac ng6n nong a ca'ng tay, chi tigt nao sau day SAI:
a. Gan gap cac ngon nong xep thanh 2 lap.
b. Gan nein 3 va 4 xgp thanh lap sau.
c. B6 cho 2 ng6n 2 va 5 la 1 co nhi than c6 gan trung gian d gifta.
d. Cac gan co gap cac ngon ming nam sau ham va trong han than kinh gida d 1/3 dildi
cang tay.
e. Co mot nguyen Uy a nda tren bar track minng quay.
724.W 6ng canh tay, thong tin nao sau day SAI:
a. Ong canh tay c6 hinh lang try tam giac.
b. Thanh trade c6 co canh tay, co nhi Tau va co qua canh tay.
c. Thanh sau la vach gian ca trong.
d. Thanh trong c6 thanh phdn sau nha't la mac nong.

504
 e. TK try di xuyen qua thanh trong d 1/3 giCia O-ng canh tay.
725. Than giaa dm dam r6i TK canh tay dacic tao bdi:
a. Nhanh truac TK gai c6 VI. d. Nhanh trudc TK gai c6 VI vb. VII.
b. Nhanh tru'ac TK gai c6 VII. e. Nhanh trade TK gai co VII va VIII.
c. Nhanh trade TK gai c6 VIII.
726. Cau nhan qua. Chon:
a. Neu (A) thing, (B) dung; (A) va (B) có lien quan nhan qud.
b. Neu (A) dung, (B) dung; (A) va (B) khong lien quan nhdn qua.
c. _Wu (A) dung, (B) sai.
d. Neu (A) sai, (B) dung.
e. Neu (A) sai, (B) sai.
(A) Nga6i to goi doan tit d6ng mach diidi vai de'n cac dung mach mu canh tay la doan that
nguy hidm cila DM nach, VI
(B) Khi that clang mach a doan giaa DM dadi vai va cac DM ma canh tay thi hoan than khong
có nhanh not nao giCfa doan tren va doan duai ch6 that
727. Cam nhan qua. Chon:
a. Ne'u (A) dung, (B) dung; (A) va (B) có lien quan nhdn quci.
b. Neu (A) dting, (B) dung; (A) va (B) khong lien quan nhdn qud.
c. Neu (A) dung, (B) sai.
d. Neu (A) sai, (B) thing.
e. Ne'u (A) sai, (B) sai.
(A) Trong trat khdp vai, chum )(acing canh tay it khi bi trat ra sau, VI
(B) phia sau khdp vai, bao khdp day hum nhCfng ch6 khac.
728. Chi tie-t nao sau day SAI khi not 176 non dan h6i:
a. Cang tit ne-p thanh am dgn b6 tren sun nhan.
b. Phan trade non tao nen day cha.'ng nhan giap.
c. Be tit do a tren tao nen day chang thanh am.
d. Gap phan tao nen thanh ben thanh quan.
e. Boy sau gan vao sun sang va mom co sun pligu.
729. Chon:
a. Neu 1,2,3 dung. d. Neu chi có 4 dung.
b. Neu 1,3 dung. e. Ne"u 1,2,3,4 dung.
c. NO"u 2,4 dung.
Trong co quan ti6n dinh 6c tai
1. Tai ngoai &foe ke to 18 tai ngoai den mang nhi.
2. Khong khi luon Ilion 1uu thong giaa hem nhi va hau qua vei tai.
3. Tai ngoai, tai giaa, tai trong deu nana trong phan da xtiong thai du'ong.
505
 4. Chi c6 tai trong mai dam nhan chLic nang thang bang.
730.Ngoai dich KHONG ca trong:
a. Khoang ngoai dich.
b. Tang tin dinh.
c. Tang mang nhi.
d. C6ng 6c tai.
e. Tat ca deu sai.
731.Cau nhan qua. Chan :
a. Neu (A) dung, (B) thing; (A) vet (B) co lien quan nhein qud.
b. Neu (A) dung, (B) dung; (A) vet (B) Oiling lien quan nhan qud.
c. Neu (A) clang, (B) sai.
d. Neu (A) sai, (B)
e. Aqu (A) sai, (B) sai.
(A) Khi bi trong ham nhi, ngnai to thaang rach mang nhi a khu tren sau mang nhi dd
thoat mu VI
(B) Khu nay khong lien quan vai nhang cU quan quan trong.
732.DOng tac co that d5ng tuf la do:
a. TK van nhan ngoai.
b. TK rang roc.
c. TK mat (thuec TK sinh ba).
d. TK pho giao cam cua TK van nhan.
e. TK giao cam.
733.Khi mat da a vi tri lies trong, ca cheo &raj co se gay dOng tac:
a. Lidc len.
b. Lidc len Ara xoay nhan cau ra ngoai.
c. Lidc xu6ng.
d. Lidc xu6ng va xoay nhan eau vao trong.
e. Tat ca ddu sai.
734.Ngach mai tren a thanh mai ngoai co 16 d6 vao
a. Xoang tran.
b. Xoang sang trnac.
c. Xoang ham tren.
d. Xoang bu'am.
e. Ong le ty.
735.Vong mac mai-1g nhat a:
a. Vdt vong mac (didm yang).

506
 b. Um trung tam.
c. Dia than kinh thi.
d. H6 dia.
e. VOng mac mom mi.
736.Th6y ben tuye-n giap nam trai dAi tit hai ben sun giap de-n:
a. Sun khi quan 3.
b. Sun kill quan 4.
c. Sun khi quan 5.
d. Sun khi quan 6.
e. Sun khi quan 7.
737.Noi v6 thanh quan, cau, nao sau day SAI:
a. Mat phang di ngang qua 145 dudi sun nhan lien quan vdi d6t song co C6.
b. Mat trudc ngoai sun pheu có lom tam giac là ncji cd thanh am barn.
c. Mang td giac tang tit nep pheu nap a tren den nep ti6n dinh a dudi.
d. Tien dinh thanh quan gidi han 2 ben IA mang td giac, sun them Ira sun sung.
e. TK cam giac phan thanh quan phia tren mep thanh am IA TK thanh quan tren.
738.Cau nao sau day SAI:
a. Hau lien quan phia trade vdi 6 mai, 6 ming ya thanh quan.
b. Phia &Jai hau thong vdi thqc quan.
c. VOng bath huyet quanh hau g6m tuy6n hanh nhan hau, tuye-n hanh nhan voi, tuye-n
hanh nhan khau cai, tuye-n hanh nhan
d. Tuye-n hanh nhan khau cai nam giita cung khau cai ya khau cai hau.
e. Tuyen hanh nhan lurisi nam tru'dc cac gai dai cda lcto i.
739.Tuye-n nctdc bot mang tai dudc chia lam hai phan nong ya sau bdi:
a. DM ham.
b. DM thai &tong nong.
c. TK mat.
d. TK tai thai dudng
e. Ong tuyen mang tai.
740.Viem amygdale (hanh nhan khau cai) có the bi sung dau a hach:
a. Hach sau tai.
b. Hach ham du'di.
c. Hach dudi ham.
d. Hach canh-hai than.
e. Hach c6

507
 741.TM canh trong a viing co:
a. Xuat phat tit than TM tay dam.
b. Di kern ben trong DM canh trong hoac DM canh chung.
c. Nam trong bao canh vdi DM canh chung va TK lang thang.
d. Tan ding a h6 TM canh, tie-p not vdi xoang TM xich ma.
e. Nam phia trong DM canh chung.
742. Cam gide da viing c6 dudc chi ph6i chu ygu bed cac nhanh than kinh
a. Dam r6i canh tay. d. Cac TK so.
b. Darn r6i c6 nong. e. Than kinh mat.
c. Dam r6i c6 sau.
743.Chon cau dung khi not va quai c6:
a. LA mot thanh phan &la dam r6i c6, nam ngay phia sau 136 mach canh.
b. Co r'6 tren xuat phat tit TK c6 1, di vao bao TK ha thiOt.
c. Re dudi xuat phat tit TK c6 2.
d. Cho nhanh van dung den Vat ca cac co cludi mang.
e. Tat ca dau sai.
744.Cd nao sau day tham gia vao dOng tac ha xtiong ham difdi (ha cam)
a. Car thai dirong. d. Co chan budm trong.
b. Car can. e. Co ha goc miOng.
c. Car chan budm ngoai.
745.DOng mach nao &di day KHONG cho nhanh n6i vdi DM du'di don
a. DM canh ngoai. d. DM chili ngyc.
b. DM canh trong. e. DM d6t
c. DM nach.
746.Noi v6 &Ong mach canh trong, cau nao SAI:
a. Khong cho nhanh ben a c6.
b. Cho nhanh canh nhi a mat trong xtro'ng dd.
c. Cho mot nhanh ben trong so la DM mat.
d. Cho 4 nhanh cOng a mom yen trudc.
e. Cap huyet cho nao va daib0 phan cac phan ine'm dm mat.
747.Thanh phan trong bao canh g6m:
a. DM canh trong, TM canh trong, than giao cam c6.
b. DM canh chung, TM canh trong, TK lang thang (X).
c. DM canh trong, TM canh trong, TK lang thang va than giao cam co.
d. DM canh trong, TM canh trong, TK hoanh.
e. DM canh trong, TM canh trong.
508
Dung cac chi tie't sau trd loi cau 748
1. Mac bao boc ca dc don chum 4. Mac bao boc ca gicip
2. Mac bao boc tuye'n mang tai 5. Mac pha mat truac cac ca bac thang
3. Mac bao boc tuye'n dudi ham
748.Thanh phan nao thuOc la track khi quan dia mac co:
a. 4. d. 2,3,4.
b. 2,4. e. 2,3,4,5.
c. 3,4.
749.Than kinh nao KHONG di qua khe 6 mat tren:
a. Than kinh van nhan. d. Than kinh mat.
b. Than kinh rang roc. e. Than kinh ham tren.
c. Than kinh van nhan ngoal.
750.L6 gai thuOc xtrung:
a. Khdu cai. d. Dinh.
b. Thai du'ung. e. Chdm.
c. Badm.
751.Khi so sanh gan than va gan tay, cau nao sau day DUNG:
a. Cac co gan than ding chia thanh 3 o flint co gan tay nhung xep thanh 4 ldp va c6 ca
d6i nem cai va cu ngon tit.
b. Cung DM gan chan tu'ung tit nha cung DM gan tay nOng.
c. DM cung d gan chan tu'ung tit nha cung DM gan tay sau.
d. TK gan chan ngoai tu'ung tii nganh ding caa than kinh tru.
e. TK gan chan trong taring to nha nganh clang caa TK quay.
752.Cau nhan qua. Choi':
a. Neu (A) clang, (B) dung; (A) va (B) có lien quan nhan quci.
b. Neu (A) citing, (B) dung; (A) va (B) khong lien quan nhan quci.
c. Neu (A) dung, (B) sai.
d. Neu (A) sai, (B)
e. Ne'u (A) sai, (B) sai.
(A) Tiem tinh mach d mat ca tha6ng chan tinh mach hidn ldn Vi
(B) Tinh mach hidn ldn to db bOc 10 va nam ngay tradc mat ca trong.
753.Chon cau SAT:
a. Tam giac dui du'uc gidi han bai : day chang ben, cac cu vang dui trade va cac co viing
dui trong.
b. Tran tam giac dui du'uc day bang mac sang va mac did.
c. San tam giac din bao g6m : co that lung ch'au, cu lauc, ca khep dai va co khep ngan.

509
 d. Dinh tam giac dui la ch6 gap nhau cua co may va co khep ngan.
e. Day cda tam giac did quay len tren, diiac gidi han Uri d/c ben va xudng chau.
754.Co nao sau day KHONG thuOc nhom ca u ng6i-xudng mu-mau chuydn:
a. Co hinh le. d. Ca bit ngoai.
b. Co sinh doi. e. Ca yang
c. Co bit trong.
755.W DM chi dudi, thong tin nao sau day DUNG:
a. DM chau ngdai va nhanh dm. DM chau trong cung cap mau cho chi dadi.
b. Khi di het 6ng ca khep, DM dui sau d6i ten thanh DM kheo.
c. DM kheo cho hai nhanh tan ar phia tren cung gan ca dep.
d. DM chay trade di cling vdi TK chay d yang tang than triidc.
e. DM mac la nhanh ben cda DM chay trade.
756. Cau nao sau day KHONG DUNG:
a. Mac gift gan dui ding vdi xacing c6 tay tao thanh 6ng c6 tay.
b. Gan cac co gap ngon nong va sau qua 6ng c6 tay xdp thanh 2 lap.
c. Gan gap cac ngdn nong d phia trade.
d. Gan gap cac ngdn sau a phia sau.
e. Gan gap cac ngon nong goi la gan thang, gan gap cac ng6n sau goi la gan xuyen.
757.Thanh ph'an nao sau day KHONG nam trong 6ng c6 tay:
a. TK giaa.
b. TK try.
c. Gan gap ngdn tai dai.
d. d. Cac gan ggp nong.
e. Cac gan gap sau.
758.Trong mang mach quanh khuYu, DM quat ngrunc gian cat se not vdi:
a. DM canh tay sau.
b. DM ben quay.
c. DM ben glib..
d. DM ben tru tren.
e. DM ben tru clued.
759.Dam r6i TK canh tay dude tao bdi :
a. Nhanh trade cac TK song c6 4,5,6,7 va nguc 1.
b. Cac TK song c6 4,5,6,7,8.
c. Cac TK sang c6 5,6,7,8 va rigac 1.
d. Nhanh trade cac TK song c6 5,6,7, nguc 1 va ngac 2.
e. Tat ca deu sai.
510
760.Khi ban tay lam clang tac sap ngda, thi laic do c6 sit tham gia hoat Ong cua:
a. Khdp quay tru tren va khdp quay tru dadi.
b. Khdp quay tru tren, khdp quay tru dadi va cac khdp c6 tay.
c. Khdp quay tru tren Nth khdp canh tay tru.
d. Khdp quay tru tren, khdp quay tru du'di va khdp canh tay quay.
e. Khdp quay tru tren va khdp canh tay quay.
761.Xnong quay co:
a. Litii cu quay dd ti6p khdp vdi khuyet quay cua xtiong tru.
b. Chom quay dd tiep khdp vdi xaong canh tay va )(acing tru.
c. Bar gian cot sac va hating ra ngOai.
d. M6m tram quay d cao hal mom tram tru.
e. Co khuyet quay nem a dau dadi.
762.Chon cau SAI:
a. LO bit do xaang ng8i va xaang mu tao nen va dadc gidi hen O tren bOi ranh bit.
b. Khuy6t ng8i ldn la met khuyet ldn O bar sau racing chau va co co hinh le di qua.
c. Dien nguyet, dien ladc la cac dien khdp cua 'along chau.
d. Gai ng8i ngan tech khuyet ng8i ldn vdi khuy6t ng8i be.
e. Gai chau trade tren la met trong cac didm m6c dd xac dinh yang tiem bap an toan a
mong.
763.NOi ve cac co tren mong, cau nao sau day DUNG:
a. Bain tan vao cac xaang dau mat.
b. Co tac dung koo xuang mong len tren va ra trade.
c. Co tac dung nang xudng mong, san mieng va day la ai len khi nu6t.
d. Co tac dung keo xadng mong ra sau va vao trong.
e. Dade van Ong cha yeu bOi TK mat.
764.Am thanh duoc den truy6n trong tai gida nhi cac cau true sau day theo this ti ti ngoai
vao trong:
a. Loa tai, mang nhi, xu'ong
b. Loa tai, 6ng tai, mang nhi va chu6i xudng con.
c. Mang nhi, xacrng baa, xaong de, )(acing ban dap.
d. Xu'ong bua, xudng de va xaang ban dap.
e. Loa tai, 6ng tai ngbai, mang nhi phu va chu8i 'along con.
765.M6ng mat c6 chile nang nao sau day:
a: Lam phong tin cho nhan eau.
b. Dieu chinh hang anh sang lot vao nhan cau.
c. Dieu hoa nhan tip.
d. Bao ye cho hau phong.
511
 e. Tiet thily dich.
766.Khi that DM canh ngoai, tuan hoan phu du'oc thanh lap qua cac nhanh lon (A) cfra dOng
mach. DM canh ngoai thing du'oc that a phia tren (B) dOng mach (C) vi a day DM
canh ngoai phan biet du'oc vdi DM canh trong qua 3 dac didin: a tru'ac ham, a trong bon
va có nhanh ben. Cau trail SAI a chi tieet nao ? Neu DUNG thi chon cau e)
a. (A). d. (B) va (C).
b. (B). e. Cau tren thing.
c. (C).
767.TK ng6i co tinh chat da:
a. G6m có 2 than kinh.
b. Di qua phia truck co bit trong.
c. Cho nhieu nhanh vao mong.
d. Di xuang dui ra lap Ming.
e. Chay xuyen qua co hinh le.
768.Dui khong the lam du'oc clang tac khep, kern then mat cam gide a phan tren trong viing
dui truac la do than kinh nao sau day bi ton thong:
a. TK d. TK rang tren.
b. TK ng6i. e. TK mang dual.
c. TK bit.
Dung hinh ye de tra to i cau 769, 780
769. Chi tiet s6 (4) tren hinh ye la
a. Ca chay trade.
b. Ca mac dai.
c. Co mac ngAn.
d. Co dui ngon cai dai.
e. Co du6i cac ngOn chan dai.
770.Chi tie't a vi tri s6 (2) se do TK nao sau
day van deng:
a. TK chay.
b. TK mac riling.
c. TK mac sau. Thigt d6 ngang cang char)
d. TK hign.
e. Tat ca deu sai.

512
 DE THI TRAC NGHIt M MON GIAI PHAU HOC
(De thi hoc phan II — Y 2009)

771.Tam gide that lung duvc gidi han bai:

a. Co cheo bung ngoai, co lung Ong, cot s6ng that lung.
b. Co cheo bung ngoai, co lung Ong, mao chau.
c. Co thang, co lung Ong, mao chau.
d. Co thang, co lung rOng, cot song that lung.
e. Co thang, co lung r6ng, co cheo bung ngoai.
772.Tieu chuan chti ydu de phan biet mot clot s6ng that lung vdi d6t song doan khdc la:
a. Than to va Ong chidu ngang.
b. L6 s6ng hinh tam gide.
c. Khong c6 16 ngang va h6 su6n.
d. MOrn ngang dai va hep.
e. Mom ngang hinh chat nhat.
773.H6 ben ngoai co dac didm:
a. Cl thanh sau 6ng ben.
han phia ngoai bai Ong mach thuong vi dudi.
b. Duac gidi
c. La not xay ra thodt vi ben trOc tiep.
d. a va c dung.
e. a, b va c thing.
774.d viing lung, ding ldp vdi co nang vai la:
a. Ca thang.
b. Co lung rOng.
c. Co tram.
d. Co rang sau teen.
e. Co rang sau &refl.
775.0 doan 2/3 tren, ld truck bao co thang bung &toe tao bdi:
a. Can co elle() bung ngoai.
b. Hai la can co cheo bung trong va can co cheo bung ngoai.
c. La truck can co cheo bung trong va mot phan can co cheo bung ngoai.
d. Can co ngang bung, can co die() bung trong, can co cheo bung ngoai.
e. Tat ca cac cau tren ddu sai.
776.Thanh phan ding thuc quan di qua 16 thuc quan cila co hohnh là:
a. Than kinh lang thang.
b. Than kinh lang thang va than kinh hoanh.
513
 c. Than kinh tang Ian Ira than kinh tang be.
d. Than kinh lang thang va 6ng ngiic.
e. Tinh mach dun.
777.Khoang mang ph6i có dac didm, NGOAI TRU:
a. La khoang ao giiia hai la mang phol
b. LuOn Won kin va có ap suat
c. Luon có mot khong khi nhat dinh gitip hai là mang ph6i khong dinh nhau.
d. O ta the dting, vi tri thap nhat la ngach wan — hoanh.
e. Khong co ski' thOng thaang gida khoang mang ph6i phai va trai.
778.Ngach mang phoi la:
a. Goc nhi din hdp Jodi hai phan mang ph6i thanh.
b. Phan mang ph6i thanh quanh r6n ph6i.
c. Phan mang ph6i thanh phia tren dinh ph6i.
d. Phan mang ph6i thanh phia tren cc hoanh.
e. Noi mang ph6i tang lien ti6p \raj mang ph6i thanh.
Cau 779, 780, awn tap hoop:
a. Neu 1, 2 thet 3 dung.
b. Neu 1 vet 3 dung.
c. Neu 2 va 4 dung.
d. Neu chi 4 dting.
e. Neu tat cd deu dung.
779. Lach co dac didm:
1. Dudc boc trong mot ldp sdi.
2. Thong thing de clang sO th a- y du'dc khi kham bung.
3. Bd tru'ac có nhi8u khia rat dac tru'ng.
4. Durqd treo vao thanh bung sau bdi mac treo lath.
780.
1. Thu-c van di tiff trung that tren qua trung that trade roi xuyen qua co hoanh.
2. Tinh mach dun va tinh mach ban dun d6 vao tinh mach cha tren.
3. DOng mach ph6 quail la nhanh ciia quaff dOng mach cha.
4. Ong nguic xuyen qua cd hoanh qua to dOng mach cha.
781.Mach va than kinh cua lath di vao lach qua:
a. Mat than.
b. Mat k6t trang.
c. Mat da day.
d. Bar

514
 e. Ba tren.
782.Van ba la có tac dung:
a. Ngan dong mau chay noac tit thdt trai len nhi trai trong thi tam thu.
b. Ngan clang mau chay nguac Ulf that trai len nhi trai trong thi tam truang.
c. Ngan dang man chay ngdoc tit that phai len nhi phai trong thi tam thu.
d. Ngan clang mau chay ngu'ac tit that phai len nhi phai trong thi tam tracing.
e. Tat ca cac cau tren deu sai.
783.B6 nhi - that:
a. ThuQc he thong clan truyan tai thing tim.
b. Di -Ur nut xoang nhi den mit nhi — thdt.
c. di ben phai vach gian nhi.
d. a va c.
e. a, b va c thing.
784.6 ngoai tam mac (khoang ngoai tam mac) la mot khoang gida:
a. Ngoai tam mac sai va ngoai tam mac thanh mac.
b. Hai la ngoai tam mac thanh mac.
c. Ngoai tam mac thanh mac va car tim.
d. Bao Ong mach va bao tinh mach.
e. Tat ca cac cau tren deu sai.
785.d tim, 16 nao sau day khang ca van?
a. L6 than thing mach ph6i.
b. L6 (Icing mach chi'.
c. L6 tinh mach chi' tren.
d. L6 tinh mach chi" duai.
e. L6 xoang tinh mach vanh.
786.Thong thuang, tam vi a ngang mac:
a. Dot song ng-tic X.
b. D6t song ngtic XI.
c. DCA song nguc XII.
d. Dot song that lung I.
e. Bet song that lung II.
787:Da day co (lac diem:
a. La mot tang trong 6 philc mac.
b. Nam a tang tren mac treo ket trang ngang.
c. CO ba tong nho not vdi ba duai gan qua mac n6i nhO.
d. a va b
515
 e. a, b va c dimg.
788.Ta trang co dee diem, NGOAI TRV:
a. Du'oc xem la phen deu caa met non.
b. lieu het c6 dinh do dinh vao thanh bung sau.
c. Thanh sau cua D2 co 16 d6 ctia eng tuy.
d. Trong chin thuang bung, doan de bi ton thuang nhet là doan D3.
e. Doan D4 thuang di huang len tren.
789.Bao xa cUa gan:
a. Bao ben ngoai hip thanh mac cua gan.
b. Nam &raj hip thanh mac cua gan.
c. Bao quanh mach mau va ang met trong me gan.
d. a va c dUng.
e. b va c dung.
790.Thanh phen hien dien trong khocing gian tieu they gan g6m:
a. Deng mach gan, tinh mach cda, eng met.
b. Deng mach gan, tinh mach gan, tinh mach cda.
c. Deng mach gan, tinh mach gan, 6ng met.
d. Tinh mach gan, tinh mach dm, eng met.
e. Deng mach gan, tinh mach gan, tinh mach dra, 6ng met.
Cau 791, 792 la cau menh de lien quan nhan qua. Chun
a. Neu (A) dung, (B) dung, (A) vet (B) co lien quan nhdn qua.
b. Neu (A) thing, (B) dung, (A) vet (B) khong lien quan nhan quci.
c. Neu (A) dung (B) sai.
d. Ne'u (A) sai (B)
e. Neu (A) sai (B) sai.
791.
(A) Binh thu'ang gan khOng di dung theo nhip tha, BOI Vi:
(B) Co nhieu phuang tien c6 dinh gan vac, ca hoanh va thanh bung.
792.
(A) Phan lan to trang khong di Ong, BOI VI:
(B) TA trang dinh vao deu tuy.
793.Thong thuang, eing met chit hep nhet tai:
a. Nai de vao cUa 6ng tui met.
b. Ngay b6 tren D1 to trang.
c. Doan di sau D1 to trang.
d. Doan xe sau deu tuy.
516
 e. Doan trong thanh td trang.
794.Thanh phan nao sau day nam ngay phia sau thing mach mac treo trang tren (doan tren
va truck td. trang)?
a. Eo tuy.
b. Mom mot tuy.
c. Phan len (D4) to trang.
d. DOng mach chii bung.
e. Tinh mach cha dad.
Cau 795, 796 IA cau menh de lien quan nhan qua. Own
a. NeU (A) dung, (B) dung, (A) va (B) có lien quan nhan quci.
b. IV& (A) dung, (B) dung, (A) va (B) khong lien quan nhan qua.
c. Neu (A) clang (B) sai.
d. 1\16u (A) sai (B) dung.
e. 1\16U (A) sai (B) sai.
795.
(A)Ta c6 the soy va nhan bieet duoc ldch de clang BOI VI:
(B) Bo dad c6 nhieu khia rat ddc trang.
796.
(A)Ta khong the cat 136 tui mat BOO Vi:
(B) Ttii mat c6 ch.& nang co ddc va dot tra mat
797.0 ngti6i ViUt Nam, runt thita thikng gdp nhA
a. Vi tri sau manh trang.
b. Vi tri trudc manh trang.
c. Vi tri du6i manh trang.
d. Vi tri chau.
e. Vi tri sau hOi trang.
798.BOng mach mac treo trang cht6i c6 ddc diem:
a. Xuat phdt tit dOng mach chil bung, ngay tren Ong mach sinh duc.
b. Di trong re mac treo k6t trang xuthig.
c. Cung cap mdu cho toan bO rut gia.
d. Co hai tinh mach di kem.
e. Cho hai nhdnh tan la dung mach true trang dudi.
Cau 799, 800, chon tap hqp:
a. Neu 1, 2 va 3 dung. d. Neu chi 4 dung.
b. Neu 1 va 3 dung. e. Neu tat ca deu dung.
c. Neu 2 vet 4 dung.
517
799. Than
1. Than nam sau phdc mac, nen thong thurang ta c6 the sa duoc than tit phia sau lung
khi tharn kham.
2. Ngodi chdc nang tao nude ti4u, than can c6 chile nang not tiet.
3. Thong thuang, tinh mach than phai dai horn tinh mach than trdi.
4. Tai rein than, dOng mach than a phia truac be than.
800. Mac than:
1. Gom hai la, la trade va la. sau, Id truck cua hai than lien tiep nhau.
2. Chi boc lay than, khOng boc lay tuyen thuong than.
3. Boc ca bao mo (lap mar quanh than).
4. Lien tiep yeti phdc mac thanh bung sau.
801.11e lay soi than, nguai ta tilde:mg rach than theo dung Hyrtl, du'Ong nay:
a. Di ngang tren ren than.
b. Di ngang duai ren than.
c. Bar ngodi than.
d. Phia truck bar ngodi than.
e. Phia sau bar ngodi than.
802.Nieu dao nam:
a. Doan tign liet ya doan mang c6 dinh.
b. Nieu dao doan x6p c6 met phan c6 dinh.
c. Nieu dao doan x6p c6 met phan thuOc nieu dao sau.
d. a ya b dung.
e. a, b va c deu dung.
803.D6ng mach tinh hoan co cdc ddc diem, NGOAI TRe:
a. Xuat phat tit Ong mach chili bung, clued dOng mach than.
b. Chay sau phLic mac.
c. Chui qua 16 ben sau.
d. Di trong thitng tinh.
e. Cho nhanh cung cap mau cho car blu.
804.Thanh duai cua h6 ng6i - trip trang duoc gidi han bdi:
a. Co that ngodi hau mon.
b. Ca bit trong.
c. Car nang hau mon.
d. Da vung hau mon.
e. Tat ca deu sai.

518
805.Ranh thanh - ket trang trai:
a. Tao bdi thanh bung ben va ket trang xich ma.
b. Thong o gan vdi chau hong be.
c. Thong 6 da day, 6 lath vdi chau hong be.
d. Thong 6 da day, 6 lath vdi h6 chau trai.
e. Cac cau tren deu sai.
806.Tinh mach (TM) cda:
a. Thiqc hap bdi TM mac treo trang tren, TM mac trang dudi, TM lath
b. Dan mau tit gan ra tinh mach chill 'lath.
c. La thanh phan ldn nhat va sau nhgt cua cugng gan.
d. a va c thing.
e. b va c thing.
807. Mac n6i nh6 co dac diem, NGOAI TRe:
a. Cdu tao g6m hai la caa phdc mac.
b. Ngi gan vdi thiic qudn, da day, to trang.
c. Phan day chinh là day chang gan — vi.
d. Phan mong tao nen thanh tilt& cua tin dinh hau cung mac n6i.
e. Bb phai, gidi han trade cda 16 mac n6i, cd 6ng clan mat.
808.6ng tuy chinh:
a. Keo dai tit duoi tuy qua than tuy den dau tuy.
b. D6 vao thanh sau D2 to trang.
c. Lu6n c6 mot doan chung vdi 6ng mat chd.
d. a va b clang.
e. Tgt ca d6u dung.
809.Cac day than kinh so sau day cd cac sai trade hach dm than kinh dgi giao cam macin
du'dng de den hach, NGOAI TR-Cf:
a. Day than kinh van nhan.
b. Day than kinh sinh ba.
c. Day than kinh mat.
d. Day than kinh thiet hau.
e. Day than kinh lang thang.
810. Cac thanh phan sau c6 ngu6n g6c tit nao sau, NGOAI T11ff:
a. Cugng nao.
b. Cau nao.
c. Flanh nao.
d. Tieu nao.
e. Nao thSt, IV.
519
811.Mang cling nao có clac diem, NGOAI
a. Co nguen g6c tit trung bl phoi.
b. Day han mang nhen va mang nuoi.
c. Nam sat mat trong )(acing so.
d. Tao nen cac xoang tinh mach mang
e. Len vao cac khe, cac ranh cua ban 4_1 dai nao.
812„Xoang tinh mach KHONG tiefp xdc yeti )(acing so la:
a. Xoang doc tren.
b. Xoang doc
c. Xoang ngang.
d. Xoang xich — ma.
e. Xoang cid tren.
813oCac nhan xam dai nao gem:
a. The van, nhan trudc toting va the hanh nhan.
b. The van, bao trong va the hanh nhan.
c. The van, bao trong, nhan trade Wang.
d. Bao trong, bao ngoai, bao ngoai ding.
e. The van, bao trong, bao ngoai, nhan trUdc
814. Mang nao:
a. Mang cling dp sat mat trong xucrng so.
b. Mang nhen len vao cac ranh tren ban can dai nao.
c. Mang mem chila cac vi mach nuoi duOng nao.
d. a va c dung.
e. a, b va c clang.
815. Coe nang mi tren duqc van dOng bai:
a. Than kinh so s6 III.
b. Than kinh so s6 IV.
c. Than kinh so s6 V.
d. Than kinh so s6 VI.
e. Than kinh so s6 VII.
816.Thanh trudc nao that III durqc tao bai:
a. Tru trudc vom nao.
b. Mep trUdc.
c. Là tan ding va giao
d. b va c dung.
e. a, b Ara c deu dung.

520
817. Car thdi &rang duqc van &Ong bai :
a. Day than kinh so s6 V1.
b. Day than kinh so s6 V2.
c. Day than kinh so s6 V3.
d. Day than kinh so s6
e. Day than kinh so s6 IX.
818.Day than kinh so di ra a ranh ben truac hanh nao la:
a. Than kinh so s6 IV.
b. Than kinh so s6 V.
c. Than kinh so s6 VII va
d. Than kinh so s6 X va XI.
e. Than kinh so s6 XII.
819.Trong he th6ng mang nao thy, dich nao thy có a:
a. Ngoai mang ding.
b. GiCia mang ding va mang nhen.
c. GiCia mang nhen va mang mem.
d. Duai mang mem.
e. Tat ca deu sai.
820.Cac sqi d6i giao cam d6n hach mi muqn &Ong cila:
a. Day than kinh so s6 II.
b. Day than kinh so so III.
c. Day than kinh so s6 IV.
d. Day than kinh so s6 V.
e. Day than kinh so s6 VI.
Cau 821, 822 chon tap hdp:
a. Neu 1, 2 vet 3 dung. d. Neu chi 4 dung.
b. Neu 1 vet 3 dung. e. Neu tat cd Wu dung.
c. Aqu 2 vet 4 dung.
821. C1 nao:
1. Mang mem nao bac len vao cac ranh cila ban cau dai nao.
2. Mach mau nu& nao nam dudi mang nhen.
3. Khoang quanh mach mau ming chiia dich nao thy.
4. Mang cting nao barn vao Om so chat Ilan nen so.
822.o gian nao:
1. Chat xam cha doi thi tap trung a la. thy doi thi.
2. Ranh ha d6i ngan cach vting ha do'i vdi tuye'n yen.
521
 3. The tang thuec yang tren
4. L6 gian nao that nam a thanh ben nao that ba.
823. Cam gide sau coy that duoc &an truyk qua:
a. B6 gai doi thi trudc.
b. B6 thon va bo chem.
c. B6 gai doi thi ben.
d. B6 gai tidu nao sau.
e. B6 hiUi gai.
824. Cac soi d6i giao cam chi ph6i phan xa anh sang dung tit se di ding:
a. Than kinh mat.
b. Than kinh thi gide.
c. Than kinh van nhan.
d. Than kinh rang roc.
e. Than kinh van nhan ngoai.
825. Co mat duoc van dung Bair
a. Than kinh so s6 V1.
b. Than kinh so s6 V2.
c. Than kinh so s6 V3.
d. Than kinh so s6 VII.
e. Than kinh so s6 IX.
826.Than kinh nao sau day don thuan la day than kinh gide quan?
a. Day than kinh so s6 II.
b. Day than kinh so s6 V.
c. Day than kinh so so VII.
d. Day than kinh so s6 IX.
e. Day than kinh so s6 X.
Dung hinh ben de tra iii cau 827 va
cau 828 bang each chon tap lulp.
Tuyeil yen
a. Neu 1, 2, 3 dung.
b. Aqu 1 vet 3 dung.
c. Ne.0 2 vet 4 dung.
d. Aqu chi có 4 dung.
e. N6c tat ca dung.
. v • v• v 4 v
827. Chi tiet s6 1 tren hinh:
C. 2

1. La day than kinh h8n hop. roc

C

2. Co nguyen uy hit d ranh hanh-cau. Thie't do cdt dung ngang qua xoang hang
522
 3. Di qua 16 trona an so.
4. Van Ong cho mat ca clia nhan cau.
828. Chi tigt s6 2 tren hinh:
1. La day than kinh h8n hap.
2. Di qua 16 tron a Ilan so.
3. Gap phan chi ph'6i cam gide da a met.
4. Van Ong cac ca nhai.
829.Trung khu chi phea hoat clang cila he than kinh to' chil la:
a. D6i thi.
b. Tuyan yen.
c. Vo nao.
d. Vimg ha d6i.
e. Tay gai.
830.Vimg va nao thOy thai ddang ngang c6 chtic nang la:
a. Vimg cam giac than thg.
b. VOng thi gide.
c. Wing tin dinh.
d. \Tang vi gide.
e. -Wing thinh gide.

DE THI TRAC NGID*M MON GIAI PHAU HOC

(Da thi Lap &I nhan chinh qui —2010)

831.Trong cac xuang a c6 chan, xtrang nao la xacing to nhat:

a. Xuang sen. d. Xdang hap.
b. )(tong g6t. e. Xu'ang ghe.
c. )(acing chem trong.
832.H6 khuSru la chi tint giai phasu a mat sau cUa:
a. )(dung canh tay. d. Xuang tru..
b. Xlicing vai. e. Xuang quay.
c. Xtiang don.
833.TK so s6 III van clang cho ca nao dad day:
a. Ca thOng tren. d. Ca cheo
b. Ca thang e. Ca 4 ca ben tren.
c. Ca thang trong.

523
834.Thanh phan nao sau day di qua tam giac canh tay tarn dau:
a. TK quay. d. Cau a va b dung.
b. DM canh tay sau. e. Cau a va c dung.
c. DM mu canh tay sau.
835.DM nao sau day KHONG là nhanh cUa DM nach:
a. DM nguc tren. d. DM ding vai nguc.
b. DM nguc trong. e. DM duai vai.
c. DM nguc ngoai.
836. Co nao KHONG lam dOng tac gap khuSTu:
a. Co canh tay quay. d. Co nhi Tau canh tay.
b. Ca sap e. a Ira b.
c. Co canh tay.
837.Than kinh nao sau day khong phai la than kinh &la chi doh:
a. TK chay. d. TK co bi.
b. TK mac 'long. e. TK
c. TK mac sau.
838. Co nao thuOc lap co gilia a yang m6ng:
a. Co mong nha. d. Cau a, b, c
b. Co mong be. e. a va c dung.
c. Co hinh le.
839. Ca tam clan cang chan la kh6i co to gOm 2 dau co bung chan va:
a. Co kheo. d. Co thon.
b. Ca ban gan. e. Co dep.
c. Co ban mang.
840. Co nao sau day khOng phai là co barn da viing mat:
a. Ca go ma kin. d. Co can.
b. Ca go ma be. e. Co ha goc mi6ng.
c. Ca nang mai tren va canh mui.
841.Than kinh thi6t hau la:
a. TK V. d. TK XI.
b. TK VII. e. TK XII.
c. TK IX.
842.Tinh mach nao sau day d6 mau v6 Tam nhi trai:
a. TM chil tren. d. Bon TM ph6i.
b. TM chi' duai. e. Ca a, b, c, d d6u dung.
c. Xoang TM vanh.
524
843.D4c didm nao sau day c6 a ph6i trai:
a. Ranh che/ch. d. Ranh dOng mach chi'.
b. Co 2 thuy: tren, doh. e. Ca. 4 dac digm tren.
c. Khuydt tim.
844. Chon cau SAI. Da day:
a. Hinh dang gi6ng chit J. d. Phia dirai n6i vai Ice/t trang.
b. Co 2 ba tong lan va nh6. e. Dirac chi ph6i bai TK X.
c. Phia tren n6i vai thu'c quan.
845.Ca nao sau day KHONG nam trong nh6m ca lam dOng tac nhai
a. Ca can.
b. Ca chan bu'am trong va ca chan bu'am ngoai.
c. Ca milt.
d. Ca thai &tang.
e. Ca c va d.
846. Thanh phgn trong bao canh
a. DM canh trong, TM canh trong, than giao cam c6.
b. DM canh chung, TM canh trong, TK lang thang (X).
c. DM canh trong, TM canh trong, TK lang thang va than giao cam co.
d. DM canh chung, TM canh trong, TK hoanh.
e. DM canh trong, TM canh trong.
847.Voi tai (Arai nhi) la 6ng thong tir hdu mid den thanh nao ctia horn nhi ?
a. Thanh ngoai (thanh mang).
b. Thanh trong (thanh me dao).
c. Thanh truck (thanh Ong mach canh).
d. Thanh sau (thanh chum).
e. Thanh &raj (thanh tinh mach canh).
848.Ca nao sau day c6 tdc dung lam tang day thanh am:
a. Ca nhdn gidp. d. Ca phAu ngang.
b. Ca gidp ph'eu. e. Ca plfeu cheo.
c. Ca nhan ph'6u ben.
Cau 849, 850 la eau menh de nhan qua. Chan:
a. Neu (A) thing, (B) thing; (A) va (B) có lien quan nhan quci.
b. Neu (A) thing, (B) dung; (A) vet (B) khong lien quan nhan qud.
c. Neu (A) thing, (B) sai.
d. Neu (A) sai, (B) dung.
e. Neu (A) sai, (B) sai.
525
849.
(A)Viem nhiem yang hau hong lau ngay co thd dan ddn viem tai giiia VI
(B) Horn nhi thong vai hang chum a phia sau qua 6ng thong hang.
850.
(A)Khdp vai rat linh hoat va co bier' dO cit dOng rat rOng Vi:
(B) Khop vai la khdp chain duy nhat ctia cci the
851.DOng mach nao sau day khong la nhanh ben dm dOng mach canh ngoai:
a. BOng mach giap tren. d. DOng mach hau len.
b. Than giap CO. e. DOng mach tai sau.
c. DOng mach lurai.
852.Tinh mach nao di bgt cheo vai co tic don churn:
a. Tinh mach canh trade. d. Tinh mach sau ham.
b. Tinh mach canh trong. e. Tinh mach &Ali don.
c. Tinh mach canh ngoai.
853. Ca nao sau day khong thuOc nhom co Judi m6ng:
a. Cu tic m6ng. d. Co tram m6ng.
b. Cu tic giap. e. Co vai ming.
c. Co giap m6ng.
854. Thit tu[ tit 'long den sau &la cac thanh phan trong h6 kheo la:
a. Than kinh chay, Tinh mach kheo, DOng mach kheo.
b. Than kinh chay, DOng mach kheo, Tinh mach kheo.
c. Tinh mach kheo, Than kinh chay, Wing mach kheo.
d. Tinh mach kheo, DO'ng mach kheo, Than kinh chay.
e. DOng mach kheo, Tinh mach kheo, Than kinh chay.
855. Co nao sau day khong do than kinh bit chi ph6i van dOng:
a. Co luvc. d. Co khep lon (B6 tren va
b. Co thou. e. Ca khep ngdn.
c. Co khdp dai.
856.136 mach - than kinh chinh cap man va chi ph6i cho viing cang chan sau la:
a. Bong mach chay sau, than kinh mac chung.
b. Ming mach chay sau, than kinh chay.
c. Being mach chay sau, than kinh mac sau.
d. Wong mach mac, than kinh chay.
e. DOng mach mac, than kinh mac chung.

526
Dung bang va each luta chon sau de tra 1di 2 cau 857, 858
1. Ming mach vi phai.
2. DOng mach vi trait.
3. Deng mach vi mac not trai.
4. Dung mach gan chung.
5. Bong mach vi mac not phai.
Chou:
a. Neu 1, 2 dung.
b. AT& 1, 2, 3 dung.
c. 1V-du 2, 4 dung.
d. Neu 3, 5 dung.
e. Neu 3, 4, 5 dung.
857.DOng mach nao la nganh ben xuat phat ngay tit thing mach than tang
858.D6ng mach nao gip phan tao nen Ong Ming mach ba tong vi ldn
859.Nhu mo ph6i duoc nuoi duang bdi:
a. DM ph6i. d. Cau a va c.
b. TM ph6i. e. Cau b va c.
c. DM pile- quan.
860. Cau nao sau day SAT:
a. Tim g6m co 3 mat: tic-shorn, hohnh, ph6i.
b. Tim thuOc trung that gida.
c. Day tim nam tren co hoanh.
d. Tim co b6p duai su' chi phol cila he thong clan truy6n ctia tim (m"it xoang, nut nhi
that, 136 nhi that) va duai su' dieu hoa dm he TK to chit.
e. Thuc quan nam ngay sau tam nhi trai.
861.Tang nao sau day khong nam trong phtic mac:
a. Da day. d. Tuy.
b. Gan. e. Than.
c. Lach.
862.Thny nao sau day khong phai la thtty cua gan:
a. Thiry trai.
b. Thiry phai.
c. Thiry
d. Thiry vuong.
e. Thiry duoi.

527
863.DOng mach nao sau day khong phan nhanh ben a viing c6 va ham met:
a. DOng mach clued don. d. DOng mach canh trong.
b. DOng mach canh chung. e. DOng mach ham.
• c. DOng mach canh ngoai.
864.Digu khidn van dOng cac ca barn da mat la do:
a. TK III. d. TK VI.
b. TK IV. e. TK VII.
c. TK V.
865.Ta trang:
a. La phdn ddu cua runt non.
b. Dai khoang 25cm.
c. CO clueing kinh lan ho'n hang trang va hoi trang.
d. Co mot doan di do, ng khong dinh vao thanh bung sau.
e. Tat ca cac cau tren de'u dung.
866.d cita gan, TM cda, DM gan Ira 6ng gan:
a. Xgp lam 3 lop. d. a,b
b. TM nam sau nh'at. e. a, b, c
c. Ong gan nam nong nhat.
867.RuOt non:
a. Nhan mau tit DM mac treo trang tren.
b. Di dOng than b0 chd khong dinh mot vai doan nhu ke't trang.
c. CO &rang kinh to ddn tif tren xu6ng
d. a, b, c clang.
e. a, b, c sai.
868.DM nao KHONG cho nhanh dgn nuoi &fang cho runt gia:
a. DM chau ngoai. d. DM mac treo trang
b. DM chau trong. e. a va b.
c. DM mac treo trang tren.
cung:
a. La nai chila bao thai. d. N6i vai voi tit cung a 2 gOc ben.
b. Gam 3 phdn: than, day va c6. e. Thong vai am dao a phia dual.
c. Gap va nga ra phia sau.
870.Nao that nao nam a giaa 2 doi thi:
a. Nao that 3. d. Nao that ben trai.
b. Nao that 4. e. a, b, c, d dgu sai.
c. Nao that ben phai.
528
871. Thanh phan nao sau day KHONG c6 trong thitng tinh:
a. Ong clan tinh. d. Dam roi TM hinh day leo.
b. DM tinh hodn. e. DM thuang vi da6i.
c. Di tich 6ng phdc tinh mac.
872. Cac day TK so nao thodt rad ranh hanh eau:
a. V, VI, VII. d. VI, VII, VII', VIII.
b. VII, VIII. e. VIII, IX, X.
c. IV, V, VI, VII.
873. Tay gai co chi") phinh a:
a. Phan c6. d. NOn tay.
b. Phan ngufc. e. a va c.
c. Phan that lung.
874. Doan runt gia not vdi phan cu6i caa runt non là:
a. Manh trang. d. Ket trang xu6ng.
b. Ket trang ngang. e. Trip trang.
c. Kgt trang len.
875. MO to v6 than kinh ng6i, cau nao sau day Sai:
a.' La than kinh thu6c chi dudi.
b. Xuat phat a yang mong.
c. Den kheo chia lam 2 nhanh tan.
d. TK chay là nhdnh tan di phia trade tang than.
e. TK mac chung la nhanh tan di den cac co mac.
876. Tuyen nude bot nao sau day co 6ng tuye'n d6 vao tin dinh mieng:
a. Tuy6n mang tai. d. Ca a va b.
b. Tuyen dadd lu th. e. Ca b va c.
c. Tuyen (lath hdm.
877. Sun nao sau day khong phai la sun thanh quan:
a. Sun gidp. d. Sun vien.
• b. Sun nhan. e. Sun sang.
c. Sun ph'eu.
878.Ong mat cha d6 vao to trang a:
a. Doan 1 (phan tren).
b. Doan 2 (phan xtang).
c. Doan 3 (phan ngang).
d. Doan 4 (phan len).
e. Tat ca deu sai.
529
879.Ndo that IV thong vdi:
a. Khoang duai nhen qua 16 giva va 2 to ben.
b. COng nao. •
c. Ong trung tam caa thy.
d. a, b, c deu thing.
e. Chi a Ira b thing.
880.DM nao KHONG cung cap mau cho mat ngoai ban cdu dai nao:
a. DM nao trudc. d. DM mang mach track.
b. DM nao gifra. e. Ca a, c va d.
c. DM nao sau.
881.Tam that trai thong a phia tren
a. Cung dOng mach chil. d. Than dung mach ph6i.
b. Tinh mach chil tren. e. Tinh mach phOi.
c. Tinh mach chil diidi.
882.Xu'cing nao sau day khong thuOc nhOm cac xacing so:
a. Xudng buam. d. Xdong tram.
b. Xudng khau cai. e. Xudng dinh.
c. Xu'cing thai dudng.
883.Xudng nao sau day khong phai la xu'ong a tai giaa:
a. Xu'ong bha. d. Xu'o'ng ban dap.
b. Xudng mong. e. a, b, c, d deu la xdong a tai gida.
c. Xu'cing de.
884.DOng mach nao sau day cap mau nuoi tim:
a. Dung mach gian d. a va b.
b. Deng mach vanh trai. e. b va c.
c. DOng mach vanh phai.
885.Vi tri cna cdu nao là a:
a. Phia tren hanh nao. d. Phia dudi hanh nao.
b. Phia tren trung nao. e. Phia sau tidu nao.
c. Phia tren tidu
886. Diem yang na.'m a vi tri nao caa nhan cau:
a. Giac mac.
b. Ciing mac.
c. Mang mat.
d. Mang mach.
e. Vong mac.
530
Dung bang va hinh ve sau d tra kii 2 cau 887, 888:
a. Co tdi mat
b. Ong tdi mat
c. Ong gan chung
d. Ong gan phai
e. Ong mat chi:

887.Chi tie't s6 1 IA gi ?
888.Chi tiet s6 2 la gi ?

Dung bang va hinh ye sau de tra ldi 2 cau 889, 890

a. DOng mach canh chung.
b. DUng mach canh ngoai.
c. DUng mach canh trong.
d. acing mach ham.
e. DOng mach mat.

889. Chi tiet s6 1 la gi?

890.Chi tie-t s6 2 la nhanh ben cilia dung mach nao?

531
 BANG TRA Ldl CAC CAU TRAC NGHIEM

1.b 27.c 53.c

2.a 28.a 54.e
3.e 29.d 55.a
4.e 30.c 56. xem hal 6
5.a 31.c 57.b
6.c 32.b 58.a
7.b 33. e 59.a
8.c 34.c 60.c
9.c 35.b 61.b
10.e 36.a 62.a
11.c 37.e 63.e
12.d 38.b 64.d
13.b 39.b 65.b
14.c 40.d 66.a
15.a 41.d 67.b
16.b 42.a 68.b
17.d 43.c 69.c
18.e 44.a 70.c
19.d 45.d 71.e
20.b 46.b 72.b
21.a 47.e 73.a
22.d 48.b 74.d
23.a 49.1, IV, V, VII 75.b
24.e 50. II 76.b
25.d 51. III. VI, VIII 77.e
26.b 52.b 78.a

532
79.b 114.b 149.b
80.e 115.d 150.e
81.d 116.d 151.a
82.e 117.c 152.a
83.a 118.c 153.c
84.e 119.c 154.c
85.b 120.b 155.d
86.a 121.a 156.a
87.b 122. TK mac chung 157.a
88.a 123.e 158.e
89.c 124.e 159.d
90.d 125.c 160.c
91.b 126.a 161.b
92.e 127.e 162.c
93.a 128.d 163.b
94.b 129.b 164.a
95.a 130.b 165.c
96.e 131.e 166.b
97.b 132.e 167.c
98.e 133.e 168.e
99.b 134.c 169.a
100.d 135.a 170.c
101.d 136.d 171.b
102.a 137.d 172.e
103.c 138.d 173.d
104.e 139.e 174.c
105.d 140.a 175.a
106.a 141.a 176.e
107.b 142.d 177.d
108.e 143.d 178.a
109. TM hien 16n 144.b 179.b
110. Co khep dai 145.a 180.d
111. Co thon 146.b 181.a
112. TK nal 147.b 182.c
113. DM dui sau 148.d 183.c

533
184.b 219.a 254.a
185.a 220.d 255.b
186.a 221.b 256.b
187.c 222.c 257.a
188.d 223.e 258.a
189.d 224.a 259.c
190.b 225.d 260.b
191.e 226.a 261.a
192.e 227.e 262.b
193.a 228.d 263.c
194.e 229.c 264.e
195.b 230.a 265.b
196.d 231.d 266.a
197.a 232.d 267.e
198.e 233.b 268.c
199. DM tai sau 234.e 269.b
200 DM cha'm 235.d 270.e
201. DM hAn len 236.c 271.b
202. DM giap tren 237.e 272.e
203. DM Weil 238.c 273.a
204. DM mat 239.c 274.a
205. DM ham 240.c 275.d
206.d 241.e 276.c
207.d 242.d 277.e
208.d 243.a 278.c
209.a 244.b 279. Xem bai 25
210.c 245.d 280.a
211.e 246.c 281. MOm mi, gong
212.a 247.d ti(, g6c mo-ng mat
213.a 248.b gide mac.
214.b 249.e 282.e
215.e 250.e 283.a
216.a 251.d 284.d
217.c 252.b 285.d
218.e 253.a 286.e
534
287.d 321. TK thiet hAu, 350.a
288.e hach tren va 351.b
289.d hach durai, 352.e
290.a TK thiet 353.b
291.d 322. CO ben tiiy 354.c
292.a gai ging 355.e
293.e lei kin 356.a
294.d 323.c 357.e
295.b 324.c 358.b
296.e 325.e 359.d
297. (A) Ong ban khuyen 326.c 360. Phai
trade (D), Ong noi. 327.e 361. Ranh tinh
298.d 328.d mach don.
299.e 329.a 362. Ranh Ong
300.d 330.e mach du'eti
301.e 331.a
302.a 332.a 363.b
303.b 333.a 364.d
304.d 334.b 365.a
305.e 335.d 366.c
306.a 336.e 367.d
307.c 337.c 368.b
308.b 338.b 369.c
309.b 339.c 370.d
310.a 340.d 371.a
311.a 341.e 372.b
312.d 342.e
313.c 343.b 374.b
314.d 344.c 375.c
315.d 376.b
316.e 345.e 377.a
317.b 346.d 378.e
318.b 347.d 379.a
319.c 348.b 380.e
320.b 349.c 381.c
535
 382.c 417.b 452.a
383.a 418.e 453.b
384.c 419.a 454.c
385.e 420.d 455.d
386.b 421.e 456.b
387.c 422.b 457.a
388.d 423.e 458.a
389.a 424.b 459.b
390.b 425.b 460.c
391.c 426.d 461.b
392.e 427.c 462.c
393.e 428.e 463.d
394.b 429.a 464.d
395.c 430.e 465.a
396.e 431.c 466.b
3974 432.b 467.b
398.c 433.c 468.d
399.e 434.a 469.e
400.b 435.d 470.e
401.b 436.e 471.b
402.a 437.e 472.a
403.d 438.a 473.d
404.d 439.d 474.a
405.c 440.b 475.e
406.e 441.d 476.d
407.d 442.c 477.e
408.d 443.c 478.e
409.b 444.b 479.a
410.b 445.c 480.d
411.d 446.e 481.d
412.e 447.b 482.b
413.e 448.d 483.d
414.b 449.a 484.d
415.e 450.c 485.e
416.a 451.c 486.b

536
487.e 522. Day chang ligrn 556.e
488.e 523. Mac not nh6 557.d
489.c 524. Day chang 558.a
490.a vi lach 559.c
491.d 525.d 560.b
492.b 526.e 561.a
493.a 527.e 562.b
494.e 528.d 563.b
495.a 529.e 564.e
496.d 530.a 565.b
497.c 531.d 566.e
498.b 532.b 567.d
499.c 533.e 568.d
500.a 534.a 569.b
501.b 535.c 570.c
502.a 536.d 571. Thiry dao
503.c 537.e 572. Bao trong
504.e 538.c 573. Duel nhan duoi
505.a 539.c 574. Wu nhan duel.
506.d 540.d 575. Khe lien
507.b 541.b ban cat'
508.c 542.a 576.b
509.d 543.b 577.d
510.b 544.b 578.d
511.a 545.d 579.e
512.d 546.d 580.e
513.c 547.e 581.b
514.d 548.c 582.a
515.e 549.c 583.b
516.c 550.b 584.b
517.d 551.b 585.a
518.d 552.d 586.d
519.b 553.c 587.c
520.c 554.e 588.b
521.c 555.e 589.b
537
 590.d 621. Thanh mac 651. e
591.c 622. Co doc. 652. b
592.e 623. Co Ong. 653. e
593.d 624. Um du'Oi 654. d
594.d niem mac. 655. a
595.c 625. Niem mac. 656. d
596.d 626. Tam duari
657. c
597. Sun khOp. thanh mac.
658. e
598. DAL' xtiong. 627.e
659. b
599. Xuong dac 628.e
660. c
than )(acing 629.e
661. c
600. Mang xu'cing. 630.b
601. Bu6ng tuy 631.c 662. e

602. Sun dau =mg. 632.a 663. e

603.a 633.d 664. a
604.c 634.a 665. b
605.d 635.c 666. b
606.e 636.e 667. d
607.d 637.d 668. e
608.e 638.e 669. e
609.e 639.c
670.a
610.c 640.a
671. b
611.d 641.d
672. e
612.a 642.d
673.d
613.c 643.d
674. c
614.d 644.e
615.d 675. c
645.e
616.d 646.d 676. e

617.b 647.e 677. c

618.d 648. Tuygn ba 678.a
619.e 649. Co dung long. 679. a
620.d 650. Hanh long. 680. c
538
681. e 711. e 741. c

682. a 712. a 742. b

683. d 713. a 743.e

684. c 714. e 744. c

685. c 715. e 745. e

686. a 716. b 746. e

687. c 717. a 747. b

688. e 718. e 748. a

689. e 719. d 749. e

690. c 720. b 750. c

691. b 721. e 751. d

692. d 722. d 752. a

693. d 723. b 753. d

694. d 724. e 754. a

695. d 725. b 755. a

696. d 726. c 756. a

697. e 727. c 757. b

698. c 728. e 758. c

699. b 729. d 759. e

700. c 730. e 760. d

701. c 731. e 761. b

702. c 732. d 762. c

703. d 733. a 763. c

704. e 734. d 764. c

705. d 735. e 765. b

706. b 736. c 766. c

707. c 737. b 767. a

708. b 738. e 768. c

709. c 739. c 769. d

710. c 740. d 770. b

539
 771. c 801. e 831. b
772. e 802. d 832. a
773. a 803. c 833. e
774.a 804. b 834. d
775. b 805. c 835. b
776.c 806. d 836. b
777. b 807. c 837. d
778.e 808. a 838. e
779. d 809. d 839. e
780. c 810. a 840. d
781. a 811. b 841. c
782. d 812. d 842. d
783. a 813. a 843. e
784. b 814. b 844. d
785. d 815. e 845. c
786. a 816. d 846. b
787. a 817. a 847. c
788. d 818. c 848. a
789. a 819. d 849. b
790. b 820. e 850. c
791. e 821. c 851. b
792. b 822. d 852. c
793. c 823. c 853. d
794. a 824. c 854. a
795. d 825. b 855. a
796. e 826. d 856. b
797. d 827. c 857. c
798. c 828. a 858. d
799. e 829. c 859. c
800. c 830. b 860. c

540
861. e 871. e 881. a

862. c 872. d 882. b

863. d 873. e 883. b

864. e 874.a 884. e

865. e 875. d 885. a

866. e 876. a 886. e

867. a 877. d 887. b

868. a 878.b 888. e

869. c 879. c.1 889. c

870. a 880. d 890. b

541
 BANG CHI DAN TRA c(fu TIENG VIET

A
Am dao 233 An da day 139
- Ba ben 234 An k6t trang 138
- Dau dual 234 An to trang 138
- Dau tren 234 An than 138
- Thanh truac 234 An tim 62
- Thanh sau 234 Ao nao 335
Am he 235 Ao nao magi 469
Am vat 236

B
Ban cAu dai nao 334 Bao sui cUa gan 415
- B6 doc dudi 345 Bao tidu thd 194
- B6 doc tren 345 Bao trong 326, 345
- B6 dai 345 Bao xo quanh mach 141
- B6 mac 345 Bat cheo cam gide 316
Ban cAu ti:du nao 318 Bat cheo cu6ng tidu nao tren 322
Bang quang 208 Bat cheo hem 316
- Lap co 212 Bat cheo thap 313
- Lap niem mac 212 Bat cheo trAn 322
- Lap thanh mac 212 Be lath 114
Bao co 414 Be vach vin 82
Bao ca thang bung 37 Beo sam 345
Bao boat dich 406, 415 Be' chaa duai nhen 365, 366
Bao khdp 407 Be dung chap 97
Bao 189 Be giao thoa 372
Bao ngoai 345 Be h6 ben dai nao 372
Bao ngoal day than kinh 369 Be' lien cu6ng nao 372
Bao quy dau 250 Be than 192
Bao sal 192 Be tidu hanh nao 372
542
 Be tuy gai 366 B6 tram - tieu nao 316
Bi 487 B6 tran - trung tam 322
Blu 243, 252 Bo trung nao-than kinh sinh ba 322
- Vach soli 252 B6 v6-cau 318
- Ldp cd barn da 252 BO v6-thi 347
B6 them 305, 307 B6 vu-thi 331
- B6 doc lung 316, 331 B6 vu-trdn 331
B6 doc trong 316 Bong gan tyy 127, 148
B6 do gai 307 Bong 6ng den tinh 244, 210
B6 gai-d6i thi ben 307 Bong voi 225
BO thi trade 307 BO may tieu h6a 438
B6 gai-tigu nao sau 307 BO phdn sinh duc ngoai cua nam 242
B6 gai-tieu nao trade 307 BO phan sinh due ngoai 234
B6 ludi-gai 307 Bac cong vi ldn 105
B6 mai-gai 307 Bd cong vi nho 105
B6 nhi that 85 Bac dudi ban cau 335
- Try phai 85 Bar tren ban cau 335
- Try trai 85 Bu6ng trung 222
B6 lung ben 307 - Bar mac treo bang truing 223
B6 phan chieu 329 - Bac to do 223
BO thap 316 - Dau tui cung 223
B6 014 ben 307 - Dau vdi 223
B6 thap thick 307 - Mat ngoai 223
136 thi-v6 329 - Mat trong 223
B6 thon 305, 307 Bang tii cung 227, 232
B6 den dinh-gai 307 Bu6ng tuy )(Long 391

C
307 Cac d6t sting ngyc 14
Cacho rieng
Cac cd dudi satin 32 Cac d6t song that lung 15
30 Cac khe cd hoanh 4G
Cac cd gian stan ngoai
Cac cd gian sudn trong 30 Cac khe tieu nao 318
39 Cac mang tuy gai 365
Cac cd u lung
Cac cd thanh bung 33 Cac nh.. chdm (nh. v6 dia. DM nao sau) 381
Cac cd thanh ngyc 28 Cac nhanh dOng mach nhap 196
Cac dOng mach Mi. trang 162 Cae nh. dinh (nh. v6 DM nao giiia) 381
Cac Ong mach hang trang 162 Cac nh. dinh (nh. v6 DM nao trade) 379
Cac Ong mach to tyy dudi 129, 162 Cac nh. dinh chdm (nh. v6 DM nao sau) 381
Cac Ong mach trung udng 381 Cac nhanh mach mac 381
Cac do, ng mach xich ma 179 Cac nhanh 6 mat (nh. v6 DM nao glib) 381
Cac dOng mach v6 . 379 Cac nh. 6 mat (nh. v6 DM nao trudc) 379
Cac diSt song c6 12 Cac nh. thai diking (dm DM nao gifia) 381
543
Cac nh. tran (nh. vO DM nao gala) 381 - C6t ben 306
Cac nh. tram (nh. vO DM nao tru'dc) 379 - C6t sau 306
Cac nhanh vO (cia DM nao gii3a) 381 - C6t trudc 306
Cac nhanh vo (cua DM nao sau) 381 Chat xuong dac 391
Cac nhanh van 381 Chat xam trung tam 322
Cac TM canh ro'n 146 Choc do duth to lon x. than' 374
Cac TM cila tram nao va trung nao 382 Choc do that lung 374
Cac TM h6i trang 164 Ch.& nao 317
Cac TM h6ng trang 164 Chu6i hach bach huyet da day 111
Cac TM lien lac 386 Chu6i hach bach huyet vi - mac n6i 111
Cac TM nao dudi 383 Chu6i hach bach huyet toy lath 111, 117, 130
Cac TM nao tren 383 Chuoi hach ben 'long 253
Cac TM tim cut nhO 87 Chu6i hach chau ngoai 247
Cac TM toy 164 Chu6i hach chau 247
Cac TM toy ta. 164 Chu6i hach h6i kgt trang 165
Cac TM trung Yang 383 Chu8i hach giao cam 358
Cac TM vo caa•nao 383 Chu6i hach lath 117
Cac tui thita mac not 170 Chu6i hach mac treo trang tren 165
Cac tuye'n cua da 489 Chu6i hach nach 235
Cac tuy6n to trang 122 Chu6i hach ngo'c trong 235
Cac xoang mang cling 383 Chu6i hach tren don 235
Can 414 Co bang quang 209
Can c6 cheo bong ngoai 51 Co quy dau 250
- C6t tru ngoai 51 Co sutin 21
- C6t tru trong 51 Co tui mat 151
- Syi gian try 51 Co tit cung 227
Can ngUc that lung 34 — Ong c6 tii cung 227
Cau nhat 330, 345 - Phan am dao 227
Can de 24 - Phan tren am dao 227
Canh tay 16i nao du'di 321, 330 Cu 412
Canh tay 16i nao tren 321, 329 Co ban gal 42
Canh tidu thUy trung tam 320 Co biu 36, 246
Cau nao 303, 317 Co chau cut 267
Cau nao, ranh nen 317 Co chau soon (cac) 41
Cau tao ludi 306, 329 Co cheo bung ngoai 34
Cay song tigu nao 321 Co cheo bung trong 34
Chat den 322 Cu cot 262, 267
Chat hoat dich 407 Cu dai (cac) 41
Chat keo 306 Co dung long 488
Chat thing sau 321, 332 Cu ding song 41, 186
Chat fining trade 339 Cu doh soon 32
Chat trang 306, 328 Co gai (cac) 41
Chat trung gian ben 306 Co gian gai (cac) 42
Chat trung gian trung tam 306 Co gian ngang 42
Chat xam 306 Cu gian satin trong ding 30
544
Ca hanh x6p 250, 259, 260 Ca van 412
Ca hoanh 43, 93 Ca yang b6ng gan tuy 148
Ca luck 80 Ca vuong that lung 38
Ca lung Ong 39 Ca xoay 42
Ca mu - Am dao 267 Co su'6n 21
Ca mu bang quang 212 ang nao 322, 326
Ca mu - cut 267 C6t am dao 234
Ca mu - tryc trang 210, 264, 267 - C6t sau 234
Ca nang hau mon 262, 267 - C6t tru'dc 234
Ca nang scan 33 C6t hau mon 176
Ca nang tuye'n tin liet 267 C6t song 10, 387
Ca nang vai 40 - Doan co 10
Ca ngang bung 36, 52 - Doan ngue 10
Ca ngang gai 42 - Doan that lung 10
Ca ngang nguc 33 C6t than 193
Ca ngang day chau nong 258 C6t vom nao 320, 341
Ca ngang day chau sau 259, 261 Cu eanh (d6t sting c6 VI) 14
Ca ng6i hang 250, 259 Cu co bac thang trade 22
Ca nhi8u than 42 Cu gian tinh mach 80
Ca nh6 sau 82 Cu mac n6i 127
Ca nh6 trade 82 Cu nhan them 313
Ca nh6 vach 82 Cu nhan thon 313
Ca quan cam giac 485 Cu sau (d6t d6i) 13
Ca quan sinh due nam 242 Cu sau cgt s6ng c6 13
Ca quan sinh due nil' 222 Cu akin 21
Ca rang sau duth 41 Cu thay nhimg 320
Ca rang sau tren 41 Cu tru'ac d6i thi 328
Ca thang 39 Cu triton d6t d6i 13
Ca thap 38 Cu trade d6t song c6 13
Ca thang bung 37 Cu xam 330
Ca that am dao 234 Cda gan 138
Ca that mon vi 105 Cue van ban nguyet 81
Ca that ngoai hau mon 262, 264 Cure cham 336
- Phan dual da 264 Cuc thai duang 336
- Phan nong 264 Cac tran 336
- Phan sau 264 Cung dOng mach chU 94
Ca that ni8u dao 260, 262 Cung dot s6ng 12
Ca that van ni8u dao 217 Cung sau (deft d6i) 13
Ca tim 84 Cung sun 20
Ca tram 41 Cung trade (d6t d6i) 13
Ca tram be 41 Cu6n mao mach 194
Ca tram to 41 Cu6ng cung d6t s6ng 12
Ca treo td trang 121 Cu6ng dai nao 321, 329
Ca tran 412 Cu6ng doi thi dudi 330
Ca trot trang bang quang 212 Cu6ng gan 290
545
Cu6ng nhung nao 320 Cu6ng tigu nao dadi 313
Cu6ng ph6i 63 Cueing tigu nao giaa 317
Cueing thg tong 329 Cu6ng tigu nao tren 317
Cueing the vu 331

D
Da 486 Day chang hohnh lath 115, 285
Da day 102 Day ch'ang khuye't 52
- Khuygt tam vi 103 Day chang lath than 115
- La ca niem mac 107 Day chang hem 137, 139
- Lap ca 105 Day chang lacic 52
- Lap ca, tang doc 105 Day chang Mackenrodt 231
- Lap ca, that cheo 105 Day chang mu-bang quang 210
- Lap niem mac 105 Day chang mu-tign liet 210
- Lap thanh mac 105 Day chang ngang c6 tit cung 231
- Ngp mao vi 107 Day chang ngang day chau 260
- Tam clued niem mac 105 Day chang ngoai bao khap 407
- Tam duai thanh mac 105 Day chang phan chigu 34, 51
- Thanh sau 104 Day chang ph6i 71
- Thanh track 104 Day chang rang 366
Dai ca doc 170 Day chang rieng bung triing 224
Dai khau 339 Day chang rein giaa 56, 209
Dai mac neii 170 Day chang rein trong 56
Dai mac treo ke't trang 170 Day chang rOng 228
Dai thi 330 Day chang tam giac phai 139
Dai than kinh mei) 341 Day chang tam gide trai 139
Dai Ai do 170 Day chang tinh mach 140, 146
Dai vo cau 347 Day chang treo bu6ng triing 224, 457
Dai vO gai 347 Day chang trim 36, 58, 231
Dai xam 341 Day chang trim cua gan 140, 146
Day chang biu 243, 454 Day chang trong bao khap 407
Day chang ben 34, 51 Day chang tii cung-cung 231
Day chang cung giaa 45 Day chang ac-ngoai tam mac 83
Day chang cung ngoai 45 • Day chang vanh 139, 283
Day chang cung trong 45 Day chang vi-hoanh 288, 291
Day chang cung-mang ding 366 Day chhng trang 291
Day chang ng6i 256 Day chang vi lath 105, 115, 285
Day chang doc sau 25 Day chang voi-bu6ng trang 224
Day chang doc track 25 Day mang cung 366
Day chang gian h6 55 Day nguyen ging 412
Day chang gan-td trang 140, 290 Day sting 466
Day chang gan-vi 140, 290 Day tan ding 305
Day chang gay 41 Day than kinh do, ng mach canh ngoai 359
Day chang hau mon-cut 264 Day than kinh dOng mach canh trong 359
Day chang hoanh gan 139 •Day than kinh lang thang 97
546
 411P.W.M."*".1 4.4t

Da gide Willis 379 Dich nao tay 373

Day than kinh tang be 361 Dien khdp 389
Day than kinh tang dutii 361 Dien khdp cu stidn 21
Day than kinh tang ldn 361 Dien khdp dau sin 21
Day than kinh tim c6 du'di 360 Dien khdp sau (d6t truc) 14
Day than kinh tim c6 giiia 360 Dien khdp trudc (d6t truc) 14
Day than kinh tim c6 tren 359 Dien nhi 17
Day than kinh tim ngkic 361 along vat 249
Day than kinh tinh mach canh 359 - Mat nieu dao 250
Dat thiet hau 358 - Quy dau 250
Day treo bang quang 56 - Re data vat 250
Di tich mom boc tinh ham 247 - Than &tang vat 250
Dich lympho 433

0
Dai than ldn 192 Dam r6i tin liet 218
Dai than nhO 192 Dam rol tim 88
Dam r6i bu6ng trdng 224, 361 Dam reCi tinh hoan 361
Dam reCi canh chung 360 Dam r6i tinh mach bang quang 209, 214
Dam r6i canh ngoai 360 Dam r6i t.m cita d.m canh trong 386
Dam r6i canh trong 360 Dam r6i tinh mach hinh day leo 224, 247
Dam r6i chit ngiic 361 Dam r6i t.m 6ng than kinh ha thiet 386
Dam r6i c6 'long 237 Dam reCi t.m tuye'n tin liet 218, 248
Dam r6i &rang 117 Dam r6i trang 361
Dam r6i gan 361 Dam r6i truc trang 361
Dam r6i ha vi 207, 361 Dam r6i tuy 361
Dam r6i lath 117, 361 Dam r6i tuygn tien liet 248
Dam r6i lien mac treo trang 361 Dam r6i ty. chit (cac) 358
Dam r6i 16 bau due 386 Dam r6i tit cung am dao 233, 361
Dam r6i mac treo trang &fed 361 Dam r6i vi 361
Dam r6i mac treo trang tren 130, 361 Day bang quang 209
Dam r6i mang mach 373 Day chau 256
Dam r6i mang mach nao that III 373 Day chau sau 262
Dam r6i mang mach nao that ben 373 Day chau tru'dc 256
Dam r6i mang mach nao that IV 373 Day ph6i 60
Dam r6i nen 385 Day thap 193
Dam rea nieu quan 361 Day till mat 150
Dam r6i ong &an tinh 247 Day tit cung 226
Dam r6i ph6i 70, 361 Day vi 103
Dam r6i tang 117, 130, 198, 361 Dau mao tinh 244
Dam reoi than kinh tit cung am dao 233 Dau stidn 21
Dam r6i than kinh ha vi 233 Dau tuy 123
Dam r6i than kinh that lung-cdng 277 Dau )(Long 390
Dam r6i than 196, 198, 207, 361 •Dem it canh 475
Dam r6i among than 361 Dem sao 475

547
Dia gian dot s6ng 24 DM duoi tuy 129
Dinh bang quang 209 DM gan 274, 280
Dinh mang pheii 71 DM gan chung 145
Dinh phoi 61 DM gan rieng 145
Dinh sting sau 306 - Nganh phai 145
Dinh tim 77 - Nganh trai 145
Dinh )(acing tang 18 DM gai ben 376
Doan nao 303, 325, 334 DM gai sau 376
- Ranh ben 335 DM gai trifdc 376
- Ranh trung tam 335 DM gian su'orn 96
- Tre len 336 DM gian tidu they 196
- Tre sau 336 DM gian they than 196
Tre truac 336 DM hanh du'ung vat 218
D8i chain 328 DM hoanh du'ai 47, 297
Doi nao 325 DM hoanh dtidi trai 109
198i thi 325 DM hoanh tren 47
- Nhan ben lung 331 DM h8i trang 164
- Nhan bung sau trong 331 DM h8i kat trang 163, 178
- Nhan bung track ben 331 DM h8i kat trang, DM len 163
- Nhan sau 331, 329 DM kat trang gida 164,180
- Nhan trade bung 328 DM kat trang len 178
- Nhan trurac lung 328 DM kat trang phai 164, 180
- Nhan trudc trong 328 DM kat trang trai 179
DOng mach 430 DM lath 117, 129, 292
DM am dao 214, 234 - DM vi ngan 117
DM bang quang du'di 207, 214, 248 - DM vi mac n6i trai 117
DM bang quang tren (cac) 213 - Nhanh lath 117
DM bit 214 - Nhanh tuy 117
DM bu8ng tritng 207, 224 DM mac treo trang difdi 179, 279, 297
DM canh chung trai 94 DM mac treo trang tren 129, 160 178, 279, 297
DM chau trong 213 DM mach mac truck 379, 381
DM chu bung 96, 161, 297 DM manh trang sau 164, 178
DM chil noic 96 DM manh trang tract 164, 178
DM ciia loan nao va gian nao 379 DM mu du'ang vat 218, 251
DM ciia tram nao 379 DM nao gala 379, 381
DM caa trung nao 379 DM nao sau 379, 381
DM cung 196 DM nao tru'dc 379
DM ding giUa 297 DM nen 379
DM cci 430 DM nguc ngoai 235
DM co btu 247 DM ngkic trong 235
DM co hoanh 47 DM nieu dao 218
DM chau chung 207 DM eing clan tinh 247
DM durdi den trai 94 DM ph6 quan 63, 70, 96
DM clan 11.8i 430 DM phi 63
DM day chau 259 DM ph6i phai 68
DM day chau Ming 253 - Nhanh dual dinh 68
DM d6t s6ng 379 - Nhanh day ben 68
548
 - Nhanh day gill-a 68 DM tuy du'ai 129
- Nhanh day sau 68 DM tuy hfin 129
- Nhanh day trade 68 DM tuy lung 129
- Nhanh dinh 68 DM tryc trang giCia 179, 214, 207, 248
- Nhanh dinh thay dutdt 68 DM true trang tren 179
- Nhanh giCia 68 DM tit cung 214, 224, 233
- Nhanh sau len 68 - Nhanh bu6ng trang 224, 233
- Nhanh sau xueing 68 - Nhanh voi trang . 233
Nhanh they gifia 68 DM vanh phai 86
- Nhanh truac len 68 DM vanh phai, nhanh gian that sau 86
- Nhanh tru'dc xu6ng 68 DM vanh trai 86
DM phoi., phan day 68 - Nhanh gian that trade 86
DM phOi. trai 69 - Nhanh mu 86
- Nhanh lu'-di 69 DM vi-gan 16n 280
- Nhanh du'di 69 DM vi gan nhO 280
- Nhanh lctari tren 69 DM vi-mac not phai 108, 292
DM r6 (cac) 378 DM vi-mac not phai, nhanh mac n6i 108
DM runt thiia 164, 180 DM vi-mac n6i trai 108, 292
DM sau ta. trang 129 DM vi ngdn 109
DM sau dung vat 218, 251 DM vi-phai 107, 145
DM sinh dye 297 DM vi-td trang 108, 129, 145, 292
DM ta. tyy &fed 129, 162 DM vi-trai 108, 274, 280
DM to tyy tren sau 129 DM vi trai, cac nhanh thyc quan 109
DM to tuy tren trade 129 D6t co nhat dinh 466
DM than tang 107, 117, 129, 145, 279, 297 Dot s6ng 10
DM than tang, nhanh dm vi-gan nho 279 - MOm gai 12
DM than tang, nhanh dm vi-gan to 279 - MOm khdp dual 12
DM than tang, nhanh dm lach 279 - Mom khdp tren 12
DM than 194, 207 - MOrn ngang 12
DM that king 297 D6t s6ng co (cac) 12
DM then ngoai 253 D6t song ding (cac) 15
DM then trong 214, 236, 259 D6t s6ng dOi 13
DM thong sau 381 D6t song 16i (C7) 14
DM thong trade 379 D6t sting ngyc 14
DM they duoi 145 D6t song thdt lung 15
DM thyc quan 96 D6t song tryc 14
DM thoyng than dual 197 Duel mao tinh 244
DM thu'yng than gifia. 197, 297 Duel ngya 304
DM thoyng than tren 56, 197 Duoi tyy 124
DM thtiong vi du-di 55 Durdng cung 17, 37
DM tinh hoar). 57, 207, 247 DYYng Oda biu 252
DM ti6u nao du'ai sau 379 Diking giiia daYng vat 250
DM tie'u nao dudi trudc 379 Dating Hyrtl 194
DM ti6u nao tren 379 DYYng ngang (cac) xuang ding 16
DM trung that 96 DuVng trong 34, 51
DM tin mat 145, 151

549
 E
Eo hoi dai 338 Eo tut cung 225
Eo tuygn tin liet 248 Eo voi 225

G
Gan 131 - ThUy trai 138, 142
- Bao xo quanh mach 141 - Wt 6ntim 134
- B6 dudi 139 - 'Wing trail 137
- DOng mach phan thily ben 145 Gan ligt hip 36, 52
- DOng mach phan thuy gida 145 G-613 ra trade 225
D'Ong mach phan thily sau 145 Gian nao 325, 469
- acing mach phan thily trudc 145 Giao thi 330
- Khe day chang tinh mach 138 GOc ding 172
- L6p thanh mac 141 Goc (lath tic 20
- Ldp x6 141 G6c day chau 172
- Mat hoanh 134 G6c kgt trang phai 172
- Mat tang 137 Goc ket trang trai 172
- Mom duoi 138, 139 G6c scion 22
- Mom nhu 139 Goc to - hang trang 119, 120
- Ong tinh mach 138 G6c to trang dudi 120
- Phan thuy ben 145 G6c td trang tren 120
- Phan thby gifia 145 Goc dc 24
- Phan thuy sau 145 Go mu 235
- Phan thuy trade 145 GO trong 316
- Phan phai 137 Gal bao trong 345
- Phan sau 137 Goi than kinh mat 318
- Phan tren 134 G6i the chai 341
- Phan truck 137 GO am dao 234
- ThUy phai 138, 142

H
Hach bach huygt 98, 433 Hach c6 ngtic 360
Hach bach huygt phi 70 Hach co tren 359
Hach bach huygt tuy lath 130 Hach ding 361
Hach than bu'elm - khau cai 358, 360 Hach diidi ham 368, 360
Hach chau hong 358 Hach khi = phg quail dudi 70
Hach chil than 361 Hach khi - ph'g quan tren 70
Hach cg dudi 360 Hach le 361
Hach c6 gitia 360 Hach mac treo trang du'di 361
550
Hach mac treo trang tren 361 - Phan giao cam, nhanh thong 358
Hach mi 358, 360 - Phan ngkfc 361
Hach ngy'c 361 HO tiA nieu 452
Hach phg quan phoi 70 HO tieu hOa • 438
Hach sao 360 HO tinh mach chil 147
Hach tai 358, 360 HO tinh mach don 97
Hach tang 361 HO miong 387
Hach that hing 361 Hoanh chau 209
Hach tim 88, 361 Hoanh chau hong 267
Hang thOng kin 392 Hoanh nieu duc 257, 260
Hai ma 331, 341 Hoanh yen 372
Ham am vat 236 H6 (phuc mac) 273
Ham man toy tren 317 H6 ben ngoai 56, 273
Ham bao quy dau 250 H6 ben trong 56, 273
Ham mei am hO 235 H6 bung trang 223
Ham van h6i - manh trang 175 H6 da day 107
Hang mon vi 103 H6 gian cu6ng 321
Hang rao mau - dich nao toy 365 H6 khdp dual (c16t dpi) 13
Hanh throng vat 215, 217, 250 H6 khUp tren (Mt dpi) 13
Hanh khiru 339 H6 ngai - trip trang 262, 263
Hanh long 488 H6 rang (dolt dpi) 13
Hanh nao 312 116 akin Judi 14
Hanh tin dinh 236, 260 H6 soon ngang 14
Hanh nhan tieu nao 320 H6 soon tren 14
Hat mang nhOn 365 H6 thuyan 215
Hau cung mac n6i 282, 293 H6 tram 316
Hep bao quy dau 250 H6 tren bang quang 56, 273
He bath huygt 433 H6 tui mat 138
HO co 412 H6 mau Tro-la 372
He giac quan 485 H6c nieu dao 216
He ho hap 446 H6i canh hai ma 339
He khop 402 H6i canh tan ding 339
He nieu sinh duc 452 H6i chain daai 336
HO not ti6t 460 H6i cham - thai doong ngoai 339
HO tim mach 419 Hai cham - thai duzing trong 339
HO than kinh 465 H6i cham tren 336
HO than kinh trung u'ong 301 H6i dai 328, 338
HO than kinh to chOi 331, 355, 465 H6i dao dad. 336
- COt nhan trung gian ngoai 358 H6i dao ngan 336
- Phan bung va 'Chau 361 Hai goc 336
- Phan dau co 359 H6i la 341
- Phan d6i giao cam 355, 356 H6i luoi 339
- Phan giao cam 355, 358 H6i nao 335
- Phan giao cam, nhan trung gian ngoai 358 H6i nOi vin 334
551
116i 6 mat 339 H6i trail gida 336
116i rang 339, 341 116i trail tren 336
116i sau trung tam 336 H6i tram trong 338
H6i thai du'ong duidi 336 H6i trang 154, 278
116i thai ding gala 336 116i tren vien 336
116i thai throng ngang 336 H6i trade them 338
1161 thai &tong tren 336 116i trudc trung tam 336
116i thong 339 Hoi lou cac xoang 384
116i tram doh 336 11-6ng trang 154, 278

Ket trang 168 Khdp bat Ong xu'o'ng 406

K6t trang len 172, 279 Khdp bat -dOng vay 404
Ket trang ngang 172, 279 Khdp chdm 408
Ket trang xich ma 172, 279 Khdp ding - chau 24
Ket trang xu6ng 172, 279 Khdp ding - cut 24
Khe am h0 235 Khdp don 409
Khe day chang tinh mach 137, 138 Khdp dOng 402, 406, 408
Khe giiia gan 144 Khdp gaOa than cac d6t ging 24
Khe lien phan thicy phai 144 Khdp hoat dich 406
Khe lien phan thily trai 144 Khdp kep 409
Khe phu giiia thdy phai 144 Khdp 16i cau 408
Khe phu giila thug trai 144 Khdp lien hop 410
Khe nao dot 335 Khdp phdc hop 410
Khe nao ngang 335 Khdp phang 408
Khi quan 94 Khdp rung roc 408
Khoang dofii,nhOn 365, 366 Khdp soan 408
Khoang day chau Tieing 257, 260 Khdp sin - clot s6ng 24
Khoang day chau sau 259, 261 Khdp sutin - ngang 24
Khoang gian su'dn 20 Khdp tru 408
Khoang ngoai mang cling 363 Khdp dc - sodn 24
Khoang ngoai mang tim 94 Khdp yen 408
Khoang sau xoong mu 209, 263 Khuyk day chang trim 138
Kh6i ben (d6t d0i). 13 Khuyk don 24
Khdp ban dOng 402, 406 Khuy6t goc 103
Khdp ban dOng mu 24 Khuyk leu tigu nao 371
Khdp ban dOng sun xo 406 Khuyk song dudi 12
Khdp ban dung sun trong 406 Khuyk s6ng tren 12
Khdp bat dOng 402, 404 Khuy6t s.utin 24
Khdp bat dOng day chang 404 Khuy6t tam vi 103
Khdp bat dOng mang 404 Khuyk tim (phcii trai) 63
Khdp bat dOng mao 405 Khuyk tinh mach canh 24
Khdp bat Ong nhip 404 Khuyk trade cham 336
Khdp bat citing rang 404 Khuyk tuy 123
Khdp bat dOng soi 404 Khdu nao 469
}chap bat dOng sun 405
552
 L
Ld dinh 326 L8 cling - lung 17
Ld sau bao co' thang bung 37 L6 du'di 16ng ngyc 20
La truck bao co thang bung 37 L6 dOng mach chi' 46, 82
Ld tan cung 330 L6 deft song 12
Ld tang mac chau 210 L6' gian d6t song 12
Ld thanh mac chau 210 L6 gian d6t s6ng (X. ding) 18
La thanh ngoai tam mac 83 L6 gian nao that 326, 343
Ld thity nhOng 320 L6 h6i - manh trang 170, 175
Ld trade (bao car thang bung) 37 L6 mac n6i. 290, 293, 294
La thy d6i thi 328 L6 mon vi 103
Ld tay ngoai 345 L6 nap vi - tuy 294
Ld tay trong 346 L6 ngang (m6m ngang d6t s6ng c6) 13
Ld vach trong snot 342 L6 nhi that phai 81
Lach 114 L6 nhi that trai 81, 82
- Bar durdi 116 L6 nieu dao ngoai 216, 236, 250
- Bar tren 116 L6 nieu dao trong 209, 211
- Dau sau 116 L6 nieu quan 206, 211
- Dau tru'dsc 115, 116 L6 nuoi xu'ang 392
- Ldp thanh mac 114 L6 6ng phong tinh 216
Ldp sdi 114 L6 runt thila 171, 175
- Mat da day 115 L6 tam vi 95, 103
- Mat hoanh 115 L6 than dOng mach phi 81
- Mat kat trang 115 L6 thuc quan 46
- Mat tang 115 L6 tinh mach chili 46
- Mat than 115 L6 tinh mach chili dudi 80
Lach phu 114 L6 tinh mach chi' tren 80
Leu tidu nao 371 L6 tinh mach nho 80
Liem ben 36, 52 L6 tinh mach phi 80
Liem dai nao 371 L6 tit 462
Liem Ong mach gan 294 L6 tren 16ng nguc 20, 61
Lidm gal 318 L6 tit cung (voi) 225
Liem ngoai 318 L6 tit cung, mep sau 227
Liem sinh ba 318 L8 tit cung, map trudc 227
Liem they dao (ndp 336 L6i ca co rang track 23
Liem tigu nao 372 L6i c6 ding 17
Liem trong 316, 318 Led nao doh 321
L6 am dao 236 L6i nao tren 321, 326
LO bau due 78 L6i the chai 341
L8 ben nong 34, 57 L6i tinh 216, 244
L6 ben sau 56 Long 488
LO bung. (voi tii cung) 225 Long may 488
L6 ding 17 Long mi 488
L6 ding - chau hong 16 Long mid 448
553
LOng mu 488 Lap sang &fol. mOng 489
Long nach 488 Lap sang quanh m6ng 489
Long tai 488 Lap sang tren m6ng 489
Long to 488 Lap to bao not tay 326, 343
ang ngac 19 Lap thanh mac 105, 274
Lap bao tinh hoan 253 Lap trang du'ang vat 251
- La tang 253 Lap trang tinh hoan 243
- LA thanh 253 Lap trong mach mau 432
Lap co nieu quail 206 Lath bang quang 211
Lap ca tran 439 Ladi ga thay nhOng 320
Lap gala mach mau 432 Lu'Oi ph6i trai 62
Lap ngodi mach mau 432 Likri tidu nal° 320
Lap niem mac 438 tinh hoan 244
Lap niem mac nieu quail 206

M
Mac 414 Mac n6i nhO 140, 283, 289, 290
Mac boc co 415 Mac not vi - gan 283
Mac chang 272 Mac not ngac 71
Mac chAng Hem 283 Mac 'long 415
Mac chAng tam giac 283 Mac sau 415
Mac chAng treo gan 290 Mac than 186
Mac chAng treo vi 291 Mac tin lidt 210
Mac chau 186, 210, 268 Mac tin lidt - phut mac 245
Mac chau hong 268 Mac tinh ngoai 246, 252
Mac ca bit trong 210 Mac tinh trong 247, 253
Mac ca biu 246 Mac treo 272, 279
Mac dinh 272 Mac treo bung 279
Mac dinh ke-t trang len 286 Mac treo bung trang 231
Mac dinh ke-t trang xu6ng 286 Mac treo chung 288
Mac dinh to trang 286 Mac treo gan - ch6 281, 283
Mac dung vat nOng 250 Mac treo gan 415
Mac dacing vat sau 251 Mac treo ke-t trang len 173
Mac day chau 'long 257 Mac treo ke-t trang ngang 173, 279, 291
Mac giCi gan 415 Mac treo k6t trang phai 279
Mac hoanh chau d6di 268 Mac treo k6t trang trai 279
Mac hoanh chau tran 210, 268 Mac treo k6t trang xich ma 173, 279
Mac hoanh mang phi 71 Mac treo k6t trang xu6ng 173
Mac hoanh nieu duc dadi 257, 259 Mac treo lung chung 277, 279, 286
Mac hohnh nieu due tren 259 Mac treo runt 159
Mac ngang 37, 55 Mac treo runt thaa 173
Mac not 272 Mac treo to trang 279
Mac not lath-tyy 285 Mac treo tidu trang 279
Mac not Ian 288, 289, 291 Mac treo true trang 279
Mac treo tii cung 231 Manh trang 168, 170, 279
Mac treo vi 279 Manh ca niem mac 439
Mac treo vi sau 279, 280, 281 Manh cung d6t song 12
Mac treo vi trade 277, 281, 283 Manh rach mang trinh 234
Mac treo voi tii cung 231 Mao mach 430
Mach bang he 431 Mao trang 122, 157
Mach bach huyet 433 Mao c6 saki 21
Mach cUa mach 432 Mao ding ben 17
Mach cilia nao 378 Mao ding gifia 16
Mach nao tuy 376 Mao ding trung gian 17
Mach n6i 431 Mao clan su'On 21
Mach not dung - tinh mach 432 Mao nieu ciao 216
Mai nao that IV 316 Mao tan ding 80
Mai trung nao 321 Mao tinh 244
Man tuy du'di 316 Mao tren tam that 81
Man tuy tren 316 Mat chau hong (x. ding) 16
Mang bung 270 Mat &Mi ban cAu dai nao 338
Mang ding 363, 365 Mat khdp 406
Mang ding nao 369 Mat lung (x. ding) 16
Mang cling toy gai 365 Mat sau (day bang quang) 209
Mang gian su'dn ngoai 30 Mat tren - ngoai ban cau dai nao 335
Mang gian stidn trong 30 Mat trong ban cgu dai nao 338
Mang hoat dich 407 Mau phu mao tinh 244
Mang mem 365, 366 Mau phu tinh hoan 243
Mang mem nao 373 Mep cu6ng tong 329
Mang mem tuy gai 366 Mep dinh gian dOi thi 326
Mang nao tuy 363 Mep moi truck 235
Mang nhen 365, 366 Mep mai sau 235
Mang nhen nao 372 Mep sau 326
Mang nhen tuy gai 366 Mep trung 306
Mang ph6i 60, 71 Mep trade 342
Mang ph6i hoanh 71 Mep yam nao 342
Mang phi su'dn 71 MO the chai 341
Mang ph'6i tang 71 Moc hai ma 339
Mang phoi thanh 71 MOm boc 58, 253
Mang pinii trung that 63, 71, 93 MOm boc phiic mac am hO 235
Mang quanh than kinh 474 MOm gai 12
Mang sdi bao khdp 407 MOm khdp 12
Mang tren mang ph6i 71 Mom khdp tren xuung ding 17
Mang tren than kinh 474 Mom moc 123
Mang trinh 234 Mom mui ki6m 24
Mang trong than kinh 474 Mom ngang 12
Mang tuy mem 305 Mom num viz 15
Mang )(dung 391 Mom phu 15
Mang lu'di dung mach vanh cua tuy 378 Mom akin (d6t song that lung) 15

555
MOi be 235 M6ng 489
MOi lan 235 Mu du'ong vat 250
- Lap co troll dac-tat 235 MO am vat 235
Mon vi 103

N
Nang bach huy6t 433 Nap la. co 227
Nang bach huyat chum 158, 175 Nap mao vi 107
Nang bach huyat chum met thaa 176 Nap ngang true trang 176
Nang bach huyat da day 107 Nap ran giaa 56
Nang bach huyat don dOc 158, 174 Nap ran ngoai 56, 274
Nang bach huyat lath 114 Nap ran trong 56, 274
Nang long 488 Nap to trang duOi 274
Nang nieu mac 279 Nap to trang tren 274
Nang tilting ran 279 Nap vi - tuy 274, 294
Nang trang 223 Nap vi - tuy trai 108
Nao be 301, 334 N6p yang • 122, 156
Nao giaa 303 Nap vai 225
Nao that ba (III) 326, 332 Nga ra tro6c 226
Nao that ben 326, 343 Ngach 274
- Phan trung tam 343 Ngach ben nao that 317
- LO gian nao that 343 Ngach canh to trang 128
- Sting doh 343 Ngach cloth gan 274
- Sang sau 343 Ngach dutch hoanh 274
- Sang tru'Oc 343 Ngach gan runt 281
Nao that tit (IV) 316 Ngach gan than 274
- 116 (lath 316 Ngach gian xich ma 274
- H6 tren 316 Ngach mang phoi 71
- LO ben 317, 374 Ngach pheu 332
- Lo gitia 317, 374 Ngach sau manh trang 173, 274
- Ranh gigi han 316 Ngach su'On - hoanh 65, 71
- Ranh gala 316 Ngach su'On - trung that 72
Nao tram 303 Ngach td trang duOi 128, 274
Nao truac 303, 325 Ngach to trang sau 128
Nap thai daring 336 Ngach to trang tren 128, 274
Nap tram 336 Ngach thi giac 332
Nap tram - dinh 336 Ngach tren th6 tong 332
Nen )(acing ding 17 Ngach tong 332
N6n nao that IV 316 Ngoai tam mac 83
Nap 274 - Thanh mac 83
Nap da day 106 Ngoai tam mac, thanh mac 83
Nap doc 122 - La tang - la thanh 83
Nap gian nieu quan 211 Ngoai tam mac sgi 83
556
Ngu'c 19 Nhan tien dinh du ii 318
Nhan ben 316 Nhan tien dinh ngodi 318
Nhan ben d6i thi 329 Nhan tien dinh tren 318
Nhan beo 345 Nhan tien dinh trong 318
Nhan 136 dorn dee 315 Nhan tien dinh - 6c tai 318
Nhan b6 gai than kinh sinh ba 315, 318 Nhan tram 316
Nhan b6 trung nao TK sinh ba 318, 322 Nhan tram phy lang 316
Nhan bung the thang 318 Nhan tram phy trong 316
Nhan bung trong 331 Nhan trail 322
Nhan bung trung gian 329 Nhan tren thi 331
Nhan cam gide chinh TK sinh ba 318 Nhan trong doi thi 328
Nhan cau 318, 321 Nhan trong la 329
Nhan chem 316 Nhan trong trung tam 329
Nhan chem phu 316 Nhan trung gian ngoai "358
Nhan Chen ke 315 Nhan track d6i thi 329
Nhan cung 316 Nhan traac thi ngoai 331
Nhan cu6ng tang 327 Nhan track thi trong 331
Nhan cu6ng tang ngoai 329 Nhan trade twang 329, 345, 346
Nhan cueing tang trong 329 Nhan tuy 25
Nhan dui d6i 330 Nhan van thing than kinh sinh ba 318
Nhan dO 322 Nhanh &Ong mach nhap 196
Nhan duoi 326, 341, 345 196
Nhanh Ong mach xuA
Nhan gian cu6ng 322, 329
Nhanh gai (cac) 376
Nhan hoai nghi 315
Nhanh gian hach (cac) 358
Nhan 16i nao (lath 322
Nhanh mach mac 381
Nhan lu6ri d6i thi 329
Nhanh 6 mat (nh. vo clia Dm nao giaa) 381
Nhan lung than kinh lang thang 315, 358
315 Nhanh thai daang (nh. vo caa DM nao sau) 381
Nhan lung thin kinh thiet hau
Nhanh than 361
Nhan lung thg thang 318
321 Nhanh vao eau nao 379
Nhan mai
306 Nhom sau tren (xoang mang cuing) 385
Nhan ngLic
Nhan naac bot 358 Nh6m traac doh (xoang mang ding) 386
Nhan nuoc bot tren 358 Nha ta. be 122
Nhan nut 321 Nha to lan 122, 148
Nhan 6c bung 318 Nha than 192
Nhan 6c lung 318 Nha vu 236
Nhan phu 358 Nhung nao 320
Nhan rang 321 Nieu dao 214
Nhan than kinh ha thiet 315 - Doan di dinh 215
Nhan than kinh mat 318 - Doan di &Ong 215
Nhan than kinh /brig roc 322 - Doan mang 215, 216, 217
Nhan than kinh sinh ba 318 - Doan tien liet 215, 216, 217
Nhan than kinh van nhan 322 - Doan x6p. 215, 216
Nhan than kinh van nhan ngoai 318 - Lap cor 218
Nhan thon 316 - Lap niem mac 218

557
Niau dao nam 214 Non tuy 304
Niau dao nil 219 Nai tam mac 85
Nieu dao sau 215 Noi tigt to 460
Niau dao trilac 215 Nu rem 475
Niau wan 201 Nu tuy bung 284
Niau quan, doan bung 202 Nu tuy It 284
Niau quan, doan then hong 202, 204 Nu manh trang 279
Niau quan, lap bao ngoai 206 Nut nhi that 85
Non thing mach 81 Nut xoang nhi 85

O chat.' hong be 293 Ong mao tinh 244

O da day 293 Ong mat chii 148
• hoanh phai 293 Ong mon vi 103
O du'ai hoanh trai 293 Ong ngyc 97
O gan phai 293 Ong nieu rgn 209
O gan trai 293 Ong noan hoang 286
6 lath 293 Ong not tuy 475
O bung 271 Ong Nuck 235
O khap 407 Ong nuoi xtiong 393
O mang ph6i. 63, 72 Ong phg nang 65
O ngoai tam mac 83 Ong phong tinh 244
O nhdp 279 Ong song 12
6 phtic mac 271 Ong sinh tinh th'Ang 244
O vach trong snot 342 Ong sinh tinh xoan 244
Ong ben 50 Ong then 263
Ong canh bung trting 226, 456 Ong tia 244
Ong c6 tit sung 227 Ong tik sita 237
Ong ding 16, 18 Ong tinh mach 138, 146
Ong den tinh 244 Ong trung tam 306
- Lap ao ngoai 244 Ong trung than 226
- Lap ca 244 Ong ttii met 148, 151
- Lap niem mac 244 - N63 hinh )(can 6c 151
O ng gan- chung 198 Ong tor 124
Ong gan phai 148 Ong tuy chinh 148, 285
Ong gan trai 148 Ong tuy phu 127, 285
Ong giap hied 462 Ong tuygn hanh - niau dao 249
Ong hen mon 168, 173 Ong tuygn tin liet 248
Ong lac 244 Ong vi 106
Ong lac dual 244 Ong xugt 244
Ong lac tren 244
558
 P
Phan they (than) 194 Phan tic (ca hoetnh) 44
Phan thUy ben (phdi) 65 Phg nang 65
Phan thity du'al dinh (phdi) 67 Phg quan chInh 63, 65
Phan they day ben (phdi) 67 Phg quan phan thity 65
Phan thiiy day giaa (phdi) 67 Phg quan thUy 65
Phan thily day sau (phdi) 67 Phu 81,. 330
Phan they day trade (phei) 67 Ph'eu vii 225
Phan they dinh 65, 67 Phinh c6 304
Phan they dinh sau (phdi) 65 Phinh that lung 304
Phan thily gida (phdi) 65 Ph6i 60
Phan they piaci dcidi (phdi) 65 - Bar du'ai 65
Phan thiiy lcioci tren (phdi) 65 - Bar thick 63
Phan they sau (phdi) 65 - Khe chgch 62
Phan thily trtfac (piaci) 65 - Khe ngang 62
Phan ben (x.cung) 17 - Mat gian thUy 62
Phan bung cau 318 - Mat hoanh 60
Phan them 338 - Mat scion 62
Phan dudi beo 345 - Mat trong 62
Phan lung can 318 - Mat trong, phan cot song 62
Phan lacin 194 - Mat trong, phan trung that 62
Phan mon vi 103 - ThUy du'ai 62, 67
Phan sau beo 345 - ThUy giiia 62, 65
Phan soon (co. hoetnh) 45 - Thuy tren 62, 65
Phan that lung (co. hoenh) 45 Philc mac 270
Phan tia 193 Phac mac tang 272
Phan tran 322 Plulc mac thanh 271

Quai beo 330 Quai runt 278

Quai cuing 330 Quai to trang 278
Quai da day 278 Quang vu 236
Quai do3i. don 360 Quy dau am vat 236
Quai ron 278 Quy dau diking vat 250

559
 R
Rang (cto't true) 13 Ranh tinh mach du'ai don 22
Ranh ben phu 339 Ranh tram du-di 336
Ranh cham ngang 336 Ranh trail tren 336
Ranh cham - thai &tang 339 Ranh trong try dai nao 321
Ranh cua 336 Ranh trung gian sau 305
Ranh doc phai (gan) 138 Ranh trung tam ciao 336
Ranh doc trai (gan) 138 Ranh trung tam 335
Ranh dadi dinh 338 Ranh trofic trung tam 336
Ranh dai 338 Ranh \Tong dao 336
Ranh dinh - chain 338 Rau 488
Ranh dinh - cham ngthai 335 Re bung 305
Ranh Ong mach dadi don 22 Re long 488
Ranh dOng mach d6t song (d6t di)i) 13 Re lung 305
Ranh Ong mach chit 63 Re mac treo 159
Ranh gian CO 40 R6n bung trang 223
Ranh gian dinh 336 R6n ph6i 63
Ranh gian mai 235 R6n lath 115
Ranh ha 'lei 326 R6n than 185
Ranh hal ma 339 Rong roc 415
Ranh khdu 339 Ruet day 168
Ranh mid 339 RuOt gia 166
Ranh nao 335 - Ldp co, ca doc, co yang 175
Ranh ngang 138 - Lap niem mac 175
Ranh nguyet 336 Lap thanh mac 175
Ranh O mat 339 - Tdm dual niem mac 175
Ranh phoi 20 - ram du-di thanh mac 175
Ranh sau trung tam 336 Rut mOng 154
Ranh swan 22 RuOt non 154
Ranh thai ding dual 336 - Lap ca 158
Ranh thai duang ngang 336 - Lap them mac 156
Ranh thai &fang tren 336 - Lap thanh mac 158
Ranh than kinh gai song 13 - Thm dual niem mac 158
Ranh the chai 338 - Thm du i thanh mac 158
Ranh thanh - ket trang phai 293 - Tang co doc 158
Ranh thanh - ket trang trai 293 - Tang ca yong 158
Ranh tinh mach chit 137, 138 Ruet thila 170
560
San de,i thi 326 Sun chem 407
San nao that IV 317 Sun dau xticing 395
SO can ngang 318 Sun khap 389,406
Sqi cung dai nao 345 Sun nhan 95
Sari cung ngoai 313, 316 Sun stun 23
Sqi cung trong 316 Sung ben 306
Sqi vo gal 316 Sung ding 17
Scri vo lu'di. 322, 347 Sung cut 19
SO vo nhan 316, 347 Sung sau 306
Sun dia kh6p 407 Sting trudc 306

T
Ta trang 119 Tang nh6 487
- Phan len 120 Tang sung 486
- Phan ngang 120 Tang trong 486
- Phan tren 120 Tang tru 486
- Phan xue-ng 120 Tang viing 326
Tam giac bang quang 211 Tang xa.m 16i nap tren 322
Tam gide ben 55 Thap hanh 313
Tam giac cu6ng ding 329 Thar) than 193
Tam giac gian o'ng tinh 244 Thap they nheng 320
Tam gide gian tin tinh 244 Than am vat 236
Tam gide khliu 339 Than bang quang 209
Tam giac than kinh ha thiet 316 Than clot song 11
Tam giac than kinh lang lang 316 Than deng mach canh tay dau 94
Tam gide that king 34 Than deng mach phOi 68, 94
Tam gide that lung sutin 46 Than mao tinh 244
Tam giac ttc sudn (khe tic su'dn) 44 Than su'Un 22
Tam nhi phai 80 Than tinh mach gian wan phai tren 96
Tam nhi trai 80, 98 Than the chai 341
Tam that phai 81 Than till mat 151
Tam that trai 82 Than tuy 123
Tam vi 103 - Bor dudi 124
Tam ditch da 487 - 136 tren 124
Tam dual niem mac 439 -. BO trade 124
Tam dad thanh mac 105, 212, 439 - Mat dual 124
Tam mach mac 335 - Mat sau 123
Tam mach mac nao that III 332, 373 - Mat trade 123
Tam mang mach nao that IV 317, 373 Than tit cung 226
Tang day 486 - Mat bang quang 226
Tang gai 486 - Mat met 226
Tang hat 486 Than tic 24
Tang lu'di 487 Than vi 103
Tang mach 232 Than vom nao 341
561
 Than (xitang stain) 22 The hanh nhan 331, 341, 346
Than xitang 390, 391 The hinh thang 318
Than kinh biu sau 253 The nhi 468
Than kinh biu tru'ac 253 The tong 329, 463
Than kinh chau ben 36, 58, 236 The van 345
- Nhanh sinh duc 236 The vu 330, 341
Than kinh chau ha vi 34, 36 -Them thuy dao 336
Than kinh ding 4 (D4) The' quanh nao that 331
- Nhanh day chau 267 Thung liing tieu nao 320
Than kinh dirdi su'Un 34 Thiry cham 336
Than kinh dem nho 475 Thiry dao 336
Than kinh gai song 304 Thiry dinh 336
Than kinh gian akin 237, 277 Thiry duoi 137, 138, 143
Than kinh hoanh 94, 277 Thiry la 468
Than kinh lang thang 97, 110 Thiry nao
- Cac nhanh mat sau da day 335
110 Thiry nheng
- Cac nhanh mat truck da day 318, 320, 468
110 - Chech
- Nhanh dam r6i tang 320
110
TK lang am vat - Cue nao 320
262
TK lung vai - Dinh 320
41
TK mu &fang vat - Tigu thity trung tam 320
251, 260
TK ngutc lung Thiry thai du'o'ng 336
40
TK phu 39 Thiry than 194
TK sinh due dui, nhanh sinh due 57, 236 Thiry tran 336
TK tang be 46 Thiry tuyen sofa 237
TK tang ldn 46 _ Thiry vuong 138, 143
TK then 251, 236 Thqc quan 95
- Nhanh day chau 235, 259, 260 Thimg gan 82
TK vat hang duc ng vat 251 Thitng tinh 36, 57, 246
Than 183 Thayng bi 486
- Bao xd 184 Tia the chai 345
- Bar ngoai 185 Tia thi gide 345
- Bei trong 185 Tia thinh gide 345
- Dau dorm 185 Tien dinh am dao 236
- Dau tren 185 Tien dinh cua tui mac n6i 281, 290, 294
- Mat sau 184 Tien nao 303, 312, 474
- Mat truo'c 184 Tidu Ong mach 430
- Phan thuy du'di 194 Tigu dOng mach thang 196
- Phan thUy sau 194 Tien nao 303, 312, 318
- Phan thily tren 194 - Khe chinh 318
- Phan thily 194 = Khe ngang 318
- Phan thily trutdc-tren 194 - Khe phu 318
The chai 341 - Khe sau ben 31$
- Kep 16n 341 - La trang 320
- Kep nh6 341 - The toy 320
The g6i ngoai 329 - Thiry nheng 318
The g6i trong 330 Tieu nao co 468
562
Tigu nao Cu 468 - L6 bau due 78
Tigu nao mai 468 - L8 nhi that phai 80, 81
Tigu phg quan ho hap 65 - L8 nhi that trai 80, 82
Tigu quan luun 194 - L8 than citing mach ph6i 81
Tigu quan mat 148 - L8 tinh mach nha 80
Tigu quan Wan 194 - L6 tinh mach chili duai 80
Tigu thg canh 464 - L8 tinh mach chu tren 80
Tigu thg chu 464 - L8 tinh mach ph6i 81
Tigu thg cut 464 - L8 xoang tinh mach vanh 80
Tigu thg hanh 488 - Mao tan cling 80
Tigu thg khap 488 - Mat hoanh 77
Tigu the Id 488 - Mat ph6i 77
Tigu thg sinh duc 488 - Mat tic suin 76
Tigu thg xUc gide 488 - Phan cu 78
Tigu thg than kinh tan cling 488 - Phan mang 78
Tigu the than 194 - Ranh gian that sau 77
Tigu they 335 - Ranh gian that trufac 76
Tigu thity ban nguygt duai 320 - Ranh tan cling 76
Tigu tilt:1y ban nguygt tren 320 - Ranh vanh 76
Tigu thliy canh trung tam 338 - Tam giac sui 84
Tigu thily dinh duai 336 - Tam nhi phai 80
Tigu thUy dinh tren 336 - Tam nhi trai 80
Tigu thily dun 320 - Tam that trai 81
Tigu thliy hai than 320 - Tam that phai 81
Tigu thliy mao tinh 244 - Tigu nhi phai 76, 80
Tigu thily tinh hob.n 243 - Tigu nhi trai 76, 81
Tigu thby trung tam 320 - Tinh mach tim gida 77
Tigu drily tuygn sita 237 - Tinh mach tim lan 76
Tigu they vo 193 - Tinh mach tim nho 87
Tigu thliy vuong 320 - Van ba la 81
Tigu tinh mach gian tigu thliy 196 - Van nhi that phai 81
Tigu tinh mach sao 196 - Van than dgng mach ph6i 81
Tigu tinh mach thang 196 - Van tinh mach chU du'ai 80
Tim 75 - Van 18 bau due 78
- Ca loot 80 - Vach gian nhi 78
- Cu gian tinh mach 80 - Vach gian that 78
- Ddy tim 75 - Van xoang tinh mach vanh 80
- Dinh tim 77 - Vign hg bau duc 78
- agng mach vanh phai 77 - Xoang tinh mach chU- 76
- Dgng mach vanh trai 76 Tinh hoan 242, 253
- HO thgng Ong sui 84 - Bar sau 243
- H6 ball due 78 - Bar truac 243
- Khuygt dinh tim 77 - Cue duUi 243
- La sau van 3 Id 81 Cue tren 243
- La trade van 3 Id 81 Tinh mach 431
- La vdch van 3 Id 81 Tinh mach ban dan 46, 97
- Ligm vach 78 Tinh mach ban dan phy 97
563
 Tinh mach biu sau 253 Tinh mach ph6i 63
Tinh mach biu trade 253 Tinh mach ph6i phai dhoti 69
Tinh mach canh ran 146 Tinh mach ph6i phai tren 69
Tinh mach chau trong 147, 214 Tinh mach ph6i trai diith 69
Tinh mach chgch c6a tam nhi trai 87 Tinh mach ph6i trai tren 69
Tinh mach chi clued 76, 139 Tinh mach ran 146, 277
Tinh mach chi tren 76, 94 TM sau cua tam that trai 87
Tinh mach cung 136 TM then ngoai 236
Tinh mach ciia nao 382 TM then trong 218, 236
Tinh mach dia 108, 145 TM thi-van 383
- Nganh phai 146 TM thiic quan 147
- Nganh trai 146 TM thuryng vi dur6i 147
Tinh mach dur6i phan thug 69 TM thuong vi tren 147
Tinh mach clan 46, 97, 147 TM tidu nao durai (cac) 382
Tinh mach gan 148 TM tigu nao tren (cac) 382
Tinh mach gan gala 144, 148 TM tim 16n 87
Tinh mach gan phai 144, 148 TM tim giUa 87
Tinh mach gan trai 144, 148 TM tim nh6 87
Tinh mach gian phan th6y 69 TM tim trade (cac) 87
Tinh mach gian set in phai tren 97 TM trong phan thUy 69
Tinh mach gian thug 196 TM trung tam tie'u they gan 142
Tinh mach gian tidu thiiy 196 TM trung tam tuygn thuvng than 197
Tinh mach h6i - kgt trang 164 TM triric trang dual 147
Tinh mach kgt trang gitia 165 TM trate trang gin'a 147
Tinh mach kgt trang phai 165 TM tryc trang tren 147
Tinh mach lath 117, 129 TM fru& mon vi 103, 146
Tinh mach lien lac chdm 386 TM tai mat 146
Tinh mach lien lac chum 386 TM tuy 117
Tinh mach lien lac dinh 386 TM tiir cung 233
Tinh mach lien lac 16i cdu 386 TM vi ngan 117
Tinh mach mac treo trang dual 117 TM vi phai 108, 146
Tinh mach mac treo trang tren 108, 164 TM vi trai 108, 146, 147
Tinh mach mach mac 383 TM vi mac n6i phai 108,165
Tinh mach mu &fang vat sau 251 TM vi mac n6i trai 109,117
Tinh mach mu am vat sau 236 Tram hanh 313
Tinh mach mu am vat nong 236 T6c 488
Tinh mach nao gala 'long 383 Tram nao 312
Tinh mach nao 16n 383 Tran tram nao 315
Tinh mach nao trong 383 Trail trung nao 322
Tinh mach nen 383 Tre caa mang cling nao (cac) 369
Tinh mach nguc ngoai 237 Tre gan ngang (ca tiding bung) 37
Tinh mach nguc trong 147, 237 Trung nao 321, 329
Tinh mach nha 432 Trung tam gan (co' hoanh) 45
Tinh mach not du'ai (Labbe) 383 Trung tam gan (day chau) 260
Tinh mach n6i tren (Trolard) 383 Trung that 93
Tinh mach nong 382, 431 Trung that gifia 94
Tinh mach phg quan 63, 70 Trung that sau 94, 95
564
Trung that tinh hoan 243 Tay xu'o'ng do 392
Trung that tren 94 Tay xaung yang 392
Trung that trade 94 Tuy 119, 122
Try am vat 236 Tit cung 225, 226
Tru dai nao 321 -136 phai 226
Try ngoai (c6 die() bung ngodi) 34 - l36 trai 226
Try phai (c6 hoanh) 45 Tuygn ba (da) 489
Try sau bao trong 345 Tuygn ba (Nang vu 236
Try trai (c6 hoanh) 45 Tuygn can giap 462
Try trong (c6 cheo bung ngoai) 34 Tuygn c6 cung 227
Tru trade bao trong 345 Tuygn da day 107
Tru yam nao 341 Tuygn dal tai 489
Tryc trang 168, 172 Tuygn giap 462
Trang 223 Tuygn hanh nieu dao 216, 248
Tua bang trang 225 Tuygn khong c6 6ng tigt 460
Tua voi 225 Tuygn nieu dao 216
Tai (6ng den tinh) 244 Tuygn m6 hell 489
Tai ding 273 Tuygn quaith hdu mon 489
Till ding bang quang-tit cung 226, 273 Tuygn runt 158
Tai ding Douglas 226 Tuygn sa'a 236, 237
Mi ding true trang - bang quang 172, 273 Tuygn tha6ng then 197; 463
Tai ding try'c trang - tii cung 226, 273 - B6 tren 197
Tai bau dyc tuygn tin liet 216, 248 -136 trong 197
Tai hoat dich 415 - Mat sau 197
Till mac n6i 293, 294 Mat till& 197
- Ngach du'ai 294 - Mat thdn 197
- Ngach lath 294 Tuygn thu6ng then phy 197
- Ngach tren 294 Tuygn thayng thdn, r6n 197
Tai mat 149 Tuygn thuvng then, tay 197
Tai phg nang 65 Tuygn thuvng then, v6 197
Tin phinh kgt trang 170 Tuygn tin dinh be 2343
Tui runt Meckel 278 Tuygn tin dinh lan 236
Tui tinh 244 Tuygnti6n 'let 247
Tay gai 301 Day 248
- Khe gia'a 305 - Dinh 248
- Phan c6 303 - Mat dikti ben 248
- Phan ngy'c 303 Mat sau 248
- Phan that lung 303 - Mat tru'Oc 248
- Ranh ben - sau 305 Thay gia'a 248
- Ranh giUa 305 - Thay phai 248
- Thang ben 305 - Thay trai 248
- Thang sau 305 - Tui bau due 248
- Thang truck 305 Tuygn tang 463
Tay hanh 312 Tuygn itc 76, 94, 463
Tay lath 114 Tuygn 'yang mon vi 107
Tay nao 312 Tuygn yen 330, 461
Tay then 193 - Tuygn 461
Tay that tan ding 306 Than kinh 461
565
 nho 15

V
Vach duung vat 251 VO nao mth 469
Vach gian co' 415 VO than 193
Vach nhi thk 78 VO tieu nao 320
Vach tinh hoar' 243 Vol Fallope 224
Vach trong suk 342 Vol tii cung 224, 225
Van bach huyk 433 Vom am dao 227
Van ban nguyet phai 81, 82 Vom nao 331, 341
Van ban nguyet trai 81, 82 \Tong not qua philc mac 147
Van ban nguyk sau 82 Yong not quanh run 147
Van ban nguyet truck 81 Vang n6i thuc quan 147
Van ang mach chi 82 Yong nal true trang 147
Van hau mon 176 Wong dung mach nao 379
Van h6 thoyen 216 Vong scri 24, 84
Van h8i manh trang - 175 Vi 236
Van nhi that trai 82 Vu phu 236
Van tang mao 82 VUng bat dinh 330
Van than Ong mach phOi 81 VUng da day 107
Van tinh mach chit dudi 80 VUng dUUi chai 339
Van xoang tinh mach vanh 80 VUng duVi. dui 327, 330
Van tinh mach 433 Wing ha d8i. 327, 330, 341
Vanh quy dau 250 - Nhan bung trong 331
Vanh tia 345 - Nhan canh nao thk 331
Van doc ngoai 341 - Nhan cU 331
Van doc trong 341 - Nhan lung trong 331
Van kill:1'u 339 - Nhan truo'c thi 331
Van tan ding 326 - Nhan sau 331
Van tUy-d8i thi 326 - Nhan the vu 331
Van tily-ndo that IV 316 - Nhantren thi 331
Vat hang am vat 236 Vimg hau mon 262
Vat hang du'ong vat 250 VUng.nieu-duc 256
Vat trail bung triing 225, 231, 456 VUng sau d8i 329
Vat x6p duong vat 250 Wing tin dinh 316
VO boc chung 486 Vimg tren dui 329,
VO dai nao 346 \Tung tri 176
566
Xoang 392 Xoang xich ma 385
Xoang blidm dinh 385 Xtiong chi duth 387
Xoang cham 384 Xuong chi tren 387
Xoang ch6ch ngoai tam mac 84 Xtiong có hoc khi 392
Xoang doc du'Oi 384 Xuong cung 15
Xoang doc tren 384 Xtiong cut 19
Xoang da du'Oi 385 Xuong dai 388
Xoang da tren 385 Xtiong det 388
Xoang hang 385 Xtiong Ring ngyc 387
Xoang hau mon 176 Xtiong ngdn 388
Xoang mao tinh 244 Xuang mat 387
Xoang mang cdrig 383 Xtiong nhi 387
Xoang ngang 385 Xtiong so 387
Xoang ngang ngoai tam mac 83 Xtiong suan 20
Xoan siia 237 Xtiong stio'n gia 20
Xoang thang 384 Xuung sI1 n that 20
Xoang than 192 Xtiong' iic 24, 93
Xoang tin liet 215 Xtiong viing 389
Xoang tinh mach vanh 88

567
 BANG CHI DAN TRA CUU TIENG LA TINH

A
Adhesio interthalamica 326 Apex prostatae 248
Adenohypophysis 461 Apex pulmonis 61
Ala lobuli centralis 320 Apex vesicae 209
Alveola pulmonis 65 Aponeurosis 414
Amphiarthrosis 402. 406 Apparatus digestorius 438
Ampulla ductus deferentis 210, 244 Appendices epiploicae 170
Ampulla hepatopancreatica 127, 148 Appendix epididymidis 244
Ampulla tubae uterinae 225 Appendix testis 243
Anastomosis arteriovenosa 432 Appendix vermiformis 170
Angulus costae 22 Aqueductus cerebri 322, 326
Angulus infrasternalis 20 Arachnoidea 365
Angulus sterni 24 Arachnoidea encephali 372
Ansa lenticularis 330 Arachnoidea spinalis 366
Ansa peduncularis 330 Archeo cerebellum 468
Ansa subclavia 360 Arbor vitae cerebelli 321
Anteflexio 225 Arcus aortae 94
Anteversio 226 Arcus costalis 20
Antrum 392 Arcus vertebrae 12
Antrum pyloricum 103 Area nuda 137
Anuli fibrosi 84 Area subcallosa 339
Anulus fibrosus 24 Area vestibularis 316
Anulus inguinalis profundis 56 Areae gastricae 107
Anulus inguinalis superficialis 34, 57 Areola mammae 236
Aorta abdominalis 96, 161
Arteria 430
Aorta thoracica 96
Arteria appendicularis 164, 178
Apertura mediana 317
A. arcuata 196
Apertura lateralis 317
A. ascendens 163, 178
Apertura thoracis inferior 20
Aa. bronchiales 63. 70
Apertura thoracis superior 20, 61
Apex cordis 77 A. bronchialis 96
Apex cornu posterioris 306 A. basilaris 379
Apex ossis sacri 18 A. cauda pancreatis 129

568
A. cecalis anterior 164, 178 A. gastroepiploica dextra 108
A. cecalis posterior 164, 178 —Rami epiploici 108
A. cerebelli inf. ant. 379 A. gastroepiploica sinistra 108, 117
A. cerebelli inf. post. 379 — Rami esophagei 109
A. cerebelli superior 379 A. hepatica communis 145
A. cerebri anterior 379 A. hepatica propria 145
Rami corticales 379 —Ramus dexter 145
— Rami frontales 379 — Ramus sinister 145
— Rami orbitales 379 Aa. ilei 162
— Rami parietales 379 A. ileocolica 163, 178
A. cerebri media 379, 381 A. ilica communis 207
— Rami corticales 381 A. intercostalis 96
— Rami frontales 381 Aa. interlobulares 196
— Rami orbitales 381 Aa. interlobares renis 196
Rami parietales 381 Aa. jejunales 162
— Rami temporales 381 A. lienalis 117
A. cerebri posterior 379, 381 —Rami lienales 117
— Rami corticales 381 —Rami pancreatici 117
— Rami occipitales 381 A. lobi caudati 145
— Rami parietooccipitales 381 A. lumbalis 297
— Rami temporales 381 A. mediastinalis 96
A. choroidea anterior 379, 381 A. mesenterica inf. 179
A. colica dextra 164, 178 A. mesenterica sup. 160, 178
A. colica media 164, 178 A. musculophrenica 47
A. colica sinistra 179 A. obturatoria 214
A. communicans post. 379 A. ovarica 207, 224
A. communicans ant. 379 A. pancreatica dorsalis 129
A. coronaria dextra 77, 86 A. pancreatica inferior 129
— Ramus interventricularis post. 86 A. pancreatica magna 129
A. coronaria sinistra 76, 86 A. pancreaticoduodenalis superior anterior 129
— Ramus circumplexus 86 A. pancreaticoduodenalis superior posterior 129
— Ramus interventricularis ant. 86 A. pancreaticoduodenales inferiores 129, 162
A. cremasterica 247 A. phrenica inferior 47

A. cystica 145, 151 A. phrenica superior 47

218, 251 Aa. phrenicae inferiores 109

A. dorsalis penis
Aa. phrenicae superiores 96
A. ductus deferentis 247
A. profunda penis 218, 281
A. epigastrica inf. 55
A. pudenda interna 214, 259
A. epigastrica superior 56 63
A. pulmonalis
A. gastrica dextra 107, 145 A. pulmonalis dextra 68
A. gastrica sinistra 108 —Ramus ant. ascendens 68
Aa. gastricae breves 109, 117 — Ramus apicalis 68
A. gastroduodenalis 108, 129, 145' —Ramus apicalis lobi inferioris 68

569
 — Ramus basalis anterior 68 — Ramus tubarius 233
— Ramus basalis lateralis 68 A. vertebralis 379
—Ramus basalis medialis 68 A. vaginalis 214, 234
—Ramus basalis posterior 68 A. vesicalis inferior 207, 214, 248
—Ramus medialis 68 Aa. vesicales superiores 213
— Ramus lobi medii 68 Arteriola 430
Ramus lateralis 68 Arteriolae rectae 196
— Ramus posterior ascendens 68 Articulatio complexa 410
— Ramus posterior descendens 68 Articulatio composita 409
—Ramus subapicalis 68 Articulatio condylaris 408

A. pulmonalis sinistra Articulatio ellipsoidea 408

69
Articulatio costotransversaria 24
— Ramus lingularis 69
Articulatio plana 408
— Ramus lingularis inferior 69
Articulatio sacroiliaca 24
—Ramus lingularis superior 69
Articulatio simplex 409
A. rectalis media 180, 207, 214, 248 Articulatio sellaris 408
A. rectalis superior 179 Articulatio spheroidea 408
A. renalis 207 Articulatio trochoidea 408
Aa. renis 194 Articulatio trochlea 408
Aa. retroduodenales 129 Articulationes costovertebrales 24
A. sacralis mediana 297 Articulationes sternocostales 24
A. segmenti anterioris 145 Astroglia 475
A. segmenti lateralis 145 Atlas 13
A. segmenti medialis 145 — Arcus anterior 13
A. segmenti posterioris 145 — Arcus posterior 13
Aa. sigmoidea 179 — Tuberculum anterius 13

A. spinalis ant. 376 — Tuberculum posterius 13

A. spinalis post. Atrium dextrum 80

376
Atrium sinistrum 80
A. suprarenalis inferior 197
Auricula 468
A. suprarenalis media 197
Auricula dextra 76, 80
A. suprarenalis superior 197 Auricula sinistra 76, 81
A. testicularis 57, 207, 247 Axis. 14
A. urethralis 218 — Dentis 14
A. uterina 214, 233 — Facies articularis ant. 14
— Ramus ovaricus 233 — Facies articularis post. 14

570
 B
Basis cordis 75 Bronchus principalis 63, 65
Basis ossis sacri 17 Bulbus olfactorius 339
Basis prostatae 248 Bulbus penis 215, 217, 250
Basis pulmonis 60 Bulbus pili 488
Basis pyramidis 193 Bulbus vestibuli 236, 260
Brachium colliculi inferioris 321, 330 Bursa omentalis 189, 282, 293
Brachium colliculi superioris 321, 330 — Recessus inferior omentalis 294
Bronchi lobares 65 — Recessus lienalis 294
Bronchi segmentales 65 — Recessus superior omentalis 294
Bronchioli respiratorii 65 Bursa synovialis 415

C
Calices renales majores 192 Cauda nuclei caudati 345
Calices renales minores 192 Cauda pancreatis 124
Canalis analis 168, 173 Cavum abdominis 271
Canalis centralis 306 ' Cavum articulare 407
Canalis cervicis uteri 227 Cavum epidurale 363
Canalis inguinalis 50 Cavum medullare 391
Canalis nutricius 393 Cavum subarachnoideale 365, 366
Canalis pyloricus 103 Cavum pericardii 83
Canalis pudendalis 263 Cavum peritonei 271
Canalis sacralis 17, 18 Cavum pleurae 63, 72, 93
Canalis ventriculi 106, 107 Cavum septi pellucidi 342
Canalis vertebralis 12 Cavum thoracis 19
Capilli 488 Cavum uteri 227, 232
Capsula adiposa 189 Cecum 168, 170
Capsula articularis 407 Centrum tendineum (diaphragma) 45
Capsula externa 345 Centrum tendineum perinei 260
Capsula fibrosa 192 Cerebellum 303, 318
Capsula glomeruli 194 — Corpus medullae 320
326, 345 — Fissura posterolateralis 318
Capsula interna
— Fissura prima 318
Caput costae 21
— Fissura secunda 318
Caput epididymidis 244 321
— Lamina albae
Caput nuclei caudati 345 Cervix uteri 227
Caput pancreatis 123 Portio supravaginalis 227
Cardia 95 — Portio vaginalis 227
Cartilago articularis 389, 406 Cervix vesicae 209
Cartilago costalis 23 Chorda 412, 466
Cartilago epiphysialis 395 Cingulum 345
Carunculae hymenales 234 Cilia 488
Cauda epididymidis 244 Circulus arteriosus cerebri 379
Cauda equina 304 Cisterna cerebellomedullaris 366, 372

571
Cisterna chiasmatis 372 Cornu coccygeus 19
Cisterna chyli 97 Cornu sacrale 17
Cisterna fossae lateralis cerebri 372 Corona glandis 250
Cisterna interpeduncularis 372 Corona radiata 345
Cisternae subarachnoideales 365 Corpus amygdaloideum 331, 341, 346
Chiasma opticus 330 Corpus callosum 341
Chordae tendineae 82 — Forceps major 341
Claustrum 345, 346 — Forceps minor 341
Clitoris 236 Corpus cavernosum clitoridis 236
Colliculus facialis 316 Corpus cavernosum penis 250
Colliculus inferior 321 Corpus clitoridis 236
Colliculus seminalis 216, 244 Corpus costae 22
Colliculus superior 321, 326 Corpus epididymidis 244
Collum costae 21 Corpus fornicis 341
Collum glandis 250 Corpus geniculatum laterale 329
Collum vesicae felleae 151 Corpus geniculatum mediale 330
Colon 168 Corpus mamillare 330, 341
Colon ascendens 172 Corpus nuclei caudati 345
Colon de scendens 172 Corpus pancreatis 123
Colon sigmoideum 172 — Facies anterior 123
Colon transversum 172 — Facies inferior 124
Collum costae 21 — Facies posterior 123
Columnae analis 176 — Margo anterior 124
Columna fornicis 330, 341 — Margo inferior 124
Columnae renales 193 — Margo superior 124
Columnae rugarum 234 Corpus penis 250
Columna rugarum ant. 234 Corpua pineale 329, 463
Columna rugarum post. 234 Corpus spongiosum penis 250
Columna vertebralis 10, 387 Corpus sterni 24
Commissura alba 306 Corpus striatum 345
Commissura anterior 342 Corpus trapezoideum 318
Commissura fornicis 342 Corpus uteri 226
Commissura habenularum 329 — Facies intestinalis 226
Commissura labiorum ant. 235 — Facies vesicalis 226
Commissura labiorum post. 235 Corpus ventriculi 103
Commissura posterior 326 Corpus vertebrae 11
Commissura superior 326 Corpus vesicae felleae 151
Confluens sinuum 384 Corpus vesicae 209
Coni epididymidis 244 Corpuscula renis 194
Conus arteriosus 81 Corpuscula tactus 488
Conus medullaris 304 Corpusculum articularia 488
Cor 75 Corpusculum bulboidea 488
— Facies diaphragmatica 77 Corpusculum genitalis 488
— Facies pulmonalis 76 Corpusculum lamellosa 488
— Facies sternocostalis 76 Corpusculum nervosa terminalis 488
— Ventriculus dexter 81 Cortex cerebelli 320
— Ventriculus sinister 82 Cortex cerebri 346
Cornu anterius 306 Cortex renis 193
Cornu laterale 306 Costae 20
Cornu posterius 306 Costae spuriae 20

572
Costae verae 20 Crus laterale (m.obliquus ext. abd. ) 34
Crista capitis costae 21 Crus mediale (m.obliquus ext. abd.) 34
Crista colli costae 21 Crus anterius capsulae internae 345
Crista sacralis intermedia 17 Crus posterius capsulae internae 345
Crista sacralis lateralis 17 Cuneus 338
Crista sacralis mediana 16 Culmen 320
Crista supraventricularis 81 Cupula pleurae 71
Crista terminalis 80 Cuspis anterior 81, 82
Crista urethralis 416 Cuspis posterior 81, 82
Crus anterius capsulae internae 345 Cuspis septalis 81
Crus cerebri 321 Curvatura ventriculi major 105
Crus clitoridis 236 Curvatura ventriculi minor 105
Crus fornicis 341

Declive 320 Ductuli prostatici 248

Decussatio lemniscorum 316 Ductulus aberians superior 244
Decussatio pedunculorum cerebellarium 322 Ductus choledochus 148
superiorum Ductus cysticus 148, 151
Decussario pyramidum 313 Dustus deferens 244
Decussatio sensoria 316 — Tunica adventitia 244
Decussationes tegmenti 322 —Tunica mucosa 244
Dermis 487 — Tunica muscularis 244
Descendus testis 253 Ductus ejaculatorius 244
Diaphragma 43,93 Ductus epididymidis 244
— Crus dextrum 45 Ductus excretorius 244
— Crus sinistrum 45 Dustus glandulae bulbourethralis 249
—Pars costalis 45 Ductus hepaticus communis 148
—Pars lumbalis 45 Ductus hepaticus dexter 148
— Pars sternalis 44 Ductus hepaticus sinister 148
Diaphragma pelvis 209,267 Ductus lactiferi 237
Diaphragma sellae 372 Ductus mesonephricus 226
Diaphragma urogenitale 257 Ductus pancreaticus 124
Diaphysis 390 Ductus pancreaticus accessorius 127
Diathrosis 402 Ductus thoracicus 97
Diencephalon 303,325,469 Ductus thyroglossus 462
Disci intervertebrales 24 Ductus venosus 138, 146
Discus articularis 407 Duodenum 119
Diverticula ampullae 244 —Pars ascendens 120
— Pars descendens 120
Dorsum penis 250
— Pars horizontalis 120
Ductuli aberrantes 244
— Pars superior 120
Ductuli alveolares 65
Dura mater 363
Ductuli biliferi 148
Dura mater encephali 369
Ductuli efferentes tegi :q 244 Dura mater spinalis 365

573
 E
Eminetia medialis 316 Epididymis 244
Encephalon 301, 334 Epithalamus 329
Endocardium 85 Eponychium 489
Endometrium 233 Epoophoron 225, 231, 456
Endoneurium 474 Esophagus 95
Ependyma 326, 343, 475 Excavatio 273
Epidermis 486 Excavatio rectouterina 226, 273
Epineurium 369, 474 Excavatino recto vesicalis 172, 273
Epiphysis 390 Excavatino vesicouterina 226, 273
Exteroceptor 486

F
Facies articularis 389, 406 Fascia pelvis parietalis 210
Facies articularis capitis costae 21 Fascia pelvis visceralis 210
Facies articularis anterior 14 Fascia penis profunda 251
Facies articularis post. 14 Fascia penis superficialis 250
Facies articularis tuberculi costae 21 Fascia phrenicopleuralis 71
Facies auricularis (os sacrum) 17 Fascia prostatae 210
Facies inferior hemispherii 338 Fascia spermatica externa 246
Facies medialis hemispherii 338 Fascia spermatica interna 247
Facies dorsalis 16 Fascia thoracolumbalis 34
Facies pelvina 16 Fascia transversalis 37, 55
Facies superolateralis cerebri 335 Fasciculi proprii 307
Falx cerebelli 372 Fasciculus atrioventricularis 85
Falx cerebri 371 — Crus dextrum 85
Falx inguinalis (tendo conjunctivus) 36, 52 — Crus sinistrum 85
Falx septi 78 Fasciculus corticothalamici 347
Fascia 414 Fasciculus cuneatus. 305, 307
Fascia cremasterica 246 Fasciculus gracilis 305, 307
Fascia diaphragmatis pelvis inferior 268 Fasciculus longitudinalis dorsalis 316, 331
Fascia diaphragmatis pelvis superior 210, 268 Fasciculus longitudinalis inf. 345
Fascia diaphragmatis urogenitalis 257, 259 Fasciculus longitudinalis medialis 316
inferior Fasciculus longitudinalis sup. 345
Fascia diaphragmatis urogenitalis superior 259 Fasciculus mamillotegmentalis 331
Fascia endothoracica 71 Fasciculus mamillothalamicus 331
Fascia iliaca 186 Fasciculus retroflexus 329
Fascia obturatoria 210 Fasciculus thalamocorticalis 328
Fascia pelvis 210, 268 Fasciculus uncinatus 345

574
Fibrae arcuatae cerebri 345 Foramen nutricium 392
Fibrae arcuatae externae 313, 316 Foramen ovale 78
Fibrae arcuatae internae 316 Foramen transversarium 13
Fibrae corticonucleares 316, 347 Foramen venae cavae 46
Fibrae corticospinales 316 Foramen vertebralis 12
Fibrae corticoreticulares 347 Foramina intervertebralis 18
Fibrae periventriculares 322, 331 Foramina sacralia dorsalia 17
Fibrae pontis transversae 318 Foramina sacralia pelvina 16
Fimbria ovarica 225 Foramina venarum minimarum 80
Fimbrae tubae 225 Formatio reticularis 306, 329
Filum durae matris spinalis 366 Fornix 331, 341
Filum terminale 305 Fornix vaginae 227
Fissura horizontalis 318 Fossa 273
Fissura lig. venosi 137, 138 Fossa inguinalis lateralis 56, 273
Fissura longitudinalis cerebri 335 Fossa inguinalis medialis 56, 273
Fissura transversa cerebri 335 Fossa interpeduncularis 321
Fissurae cerebelli 318 Fossa ischiorectalis 262, 263
Flexura coli dextra 172 Fossa navicularis urethrae 215
Flexura coli sinistra 172 Fossa ovalis 78
Flexura duodeni inf. 120 Fossa rhomboidea 316
Flexura duodeni sup. 120 Fossa supravesicalis 56,273
Flexuraduodenoj ejunalis 119, 120 Fossa vesicae•felleae 138
Flexura perinealis 172 Fovea articularis inf. 13
Flexura sacralis 172 Fovea articularis sup. 13
Flocaus 320, 468, Fovea costalis inf. 14
Folliculi lymphatici aggregati 158, 174 Fovea costalis sup. 14
Folliculi lymphatici aggregati appendicis 175 Fovea costalis transversalis 14
vermiformis Fovea dentis 13
Folliculi lymphatici gastrici 107 Foveolae gastricae 107
Folliculi lymphatici lienales 114 Frenulum clitoridis 236
Folliculi lymphatici solitarii 158, 174 Frenulum labiorum pudendi 235
Folliculus lymphaticus 433 Frenulum preputii 250
Folliculi ovarii vesiculosi 223 Frenulum valvae ileocecalis 175
Folliculi pilli 488 Frenulum veli medullaris superioris 317
Folium vermis 320 Fundus uteri 226
Foramen cecum 462 Fundus ventriculi 103
Foramen epiploicurn 290, 293, 294 Fundus vesicae 209
Foramen interventriculare 326, 343 Fundus vesicae felleae 150
Foramen intervertebrale 12 Funiculus spermaticus 246

575
 G
Ganglia aorticorenalia 361 Glandulae intestinales 158
Ganglia cardiaca 88, 361 Glandulae pyloricae 107
Gangli celiaca 361 Glandulae sebacese 489
Ganglia lumbalia 361 Glandulae sine ductibus 460
Ganglia pelvina 358 Glandulae sudoriferae 489
Ganglia sacralia 361 Glandulae suprarenales accessoriae 197
Ganglia thoracia 361 Glandulae urethrales 216
Ganglia trunci sympathici 358 Glandula vestibularis major 236
Ganglion cervicale inf. 360 Glandulae vestibularis minor 236
Ganglion cervicale medium 360 Glans clitoridis 236
Ganglion cervicale sup. 359 Glans penis 250
Ganglion cervicothoracium 360 Globus pallidus 330, 345
Ganglion ciliare 358 Glomerulus 194
Ganglion impar 361 Glomus aorticum 464
Ganglion mesentericum inf. 361 Glomus caroticum 464
Ganglion mesentericum sup. 361 Glomus coccygeum 464
Ganglion oticum 358 Granulationes arachnoideales 365
Ganglion pterygopalatinum 358 Gubernaculum 457
Ganglions splanchnicum 361 Gubernaculum testis 243, 454
Ganglion stellatum 360 Gyri breves insulae 336
Ganglion submandibulare 358 Gyri cerebri 335
Genu capsulae internae 345 Gyri orbitales 339
Genu corporis callosi 341 Gyri temporales transversi 336
Genu n. facialis 318 Gyrus angularis 336
Glandula bulbourethralis 216, 248 Gyrus cinguli 328, 338
Glandula mammaria 236, 237 Gyrus dentatus 339, 341
Glandula pituitaria 461 Gyrus fasciolaris 341
Glandula suprarennalis 197, 463 Gyrus frontalis inf. 336
— Cortex 197 Gyrus frontalis medialis 338
— Facies anterior 197 Gyrus frontalis medius 336
— Facies posterior 197 Gyrus frontalis sup. 336
— Facies renalis 197 Gyrus lingualis 339
— Hilus 197 Gyrus longus insulae 336
— Margo medialis 197 Gyrus occipitotemporalis lateralis 339
— Margo superior 197 Gyrus occipitotemporalis medialis 339
— Medulla 197 Gyrus parahippocarnpalis 339
Glandula parathyroidea 462 Gyrus paraterminalis 339
Glandula thyroidea 462 Gyrus posteentralis 336
Glandulae areolares 236 Gyrus precentralis 336
Glandulae cervicales uteri 227 Gyrus rectus 339
Glandulae ceruminosae 489 Gyms supramarginalis 336
Glandulae circumanales 489 Gyrus temporalis inf. 336
Glandulae cutis 489 Gyrus temporalis medius 336
Glandulae duodeni 122 Gyrus temporalis sup 336
Glandulae gastricae 107

576
Habenulae 329 — Segmentum posterius 145
Haustra coli 170 — Tunica fibrosa 141
Hemispherium 325, 334 — Tunica serosa 141
Hemispherium cerebelli 318 Hiatus aorticus 46
Hepar 133 Hiatus esophageus 46
— Capsula fibrosa perivascularis 141 Hiatus sacralis 17
— Facies diaphragmatica 134 Hilus lienis 115
— Facies visceralis 137 Hilus nuclei olivaris 316
— Impressio cardiaca 134 Hilus ovarii 223
— Margo inferior 139 Hilus pulmonis 63
— Pars anterior 137 Hilus renalis 185, 192
— Pars dextra 137 Hippocampus 331, 341
— Pars posterior 137 Hirci 488
- Pars superior 134 Hymen 234
— Segmentum anterius 145 Hypophysis 330, 461
— Segmentum laterale 145 Hyponychium 489
— Segmentum mediale 145 Hypothalamus 327, 330, 341

Ileum 154 Incisura vertebralis sup. 12

Impressio cardiaca 62 Indusium griseum 341
Impressio colica 138 Infundibulum 81, 330
Impressio duodenalis 138 Infundibulum tubae uterinae 225
Impressio gastrica 139 Insula 336
Impressio renalis 138 Integumentum commune 486
Incisura angularis 103 Intersectiones tendinae 37
Incisura apicis cordis 77 Interoceptor 486
Incisura cardiaca 103 Intestinum crassum 168
Incisura cardiaca pulmonis sinistri 63 — Tela submucosa 175

Incisura clavicularis 24 — Tela subserosa 175

Incisura costalis 24 — Tunica mucosa 175

Incisura jugularis 24 — Tunica muscularis 175

Incisura lig. teretis 138 + Stratum circulare 175

Incisura pancrealis 123 + Stratum longitunale 175

Incisura preoccipitalis 336 — Tunica serosa 175

Incisura tentorii 371 Intestinum tenue 154

Incisura vertebralis inf. 12 — Tela submucosa 158

577
 - Tela subserosa 158 Intumescentia lumbalis 304
- Tunica mucosa 156 Isthmus gyri cinguli 338
- Tunica muscularis 158 Isthmus prostatae 248
+ Stratum circulare 158 Isthmus tubae uterinae 225
+ Stratum longitudinale 158 Isthmus uteri 225
Intumescentia cervicalis 304

J
Jejunum 154 Junctura sacrococcygea 24
Junctura cartilaginea 405 Junctura synovialis 406
Junctura fibrosa 404

L
Labium majus pudendi 235 - Facies renalis 115
Labium minus pudendi 235 - Facies visceralis 115
Lacunae urethrale 216 - Margo inferior 116
Lamina affixa 326 - Margo superior 116
Laminac albae 320 - Tunica fibrosa 114
Lamina anterior 37 - Tunica serosa 114
Lamina arcus vertebrae 12 Lien accessorius 114
Lamina medullaris lateralis 345 Ligamentum anococcygeum 264
Lamina medullaris medialis 346 Lig. arcuatum laterale 45
Lamina muscularis mucosae 439 Lig. arcuatum mediale 45
Lamina parietalis 83 Lig. arcuatum medianum 45
Lamina posterior 37 Lig. coronarium hepatis 139, 283
Lamina septi pellucidi 342 Lig. denticulatum 366
Lamina terminalis 330 Lig. falciforme hepatis 137, 139, 283
Lamina visceralis 83 Lig. gastrocolicum 291
Lamina medullares thalami 328 Lig. gastrolienale 105, 115, 285
Lanugo 488 Lig. gastrophrenicum 288, 291
Lemnicus lateralis 318 Lig. hepatoduodenale 140, 290
Lemnicus medialis 316 Lig. hepatogastricum 140, 290
Lemnicus spinalis 318 Lig. inguinale 34, 51
Lemnicus trigeminalis 318 Lig. interfoveolare 55
Lien 114 Lig. intracapsularia 407
- Extremitas anterior 116 Lig. lacunare 52
- Extremitas posterior 116 Lig. latum uteri 228
- Facies colica 115 Lig. lienorenale 115
- Facies diaphragamatica 115 Lig. longitudinale ant. 25
- Facies gastrica 115 Lig. longitudinale post. 25

578
Lig. nuchae 41 Lobi cerebri 335
Lig. ovarii proprium 224 Lobi glandulae mammariae 237
Lig. pectineale 52 Lobi renales 194
Lig. phrenicolienale 115, 285 Lobuli cerebri 335
Lig. puborirostaticum 210 Lobuli corticales 193
Lig. pubovesicale 210 Lobuli epididymidis 244
Lig. pulmonale 71 Lobuli glandulae mammariae 237
Lig. reflexum 34, 51 Lobuli testis 243
Lig. sacrotuberale 256 Lobulus biventer 320
Lig. sternopericardiaca 83 Lobulus centralis 320
Lig. suspensorium ovarii 224 Lobulus paracentralis 338
Lig. teres hepatis 140, 146 Lobulus parietalis inf. 336
Lig. teres uteri 231 Lobulus parietalis sup. 336
Lig. transversum perinei 260 Lobulus quadrangularis 320
Lig. triangulare 283 Lobulus semilunaris inf. 320
Lig. triangulare dextrum 139 Lobulus semilunaris superior 320
Lig. triangulare sinistrum 139 Lobulus simplex 320
Lig. umbilicale mediale 56 Lobulus caudatus 137, 138, 143
Lig. umbilicale medianum 56, 209 Lobus frontalis 336
Lig. venosum 140, 146 Lobus hepatis dexter 138, 142
Limbus fossae ovalis 78 Lobus hepatis sinister 138, 142
Limen insulae 336 Lobus occipitalis 336
Linea alba 34, 51 Lobus parietalis 336
Linea arcuata 17, 37 Lobus quadratus 138, 143
Linea transversae 16 Lobus temporalis 336
Lingula cerebelli 320 Lympha 433
Lingula pulmonis sinistri 62 Lunula 489
Liquor cerebrospinalis 373

M
Mamma 236 Medulla ossium rubra 392
Mammae accessoriae 236 Medulla renis 193
Manubrium sterni 24 Medulla spinalis 301
Margo uteri dexter 226 - Fissura mediana 305
Margo uteri sinister 226 - Funiculus anterior 305
Massa lateralis 13 _ Funiculus latealis 305
Mediastinum 93 - Funiculus posterior 305
Mediastinum anterius 94 - Pars cervicalis 303
Mediastinum medium 94 - Pars lumbalis 303
Mediastinum posterius 94 - Pars thoracica 303
Mediastinum superius 94 - Sulcus medianus 305
Mediastinum testis 243 Membrana fibrosa 407
Medulla oblongata 303, 312 Membrana intercostalis externa 30
Medulla ossium flava 392 Membrana intercostalis interna 30

579
Membrana suprapleuralis 71 Musculus levator scapulae 40
Membrana synovialis 407 Musculus longissimus 41
Meninges 363 Musculus multifidus 42
Mesencephalon 303, 321, 329 Musculus obliquus externus abdominis 34, 51
Mesenterium 159 — Crus laterale 34
Mesenterium dorsale commune 277, 279, 286 — Crus mediale 34
Meso appendix 173 — Fibrae intercruralis 51
Mesocolon ascendens 173 Musculus obliquus internus abdominis 34, 51
Mesocolon descendens 173 Musculus papillaris ant. 82
Mesocolon sigmoideum 173 Musculus papillaris post. 82
Mesocolon transversum 173, 291 Musculus pubococcygeus 267
Mesogastrium 279 Musculus puborectalis 264, 267
Mesometrium 231 M. pubovaginalis 267
Mesosalpinx 231 M. pubovescicalis 212
Mesotendineum 415 Musculus pyramidalis 38
Mesovarium 231 Musculus quadratus lumborum 38
Metathalamus 329 Musculus rectovesicalis 212
Metencephalon 303, 3 f2 Musculus rectus abdominis 37
Microgolicyte 475 Musculus rhomboideus 41
Mons pubis 235 Musculus rhomboideus major 41
Musculi abdominis 33 Musculus rhomboideus minor 41
Musculi dorsi 39 Musculus semispinalis 42
Musculi intercostales externi 30 Musculus serratus post. inf. 41
Musculi intercostales interni 30 Musculus serratus post. sup. 41
Musculi intercostales intimi 30 Musculus sphincter ampullae 148
Musculi interspinales 42 hepatopancreaticae
Musculi intertransversarii 42 Musculus sphincter ani externus 262, 264
Musculi levatores costarum 33 — Pars profunda 264
Musculi papillares septales 82 — Pars subcutanea 264
Musculi pectinati 80 — Pars superficialis 264
Musculi rotatores 42 Musculus sphincter pylori 105
Musculi subcostales 32 Musculus sphincter urethrae 260
Musculi thoracis 28 Muculus sphincter vesicae 217
Musculus 412 Musculus spinalis 41
Musculus arrectores pilorum 488 Musculus suspensorius duodeni 121
Musculus bulbospongiosus 250, 259 Musculus transversospinalis 42
Musculus coccygeus 262, 267 Musculus transversus abdominis 36, 52
Musculus cremaster 36, 246 Musculus transversus perinei profundus 259, 261
Musculus erector spinae 41, 186 Musculus tranversus perinei superficialis 258
Musculus iliococcygeus 267 Musculus transversus thoracis 33
Musculus iliocostalis 41 Musculus trapezius 39
Musculus ischiocavernosus 250, 259 Myelencephalon 303, 312
Musculus latissimus dorsi 39 Myocardium 84
Musculus levator ani 262, 267 Myometrium 232
Musculus levator prostatae 267 Myotome 466

580
 N
Neocortex 469 Nodi lymphatici mesenterici superiores 165
Neencephalon 469 Nodi lymphatici pancreaticolienales 111, 117, 130
Neocerebellum 468 Nodi lymphatici pulmonalis 70
Neurohypophysis 461 Nodi lymphatici tracheobronchiales inferiores 70
Nervi cardiaci thoracici 361 Nodi lymp. tracheobronchiales superiores 70
Nervi carotici externi 359 Noduli valvularium semilunarium 81
Nervi cavernosi penis 252 Nodulus 320
Nervi scrotales anteriores 253 Nodus atrioventricularis 85
253 Nodus lymphaticus 433, 435
Nervi scrotales posteriores
304 Nodus sinuatrialis 85
Nervi spinalis
39 Nuclei anteriores thalami 328
Nervus accessorius
Nuclei arcuati 316
Nervus cardiacus cervicalis inf. 360
Nuclei habenulae 327
Nervus cardiacus cervicalis medius 360
Nuclei habenulae laterales 329
Nervus cardiacus superior 359
Nuclei habenulae mediales 329
Nervus caroticus internus 359
Nuclei intralaminares 329
Nervus dorsalis clioridis 262
Nuclei laterales thalami 329
Nervus dorsalis penis 251
Nuclei n.ve stibulocochlearis 318
Nervus dorsalis scapulae 41
Nuclei pontis 318
Nervus genitofemoralis 57, 236
Nuclei tub erales 331
Nervus iliohypogastricus 34
N. accessorius 358
Nervus ilioinguinalis 36, 57, 236
Nucleus ambiguus 315
Ramus genitalis 236
Nucl. anterodorsalis 328
Nervus jugularia 359
Nucl. anteromedialis 328
Nervus pudendus 236, 251
Nucl. anteriores thalami 328
- Ramus perinealis 236
Nucl. anteroventralis 328
Nervus splanchnicus imus 361 326, 341, 345
Nucl. caudatus
Nervus splanchnicus, ramus renalis 36 318
Nucl. cochlearis dorsalis
Nervus splanchnicus major 46, 361 318
Nucl. cochlearis ventralis
Nervus splanchnicus minor 46, 361 322
Nucl. colliculi inferioris
Nervus subcostalis 34 Nucl. corporis mamillaris 331
Nervus thoracodorsalis 40 Nucl. cuneatus 316
Nervus vagus 97 Nucl. cuneatus accessorius 316
- Rami celiaci 110 Nucl. dentatus 321
- Rami gastrici anteriores 110 Nucl. dorsalis corporis trapezoidei 318
- Rami gastrici posteriores 110 Nucl. dorsalis n. glossopharyngei 315
Nodi lymphatici 434 Nucl. dorsalis n. vagi 315, 358
Nodi lymphatici bronchopulmonales 70 Nucl. dors omedi alis 331
Nodi lymphatici gastrici 111 Nucl. emboliformis 321
Nodi lymphatici gastroepiploici 111 Nucl. fastigii 321
Nodi lymphatici ileocolici 165 Nucl. globosus 321
Nodi lymphatici iliaci ext. 247 Nucl. gracilis 316
Nodi lymphatici iliaci interni. 247 Nucl. intralaminares 329
Nodi lymphatici lienales 117 Nucl. intercalatus 315

581
Nucl. interpeduncularis 322, 329 Nucl. reticularis thalami 329
Nucl. lateralis 316 Nucl. ruber 322
Nucl. lateralis dorsalis 329 N. salivatorius superior et mferior 358
Nucl. lateralis thalami 329 Nucl. sensorius principalis 318
Nucl. intermedius lateralis 358 Nucl. subthalamicus 330
Nucl. lentiformis 345 Nucl. supraopticus 331
Nucl. medialis centralis 329 Nucl. tegmenti 322
Nucl. medialis thalami 328 Nucl. thoracicus 306
Nucl. motorius n. trigemini 318 Nucl. tractus spinalis n. trigemini 315, 318
Nucl. n. abducentis 318 Nucl. tractus mesencephalici n. trigemini 318
Nucl. n. facialis 318 Nucl. tractus solitarii 315
Nucl. n. hypoglossi 315 Nucl. tuberales 331
Nucl. n. oculomotorii 322 Nucl. ventralis anterolateralis 329
Nucl. n. trigemini 318 Nucl. ventralis intermedius 329
Nucl. n. trochlearis 322 Nucl. ventralis posteromedialis 329
Nucl. n. vestibulocochlearis 318 Nucl. ventralis posterolateralis 329
Nucl. olivaris 316 Nucl. ventralis corporis trapezoidei 318
Nucl. olivaris accessorius dorsalis 316 Nucl. ventromedialis 331
Nucl. olivaris accessorius medialis 316 Nucl. vestibularis inf. 318
Nucl. paraventricularis 331 Nucl. vestibularis lat. 318
Nucl. posterior 329, 331 Nucl. vestibularis medialis 318
Nucl. pulposus 25 Nucl. vestibularis sup. 318

O
Obex 317 Ostium appendicis vermiformis 171, 175
Oligodendroglia 475 Ostium aortae 82
Oliva 313 Ostium atrioventriculare dextrum 80, 81
Omentum majus 288,291 Ostium atrioventriculare sinistrum 80, 82
Omentum minus 140, 283,289 Ostium cardiacum 103
Operculum frontale 336 Ostium ileocecale 170, 175
Operculum frontoparietale 336 Ostium pyloricum 103
Operculum temporale 336 Ostium trunci pulmonalis 81
Organa genitalia feminina 222 Ostium ureteris 206, 211
Organa genitalia masculina 242 Ostium urethrae externum 216, 236, 250
Organa sensuum 485 Ostium urethrae internum 209
Os breve 388 Ostium uteri 227
Os coccygis 19 - Labium anterius 227
Os longum 388 - Labium posterius 227
Os pneumaticum 392 Ostium uterinum tubae uterinae 225
Os planum 388 Ostium vaginae 236
Os sacrum 15 Ostium venae cavae inferioris 80
Os sesamoidea 389 Ostium venae cavae superior 80
Ossa cranii 387 Ovarium 222
Ossa faciei 387 - Extremitas tubaria 223
Ossa membri inferioris 387 - Extremitas uterina 223
Ossa membri superioris 387 - Facies lateralis 223
Ossicula auditus 387 - Facies medialis 223
Ostia venarum pulmonalium - Margo liber 223
81
Ostium abdominale tubae uterinae 225 - Margo mesovaricus 223
Ovum 223

582
Paleocerebellum 468 Peritoneum parietale 271
Pallium 335 Peritoneum viscerale 272
Pancreas 119, 122 Perionyx 489
Papilla duodeni major 122, 148 Phimosis 250
Papilla duodeni minor 122 Pia mater 365
Papilla mammae 236 Pia mater encephali 373
Papillae renales 192 Pia mater spinalis 305, 366
Paroophoron 226, 456 Pleura 60, 71
Pars abdominales et pelvina systematis 361 Pleura costalis 71
autonomici Pleura diaphragmatica 71
Pars cardiaca 103 Pleura mediastinalis 63, 71, 93
Pars convoluta 194 Pleura parietalis 71
Pars dorsalis pontis 318 Pleura pulmonalis 71
Pars lateralis 17 Plexus aorticus thoracicus 361
Pars pylorica 103 Plexus autonomici 358
Pars radiata 193 Plexus basilaris 385
Pars uterina 225 Plexus cardiacus 88, 361
Pars retrolentiformis 345 Plexus cardiacus communis 360
Pars sublentiformis 345 Plexus caroticus externus 360
Pars ventralis pontis 318 Plexus caroticus internus 360
Pars thoracica systematis autonomici 361 Plexus celiacus 117, 130, 198, 361
Partes genitales femininae externae 234 Plexus choroideus 373
Partes genitales masculinae externae 242 Plexus choroideus ventriculi lateralis 373
Pediculus arcus vertebrae 12 Plexus choroideus ventriculi quarti 373
Pedunculus cerebellaris inf. 313 Plexus choroideus ventriculi tertii 373
Pedunculus cerebellaris medius 317 Plexus entericus 361
Pedunculus cerebri 321, 329 Plexus gastrici 361
Pedunculus corporis mamillaris 331 Plexus hepaticus 361
Pedunculus flocculi 320 Plexus hypogastricus 207, 233, 361
Pedunculus thalami inf. 330 Plexus hypogastricus inf. 233
Pelvis renalis 192 Plexus intermesentericus 361
Penis 249 Plexus lienalis 117, 361
- Facies urethralis 250 Plexus mesentericus inf. 361
Pericardium 83 Plexus mesentericus sup. 130, 361
Pericardium fibrosum 83 Plexus ovaricus 224, 361
Pericardium serosum 83 Plexus pampiniformis 224, 247
Perimetrium 232 Plexus pancreaticus 361
Perineum 256 Plexus prostaticus 218
Perineurium 474 Plexus pulmonalis 70, 361
Periosteum 391 Plexus rectalis 361
Perimysium 414 Plexus renalis 196, 198, 207, 361
Peritoneum 270 Plexus suprarenalis 361

583
 Plexus testicularis 361 Prosessus papillaris 139
Plexus uretericus 361 Processus spinosus 12
Plexus uterovaginalis 233, 361 Processus transversus 12
Plexus venosus canalis hypoglossi 386 Processus uncinatus 123
Plexus venosus caroticus internus 386 Processus vaginalis peritonei 235, 253
Plexus venosus foramina ovalis 386 Processus xiphoideus 24
Plexus venosus prostaticus 218, 248 Promontorium 15
Plexus venosus vesicalis 209, 214 Prosencephalon 303, 325
Plica 274 Prostata 247
Plica duodenalis inferior 274 — Fades anterior 248
Plica duodenalis superior 274 — Facies inferolateralis 248
Plica interureterica 211 — Facies posterior 248
Plica longitudinalis duodeni 122 — Lobus dexter 248
Plica spinalis 151 — Lobus medius 248
Plica umbilicalis lateralis 56, 274 — Lobus sinister 248
Plica umbilicalis medialis 56, 274 Pubes 488
Plica umbilicalis mediana 56 Pudendum femininum 235
Plicae circulares 122, 156 Pulmo 60
Plicae gastricae 106 — Facies costalis 62
Plica gastropancreaticae 274, 294 — Facies diaphragmatica 60
Plica gastropancreaticae sinistra 108 — Facies interlobares 62
Plicae palmatae 227 — Facies medialis 62
Plicae semilunares coli 174 — Fissura horizotalis 62
Plicae transversales recti 176 — Fissura obliqua 62
Plicae tubariae 225 — Lobus inferior 62
Polus frontalis 336 — Lobus medius 62
Polus occipitalis 336 — Lobus superior 62
Polus temporalis 336 — Margo anterior 63
Pons 303, 317 — Margo inferior 65
Porta hepatis 138 — Pars mediastinalis 62
Precuneus 338 — Pars vertebralis 62
Preputium clitoridis 235 Pulpa lienis 114
Proprioceptor 486 Pulvinar 328
Preputium penis 250 Putamen 345
Processus accessorius 15 Pylorus 103
Processus articularis inf. 12 Pyramides renales 193
Processus articularis sup. 12, 17 Pyramis 313
Prosessus caudatus 138, 139 Pyramis vermis 320
Prosessus costarius 15
Prosessus mamillaris 15

584
ir

R
Radiatio acustica 345 Recessus retrocecalis 173, 274
Radiatio corporis callosi 345 Recessus retroduodenalis 128
Radiatio optia 345 Recessus subhepatici 274
Radix dorsalis 305 Recessus subphrenici 274
Radix mesenterii 159 Recessus suprapinealis 332
Radix penis 250 Rectum 168, 173
Radix pili 488 Regio analis 262
Radix pulmonis 63 Regio urogenitalis 256
Radix ventralis 305 Ren 183
Rami ad pontem 379 - Capsula adiposa 189
Rami centrales 381 - Capsula fibrosa 184, 192
Rami interganglionares 358 - Extremitas inferior 185
Rami spinales 376 - Extremitas superior 185
Rami striati 381 - Facies anterior 184
Ramus choroideus 381 - Facies posterior 184
Raphe penis 250 - Margo lateralis 185
Raphe scroti 252 - Margo medialis 185
Recessus 274 - Segmentum ant, inf. 194
Recessus costodiaphragmaticus 65, 71 - Segmentum ant, sup. 194
Recessus costomediastinalis 72 - Segmentum inf. 194
Recessus duodenalis inf. 128, 274 - Segmentum posterius 194
Recessus duodenalis sup. 128, 274 - Segmentum superius 194
Recessus hepatorenalis 274 Rete testis 244
Recessus infundibuli 332 Retinacula tendinum 415
Recessus intersigmoideus 274 Rhinencephalon 469
Recessus lateralis ventriculi quarti 317 Rhombencephalon 303, 312
Recessus opticus 332 Rima pudendi 235
Recessus paraduodenalis 128 Rostrum corporis callosi 341
Recessus pinealis 332 Rugae vaginales 234
Recessus pleurales 71

S
Sacculi alveolares 65 Segmentum basale anterius (pulmo) 67
Scrotum 243, 252 Segmentum basale laterale (pulmo) 67
252 Segmentum basale mediale (pulmo) 67
- Septum scroti
Segmentum basale posterius (pulmo) 67
- Tunica dartos 252
Segmentum laterale (pulmo) 65
Segmentum anterius (pulmo) 65
Segmentum lingulare inferius (pulmo) 65
Segmentum apicale (pulmo) 65, 67 65
Segmentum lingulare superius (pulmo)
Segmentum apicoposterius (pulmo) 65 Segmentum mediale (pulmo) 65

585
Segmentum posterius (pulmo) 65 Stratum spinosum 486
Segmentum subapicale (pulmo) 67 Stratum vasculosum 232
Septa intermuscularia 415 Stratum zonale 326
Septula testis 243 Stria longitudinalis lateralis 341
Septum atrioventriculare 78 Stria longitudinalis medialis 341
Septum interatriale 78 Stria medullaris thalami 326
Septum interventriculare 78 Stria terminalis 327
- Pars membranacea 78 Striae medullares ventriculi quarti 316
- Pars muscularis 78 Striae olfactoriae 339
Septum penis 251 Substantia alba 306, 328
Septum pellicidum 342 Substantia compacta 391
Sinus 392 Substantia gelatinosa 306
Sinus anales 176 Substantia grisea 306, 328
Sinus cavernosus 385 - Columna anterior 306
Sinus coronarius 88 - Columna lateralis 306
Sinus durae matris 383 - Columna posterior 306
Sinus epididymidis 244 Substantia grisea centralis 322
Sinus lactiferi 237 Substantia intermedia centralis 306
Sinus obliquus pericaridii 84 Substantia intermedia lateralis 306
Sinus occipitalis 384 Substantia nigra 322
Sinus petrosus inferior 385 Substantia perforata anterior 339
Sinus petreosus superior 385 Substantia perforata posterior 321, 332
Sinus prostaticus 215 Subthalamus 330
Sinus rectus 384 Sulci cerebri 335
Sinus renalis 192 Sulci orbitales 339
Sinus sagittalis inferior 384 Sulci temporales transversi 336
Sinus sagittalis superior 384 Sulcus a. subclaviae 22
Sinus sigmoideus 385 Sulcus arteriae vertebralis 13
Sinus sphenoparietalis 385 Sulcus basilaris 317
Sinus transversus 385 Sulcus calcarinus 336
Sinus transversus pericardii 83 Sulcus centralis insulae 336
Sinus venarum cavarum 76 Sulcus cinguli 338
Spatium intercostale 20 Sulcus circularis insulae 336
Spatium perinei superficiale 257 Sulcus collateralis 339
Spatium perinei profundum 259 Sulcus coronarius 76
Spatium retropubicum 210, 263 Sulcus corporis callosi 338
Sphincter vaginae 234 Sulcus costea 22
Splenium corporis callosi 341 Sulcus frontalis inferior 336
Sternum 24, 93 Sulcus frontalis superior 336
Stratum basale 486 Sulcus hippocampi 339
Stratum cylindricum 486 Sulcus hypothalamicus 326
Stratum corneum 486 Sulcus intermedius posterior 305
Stratum grannulosum 486 Sulcus interparietalis 336
Stratum griseum colliculi superioris 322 Sulcus intertubercularis 40
Stratum lucidum 486 Sulcus interventricularis ant. 76
Stratum papillare 487 Sulcus interventricularis post. 77
Stratum reticulare 487 Sulcus lateralis posterior 305

586
Sulcus limitans 316 Sutura plana 404
Sulcus lunatus 336 Sutra serrata 404
Sulcus medialis cruris cerebri 321 Sutura squamosa 404
Sulcus n. spinalis 13 Symphysis pubica 24
Sulcus occipitalis transversus 336 Synarthrosis 402
Sulcus occipitotemporalis 339 Synostosis 406
Sulcus olfactorius 339 Symphysis 406
Sulcus medianus 305, 316 Synchondrosis 406
Sulcus parietooccipitalis 338 Synovia 407
Sulcus parietooccipitalis externus 335 Systema digestorium 438
Sulcus postecentralis 336 Systema respiratorium 446
Sulcus precentralis 336 Systema nervosum 465
Sulcus pulmonalis 20 Systema nervosum autonomicum 331, 355, 465
Sulcus rhinalis 339 - Pars cephalica et cervicalis 359
Sulcus subparietalis 338 systematis autonomici
Sulcus temporalis inf. 336 - Pars parasympathica 355, 356, 358
Sulcus temporalis sup. 336 - Pars sympathica 355, 358
Sulcus terminalis 76 - Pars sympathica, rami 358
Sulcus venae cavae 137, 138 communicantes
Sulcus venae subclaviae 22 Systema nervosum centrale 301
Supercilia 488

T
Tectum mesencephali 321 Tenia thalami 326
Tegmen ventriculi quarti 316 Tenia ventriculi quarti 317
Tegmentum 322 Teniae coli 170
Tegmentum rhombencephali 315 Tentorium cerebelli 371
Tela choroidea 335 Testis 242
Tela choroidea ventriculi quarti 317, 373 - Extremitas inferior 243
Tela choroidea ventriculi tertii 332, 373 - Extremitas superior 243
Tela submucosa 212, 439 - Margo anterior 243
Tela subserosa 212, 274, 439 - Margo posterior 243
Telencephalon 303, 325, 334 Thalamencephalon 325
- Ramus anterior 336 Thalamus 325
- Ramus ascendens 336 Thorax 19,387
- Ramus posterior 336 Thymus 76,94,463
- Sulcus centralis 335 Tonsilla cerebelli 320
- Sulcus lateralis 335 Trabecula septomarginalis 82
Tendo conjunctivus 36, 52 Trabeculae lienis 114
Tenia libera 170 Trachea 94
Tenia mesocolica 170 Tractus corticopontinus 318,347
Tenia omentalis 170 Tractus corticospinalis 347

587
Tractus dorsolateralis 307 Tuba uterina 224
Tractus mesencephalicus n. trigemini 322 Tuber cinereum 330
Tractus nervosi commissurales 341 Tuber omentale 127
Tractus olfactorius 339 Tuber vermis 320
Tractus olivocerebellaris 316 Tuberculum anterius thalami 328
Tractus opticus 330 Tuberculum anterius vertebrarum cervicalium 13
Tractus pyramidalis 316 Tuberculum caroticum vertebrae 14
Tractus pyramidalis lateralis 307 cervicalis VI
Tractus pyramidalis anterior 307 Tuberculum costae 21
Tractus reticulospinalis 307 Tuberculum intervenosum 80
Tractus rubrospinalis 307 Tuberculum m. scaleni anterioris 22
Tractus spinocerebellaris anterior 307 Tuberculum nuclei cuneati 313
Tractus spinocerebellaris posterior 307 Tuberculum nuclei gracilis 313
Tractus spinothalamicus anterior 307 Tuberculum posterius (vertebrarum 13
Tractus spinothalamicus lateralis 307 cervicalium)
Tractus supraopticohypophysialis 331 Tuberosistas m. serrati anterioris 23
Tractus tectospinalis 307 Tubersosistas sacralis 17
Tractus tegmentalis centralis 322 Tubuli renales contorti 194
Tractus vestibulospinalis 307 Tubuli renales recti 194
Tragi 488 Tubuli seminiferi contorti 244
Trigona fibrosa 84 Tubuli seminiferi recti 244
Trigonum habenulae 329 Tunica albunginea 243, 251
Trigonum inguinale 55 Tunica dartos labialis 235
Trigonum lumbale 34 Tunica externa 432
Trigonum n. hypoglossi 316 Tunica intima 432
Trigonum n. vagi 316 Tunica media 432
Trigonum ofactorium 339 Tunica mucosa 438
Trigonum vesicae 211 Tunica muscularis 439
Trochlea 415 Tunica serosa 460
Truncus brachiocephalicus 94 Tunica vaginalis testis 253
Truncus celiacus 107, 117, 129, 145 - Lamina parietalis 253
Truncus corporis callosi 341 - Lamina visceralis 253
Truncus pulmonalis 68

U
Uncus 339 Urethra 214
Unguis 489
- Pars membranacea 215
- Corpus 489
- Radix - Pars spongiosa 215
489
Urachus 209 - Pars prostatica 215
Ureter 201 Uterus 225
- Pars abdominalis 202 Utriculus prostaticus 216, 248
- Pars pelvina 202 Uvula vesicae 211
- Tunica adventitia 206
Uvula vermis 320
- Tunica mucosa 206
- Tunica muscularis 206

588
ip ' Al.NWFWVINWI
. gffirrINNIMNIIIVINVIR

V
Vagina 233 V. bronchiales 63, 70
- Paries anterior 234 V. cava 147
- Panes posterior 234 V. cava inferior 76, 139
Vagina fibrosa tendinus 415 V. cava superior 76
Vagina m. recti abdominis 37 V. centralis 197
Vagina synovialis tendinus 415 Vv. cerebelli inferiores 382, 383
Vallecula cerebelli 320 Vv. cerebelli superiores 382, 383
Valva mitralis 82 Vv. cerebri inferiores 383
Valva aortae 82 Vv. cerebri internae 383
Valva atrioventricularis dextra 81 V. cerebri magna 383
Valva atrioventricularis sinistra 82 V. cerebri media superficialis 383
Valva tricuspidalis 81 Vv. cerebri superiores 383
Valva trunci pulmonalis 81 V. choroidea 383
Valva ileocecalis 175 V. colica dextra 165
Valva foraminis ovalis 78 V. colica media 165
Valvula fossase navicularis 216 V. cordis anteriores 87
Valvula lymphatica 433 V. cordis magna 76, 87
Valvula semilunaris anterior 81 V. cordis media 77, 87
Valvula semilunaris dextra 81, 82 Vv. cordis minimae 87
Valvula semilunaris posterior 82 V. cordis parva 87
Valvula semilunaris sinistra 81, 82 V. cystica 146
Valvula sinus coronarii 80 V. cutanea 431
Valvula venae cavae inferioris 80 V. dorsalis penis profunda 251
Valvula venosa 431 V. emissaria condylaris 386
Valvulae anales 176 V. emissaria mastoidea 386
Vas afferens 196 V. emissaria occipitalis 386
Vas anastomoticum 431 V. emissaria parietalis 386
Vas capillare 430 Vv. emissariae 386
Vas collaterale 432 V. epigastrica inferior 147
Vas efferens 196 V. epigastrica superior 147
Vas lymphaticum 433 Vv. esophageae 147
Vas vasorum 432 Vv. gastricae breves 117
Vasa corona 378 V. gastrica dextra 108, 146
Velum medullare inferior 316 V. gastrica sinistra 108, 146, 147
Velum medullare superior 317 V. gastroepiploica dextra 108, 165
Vena 431 V. gastroepiploica sinistra 109, 117
Vena anastomotica inferior 383 V. hemiazygos 97
Vena anastomotica superior 383 V. hemiazygos accesoria 97
V. appendicularis 164 Vv. hepaticae 148
V. arcuatae 196 Vv. hepaticae dextra 144, 148
V. azygos 97, 147 Vv. hepaticae mediae 144, 148
V. basalis 383 Vv. hepaticae sinistra 144, 148

589
V. ilei 164 - Cornu anterius 343
V. iliaca interna 147, 214 - Cornu inferius 343
V. ileocolica 164 - Cornu posterius 343
V. intercostalis sup. dextra 96 - Pars centralis 343
Vv. interlobares 196 Ventriculus, paries anterior 104
Vv. interlobulares 148, 196 Ventriculus, panes posterior 104
V. intersegmentalis 69 Ventriculus, plicae villosae 107
V. intrasegmentalis 69 Ventriculus quartus 316
Vv. jejunales 164 - Fovea inferior 316
V. lienalis 117 - Fovea superior 316
V. mesenterica inferior 117 - Sulcus limitans 316
V. mesenterica superior 164 - Sulcus medianus 316
V. obliqua atrii sinistri 87 Ventriculus, tela submucosa 105
Vv. pancreaticae 117, 164 Ventriculus, tela subserosa 105
Vv. pancreaticoduodenales 164 Ventriculus tertius 326,332,342
Vv. paraumbilicales 146 Ventriculus, tunica mucosa 105
V. portae 108, 145 Ventriculus, tunica muscularis 105
- Ramus dexter 146 - Fibrae obliquae 105
- Ramus sinister 146 - Stratum circulae 105
V. posterior ventriculi sinistri 87 - Stratum longitudinales 105
V. prepylorica 103, 146 Ventriculus, tunica serosa 105
Vv. pulmonales 63 Ventriculus terminalis 306
V. pulmonalis inf. dextra 69 Venula 432
V. pulmonalis sup. sinistra 69 Venulae rectae 196
V. pulmonalis sup. dextra 69 Venulae stellatae 196
V. pulmonalis sup sinistra 69 Vermis 318,468
Vv. rectales inferiores 147 Vertebra 10
Vv. rectales mediae 147 Vertebrae cervicales 12
V. rectales superior 147 Vertebrae lumbales 15
Vv. scrotales anteriores 253 Vertebra prominens 14
Vv. scrotales posteriores 253 Vertebrae sacrales 15
V. thalamostriata 383 Vertebrae thoracicae 14
Vv. thoracicae internae 147 Vesica fellea 149
V. umbilicalis 146 Vesica urinaria 208
Vv. uterinae 233 Vesicula seminalis 244
Ventriculus 102 Vestigium processus vaginalis 247
- Incisura angularis 103 Vestibulum bursa omentalis 281,290,294
- Incisura cardiaca 103 Vestibulum vaginae 236
- Lamina muscularis mucosae 107 Vibrissae 488
Ventriculus lateralis 326, 343 Villi intestinales 122, 157

Zona hemorrhoidalis 176 I Zona incerta 330

590
 CONG TY TNHH MOT THANH VIEN
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CHI NHANH TAI THANH PHO HO CHI MINH
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 CONG TY TNHH MOT THANH VIEN
NHA XL

I
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