Neck plexus. Cervical sympathetic trunk

sympathetic trunk (truncus sympathicus) - a paired formation located on the side of the spine (Fig. 9-67, 9-68). Of all the organs of the posterior mediastinum, it is located most laterally and corresponds to the level of the heads of the ribs. Consists of nodes of the sympathetic trunk (nodi trunci sumpathici), connected by internodal branches (rami interganglionares).

Each node of the sympathetic trunk (ganglion trunci sympathici) gives off a white connecting branch (ramus communicans albus) and gray connecting branch (ramus communicans griseus). In addition to the connecting branches, a number of branches depart from the sympathetic trunk, which take part in the formation of reflexogenic zones - autonomic plexuses on the vessels and organs of the chest and abdominal cavities.

Great splanchnic nerve (p. splan-chnicus major) begins with five roots from V to IX thoracic nodes. Having connected into one trunk, the nerve goes to the diaphragm, penetrates into the abdominal cavity between the legs of the diaphragm and takes part in the formation of the celiac plexus (Plexus coeliacus).

Small splanchnic nerve (n. splanchnicus

minor) starts from the tenth-eleventh thoracic sympathetic nodes and penetrates along with the large splanchnic nerve into the abdominal cavity, where it is partly part of the celiac plexus (Plexus coeliacus), superior mesenteric plexus (plexus mesentericus superior) and forms the renal plexus (plexus renalis).

inferior splanchnic nerve (n. splanchnicus imus s. minimus s. tertius) starts from the twelfth thoracic sympathetic node and also enters the renal plexus.

Thoracic cardiac nerves (pp. cardiaci thoracici) depart from the second-fifth thoracic sympathetic nodes, pass forward and medially, take part in the formation of the aortic plexus (plexus aorticus). Branches of the thoracic aortic plexus on the arteries extending from the thoracic aorta form the periarterial plexuses.

Numerous subtle sympathetic non-

ditches extending from the thoracic nodes of the sympathetic trunk - esophageal branches (rami esophagei), pulmonary branches (ramipulmonales)-

734 <■ TOPOGRAPHICAL ANATOMY AND OPERATIONAL SURGERY « Chapter 9

Rice. 9-67. Sympathetic trunk. 1 - celiac plexus, 2 - small splanchnic nerve, 3 - large splanchnic nerve, 4 - thoracic nodes of the sympathetic trunk, 5 - unpaired vein, 6 - right superior intercostal vein, 7 - subclavian loop, 8 - subclavian artery, 9 - brachial plexus , 10 - anterior scalene muscle, 11 - phrenic nerve, 12 - anterior branches of the cervical nerves, 13 - superior cervical node of the sympathetic trunk, 14 - hypoglossal nerve, 15 - vagus nerve, 16 - middle cervical node of the sympathetic trunk, 17 - common carotid artery, 18 - cervicothoracic node, 19 - brachiocephalic trunk, 20 - esophagus, 21 - lung, 22 - thoracic aorta, 23 - celiac trunk. (From: Sinelnikov V.D.

Topographic anatomy of the chest

Rice. 9-68. The course of the fibers of the spinal nerves, their connection with the sympathetic trunk (diagram). 1 - anterior branch (spinal nerve), 2 - posterior branch (spinal nerve), 3 - gray connecting branch, 4 - somatic sensory nerve fibers of cells of the spinal node, 5 - trunk of the spinal nerve, 6 - white connecting branch, 7 - spinal node , 8 - posterior root, 9 - posterior horn, 10 - posterior cord, 11 - lateral cord, 12 - white matter, 13 - lateral horn, 14 - gray matter, 15 - central canal, 16 - central intermediate gray matter, 17- node of the autonomic plexus, 18 - anterior median fissure, 19 - anterior cord, 20 - anterior horn, 21 - sympathetic prenodal nerve fibers of the cells of the lateral horn of the spinal cord, 22 - sympathetic postnodal nerve fibers of the cells of the nodes of the autonomic plexuses, 23 - sympathetic postnodal fibers to the spinal nerve, 24 - anterior root, 25 - motor fibers of the cells of the anterior horn of the spinal cord, 26 - sympathetic post-nodal nerve fibers of the cells of the nodes of the sympathetic st ox, 27 nodes of the sympathetic trunk. (From: Sinelnikov V.D. Atlas of human anatomy. - M., 1974. - T. III.)

take part in the formation of the esophageal plexus (plexus esophageus) and pulmonary plexus (plexus pulmonalis).

Cellular spaces of the mediastinum

Intrathoracic fascia (fascia endothoracica) lines the inner surface of the chest and below passes to the diaphragm, pre-

rotating into the diaphragmatic-pleural fascia (fascia phrenicopleuralis). The spurs of the intrathoracic fascia cover the mediastinal pleura, and also approach the organs and neurovascular formations of the mediastinum, forming fascial sheaths. Fascial spurs limit the following interfascial spaces.

The prepericardial space is located posterior to the sheet of intrathoracic fascia lining the transverse muscle of the chest.

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(i.e. transversus thoracis). Posteriorly, this space is limited by the fascial sheaths of the thymus gland and vessels located anterior to the trachea, and the pericardium. From below, the prepericardial space is limited by the diaphragmatic-pleural fascia, communicating with the preperitoneal tissue through the sternocostal triangle. From above, this space communicates with the pre-visceral space of the neck.

The pretracheal space is limited on the left by the aortic arch and the initial sections of its branches, and on the right by the mediastinal pleura and azygous vein. In front, this space is limited by the fascial sheath of the thymus gland and the posterior wall of the pericardium, A behind - a trachea and a fascial sheet stretched between the main bronchi.

The periesophageal space in the upper mediastinum is separated laterally and posteriorly by sheets of the intrathoracic fascia adjacent to the mediastinal pleura and the prevertebral fascia, and in front by the trachea, to which the esophagus is directly adjacent. In the posterior mediastinum, the periesophageal space is located between the posterior wall of the pericardium and the intrathoracic fascia lining the aorta. The lower part of the periesophageal space is divided by fascial spurs connecting the side walls of the fascial sheath of the esophagus with the mediastinal pleura below the roots of the lungs, into the anterior and posterior sections. The periesophageal space communicates from above with the retrovisceral space of the neck, and from below through the aortic opening of the diaphragm and the lumbocostal triangle - with the retroperitoneal space.

In the chest cavity, purulent inflammation of the mediastinal tissue can occur - media stinitis. There are anterior and posterior media-astinitis.

With anterior purulent mediastinitis, purulent fusion of tissues along the intercostal space, destruction of the pericardium - purulent pericarditis or empyema of the pleural cavity are observed.

With posterior mediastinitis, pus penetrates the subpleural tissue and can go down into the retroperitoneal tissue through the openings of the diaphragm - the lumbocostal triangle, the aortic or esophageal openings. Sometimes pus breaks into the trachea or esophagus. Factors contributing to the spread of purulent inflammatory processes in the mediastinum:

Uneven development of fascial bundles and fiber, as a result of which the various sections of the mediastinum are not delimited from each other.

Mobility of the pleural sheets and diaphragm, constant spatial and volumetric changes in the organs and vessels of the mediastinum. /

The central part of the sympathetic nervous system (SNS) is represented by the nuclei of the lateral horns of the gray matter of the spinal cord, which are present only in 15-16 segments - from the last cervical or first thoracic to the third lumbar. Each segment contains three pairs of nuclei: intermediate-lateral, consisting of the main and cord parts, intercalary and central. (Figure 2) Most sympathetic neurons are located in the intermediolateral nuclei, also called the intermediolateral or simply lateral nuclei of the lateral horns. They are the main sources of preganglionic fibers for almost all sympathetic ganglia. The exception is the inferior mesenteric node, which receives 75% of the preganglionic fibers from the central nuclei. It is believed that functionally different neurons are localized in different parts of the intermediate zone. In particular, the neurons innervating the effector formations of the skin and vessels of the skeletal muscles occupy a more lateral position in the intermediate-lateral nuclei, and the neurons involved in the innervation of the internal organs lie more medially.

Rice. 2. Sympathetic nuclei of the spinal cord and the autonomic reflex arc of the spinal level.

Sympathetic nuclei of the lateral horns: 1 - central; 2 - insert; 3 - intermediate-lateral; 4 - sensitive neurons of the spinal ganglion; 5 - associative neurons of the posterior horns of the spinal cord; 6 - neurons of the sympathetic nuclei of the spinal cord; 7 - efferent neuron of the paravertebral sympathetic ganglion.

The sympathetic nuclei of the spinal cord are composed of small multipolar spindle-shaped neurons. These are the associative neurons of the autonomic reflex arc. Axons form synapses on their bodies and dendrites:

a) pseudo-unipolar neurons of the spinal nodes that carry impulses from the internal organs;

b) sensitive neurons of the ANS (type II Dogel cells), whose bodies are located in the autonomic ganglia;

c) descending from the centers of regulation of autonomic functions located in the medulla oblongata.

In sympathetic neurons of the spinal cord, the dendrites are short, do not have a myelin sheath, and branch near the perikaryon. Their axons are thin, usually form myelinated fibers that leave the spinal cord as part of the anterior roots, end in the sympathetic nerve ganglions and are therefore called preganglionic fibers. The peripheral part of the SNS includes nerve nodes, trunks (nerves), plexuses and endings. Sympathetic nerve ganglions are divided into paravertebral (paravertebral) and prevertebral (prevertebral).

Paravertebral nodes located on both sides of the spine from the base of the skull to the coccyx. They lie near the vertebral bodies, surrounded by loose fibrous connective tissue; in the thoracic and abdominal cavities are covered, respectively, by the pleura and peritoneum. The nodes of each side are interconnected by longitudinal branches, forming chains called sympathetic trunks. Below the diaphragm, the sympathetic trunks gradually converge and at the level of the first coccygeal vertebra are connected in an unpaired coccygeal ganglion. Longitudinal internodal branches consist of myelinated and unmyelinated fibers. In addition, there are transverse commissures similar in structure, connecting the nodes of the right and left sides. The sizes of nodes of sympathetic trunks are different: from microscopic to several centimeters in length.

The sympathetic trunks (SS) have multiple connections: with the nuclei of the spinal cord and with the spinal nerves - through the white and gray connecting branches, and with the internal organs, vessels and prevertebral nerve plexuses - through the visceral branches. The color of the connecting branches is due to the presence of myelin in the sheath of the nerve fibers: the white connecting branches are composed mainly of myelinated fibers, while the gray ones are composed of unmyelinated ones (Fig. 3).

White connecting branches are formed by axons of neurons of the sympathetic nuclei of the spinal cord. Axons leave the spinal cord as part of the anterior roots, enter the spinal nerve, then separate from it in the form of white connecting branches and enter the nearest SS node. white connecting branches are present only in the thoracic and lumbar sections of the SS, that is, at the level of those segments of the spinal cord where there are sympathetic nuclei.

The preganglionic fibers entering the SS nodes behave differently. Some of them end, forming synapses on the effector neurons of the node (Fig.3,4). The axons of these effector neurons form unmyelinated postganglionic fibers, which constitute the main component of the gray connecting rami.

Rice. 3. White and gray connecting branches in the sympathetic nervous system.

Rice. 4. Switching of the sympathetic preganglionic fiber, which has passed through the paravertebral node, to the efferent neuron of the prevertebral node.

The latter are included in the spinal nerves and in their composition follow to the innervated organs. According to this scheme of the effector pathway, the vessels of the skeletal muscles, the pilomotor muscles of the skin, the sweat and sebaceous glands receive sympathetic innervation.

Another part of the preganglionic fibers passes through the SS nodes without interruption, leaving them as part of gray connecting or visceral branches and is sent to switch to the effector neuron in the prevertebral nodes (Fig. 3) or directly to the organs of the chest, abdominal and pelvic cavities, where they form synapses in nodes of the nerve plexuses of the organs themselves. (Fig. 4)

gray connecting branches depart from all nodes of the sympathetic trunk. They also contain afferent fibers formed by the dendrites of neurons of the spinal nodes and the axons of Type II Dogel cells, whose bodies are located in the vegetative nodes. A characteristic feature of the gray connecting branches is their connection with the vessels: moving along with them, they spread over considerable distances, carrying out effector and sensitive innervation of the vessels of the body and internal organs.

Visceral (organ) branches SS depart from its nodes, as well as from internodal branches to internal organs and vessels (cardiac, pulmonary branches, etc.). They include: postganglionic fibers originating in the nodes of the sympathetic trunk, preganglionic fibers passing through them without switching, as well as afferent fibers from the same sources as in the gray connecting branches. The visceral branches innervate the organs not only of their own, but also of the opposite side, following them as part of the transverse commissures of the SS.

In the sympathetic trunks, the cervical, thoracic, lumbar and sacral regions are distinguished. Each section usually contains fewer nodes than segments of the spinal cord. Children have more paravertebral nodes than adults, since in postnatal ontogenesis some of them merge with each other, forming larger nodes. For the same reason, differences are often observed in the number, size, localization and microscopic structure of the nodes of the sympathetic trunks of the right and left sides. Knowledge of these features of the structure of the sympathetic trunks is of clinical importance, since in some pathological conditions surgical or pharmacological intervention is required at the level of paravertebral sympathetic nodes.

In the cervical region most often there are 2-4 nodes: upper, middle, vertebral and lower. The upper (cranial) cervical node, 1.5–10 cm long, is one of the largest, has a fusiform shape, and is located at the level of the upper cervical vertebrae behind the internal carotid artery. The middle cervical node is characterized by an oval or triangular shape, smaller sizes (0.75 - 1.5 cm), located at the level from the fourth to the seventh cervical vertebra. It is often absent. The vertebral node is 0.4 - 1.0 cm long, has a rounded or triangular shape, is located at the level of the sixth or seventh cervical vertebra next to the vertebral artery. The lower cervical node is spindle-shaped, about 2 cm long - the most constant, located between the transverse process of the seventh cervical vertebra and the head of the first rib. It often fuses with the superior thoracic node, forming a large stellate node. Since the cervical nodes do not have their own white connecting branches, preganglionic fibers come to them from the thoracic segments of the spinal cord. (Fig.5)

Rice. 5. The course of the preganglionic fiber from the sympathetic nucleus of the spinal cord to the cervical node of the sympathetic trunk.

At the same time, rising as part of longitudinal internodal commissures, they can pass without interruption through several nodes and in each of them give off collaterals that form synapses in these nodes on effector neurons, the axons of which, forming gray connecting branches, are included in the composition of the spinal nerves. Therefore, irritation of one paravertebral node can cause a reaction in the zone of innervation of several spinal nerves.

The cervical SS gives off gray connecting and visceral branches. Gray connecting branches emerge from the nodes and internodal commissures, enter the cervical spinal nerves, as well as the cervical and brachial plexuses; part of the gray branches is involved in the formation of the plexus along the vertebral artery and its branches. The visceral branches of the cervical SS are divided into vascular and organ. The first go to the vessels of the neck and head, form plexuses around them. In the thickness of the nerve branches and in the places of their interlacing there are nodes consisting of Type I and Type II Dogel neurons. The second group of visceral branches forms the cardiac nerves (upper, middle, lower) and gives off the laryngeal-pharyngeal branches. Some visceral branches reach their targets through connections with cranial nerves and with parasympathetic nodes (ciliary, parotid). In addition, part of the visceral branches of the cervical region goes to the organs of the chest and abdominal cavities as part of the phrenic nerve.

Thoracic SS includes from 9 to 12 knots of irregular polygonal shape, 1–16 cm long, located under the pleura along the line of the heads of the ribs. This department has both types of connecting branches (white and gray), as well as visceral branches. Preganglionic fibers enter the white connecting branches. Some of them end in synapses in the nodes of this department, others, as part of the visceral branches, go to the nodes of the prevertebral plexuses. From each node, gray connecting branches emerge into the intercostal spaces, consisting of postganglionic fibers formed by axons of neurons in this department. They enter the spinal nerves and in the zone of their branching provide sympathetic innervation of the vessels, pilomotor muscles, glands, cells of the diffuse endocrine system.

The visceral branches, as in the cervical SS, include efferent (pre- and postganglionic) and afferent fibers. Afferent fibers of the thoracic SS are formed by peripheral processes of neurons of the spinal nodes and axons of type II Dogel cells, whose bodies are located in the nodes of the abdominal cavity, mainly in the Auerbach plexus of the intestine. These afferents in the prevertebral plexuses enter the visceral branches, then through the SS and white connecting branches are included in the spinal nerves and through them reach the spinal nodes and through the posterior root to the sympathetic nuclei of the spinal cord.

The visceral branches of the thoracic SS are:

1. Thoracic cardiac nerves (depart from 5-6 nodes), which join the cervical cardiac nerves and are included in the superficial plexus of the heart.

2. Pulmonary branches - enter the pulmonary plexus.

3. Mediastinal branches - participate in the formation of plexuses of the mediastinal pleura, blood vessels, thymus, as well as the thoracic aortic and esophageal plexuses.

The visceral branches that follow into the abdominal cavity form the large and small splanchnic nerves. The large splanchnic nerve is formed by the visceral branches of the V-X nodes, penetrates through the diaphragm into the abdominal cavity and enters the celiac plexus node. The small splanchnic nerve is composed of visceral branches X-XI of the thoracic nodes and also penetrates into the abdominal cavity. Some of its fibers enter the nodes of the celiac plexus, the rest are distributed in the renal and adrenal plexuses.

Lumbar SS consists of 2-7 nodes, contains connecting and visceral branches. White connecting branches come to nodes from 2-3 upper lumbar spinal nerves, and gray connecting branches go to all lumbar spinal nerves. Visceral branches of various thicknesses connect the lumbar region with the prevertebral plexuses of the abdominal cavity, with plexuses of the lumbar arteries and other vessels, and, in addition, many visceral branches extend to the parietal peritoneum and retroperitoneal connective tissue.

Sacral (or pelvic) section of the SS usually contains four nodes connected by longitudinal and transverse commissures. The trunks of the right and left sides gradually converge and merge in an unpaired coccygeal node. The gray connecting branches go to the sacral and coccygeal spinal nerves, and the visceral branches go to the upper and lower hypogastric plexuses, hypogastric nerves, organs and vascular plexuses of the small pelvis.

Prevertebral nodes of the SNS are constituent elements of the prevertebral plexuses of the autonomic nervous system, located in front of the spinal column along the aorta and its branches. Pre- and postganglionic sympathetic fibers, numerous branches of the vagus nerve and visceral afferents pass through these plexuses. In the course of the plexuses, in addition to the nodes, there are also individual neurons.

The prevertebral plexuses of the neck, thoracic, abdominal and pelvic cavities are distinguished.

The nerve plexuses of the neck are formed mainly due to the branches of the cervical and upper thoracic nodes of the SS.

In the chest cavity, large prevertebral plexuses are located in the region of the heart, the hilum of the lung, along the descending aorta and around the esophagus. Plexuses of the heart are formed by sympathetic and parasympathetic nerves. The sympathetic nerve branches originate from the cervical and upper thoracic nodes of the SS: these are the superior, middle, and inferior cardiac nerves and the thoracic cardiac nerves. The parasympathetic nerves involved in the formation of the plexuses of the heart will be characterized in the next section.

In recent decades, in connection with the introduction into the practice of heart transplantation, much attention has been paid to the study of its innervation. It has been established that none of the cervical cardiac sympathetic nerves and branches of the vagus nerves independently reach the heart. They form multiple connections with each other, exchanging connecting branches. Then they form a "cervicothoracic" plexus on the neck and in the chest cavity, which includes up to 200 branches that innervate the organs of the neck and mediastinum, including the heart. Mixed nerves coming from the cervicothoracic plexus approach the heart directly. These nerves pass under the epicardium, break up into branches and form 6 plexuses there, closely interconnected. Each plexus is intended for certain territories and contains a large number of vegetative nodes. The nerve branches from under the epicardium go deep and form the myocardial and endocardial plexuses. The plexuses of all three layers are interconnected and their fibers pass from one layer to another. The highest density of adrenergic sympathetic fibers is observed in the region of the sinoatrial and atrioventricular nodes of the conduction system of the heart. Abundantly innervated and aortic valves. In the myocardium, the nerves follow the course of the branches of the coronary arteries, which, in terms of the density of the arrangement of nerve receptors, are in first place among the vessels of the heart. The nerves surrounding the coronary arteries are located in the adventitia, and at the level of the arterioles they penetrate into the muscle layer. Nerves accompany the vessels to their smallest branches, and there are receptors even on the capillaries. In the cardiac plexus there are a large number of nerve cells and nodules.

In the region of the roots of the lungs, there is a pulmonary plexus formed by branches from the five upper thoracic nodes of the SS and branches of the vagus nerves. The networks of the pulmonary plexus contain a large number of nerve nodes and neurocytes located one by one. From the pulmonary plexus, the nerves spread along the vessels and bronchi, and form smaller plexuses in the vascular-bronchial bundles.

The prevertebral plexuses of the abdominal cavity are located in front of the abdominal aorta and around its branches. These include: celiac, superior mesenteric, abdominal aortic, inferior mesenteric, superior and inferior hypogastric plexuses and the hypogastric nerves connecting them.

celiac plexus- the largest of the prevertebral nerve plexuses of the abdominal cavity - is located around the artery of the same name. The large and small splanchnic nerves and visceral branches of the upper lumbar nodes of the SS enter the celiac plexus; they all contain pre- and postganglionic efferent sympathetic fibers. As part of this plexus, there are two prevertebral celiac nodes - right and left - lying symmetrically on the sides of the celiac artery. The left node is adjacent to the aorta, and the right node to the inferior vena cava, between the liver and the head of the pancreas. On one side (usually the right one), the celiac node is represented by one massive formation, and on the other side there may be one main and several additional small nodes, or a large number of medium-sized nodes of various sizes. The nodes of the two sides are connected by three transverse commissures (upper, middle, lower). Along the course of the lower commissure there are nerve nodes of various sizes. The commissures contain postganglionic fibers from the celiac nodes and branches of the large splanchnic nerves, consisting of preganglionic fibers. They participate in the innervation of the organs of the opposite side. The vast majority of preganglionic fibers ending in the celiac nodes come out of the XI thoracic segment of the spinal cord.

Nerves depart from the celiac nodes, which form plexuses along the branches of the celiac artery, heading to various organs. These organ plexuses include:

a) hepatic;

b) splenic;

c) gastric (anterior and posterior);

d) pancreas;

e) adrenal;

f) phrenic (pair), which also receives branches from the phrenic nerve.

From the celiac plexus there are also branches to the superior mesenteric plexus and to the aortorenal node.

superior mesenteric plexus surrounds the artery of the same name. It is closely related to the celiac plexus, and they are often combined under one name - "solar plexus". In the superior mesenteric plexus there is a large nerve node of the same name and small nodes of various sizes and shapes. The plexus is formed by preganglionic fibers that passed through the celiac plexus without switching, as well as postganglionic sympathetic and afferent fibers.

The superior mesenteric plexus innervates mainly the small intestine and the proximal colon. The nerves follow the course of the intestinal arteries. There are numerous connections between the intestinal nerves that ensure the coordination of the movements of various parts of the intestine.

Abdominal aortic and inferior mesenteric plexus are located around the corresponding arterial trunks. They are formed, like the previous plexuses, by pre- and postganglionic sympathetic and afferent fibers. On the branches of the abdominal aortic plexus, along their entire length, there are nerve nodes of various shapes and sizes. The composition of the inferior mesenteric plexus includes a large inferior mesenteric and a number of small nodes. The branches of the abdominal aortic plexus form the testicular and ovarian plexuses, extend to the ureters, participate in the formation of connections with other plexuses, and are included in the paired renal plexuses. Branches of the solar plexus, visceral branches of the lumbar SS, ascending trunks from the inferior mesenteric and superior hypogastric plexuses also participate in the formation of the latter. The renal plexus contains 1-2 large and numerous small nerve nodes.

Branches of the inferior mesenteric plexus innervate the left colon, sigmoid, rectum, and ureters.

Superior hypogastric plexus (single) located retroperitoneally on the bodies of the lower lumbar vertebrae. It is formed by the continuation of the branches of the abdominal aortic and inferior mesenteric plexuses. The visceral branches of the lumbar nodes of the SS, the trunks from the three upper sacral spinal nerves, from the renal and both mesenteric plexuses also enter it. The nerves of the superior hypogastric plexus contain afferent and efferent (pre- and postganglionic) fibers to the pelvic organs. This plexus is divided into the right and left hypogastric nerves, which descend into the small pelvis on the sides of the rectum and, breaking up into branches, enter the lower hypogastric (pelvic) plexus. The upper hypogastric plexus, hypogastric nerves and their branches contain nerve bundles and individual neurons. Branches depart from the superior hypogastric plexus and hypogastric nerves to the distal colon, bladder, ureters, pelvic arteries, and ascending branches to the overlying plexuses.

Inferior hypogastric (pelvic) plexus- one of the largest vegetative plexuses. It includes sympathetic and parasympathetic components. The sympathetic system in it is represented by hypogastric nerves, consisting mainly of postganglionic fibers, and visceral branches from the sacral nodes of the SS, and the parasympathetic system is represented by pelvic splanchnic nerves, which are formed by preganglionic fibers emerging from the sacral parasympathetic nuclei. These are paired formations located symmetrically at the side walls of the small pelvis, surrounded by loose fibrous connective tissue and fatty tissue between the bladder and rectum. They look like mesh-like plates formed by the interweaving of nerve trunks and commissural branches. Along the course of the nerves and at the intersections, there are a large number of nerve nodes, which are located either in a concentrated manner, forming continuous nodal plates, or in separate groups. Inside the nerve trunks between the bundles of nerve fibers contains a large number of nerve cells located one by one. Numerous branches depart from the lower hypogastric plexus, which are involved in the formation of a number of organ plexuses, such as rectal, bladder, vas deferens and prostate plexuses, uterovaginal and cavernous (penis and clitoris).

In the cervical part of the sympathetic trunk, there are three nodes - the upper, posterior and lower cervical nodes.
From the superior cervical sympathetic ganglion, postganglionic sympathetic fibers go to the choroid plexuses of the internal carotid, vertebral, and basilar arteries in various regions of the head. These include the jugular nerve and the internal carotid nerve, which forms a wide-loop network around the internal carotid artery - the internal carotid plexus, which later passes to branches of the internal carotid artery, forms a number of plexuses and gives off the following nerve branches: carotid-tympanic nerves, deep stony nerve (has a sympathetic root in the pterygopalatine node) and the cavernous plexus. The latter surrounds the trunk of the internal carotid artery at the site of its occurrence in the cavernous sinus and sends branches to the nerves and other formations lying in this area and in the cavity of the orbit:

to the pituitary
to the trigeminal node;
to the middle portion of the muscle that lifts the upper eyelid (Muller's muscle);
to the orbital (circular) muscle of the eye and to the lacrimal gland;
to blood vessels, sweat glands of the skin of the face and neck;
to the ophthalmic artery, forming a plexus on its walls, which sends a stem that accompanies the central retinal artery to the retina itself;
to the anterior artery and middle artery of the brain, to the anterior artery of the choroid plexus;
to the ciliary ganglion, from which the sympathetic branch as part of the short ciliary nerves goes to the muscle.

Superior cervical sympathetic ganglion syndrome
The clinical picture can develop according to one of the types - a variant of loss or irritation is possible.
In the variant of prolapse on the homolateral half of the face, vasomotor disorders occur.
With a variant of irritation, attacks of burning pain appear, which last from several hours to several days. The pain appears in the occipital region and radiates to the neck, shoulder and forearm. The development of an attack is provoked by hypothermia, sinusitis, frontal sinusitis.
eye symptoms. A characteristic manifestation of loss of function is the appearance of signs of the Bernard-Horner syndrome. The manifestations of the syndrome are caused by a violation of the sympathetic innervation of the eyeball, which includes the following symptoms:

narrowing of the palpebral fissure - associated with partial ptosis resulting from dysfunction of the middle portion of the muscle that lifts the upper eyelid (Muller muscle). As a rule, there is a drooping of the upper eyelid by 1-2 mm in combination with a rise of the lower eyelid by 1 mm;
enophthalmos occurs due to a decrease in the tension of the orbital muscle;
miosis is due to the absence of contraction of the pupil dilator;
heterochromia is observed, which is manifested by a lighter color of the iris on the affected side. Basically, heterochromia occurs with a congenital syndrome, although cases of heterochromia have also been described in patients with an acquired disorder;
lack of sweating is associated with damage to preganglionic neurons. The process of sweating on the ipsilateral side of the face is disturbed, there are flushes of blood to the face, conjunctival injection and difficulty in nasal breathing.

In the variant of irritation, Petit's syndrome develops, which includes the following symptoms: mydriasis, expansion of the palpebral fissure, exophthalmos. As a rule, one-sided irritation of the cervical sympathetic nodes is observed. In the case of bilateral irritation, signs of Petit's syndrome are observed on both sides, as a result of which external signs of arousal appear (wide-open shiny eyes).

Syndrome of the cervicothoracic (stellate) node
Clinical signs and symptoms. There are pains in the neck, chest to the level of the V-VI ribs, and pain in the arm also occurs. It should be noted that there are no pain sensations on the inner surface. There is a decrease in pain sensitivity, impaired sweating and piloarrection in these areas.
eye symptoms.

Posterior cervical sympathetic syndrome (syn. Barre-Lie syndrome, "cervical migraine")
The defeat of the sympathetic plexus of the vertebral artery can occur due to transient circulatory disorders, mechanical compression, intoxication and infectious processes. The most common causes of the development of the syndrome are osteochondrosis of the cervical spine, arachnoiditis, lymphadenitis, stenosing processes in the basin of the vertebral and main arteries, tumors located in the neck, injuries with displacement of the intervertebral cartilage.

There are three variants of the syndrome:

manifested by damage to the spinal nerves;
accompanied by a violation of the diencephalon;
involving peripheral nerves.

Clinical signs and symptoms. There is a constant long (up to 1 day or more) excruciating headache. Less commonly, the pain may be paroxysmal in nature. The pain is usually unilateral. Initially, it appears in the back of the neck and occipital region and spreads to the parietal, frontal regions, as well as to the orbit and the region of the nose; may be aggravated by turning the head, at night and after sleep. At the peak of a headache attack, debilitating vomiting may occur. Along with the headache, vestibular dizziness, loss of stability when standing and walking, hearing disorders, tinnitus, sweating, feeling hot, redness of the face, sometimes pain in the face, and discomfort in the pharynx appear. Neurotic phenomena often occur (fixed position of the head in the direction of the lesion, palpitations, pain in the hands, paresthesia and numbness of the hands).
eye symptoms. Against the background of a headache, blurred vision, photopsia, atrial scotomas, photophobia, accommodative asthenopia, pain behind the eyeball, a feeling of pressure in the eyes, blepharospasm occur, and a decrease in the sensitivity of the cornea is observed. In some cases - deterioration of blood circulation in the arterial vessels of the retina, signs of retrobulbar neuritis, superficial keratitis, miosis, Fuchs heterochromia; increase in IOP is possible.
Differential diagnosis is carried out with hypertensive cerebral crises, occipital neuralgia, atypical trigeminal neuralgia, with Meniere's, Barani's syndromes, etc.

Jugular foramen syndrome (syn. Berne-Sicard-Colle syndrome)
Occurs when the glossopharyngeal, vagus and accessory nerves are damaged. It is observed with the localization of pathological processes in the region of the jugular foramen. The cause of the development of the syndrome can be fractures of the base of the skull, sarcoma, etc.
eye symptoms. There are signs of the Bernard-Horner syndrome.

Riley-Day syndrome (syn. autonomic dysfunction, familial dysautonomy)
Occurs mainly in Jewish children.
The disease occurs due to the disintegration of the functions of the autonomic nervous system, one of the causes of which, perhaps, is a congenital defect in the conversion of catecholamine precursors to norepinephrine and epinephrine.
Clinical signs and symptoms. Characterized by vasomotor lability, decreased pain sensitivity and perception of smells and tastes, episodic rises in body temperature, attacks of respiratory and cardiac disorders, transient arterial hypertension. There is difficulty in swallowing, increased salivation and sweating, impaired urination. Most patients develop coordination disorders, epileptiform convulsions, vomiting, aspiration of vomit, diarrhea. There is a delay in physical development. At the age of 8-10 years, scoliosis develops in half of the cases. Approximately half of patients have mental retardation.
In the blood plasma, the concentration of epinephrine and norepinephrine is increased, in the urine there is a high level of O-tyrosine and homovaleric acid.
The prognosis for life is unfavorable. Patients often die in adolescence from renal hypertension, bronchopneumonia and other diseases.
Eye symptoms. There is a decrease or absence of tear production, dry eyes, decreased sensitivity and ulceration of the corneas, sometimes without signs of inflammation and without pain, corneal perforation may occur. With ophthalmoscopy, attention is drawn to the tortuosity of the retinal vessels. In most cases myopia develops.
Differential diagnosis is carried out with Sjögren's syndrome, congenital analgia syndrome.

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In this article, we will consider what the sympathetic and parasympathetic nervous systems are, how they work, and what are their differences. We have previously covered the topic as well. The autonomic nervous system, as you know, consists of nerve cells and processes, thanks to which there is a regulation and control of internal organs. The autonomic system is divided into peripheral and central. If the central is responsible for the work of the internal organs, without any division into opposite parts, then the peripheral is just divided into sympathetic and parasympathetic.

The structures of these departments are present in every internal human organ and, despite opposite functions, work simultaneously. However, at different times, one or another department is more important. Thanks to them, we can adapt to different climatic conditions and other changes in the external environment. The autonomic system plays a very important role, it regulates mental and physical activity, and also maintains homeostasis (the constancy of the internal environment). If you rest, the autonomic system activates the parasympathetic and the number of heartbeats decreases. If you start running and experiencing great physical exertion, the sympathetic department turns on, thereby accelerating the work of the heart and blood circulation in the body.

And this is only a small section of the activity that the visceral nervous system performs. It also regulates hair growth, constriction and expansion of the pupils, the work of one or another organ, is responsible for the psychological balance of the individual, and much more. All this happens without our conscious participation, which at first glance seems difficult to treat.

Sympathetic division of the nervous system

Among people who are unfamiliar with the work of the nervous system, there is an opinion that it is one and indivisible. However, in reality, things are different. So, the sympathetic department, which in turn belongs to the peripheral, and the peripheral refers to the vegetative part of the nervous system, supplies the body with the necessary nutrients. Thanks to its work, oxidative processes proceed quite quickly, if necessary, the work of the heart accelerates, the body receives the proper level of oxygen, and breathing improves.

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Interestingly, the sympathetic department is also divided into peripheral and central. If the central part is an integral part of the work of the spinal cord, then the peripheral part of the sympathetic has many branches and ganglions that connect. The spinal center is located in the lateral horns of the lumbar and thoracic segments. The fibers, in turn, depart from the spinal cord (1 and 2 thoracic vertebrae) and 2,3,4 lumbar. This is a very brief description of where the divisions of the sympathetic system are located. Most often, the SNS is activated when a person finds himself in a stressful situation.

Peripheral department

Representing the peripheral department is not so difficult. It consists of two identical trunks, which are located on both sides along the entire spine. They start from the base of the skull and end at the coccyx, where they converge into a single knot. Thanks to internodal branches, two trunks are connected. As a result, the peripheral part of the sympathetic system passes through the cervical, thoracic and lumbar regions, which we will consider in more detail.

Neck department. As you know, it starts from the base of the skull and ends at the transition to the thoracic (cervical 1 rib). There are three sympathetic nodes, which are divided into lower, middle and upper. All of them pass behind the human carotid artery. The upper node is located at the level of the second and third vertebrae of the cervical region, has a length of 20 mm, a width of 4 - 6 millimeters. The middle one is much more difficult to find, as it is located at the intersections of the carotid artery and the thyroid gland. The lower node has the largest value, sometimes even merges with the second thoracic node.
Thoracic department. It consists of up to 12 nodes and it has many connecting branches. They stretch to the aorta, intercostal nerves, heart, lungs, thoracic duct, esophagus and other organs. Thanks to the thoracic region, a person can sometimes feel the organs.
The lumbar region most often consists of three nodes, and in some cases it has 4. It also has many connecting branches. The pelvic region connects the two trunks and other branches together.

Parasympathetic department

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This part of the nervous system begins to work when a person tries to relax or is at rest. Thanks to the parasympathetic system, blood pressure decreases, the vessels relax, the pupils constrict, the heart rate slows down, and the sphincters relax. The center of this department is located in the spinal cord and brain. Thanks to the efferent fibers, the hair muscles relax, the release of sweat is delayed, and the vessels expand. It is worth noting that the structure of the parasympathetic includes the intramural nervous system, which has several plexuses and is located in the digestive tract.

The parasympathetic department helps to recover from heavy loads and performs the following processes:

Reduces blood pressure;
Restores breath;
Expands the vessels of the brain and genital organs;
Constricts pupils;
Restores optimal glucose levels;
Activates the glands of digestive secretion;
It tones the smooth muscles of the internal organs;
Thanks to this department, purification occurs: vomiting, coughing, sneezing and other processes.

In order for the body to feel comfortable and adapt to different climatic conditions, the sympathetic and parasympathetic divisions of the autonomic nervous system are activated at different times. In principle, they work constantly, however, as mentioned above, one of the departments always prevails over the other. Once in the heat, the body tries to cool down and actively releases sweat, when you need to urgently warm up, sweating is blocked accordingly. If the autonomic system works correctly, a person does not experience certain difficulties and does not even know about their existence, except for professional necessity or curiosity.

Since the topic of the site is devoted to vegetovascular dystonia, you should be aware that due to psychological disorders, the autonomic system is experiencing failures. For example, when a person has a psychological trauma and experiences a panic attack in a closed room, his sympathetic or parasympathetic department is activated. This is a normal reaction of the body to an external threat. As a result, a person feels nausea, dizziness and other symptoms, depending on. The main thing that should be understood by the patient is that this is only a psychological disorder, and not physiological abnormalities, which are only a consequence. That is why drug treatment is not an effective remedy, they only help to remove the symptoms. For a full recovery, you need the help of a psychotherapist.

If at a certain point in time the sympathetic department is activated, there is an increase in blood pressure, the pupils dilate, constipation begins, and anxiety increases. Under the action of the parasympathetic, constriction of the pupils occurs, fainting may occur, blood pressure decreases, excess mass accumulates, and indecision appears. The most difficult thing for a patient suffering from a disorder of the autonomic nervous system is when he is observed, since at this moment violations of the parasympathetic and sympathetic parts of the nervous system are observed simultaneously.

As a result, if you suffer from a disorder of the autonomic nervous system, the first thing to do is to pass numerous tests to rule out physiological pathologies. If nothing is revealed, it is safe to say that you need the help of a psychologist who will relieve the disease in a short time.

SYMPATIC PART OF THE AUTONOMOUS (VEGETATIVE) NERVOUS SYSTEM

TO sympathetic part,pars sympathica (sympathetica), include: 1) lateral intermediate (gray) substance (vegetative nucleus) in the lateral (intermediate) columns from VIII cervical segment of the spinal cord to II lumbar; 2) nerve-

nye fibers and nerves running from the cells of the lateral intermediate substance (lateral column) to the nodes of the sympathetic trunk and autonomic plexuses; 3) right and left sympathetic trunks; 4) connecting branches; 5) nodes of autonomic plexuses located anterior to the spine in the abdominal cavity and pelvic cavity and nerves lying near large vessels (perivascular plexus); 6) nerves going from these plexuses to the organs; 7) sympathetic fibers that go as part of somatic nerves to organs and tissues.

Sympathetic preganglionic nerve fibers are usually shorter than postganglionic fibers.

Sympathetic trunk, truncus sympathicus-

a paired formation located on the sides of the spine. It consists of 20-25 knots connected internodal branches,rr. interganglionares.

nodes of the sympathetic trunk,ganglia trunci sympathici (sym-pathetici), spindle-shaped, ovoid and irregular (polygonal) shape. The sympathetic trunk is located on the anterior-lateral surface of the spine. Only one type of branches approaches the sympathetic trunk - the so-called white connecting branches, and gray connecting branches go out, as well as nerves to the internal organs, blood vessels and large prevertebral plexuses of the abdominal cavity and pelvis. White connecting branch, r . communicantalbus, called a bundle of preganglionic nerve fibers, branching off from the spinal nerve and entering into the nearby node of the sympathetic trunk.

As part of the white connecting branches, there are preganglionic nerve fibers, which are processes of neurons of the lateral columns of the spinal cord. These fibers pass through the anterior columns (horns) of the spinal cord and exit as part of the anterior roots, and then go to the spinal nerve, from which they branch off after it exits the spinal foramen. White connecting branches are present only in the VIII cervical, all thoracic and two upper lumbar spinal nerves and are suitable only for all thoracic (including cervicothoracic) and two upper lumbar nodes of the sympathetic trunk. The white connecting branches are not suitable for the cervical, lower lumbar, sacral and coccygeal nodes of the sympathetic trunk. Preganglionic fibers enter the named nodes along the internodal branches of the sympathetic trunk, passing without interruption through the corresponding thoracic and lumbar nodes.

Gray connecting branches emerge from the nodes of the sympathetic trunk along the entire length, rami communicantes gri-sei, that go to the nearest spinal nerve

Rice. 196. Cervical and thoracic sections of the sympathetic trunk; front view. 1 - gangl. cervicale superius; 2-gangl. cervical medium; 3 - gangl. cervi-cothoracicum; 4 - plexus subclavius; 5 - gangl. thora cica; 6-r. communicans griseus; 7-n. splanchnicus major; 8-n. splanchnicus minor.

woo. Gray connecting branches contain postganglionic nerve fibers - processes of cells lying in the nodes of the sympathetic trunk.

As part of the spinal nerves and their branches, postganglionic sympathetic fibers are sent to the skin, muscles, all organs and tissues, blood and lymphatic vessels, sweat and sebaceous glands, to the muscles that raise the hair, and carry out their sympathetic innervation. From the sympathetic trunk, in addition to the gray connecting branches, to the internal organs and vessels, nerves depart, containing postganglionic fibers, as well as nerves following to the nodes of the autonomic plexuses and containing preganglionic fibers that have passed through the nodes of the sympathetic trunk. Topographically, 4 sections are distinguished in the sympathetic trunk: cervical, thoracic, lumbar, sacral. The cervical region of the sympathetic trunk (Fig. 196) is represented by three nodes and internodal branches connecting them, which are located on the deep muscles of the neck behind the prevertebral plate of the cervical fascia. Preganglionic fibers approach the cervical nodes along the internodal branches of the thoracic sympathetic trunk, where they come from the autonomic nuclei of the lateral intermediate (gray) substance of the VIII cervical and six to seven upper thoracic segments of the spinal cord.

upper neck knot, ganglion cervicale superius, is the largest node of the sympathetic trunk. The node is fusiform, its length reaches 2 cm or more, thickness - 0.5 cm. The upper cervical node is located in front of the transverse processes of II - III cervical vertebrae. In front of the node are the carotid artery, laterally - the vagus nerve, behind - the long muscle of the head. Branches containing postganglionic fibers depart from the upper cervical node:

1) gray connecting branches, rr. communicntes grisei, co
unite the upper cervical node with the first three (sometimes IV)
cervical spinal nerves;

2) internal carotid nerve, n. caroticus internus, guide
from the upper pole of the node to the artery of the same name and along its
the course forms the internal carotid plexus, plexus caroticus
internus. Together with the internal carotid artery, this plexus
enters the carotid canal, and then into the cranial cavity. Sleepy
canal from the plexus depart carotid-tympanic nerves to the mucosa
that sheath of the middle ear. After the release of the internal carotid ar
the teri from the canal from the internal carotid plexus is separated
deep stony nerve, n. petrosus profundus. He
passes through the fibrocartilage of the torn foramen and enters
pterygoid canal of the sphenoid bone, where it connects with pain
shim stony nerve, forming nerve of the pterygoid canal,
n. canalis pterygoidei. The latter, entering the pterygopalatine fossa,
joins the pterygopalatine node. Having passed through
pterygopalatine ganglion, sympathetic fibers along pterygopalatine nerves
enter the maxillary nerve and spread as part of
its branches, carrying out sympathetic innervation of blood vessels,
tissues, glands, oral and nasal mucosa,
conjunctiva of the lower eyelid and facial skin. Part of inner dream
foot plexus, located in the cavernous sinus, often
called the cavernous plexus plexus cavernosus. Into the eye
sympathetic fibers enter in the form of periarterial
leg plexus of the ophthalmic artery - branches of the internal carotid arte
rii. Branches from the ophthalmic plexus sympathetic kore
shock, radix sympathicus, to the eyelash. The fibers of this
the tails pass through the ciliary node in transit and as part of the co
short ciliary nerves reach the eyeball. pretty
sky fibers innervate the vessels of the eye and muscle, expanding
pupil. In the cranial cavity, the internal carotid plexus
should in the perivascular plexus branches of the internal sleep
noah artery;

3) external carotid nerves, pp. carotici externi, is 2-3
stem, they are sent to the external carotid artery and
peace along its course is the external carotid plexus, plexus caroticus
externus. This plexus spreads along the branches of the same name
noah artery, carrying out sympathetic innervation of blood vessels,
glands, smooth muscle elements and tissues of the organs of the head.
The internal and external carotid plexuses are connected at a common

carotid artery, where common carotid plexus,plexus caroticus communis;

4) jugular nerve, n. jugularis, climbs up the wall
jugular vein to the jugular foramen, where it divides into
branches leading to the superior and inferior nodes of the vagus nerve
to the inferior node of the glossopharyngeal nerve and to the hypoglossal nerve.
Due to this, sympathetic fibers spread in
the composition of the branches of the IX, X and XII pairs of cranial nerves;

5) laryngeal-pharyngeal branches, rr. laryngopharyngei /laryngo-
pharyngeales], participate in the formation of the laryngeal-pharyngeal
plexuses, innervate (sympathetic innervation) vessels,
mucous membrane of the pharynx and larynx, muscles and other tissues.
Thus, postganglionic nerve fibers
from the upper cervical node, carry out the sympathetic inner
vation of organs, skin and vessels of the head and neck;

6) superior cervical cardiac nerve, n. cardiacus cervicdtis superior, descends parallel to the sympathetic trunk anterior to the prevertebral plate of the cervical fascia. The right nerve runs along the brachiocephalic trunk and enters the deep part of the cardiac plexus on the posterior surface of the aortic arch. The left upper cervical cardiac nerve is adjacent to the left common carotid artery, descends into the superficial part of the cardiac plexus, located between the aortic arch and the bifurcation of the pulmonary trunk (Fig. 197).

middle neck knot,ganglion cervical, unstable, located anterior to the transverse process of the VI cervical vertebra, behind the inferior thyroid artery. The dimensions of the node do not exceed 5 mm. The middle cervical node is connected to the upper cervical node by one internodal branch, and to the cervicothoracic (stellate) node by two, less often three internodal branches. One of these branches passes in front of the subclavian artery, the other - behind, forming subclavian loop,dnsa subclavia. The following branches depart from the middle cervical node: 1) gray connecting branches to V and VI cervical spinal nerves, sometimes to VII;

2) middle cervical cardiac nerve, n. cardiacus cervicalis
medius. It runs parallel and lateral to the superior cervical
cardiac nerve. Right middle cervical cardiac nerve
relies along the brachiocephalic trunk, and the left - along the left
common carotid artery. Both nerves enter the deep part
cardiac plexus;

3) one or two thin nerves from the middle cervical node
participate in the formation of the common carotid plexus and plexus
inferior thyroid artery, innervating the thyroid and about
thyroid glands. In the absence of the middle cervical node, all
named branches depart from the internodal branches at the level of the pope
riverine process of the VI cervical vertebra, and postnodal fibers
these branches enter from the cervicothoracic node.

Cervical (stellate) node,ganglion cervicothoracicum,

Rice. 197. Cervical sympathetic trunk and cardiac plexus.

1 - gangl. cervicale superius; 2 - n. cardiacus cervicalis superior; 3 - gangl. cervicothoracicum; 4 - plexus cardiacus (superficial); 5 - plexus cardiacus (deep); 6 - n. cardiacus cervicalis inferior; 7 - years. cardiaci cervicales superiores; 8 - gangl. cervical medium; 9-n. vagus.

lies at the level of the neck of the 1st rib behind the subclavian artery, at the place where the vertebral artery originates from it. The node was formed as a result of the fusion of the lower cervical node with the first thoracic node. The cervicothoracic node is flattened in the anteroposterior direction, has an irregular (star-shaped) shape, its average diameter is 8 mm. The following branches depart from the node:

1) gray connecting branches, rr. communlcantes grisei, on
go to VI, VII, VIII cervical spinal nerves;

2) several branches, including from the subclavian loop,
form subclavian plexus,plexus subclavius,
continuing on the vessels of the upper limb. Together with branches
mi subclavian artery sympathetic fibers of this plexus
ion reach the thyroid gland, parathyroid glands,
organs of the upper and anterior mediastinum, and also innervate
branches of the subclavian artery;

3) several branches join the vagus nerve
and its branches, as well as to the phrenic nerve;

4) vertebral nerve, n. vertebralis, approaches the vertebral
arteries and participates in the formation of sympathetic spine
foot plexus,plexus vertebralis. Almost always at the entrance
da vertebral artery into the foramen of the transverse process VI

cervical vertebra along the course of the vertebral nerve, a small vertebrate node, ganglion vertebrate. The vertebral plexus innervates the vessels of the brain and spinal cord and their membranes;

5) lower cervical cardiac nerve, n. cardiacus cervicatis inferior, passes on the right behind the brachiocephalic trunk, and on the left - behind the aorta. The right and left nerves enter the deep part of the cardiac plexus.

The thoracic region of the sympathetic trunk includes 10-12 chest nodes,ganglia thordcica, flattened, spindle-shaped or triangular. The dimensions of the nodes are 3-5 mm. The nodes are located anterior to the heads of the ribs on the lateral surface of the vertebral bodies, behind the intrathoracic fascia and parietal pleura. Behind the sympathetic trunk in the transverse direction are the posterior intercostal vessels. To the thoracic nodes of the sympathetic trunk from all the thoracic spinal nerves, white connecting branches containing pre-ganglionic fibers approach. Several types of branches depart from the thoracic nodes of the sympathetic trunk:

1) gray connecting branches, rr. comunicantes grisei, containing postganglionic fibers, join adjacent spinal nerves;

2) thoracic cardiac branches, pp. (rr.) cardiaci thoracici, from
go from the second, third, fourth, fifth chest nodes,
are directed forward and medially and participate in the formation
cardiac plexus;

3) departing from the chest nodes of the sympathetic trunk are thin
sympathetic nerves (pulmonary, esophageal, aortic) together
ste with branches of the vagus nerve form the right and left
pulmonary plexus,plexus pulmonalis,esophageal plexus,
plexus esophagedlis / oesophagedlis], And thoracic aortic spleen
shading,plexus aorticus thordcicus. Branches of the thoracic aortic
plexuses continue to intercostal vessels and other branches
thoracic aorta, forming along their course periarterial plexuses.
Sympathetic nerves also approach the walls of the unpaired and
semi-unpaired veins, thoracic duct and participate in their innervation
tions.

The largest branches of the sympathetic trunk in the thoracic region are the large and small splanchnic nerves;

4) large splanchnic nerve, n. splanchnicus major, It is formed from several branches extending from the 5th-9th thoracic node of the sympathetic trunk and consisting mainly of preganglionic fibers. On the lateral surface of the thoracic vertebral bodies, these branches are combined into a common nerve trunk, which goes down and medially, penetrates into the abdominal cavity between the muscle bundles of the lumbar diaphragm next to the unpaired vein on the right and the semi-unpaired vein on the left and ends at the nodes of the celiac plexus. At the level of the XII thoracic vertebra, along the course of the large internal nerve,

comes in small sizes [thoracic] splanchnic node,

ganglion spldnchnicum;

5) small splanchnic nerve, n. splanchnicus minor, nachi
comes from the 10th and 11th thoracic nodes of the sympathetic trunk and
also contains predominantly preganglionic
fibers. This nerve descends lateral to the greater
splanchnic nerve, passes between the muscle bundles
lumbar diaphragm (together with the sympathetic trunk)
and enters the nodes of the celiac plexus. From a small internal
nerve departs renal branch, r. renalis, ending in
aorto-renal node of the celiac plexus;

6) lower splanchnic nerve, n. splanchnicus imus, not
standing, goes next to the small splanchnic nerve. Nachi
originates from the 12th (sometimes the 11th) thoracic node of the sympathetic
trunk and ends at the renal plexus.

The lumbar section of the sympathetic trunk (Fig. 198) is represented by 3-5 lumbar nodes and internodal branches connecting them.

lumbar nodes,ganglia lumbalia, spindle-shaped, their dimensions do not exceed 6 mm. The nodes are located on the anterior-lateral surface of the bodies of the lumbar vertebrae medial to the psoas major muscle and are covered by the retroperitoneal fascia. The inferior vena cava adjoins the lumbar nodes of the right sympathetic trunk in front, the nodes of the left trunk are adjacent to the left semicircle of the abdominal aorta. The lumbar nodes of the right and left sympathetic trunks are connected by transversely oriented connecting branches lying on the anterior surface of the lumbar vertebrae, behind the aorta and inferior vena cava.

From the I and II lumbar spinal nerves belonging to the corresponding segments of the spinal cord (L I - L II), white connecting branches approach the upper two lumbar nodes of the sympathetic trunk. The remaining lumbar nodes do not have white connecting branches.

Two types of branches depart from each lumbar node: 1) gray connecting branches, containing postganglionic fibers heading to the lumbar spinal nerves; 2) lumbar splanchnic nerves, nervi splanchnici lumbales, which are sent to the celiac plexus and organ (vascular) autonomic plexuses: splenic, hepatic, gastric, renal, adrenal. These nerves have both preganglionic and postganglionic nerve fibers.

The pelvic section of the sympathetic trunk is formed by four sacral nodes. sacral nodes,ganglia sacralia, spindle-shaped, each about 5 mm in size, connected by internodal branches. These nodes lie on the pelvic surface of the sacrum medially to the pelvic sacral foramen. Below, the right and left sympathetic trunks converge and end

Rice. 198. Lumbar and sacral sections of the sympathetic trunk. 1 - gangll. lumbalia; 2-rr. communicantes (transverse); 3 - gangll. sa cralia; 4-gang], impar; 5-r. communicans (griseus); 6 - nn. splanchnici lumbales.

V unpaired node,ganglion impar, which lies on the anterior surface of the I coccygeal vertebra. As in the lumbar region, there are transverse connections between the nodes of the sympathetic trunks of the right and left sides. Branches depart from the sacral nodes:

1) gray connecting branches go to the sacral spinal nerves, which include postnodal sympathetic

skee fibers are sent to innervate blood vessels, glands, organs and tissues in those areas where the somatic sacral nerves branch;

2) sacral splanchnic nerves, nervi splanchnici sacra-les, follow to the upper and lower hypogastric (pelvic) vegetative plexuses.