tracheal bifurcation

WordNet

1. a bifurcating branch (one or both of them)
2. the place where something divides into two branches
3. the act of splitting into two branches
4. membranous tube with cartilaginous rings that conveys inhaled air from the larynx to the bronchi (同)windpipe
5. one of the tubules forming the respiratory system of most insects and many arachnids
6. relating to or resembling or functioning like a trachea

PrepTutorEJDIC

1. 〈U〉分岐,二また状 / 〈C〉分岐点
2. 気管

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2017/10/18 21:09:00」(JST)

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[Wiki en表示]

Carina of trachea
Cartilages of larynx, trachea and bronchi. (Carina is at the point of bifurcation.)
Transverse section of the trachea, just above its bifurcation, with a bird’s-eye view of the interior. (Carina not labeled; the ridge that separates the left and right bronchus.)
Details
System	Respiratory system
Identifiers
Latin	Carina tracheae, bifurcatio tracheae
Dorlands /Elsevier	c_11/12215629
TA	A06.3.01.009
FMA	7465
Anatomical terminology

In anatomy, the carina is a ridge of cartilage in the trachea that occurs between the division of the two main bronchi. This occurs at the lower end of the trachea (usually at the level of the 4th thoracic vertebra, which is in line with the sternal angle, but may raise or descend up to two vertebrae higher or lower with breathing). This ridge lies to the left of the midline, and runs antero-posteriorly (front to back). Foreign bodies that fall down the trachea are more likely to enter the right bronchus.

The mucous membrane of the carina is the most sensitive area of the trachea and larynx for triggering a cough reflex. Widening and distortion of the carina is a serious sign because it usually indicates carcinoma of the lymph nodes around the region where the trachea divides.

Tracheobronchial injury, an injury to the airways, occurs within 2.5 cm of the carina 60% of the time.

External links

• Atlas image: lung_carina at the University of Michigan Health System - "Cast of trachea and bronchi, anterior view" (#2)
• "Trachea and carina — tomogram, coronal plane" at SUNY Downstate Medical Center
• Carina tracheae entry in the public domain NCI Dictionary of Cancer Terms

 This article incorporates public domain material from the U.S. National Cancer Institute document "Dictionary of Cancer Terms".

UpToDate Contents

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• 1. 気管領域の手術を行う際の麻酔管理anesthesia for tracheal surgery [show details]
  …anesthetic management of adult patients undergoing surgery in the tracheal region from the distal edge of the larynx to the tracheal bifurcation at the carina. Anesthetic management for laryngeal, esophageal …
• 2. 気管の放射線学radiology of the trachea [show details]
  …the mainstem bronchi. The average tracheal length is 10 to 12 cm, and the normal angle of the tracheal bifurcation is 70 ± 20 degrees With deep inspiration, the tracheal length increases by as much as 2 …
• 3. 小児における細菌性気管炎：臨床的特徴および診断bacterial tracheitis in children clinical features and diagnosis [show details]
  …treatment. Foreign bodies lodged in the esophagus in the area of the cricoid cartilage or the tracheal bifurcation can compress the airway, causing partial airway obstruction. Symptoms are likely to have an …
• 4. 小児における急性上気道閉塞の緊急評価emergency evaluation of acute upper airway obstruction in children [show details]
  … Esophageal FB – FBs lodged in the esophagus in the area of the cricoid cartilage or the tracheal bifurcation can compress the airway causing partial airway obstruction It is also possible that an esophageal …
• 5. 小児における嚥下障害の評価evaluation of dysphagia in children [show details]
  …esophagus, respectively. Foreign bodies lodged in the esophagus at the cricoid cartilage or the tracheal bifurcation can compress the airway causing partial airway obstruction It is also possible that an esophageal …

English Journal

• Tracheobronchial Angle Measurements in Children: An Anthropometric Retrospective Study With Multislice Computed Tomography.

• Herek D1, Herek O2, Ufuk F1.
• Clinical and experimental otorhinolaryngology.Clin Exp Otorhinolaryngol.2017 Jun;10(2):188-192. doi: 10.21053/ceo.2016.00185. Epub 2016 Jun 18.
• PMID 27334508

• Thoracic stomach-right main bronchus fistula treated with dual Y-shaped covered airway stents.

• Li ZM1, Lu HB1, Ren KW1, Han XW2, Wu G1, Jiao DC1.
• Clinical radiology.Clin Radiol.2017 Jun;72(6):517.e1-517.e6. doi: 10.1016/j.crad.2016.12.008. Epub 2017 Mar 11.
• PMID 28292511

Japanese Journal

• Sequential Stenting for Extensive Malignant Airway Stenosis

• , , , , ,
• Annals of Thoracic and Cardiovascular Surgery 21(2), 114-118, 2015
• … Purpose: Malignant airway stenosis extending from the bronchial bifurcation to the lower lobar orifice was treated with airway stenting. … We herein examine the effectiveness of airway stenting for extensive malignant airway stenosis.Methods: Twelve patients with extensive malignant airway stenosis underwent placement of a silicone Dumon Y stent (Novatech, La Ciotat, France) at the tracheal bifurcation and a metallic Spiral Z-stent (Medico's Hirata, Osaka, Japan) at either distal side of the Y stent. …
• NAID 130005065151

• 先端スパイラル型分離肺換気二腔チューブが有効であった気管分岐部を含む右肺全摘術の麻酔経験

• 松波 小百合,駒澤 伸泰,葛川 洋介 [他]
• 麻酔 63(7), 794-796, 2014-07
• NAID 40020146643

Related Links

• Tracheal bifurcation | definition of tracheal bifurcation by ...

tracheal bifurcation [TA] the division of the trachea into the right and left main bronchi; it occurs at the level of the fifth or sixth thoracic vertebral body and is marked internally by the presence of a carina or keellike ridge between the ...

• Bifurcation of trachea | definition of bifurcation of trachea by ...

tracheal bifurcation [TA] the division of the trachea into the right and left main bronchi; it occurs at the level of the fifth or sixth thoracic vertebral body and is marked internally by the presence of a carina or keellike ridge between the ...

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★リンクテーブル★

リンク元	「食道」「気管分岐部」
関連記事	「bifurcation」「tracheal」

「食道」

　　[★]

英

esophagus (Z)

関

消化器系

解剖

• 正中面付近を下行してくるが、横隔膜近傍で左側に寄り、背面で胸大動脈と交叉する。
• L10椎体の高さで、食道裂孔を食道神経叢と共に通過して腹腔に入る

部位区分

SSUR.456

			O:食道入口部 esophageal orifice
Ce: 頚部食道 cervical esophagus
			S: 胸骨上縁 margin of the sternum
Te: 胸部食道 thoracic esophagus	Ut: 胸部上部食道 upper thoracic esophagus
	Mt: 胸部中部食道 middle thoracic esophagus	↑	B: 気管分岐部下縁 tracheal bifurcation
		↓
	Lt: 胸部下部食道 lower thoracic esophagus	↑
			D: 横隔膜 diaphragm
			H: 食道裂孔 esophageal hiatus
Ae: 腹部食道 abdominal esophagus		↓
			EGJ: 食道胃接合部 esophagogastric junction

生理的狭窄部 (KL.283, KH. 139)

• 第1狭窄部位：輪状軟骨狭窄部：cricopharyngeal constriction
  • 切歯から15cm
  • 食道の上端で、咽頭に連なる部位
  • 下咽頭収縮筋が食道を囲み、輪状軟骨に付き、この筋の緊張によると考えられる
• 第2狭窄部位：大動脈狭窄部：bronchoaortic constriction
  • 切歯から25cm
  • 食道の中部で、大動脈弓と左気管支が交叉し、それによって圧される。つまり大動脈弓の
• 第3狭窄部位：横隔膜狭窄部：diaphragmatic constriction
  • 切歯から38-40cm
  • 下部で横隔膜を貫く部位

運動 (SP.720)

部位	名称		筋肉	神経	運動性	シナプスする構造	最終的な伝達物質	運動
上部1/3	上食道括約部	UES	横紋筋	舌咽神経、迷走神経(疑核)	随意性	運動終板のアセチルコリン受容体	アセチルコリン	弛緩
			平滑筋	迷走神経	不随意性	壁内コリン作動性運動神経
下端部	下食道括約部	LES	平滑筋	迷走神経	不随意性	壁内非アドレナリン作動性抑制運動神経	NO, VIP	弛緩
				交感神経		平滑筋α受容体	アドレナリン	収縮

組織

• 食道腺は粘膜筋板の下に存在する。　←　粘膜下組織に腺があるのは食道の固有食道腺と十二指腸のブルンネル腺だけ
• 食道は横隔膜より上位では漿膜がなく、癌が周囲に浸潤しやすい

食道の上皮と上皮下の組織

層構造

1

2

3

4

5

6

器官

単層扁平上皮

単層立方上皮

単層円柱上皮

角化重層扁平上皮

非角化重層扁平上皮

上皮表層の構成細胞

粘膜固有層

腺の構成細胞

粘膜筋板

粘膜下組織 (大抵、粗結合組織)

筋層

漿膜(結合組織+単層扁平上皮) 外膜(結合組織のみ)

食道

○

食道噴門腺 (咽頭付近と胃付近に局在)、粘液腺

粘液細胞 (スムーズに食べ物を流す)

縱層 (縦走筋のみ)

固有食道腺(粘液腺、管状胞状、ペプシノーゲン、リゾチーム)

内輪筋層 外縱筋層 (食道上1/3:骨格筋、食道中1/3:骨格筋、平滑筋、食道下1/3:平滑筋)

外膜(横隔膜まで) 漿膜

臨床関連

• 食事の通過障害は生理的狭窄部でおこりやすい。特に第1狭窄部で異物が見られる (KH.141)
• 生理的狭窄部は癌の好発部位であり、第2,第3狭窄部位に多い (KH.141)

「気管分岐部」

　　[★]

英

tracheal bifurcation (Z)

関

気管

• 分岐開始部の下縁はT5椎体の高さ(Z.52)。T4-T5椎体の間とする文献もある。

「bifurcation」

　　[★]

• 二分枝、分岐

関

arborize、bifurcate、diverge、divergence、multibranch、multibranched

　 　 　 　

「tracheal」

　　[★]

• adj.

• 気管の

関

trachea、tracheae、tracheal tube、trachealis、tracheary