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  • SCH O TO BC s A KH O A w mCh bin: GS.TS. TRNH BNH

    NH XUT BN Y HC

  • B Y T

    M - PHIPHN M HC

    SCH O TO BC s A KHOA

    M s: .01 Y.03

    Ch bin: GS.TS. TRNH BNH

    TRNGCAO ANG

    Y t PHU TH

    T h v i .v

    s:.& t -

    NH XUT BN Y HC

    H NI - 2007

  • CH O B1N SON:V khoa hoc v o to, B Y t

    CH BIN:

    GS.TS. Trnh Bnh

    NHNG NGI BIN SO N :

    GS.TS. Trinh Bnh

    PGS.TS. Nguyn Th Binh

    PGS.TS. Nguyn Ngoe Hng

    TS. Nguyn Khang Sn

    TS. Ng Duy Thn

    BS. Lu nh Mi

    T H K B N SO N :

    BS. Lu nh Mi

    TH AM G IA T C H C BN TH O :

    ThS. Ph Vn Tham

    BS. Nguyn Ngoe Thinh

    Ban quyn thuoc B Y t (Vu Khoa hc va ao to)

  • LI GII THIU

    Thc hin mt s" iu ca Lun Gio dc, B Gio c & o to v B Y t ban hnh chng trnh khung o to Bc s a khoa. Bo Y t t chc bin son ti liu y - hoc cc mn c s, chuyn mn v c bn chuyn ngnh theo chng trnh trn nhm tng bc xy dng b sch chun v chuyn mn m bo cht lng o to nhn lc y t.

    Sch M - Phi (Phn Mo hc) c bin son da trn chng trnh gio dc i hc ca Trng i hc Y H Ni trn c s chng trnh khung a dc ph duyt. Sch c cc nh gio giu kinh nghim v tm huyt vi cng tc o tao bin soan theo phng chm: Kin thc c bn, h thong; ni dung chnh xc, khoa hc; cap nht cc tin b khoa hc, k thuat hin i v thc tin Vit Nam.

    Sch Mo - Phi (Phn M hc) c Hi ng chuyn mn Thm nh sch v Ti liu day - hoc chuyn nganh Bc s a khoa ca B Y t tham inh vo nm 2006. B Y t ban hnh lm ti liu y - hc t chun chuyn mn ca ngnh Y t trong giai oan 2006 - 2010. Trong qu trnh s dng, sch phi c chnh l, b sung v cap nhat.

    B Y t xin chn thnh cm n cc ging vin B mn M-Phi Trng i hc Y H Ni dnh nhiu cng sc hon thnh cun sch ny, kp thi phc v cho cng tc ao to nhn lc y t.

    V lan u xut bn, chng ti mong nhn c kin ng gp ca ng nghip, cc bn sinh vin v cc c gi ln xut bn sau c hon thin hn.

    V KHOA HC V O TO

    B Y T

    3

  • LI NI U

    Cun sch Mo-Phi (phn m hc) c vit vo p k nim 30 nm t nc thng nht v hon ton c lp, vi s tham gia ca cc gio s, ph gio s, tin s, bac s l can b ging ay co kinh nghim trong Bo mn M-Phi hc Trng i hc Y H Noi.

    Nhng thng tin khoa hc chuyn ngnh c trnh by trong cun sch mang tnh h thng v cp nht, theo chng trnh v mc tiu ging dy ca mn hc c Hi ng Khoa hc Gio c Trng i hoc Y H Ni thng qua. i tng dng cun sch l sinh vin nm th hai, sau khi hon thnh chng trnh cc mn hc c bn cho ngnh Y v mon Gii phu hoc. Mn M - Phi hc c b" tr hc trong cng mt nm hc vi cc mn Ho sinh hc v Sinh l hc, s gip cho sinh vin hon thin khi kin thc v Cu trc t vi, trong mi lin quan cht ch gia cu to hnh thi v hot ng chc nang ca cc c quan c th ngi bnh thng, chun b cho vic tip thu nhng kin thc v bnh hc v lm sng trong nhng nam hc sau.

    Ni ung cun sch gm hai phn: M hc i cng v Mo hc cc h c quan, c xp thnh 16 chng. Cui cun sch l phn ph lc gm nhng thong tin c trnh bay ngn gn ca hai chng: T bo (sinh vin c hc mn Sinh hc) v Mu, s to mu, bach huyt (s c hc mn Sinh l hc), gip sinh vin tra cu nhanh nhng thng tin c lin quan khi c cc chng khc ca cun sch ny. Nhiu hnh v, nh hin vi v siu hin vi c a vo tng chng minh ho. y l c th ca cun sch v mn hc hnh thi. Cac ch s" t trong dau ngoc vung phn ch thch cc hnh v nh chp l s" th t ca cun sch v cc tc gi c trch dn (xem phn ti liu tham kho).

    M u mi chng u c phn mc tiu hoc tp, sinh vin cn nm chc v hc theo mc tiu t c kt qu thi ki t thc mn hc. Tuy nhin, chng ti vn khuyn khch vic c thm nhng phn ngoi mc tiu m rng kin thc v mn hc. Cui mi chng l nhng cu hi gip sinh vin t lng gia kin thc.

    Chng ti chn thnh cm n c gi v nhng gp cho cun sch, nham hon thin hn cho nhng ln ti bn.

    H Ni, ngy 30 thng 4 nm 2005

    GS.TS. T r n h B inh

    5

  • MC LC

    Li gi'>i thiu

    Li ni du

    Gi thiu mn hoc

    PHN MT: M HC I CNG Chng 1. B iu m

    - i cng

    - Nhng tnh cht ca biu m

    - Phn loai biu m

    - Bin i ca t bo biu m

    - S ti to biu m

    Chng 2: M lin k t

    - M lin kt chnh thc

    - M sn

    - M xng

    Chng 3: M c

    - c im chung

    - Phn loai c

    - C vn

    - C tim

    - C trn

    Chng 4: M th n k in h

    - i cng

    - Nron

    - Xung ng than kinh

    - T bao thn kinh m

    21

    GS.TS. Trnh Bnh 21

    21

    23

    29

    36

    36

    GS. TS. Trnh Bnh 38

    39

    53

    56

    GS.TS. Nguyn Th Bnh 71

    71

    72

    72

    78

    82

    TS. Ng Duy Thn 85

    85

    85

    92

    94

    5

    11

    7

  • PHN HAI: M HOC H c QUAN 97

    Chng 5: H tun hon BS. Lu inh Mi 97

    - H tun hon mu 97

    - H tun hon bch huyt 106

    C hng 6: H bch h u y t - m in d ch GS.TS. Trinh Bnh 108

    - Nhng t bo thuc h bch huyt 109

    - Ty xng 115

    - Tuyn c 118

    - Nang bch huyt - Trung tm sinh san ca m bch huyt 122

    - Bch hach (Hch bch huyt) 124

    - Lch 128

    - Vng bch huyt quanh hng (Nhng hnh nhn) 133

    C hng 7: Da v cc b p h n p h th u c d a BS. Lu inh M ui 137

    - D a 137

    - Cac b phn ph thuc da 141

    - Phn b' mach v than kinh 146

    Chng 8: H h hp PGS.TS. Nguyn Ngoe Hung 147- ng dn kh ti phi 14 7

    - Phi 151

    C hng 9: H t i u hoa PGS.TS. Nguyn Th B inh 159

    - Khoang ming 1 5 9

    -H ng 165

    - Ong tiu ha chnh thc 10 5

    - Nhng tuyn tiu ha 77

    Chng 10. He tit niu BS. Lu nh Mui 190- T h n 190

    - Nhng ng bi xut nc tiu ^gg

    Chng 11: H ni tit BS. Lu nh Mui 200

    - ai cng v h ni tit OQQ

    8

  • - Tuy n y n 201

    - Tuyn thng thn 205

    - Tuyn gip 207

    - Tuyn cn gip 210

    Chng 12: H s inh d c n a m BS. Lu nh Mui 212

    - Tinh hon 212

    - Nhng ng dn tinh 219

    - Nhng tuyn ph thuc cc dng dn tinh 220

    - Dng vt 222

    Chng 13: H s in h d c n PGS.TS. Nguyen Th Bnh 223

    - Bung trng 224

    -V i trng 232

    - T cung 232

    - m o 238

    - C quan sinh c ngoi 238

    - Tuyn v 238

    Chng 14: H th n k in h TS. Ng Duy Thn 242

    - i cng 242

    - H thn kinh trung ng 242

    - H thn kinh ngoi vi 251

    - H thn kinh thc vt 255

    Chng 15: T h g ic q u a n TS. Nguyn Khang Sn 257

    - i cng 257

    - Cu tao cc mng ca nhn cu 258

    - Nhng mi trng chit quang ca nhn cu 266

    - Nhng b phn ph thuc nhn cu 267

    9

  • C hng 16: T h n h gic q u a n TS. Nguyn Khang Sn 270

    - T a i ngoai 270

    - Tai gia 271

    - Tai trong (M o) 272

    P h lc 1: T bao GS.TS. Trinh Binh 282

    P h luc 2: M u, s to m u, b ch h u y t PGS.TS. Nguyn Th Binh 292

    - Thnh phan cua mu 292

    - To mu trong thi ky phi thai 295

    - S tao mu t khi tre ra i 296

    - Dy hng cu v bch cau c ht 297

    - Bch huyt v dng chp 298

    Ti liu th a m k h o 299

    10

  • GII THIU MN HC

    1. I CNG

    l l . inh n g h a

    M hoc La mon khoa hoc nghin cu h nh thi ui th va siu vi th cua t bao, m, c quan c th ngi binh thng, trong mi lin h cht ch vi ngha chc nng cua chng.

    T bo la n v cu to v chc nng c bn ca c th soing. Da uao chc nng c th xep t bo ca c th thnh cac nhm c br sau: t bao gc, t bao biu m, t bo chng , t bo co rt (t bao c), t bao thn kinh, t bo mu, t bo min dch v t hao ch tit hormon.

    M gom qun th t bo chuyn mn ho va nhng san phm cua t bo m nhiem mt hoc nhicu chc phn nht nh. C th ngi co bn m c bn, o la: (1) Biu mo; (2) M lin kt (m lin kt chnh thc, m sun, m xng, m mu); (3) M c; (4) M thn kinh.

    C quan l ii vi cu trc gom cc nhm m, m nhim mt hoc nhiu chc nng Kht nh. Phn ln cc c quan ca c th co c bon loi m c bn.

    H c qu an gom mt nhm cc c quan lin h hoc ph thuc nhau, m nhim mt hoc nhiu chc phn nhi inh.

    C th ngi bao gom cac c quan va cac h c quan hot ng tng tac vi nhau, am bo s thch nghi trong mi trng sng.

    1.2. Ni d u n g c h n h v n v d n g t r o n g m hc

    M hc c xac nh gm 3 phan chnh: (1) Te bao hoc: Nghin cu t bo; (2) M hc i cng-. Nghin cu v cc m; (3) M hc he c quan (cn goi l gii phu hin vi): Nghin cu cau trc cc c quan v h c quan.

    n v o lng quc t hin c dng trong m hc l: (1) milimet (mm); (2) micromet (|im); (3) nanomet (nm). lm m = 103|im - 106nm. Trc nam 1983 cn dng n v ngstrom (=0,1 nm).

    2. QUAN H GIA M HC V CAC MN HC KHC TRONG Y SINH HC

    M hc c coi l mn hoc c P v hnh thai cho cac mon hoc c s chc nng (nh sinh ly hoc, sinh hoa hc) v cac mon hoc tin lm sng (nh giai phu bnh, sinh ly benh, dc ly hc...).

    11

  • M hoc v tr i ng t g i a cc mn hc y - s inh

    - Vi giai phau hoc: Giai phu hc v m hoc l hai mn hnh thi hc m sinh vin c hoc ngay nhng nm u khi vo trng y. Gii phu hc nghin cu m ta bng quan sat i th, m hc nghin cu m ta cu trc c th mc hin vi. Nhng phat hin v hiu bit v giai phu hc l tin ngnh m hc i su nghin cu; ng thi nhng kin thc v m hoc lm phong ph v su them v nhng hiu bit v giai phu.

    - Vi sinh ly hoc: Sinh l hc nghin cu nhng c ch v qui lut hot ng chc nng cua cac c quan, h c quan ca c th ngi. Nhng hiu bit v cu trc ai th (giai phu hoc) v c biet l nhng kin thc vi th va siu vi th (mo hoc), gip tra li cho cu hi v sao cc c quan, h c quan lai thc hin c nhng chc nng o.

    Vi nhng hiu bit hin nay ve c the con ngi, c th ni: Trong c th khng co mut cu truc nao khng am nhim mt chc nng, khng c chc nng no khng lin quan n mt cu truc. Khi nghin cu m ta cu trc hnh thai cua t bao, mo cua c quan nao o. ngi lm mo hc lun tm hiu lin h vi y ngha chc nng cua t bao v m y. Mo hc khng c nhim v nghin cu hoat ng sinh ly cua cc c quan, h c quan, nhng mo hc lun tm hiu ngha chc nng cua cac cu trc nghin cu. Ngav nay, m sinh ly hoc l mt trong nhng hng nghin cu cua mo hc hin i.

    - Vi sinh ho hoc: Vic ap dng nhng k thu t nghin cu ho-t bo, hoa-m nham phat hin v xac nh v