Tumors of the ovary and oviduct Old doves have tumors of the ovary and oviduct that merge with each other. Ovariocarcinomas were found in pigeons both as independent lesions and with carcinomas of other organs. Differential diagnostic studies

Ovary , ovarium . In it, female reproductive cells (eggs) develop and mature, and female sex hormones entering the blood and lymph are formed.

Topography of the ovaries

There are two free surfaces in the ovary: medial,faWithes medialis, And lateral,faWithes lateralis.

The surfaces of the ovary pass into free edge,margo liber, front - in mesenteric edge,margo mesovaricus, attached to the mesentery of the ovary.

At this edge of the organ there is ovarian hilum,hilum ovarii, through which the artery, nerves enter the ovary, veins and lymphatic vessels exit.

In the ovary the upper pipe end,extremitas tubaria, and lower uterine end,extremitas uterina, connected to the uterus own ligament of the ovary,lig. ovdrii proprium.

The ligamentous apparatus of the ovary also includes ligament that suspends the ovarylig. suspensorium ovdrii. Ovary fixed mesentery,mesovdrium, which is a duplication of the peritoneum. The ovaries themselves are not covered by peritoneum.

Topography of the ovary depends on the position of the uterus, its size (during pregnancy).

Structure of the ovary

Underneath the epithelium lies dense connective tissue tunica albuginea,tunica albuginea. The connective tissue of the ovary forms it stroma,strotna ovarii.

The substance of the ovary is divided into outer and inner layers. The inner layer is called brain matter,medulla ovarii. The outer layer is called cortex,cortex ovarii. It contains a lot of connective tissue in which vesicular ovarian follicles are located, folliculi ovarici vesiculosi, and maturing primary ovarian follicles , folliculi ovarici primarii. A mature ovarian follicle has a connective tissue membrane - flowing It contains the theca externa, theca externa, and internal flow, theca interna. Adjacent to the inner shell granular layer,stratum granulosum. In one place this layer is thickened and forms an egg-bearing mound, cumulus oophorus, in which the egg lies - oocyte,ovocytus. Inside the mature ovarian follicle there is a cavity containing follicular fluid, liquor folliculdris. The egg is located in the ovarian mound, surrounded by a transparent zone, zone pellucida, and a radiant crown, corona radidta, from follicular cells.

At the site of the burst follicle, a yellow body,corpus liiteum. If fertilization of the egg does not occur, then the corpus luteum is called cyclical yellow bodycorpus liiteum ciclicum (menstruationis). Later it gets the name whitish bodies,corpus albicans.

Vessels and nerves of the ovary

The ovary is supplied with blood by branches of the ovarian artery (a. ovarica- from the abdominal aorta) and ovarian branches (rr. ovdricae- from the uterine artery). Venous blood flows through the veins of the same name. The lymphatic vessels of the ovary drain into the lumbar lymph nodes.

The ovary is innervated from the abdominal aortic and inferior hypogastric plexuses (sympathetic innervation) and the pelvic splanchnic nerves (parasympathetic innervation).

Every girl and woman simply needs to know how her body works. Moreover, he simply has magical powers, namely the ability to reproduce a person into the world.

In this work we propose to consider the structure of the ovary, uterus, and their functions. We will also talk about some of the problems that the fair sex may face. Let's start with the fact that the ovaries are paired sex glands. The ovaries perform two main functions: generative and endocrine. We'll definitely talk about this a little later. We suggest starting with the structure of these gonads.

Structure of the ovaries

As we have already said, the ovaries are paired organs that represent the female body. It is there that the formation of eggs and their maturation occur. Before we look at the structure of the ovary, let’s determine how it is located relative to other female organs. The ovaries are located on both sides of the uterus. Each of them is located near the side wall of the pelvis.

They have a pale bluish color, the surface is lumpy, the ovaries themselves are oval and slightly flattened. The structure of the ovary is actually a very difficult question. Their surfaces are distinguished:

• medial;
• lateral.

• mesenteric;
• free.

Two ends:

• pipe;
• uterine.

Now a little about the parameters. In a mature girl, the ovaries can reach the following sizes; of course, you need to take into account age and individual characteristics:

Each ovary has a covering in the form of a tunica albuginea; they are connected to the abdominal part only through the fusion of the peritoneum and the mesenteric edge. Under the tunica albuginea there is also a cortical covering, which is much stronger than the first; in the very center there is the so-called medulla, which is distinguished by the presence of many vessels and its loose consistency, needed as connective tissue.

Let us also note that the cortex contains follicles, which are divided into types:

• primary;
• vesicular.

The first on our list are immature follicles, the second are already fully mature and contain follicular fluid. It is in them that the main sex cells, the eggs, are formed. The mature follicle and egg are involved in the process of ovulation. The first one bursts, the egg moves with the help of the fimbria into the uterine cavity through the fallopian tube. Sometimes it happens that the follicle begins to resolve without completing its maturation.

Structure of the uterus

Let's consider the following question - the structure of the uterus and ovaries. These two organs are directly related to each other. It is their joint work that allows them to reproduce and continue the human race. The uterus has the shape of a pear, its normal weight is from 40 to 60 grams. Its structure includes:

• body;
• neck;
• isthmus.

It is also important to note the fact that the uterus is a hollow organ, that is, there is a free cavity inside. Its walls touch, which is why this cavity looks like a gap.

Let's select the layers of the walls:

• the endometrium, or mucous membrane, is the inner layer;
• myometrium, or muscle, is the middle layer of the uterine wall;
• The serosa and peritoneum are the last, outer layer of the uterus.

Each layer undergoes some changes during a woman’s life. The endometrium can be from one to three millimeters thick (all this depends on the phase of the cycle). There are no changes in the myometrium until pregnancy and childbirth; its thickness ranges from three to ten millimeters. The last layer covers all female organs.

We propose to briefly highlight the main functions and purposes of this body:

• protection against infections;
• self-cleaning;
• transportation of spermatozoa;
• implantation;
• creating conditions for the embryo;
• expulsion of the fetus (during childbirth);
• strengthening the pelvic floor.

Functions of the ovaries

We looked at such genital organs as the uterus and ovaries and their structure. And the functions of the ovaries is our next question. We mentioned at the very beginning of this article that the ovaries perform two main functions:

• generative;
• endocrine.

The first function is the formation of germ cells. We propose to briefly consider the process of oogenesis. It differs from the process of spermatogenesis; there are three stages in it:

• reproduction;
• height;
• maturation.

During the first stage, oogonia multiply, which in most cases occurs during intrauterine development. This process stops when the cell enters meiosis. At this stage, development stops until puberty. The growth stage already occurs in the mature ovary, which is functioning. The last stage begins with the formation of second-order oocytes, and this process ends with release as a result of ovulation.

The main difference from spermatogenesis is the absence of a formation stage.

We mentioned another function of the ovaries - endocrine. Granulosa, whose functions are regulated to a greater extent by lutropin, produce hormones:

• estradiol, formed from the precursor of testosterone;
• estrone, it helps the formation of estriol in the liver and placenta;
• progesterone, which is simply necessary during ovulation.

Ovarian development

We have looked at the structure of a woman’s ovary, now we propose to talk very briefly about its development.

It is worth noting that the formation of this organ begins in intrauterine development. Already in the fifth month, girls have fully developed gonads that have follicles. After which they atrophy. The ovaries are fully formed in girls at the age of two years.

Pregnancy

We examined the question of the structure of the ovaries, tubes, and eggs. But what happens in a woman's body during pregnancy? The ovaries have a decisive role, namely the production of necessary hormones. It is also a cradle for maturing eggs. During fertilization of the egg, a corpus luteum is formed in one of the two ovaries. It is needed for increased production of progesterone. helps the placenta to fully form; at the twelfth week it begins to die, since its main function is completed.

You should also know that during pregnancy, a woman’s ovaries go into “hibernation” so that another ovulation does not occur.

Exhaustion

We have already looked at the internal structure of the ovary, but did not talk about the fact that their depletion occurs. What is it? This disease is briefly called and includes a whole range of symptoms:

• amenorrhea;
• disorders in the vegetative-vascular system;
• infertility before a woman reaches 40 years of age.

Doctors can make this diagnosis provided that the woman has not previously experienced difficulties with menstrual and reproductive function. Despite this complex of symptoms, this disease is quite treatable.

Multifollicularity

The multifollicular structure of the ovaries is almost no different from the structure of healthy ones; the only difference is that eight or more follicles simultaneously exist in the ovaries. The norm is from 4 to 7, only one of them reaches full maturity, less often two. Multifollicularity can be detected using ultrasound (ultrasound), and the picture is as follows: in the ovaries there are more than seven follicles in the maturation stage.

It is also important to note that it is difficult to make an accurate diagnosis using ultrasound, because multifollicularity can be very similar to polycystic disease. If a threat is seen, then a consultation with a gynecologist and an analysis to determine hormonal levels are prescribed.

Removal

In some cases, the ovaries may be removed. Let's briefly consider the options when they are removed:

• hormone-dependent breast tumor;
• cyst;
• inflamed pelvic organs.

The ovaries, the structural features of which we have examined, are often removed together with the fallopian tubes. After the removal of two ovaries, the possibility of becoming pregnant can no longer be discussed. First, the ovulation process stops and the menstrual cycle stops. Further, a lack of estrogen is noticed in the body, as a result of which the uterine mucosa atrophies.

We looked at the structure of the ovary and listed some diseases. Remember that it is very important to protect women’s health, because the ability to have children depends on it.

The structure of the internal genital organs is shown schematically in Fig. 1.2.

Vagina(vagina) is a stretchable muscular-fibrous tube about 10 cm long. It is somewhat curved, the bulge is directed posteriorly. The upper edge of the vagina covers the cervix, and the lower edge opens into the vestibule of the vagina.

The anterior and posterior walls of the vagina are in contact with each other. The cervix protrudes into the vaginal cavity, a groove-like space is formed around the cervix - the vaginal vault (fortnix vaginae). It distinguishes between the posterior arch (deeper), anterior (flatter) and lateral arches (right and left). The anterior wall of the vagina in the upper part is adjacent to the bottom of the bladder and is separated from it by loose tissue, and the lower part is in contact with the urethra. The upper quarter of the posterior wall of the vagina from the abdominal cavity is covered with peritoneum (rectouterine recess - excavatio retrouterina); below, the posterior wall of the vagina is adjacent to the rectum.

The walls of the vagina consist of three layers: the outer layer (dense connective tissue), the middle layer (thin muscle fibers crossing in different directions) and the inner layer (vaginal mucosa, covered with stratified squamous epithelium). There are no glands in the vaginal mucosa. In the lateral sections of the vaginal walls, remnants of Wolffian ducts (Gartner canals) are sometimes found. These rudimentary formations can serve as a starting point for the development of vaginal cysts.

Uterus(uterus, s. metra, s. hysteria) - an unpaired hollow muscular organ located in the small pelvis between the bladder (front) and the rectum (back). The uterus is pear-shaped, flattened in the anteroposterior direction, about 7–9 cm long in a nulliparous woman and 9–11 cm in a woman who has given birth; the width of the uterus at the level of the fallopian tubes is approximately 4 - 5 cm; the thickness of the uterus (from the anterior surface to the posterior) does not exceed 2 - 3 cm; the thickness of the walls of the uterus is 1 - 2 cm; its average weight ranges from 50 g in nulliparous women to 100 g in multiparous women. The position of the uterus in the pelvis is not constant. It can change depending on a number of physiological and pathological factors, for example, during pregnancy or the presence of various inflammatory and tumor processes in the uterus itself, and in its appendages, as well as the abdominal organs (tumors, cysts, etc.).

The uterus is divided into a body (corpus), an isthmus (istmus) and a cervix (cervix), shown in Fig. 1.3. The body of the uterus has a triangular shape, gradually narrowing towards the cervix (see Fig. 1.3, a). The organ is divided by a pronounced constriction like a waist, about 10 mm wide. The cervix is ​​divided into supravaginal (upper 2/3) and vaginal (lower 1/3) parts.

The upper part of the uterus, protruding above the level of the fallopian tubes, forms the fundus uteri. Somewhat lower anteriorly from the place of origin of the fallopian tubes, the round uterine ligaments (lig. rotundum, s. teres) extend from both sides, and at the same height, the own ovarian ligaments (lig. ovarii proprii) are attached to the back. In the uterus, there is an anterior, or vesical (facies vesicalis), and a posterior, or intestinal, surface (facies intestinalis), as well as the right and left lateral edges (margo uteri dexter et sinister).

Usually between the body and the cervix there is an angle corresponding to an average of 70-100", open anteriorly (anteflexio); the entire uterus, in addition, is inclined anteriorly (anteversio). This position of the uterus in the small pelvis is considered normal.

The wall of the uterus consists of the following layers: the mucous membrane (endometrium), the muscular layer (myometrium) and the peritoneum (peritoneum).

The endometrium is represented by two layers: basal (deep) and functional (superficial), facing the uterine cavity. The endometrium lines the uterine cavity from the inside and is fused with the muscular layer without a submucosal layer. The thickness of the mucosa reaches 1 mm or more. In the stroma of the basal layer, consisting of connective tissue cells, the excretory parts of the glands located in the functional layer are located. The epithelium of the glands is single-row cylindrical. The functional layer of the endometrium, consisting of cytogenic stroma, glands and vessels, is extremely sensitive to the action of steroid sex hormones; it is lined with surface epithelium, similar in structure to the epithelium of the glands (Fig. 1.4).

The muscular layer of the uterus (myometrium) consists of three powerful layers of smooth muscle fibers. Some of the superficial muscle bundles extend to the uterine ligaments. Of practical importance is the generally accepted structure of the myometrium in relation to the preferential direction of its various layers. The outer layer has a mainly longitudinal direction, the middle layer has a circular and oblique direction, and the inner layer has a longitudinal direction. In the body of the uterus the circular layer is most developed, while in its cervix the longitudinal layer is most developed. In the area of ​​the external and internal pharynx, as well as the uterine orifices of the tubes, the muscle fibers are located predominantly circularly, forming something like sphincters.

Rice. 1.3. Anatomical parts of the uterus:

a - frontal section; b - sagittal section; 1 - body of the uterus, 2 - isthmus, 3 - cervix (supravaginal part), 4 - cervix (vaginal part)

Rice. 1.4. Structure of the endometrium (diagram):

I - compact layer of the endometrium; II - spongy layer of the endometrium; III - basal layer of the endometrium; IV - myometrium; A - myometrial arteries; B - arteries of the basal layer; B – spiral arteries of the functional layer; G - glands

The body of the uterus and the posterior surface of the supravaginal part of the cervix are covered with peritoneum.

The cervix is ​​an extension of the body. It distinguishes two sections: the vaginal part (portio vaginalis) and the supravaginal part (portio vaginalis), located above the place of attachment to the neck of the vaginal fornix. On the border between the body of the uterus and the cervix there is a small section - the isthmus (istmus uteri), from which the lower segment of the uterus is formed during pregnancy. The cervical canal has two narrowings. The junction of the cervix and the isthmus corresponds to the internal os. In the vagina, the cervical canal opens with the external os. This hole is round in women who have not given birth and transversely oval in women who have given birth. The vaginal part of the cervix, located in front of the external os, is called the anterior lip, and the part of the cervix behind the external os is called the posterior lip.

Topographically, the uterus is located in the center of the small pelvis - the correct position. Inflammatory or tumor processes of the pelvic organs can displace the uterus anteriorly (antepositio), posteriorly (retropositio), left (sinistropositio) or right (dextropositio). In addition, in a typical position, the uterus is entirely tilted anteriorly (anteversio), and the body and cervix form an angle of 130-145°, open anteriorly (anteflexio).

UTERINE APPENDAGES:

Fallopian tubes(tuba uterinae) extend on both sides from the lateral surfaces of the uterine fundus (see Fig. 1.2). This paired tubular organ, 10-12 cm long, is enclosed in a fold of peritoneum, which makes up the upper part of the broad uterine ligament and is called the mesosalpinx. There are four sections of it.

The uterine (interstitial, intrawall) part of the tube (pars uterina) is the narrowest (the lumen diameter in the atomic section is more than 1 mm), located in the thickness of the uterine wall and opens into its cavity (ostium uterinum tube). The length of the interstitial part of the tube ranges from 1 to 3 cm.

The isthmus of the fallopian tube (istmus tubae uterinae) is a short section of the tube at its exit from the wall of the uterus. Its length is no more than 3-4 cm, but the wall thickness of this section of the pipe is the greatest.

The ampulla of the fallopian tube (ampulla tubae uterinae) is a convoluted and longest part of the tube that expands outward (about 8 cm). Its diameter is on average 0.6-1 cm. The thickness of the walls is less than that of the isthmus.

The funnel of the fallopian tube (infundibulum tubae uterinae) is the widest end of the tube, ending with many outgrowths or fimbriae tubae (fimbriae tubae) about 1-1.6 cm long, bordering the abdominal opening of the fallopian tube and surrounding the ovary; the longest of the fimbriae, about 2-3 cm long, is often located along the outer edge of the ovary, fixed to it and called ovarian (fimbriae ovarica).

The wall of the fallopian tube consists of four layers.

1. Outer, or serous, membrane (tunica serosa).

2. Subserosa tissue (tela subserosa) - a loose connective tissue membrane, weakly expressed only in the area of ​​the isthmus and ampulla; on the uterine part and in the area of ​​the funnel of the tube, subserosal tissue is practically absent.

3. The muscular layer (tunica muscularis) consists of three layers of smooth muscle: a very thin outer layer - longitudinal, a larger middle layer - circular and inner layer - longitudinal. All three layers of the muscular lining of the tube are closely intertwined and directly pass into the corresponding layers of the uterine myometrium.

4. The mucous membrane (tunica mucosa) forms longitudinally arranged tubular folds in the lumen of the tube, which are more pronounced in the area of ​​the ampulla.

The main function of the fallopian tubes is to transport the fertilized egg to the uterus through peristaltic contractions of the muscular layer.

Ovary(ovarium) - a paired organ that is the female reproductive gland. It is usually located on the side wall of the pelvis in the recess of the parietal peritoneum, at the place where the common iliac artery divides into external and internal - in the so-called ovarian fossa (fossa ovarica).

The length of the ovary is 3 cm, width 2 cm, thickness 1-1.5 cm (see Fig. 1.2). It distinguishes between two surfaces, two poles and two edges. The inner surface of the ovary faces the midline of the body, the outer surface looks down and outward. One pole of the ovary (uterine) is connected to the uterus using its own ovarian ligament (lig. Ovarii proprium). The second pole (tubal) faces the funnel of the tube; a triangular fold of the peritoneum is attached to it - the ligament that suspends the ovary (lig. Suspensorium ovarii) and descends to it from the boundary line. The ligament contains ovarian vessels and nerves. The free rounded edge of the ovary faces the peritoneal cavity, the other edge (straight) forms the hilus of the ovary (hilus ovarii), attaching to the posterior layer of the broad ligament.

On most of the surface, the ovary does not have a serous cover and is covered with germinal (primordial) epithelium. Only a slight clearness of the mesenteric edge in the area of ​​​​attachment of the mesentery of the ovary has a peritoneal covering in the form of a small whitish rim (the so-called white, or border, line, or Farr-Waldeyer ring.

Under the epithelial cover is the tunica albuginea, consisting of connective tissue. This layer, without a sharp boundary, passes into a thick cortical layer, in which there are large numbers of germinal (primordial) follicles, follicles at different stages of maturation, atretic follicles, yellow and white bodies. The medulla of the ovary, which passes into the hilum, is richly supplied with blood vessels and nerves (Fig. 1.5).

Rice. 1.5. Longitudinal section through the ovary (diagram):

1 - peritoneum; 2 - follicles in different stages of maturation; 3 - white body; 4 - yellow body; 5 - vessels in the medulla; 6 - nerve trunks

In addition to the mesovarium, the following ovarian ligaments are distinguished.

Ovarian suspension(lig. suspensorium ovarii), previously referred to as the ovarian-pelvic or infundibulopelvic ligament. This ligament is a fold of the peritoneum with blood vessels passing through it (a. et v. ovarica), lymphatic vessels and nerves of the ovary, stretched between the side wall of the pelvis, the lumbar fascia (in the area of ​​division of the common iliac artery into the external and internal) and the upper ( tubal) end of the ovary.

Proper ovarian ligament(lig. ovarii proprium), presented in the form of a dense fibrous-smooth muscle cord, passes between the leaves of the wide uterine ligament, closer to its posterior layer, and connects the lower end of the ovary with the lateral edge of the uterus. To the uterus, the own ligament of the ovary is fixed in the area between the beginning of the fallopian tube and the round ligament, posterior and superior to the latter, and the thicker ligaments pass rr. ovarii, which are the terminal branches of the uterine artery.

Appendicular-ovarian ligament Clado (lig. appendiculoovaricum Clado) stretches from the mesentery of the appendix to the right ovary or broad ligament of the uterus in the form of a fold of peritoneum containing fibrous connective tissue, muscle fibers, blood and lymphatic vessels. The ligament is unstable and is observed in 1/2 -1/3 of women.

Blood supply to the internal genital organs

Blood supply to the uterus occurs due to the uterine arteries, arteries of the round uterine ligaments and branches of the ovarian arteries (Fig. 1.6).

The uterine artery (a.uterina) arises from the internal iliac artery (a.illiaca interna) in the depths of the small pelvis near the lateral wall of the pelvis, at a level of 12-16 cm below the innominate line, most often together with the umbilical artery; Often the uterine artery begins immediately below the umbilical artery and approaches the lateral surface of the uterus at the level of the internal os. Continuing further up the side wall of the uterus (“rib”) to its corner, having a pronounced trunk in this section (with a diameter of about 1.5-2 mm in nulliparous women and 2.5-3 mm in women who have given birth), the uterine artery is located almost at along its entire length next to the “rib” of the uterus (or at a distance of no more than 0.5-1 cm from it. The uterine artery along its entire length gives off from 2 to 14 (on average 8-10) branches of unequal caliber (with a diameter of 0. 3 to 1 mm) to the anterior and posterior walls of the uterus.

Next, the uterine artery is directed medially and forward under the peritoneum above the levator ani muscle, to the base of the broad ligament of the uterus, where branches usually extend from it to the bladder (rami vesicales). Not reaching 1-2 cm from the uterus, it intersects with the ureter, located above and in front of it and giving it a branch (ramus utericum). The uterine artery then divides into two branches: the cervicovaginal branch, which supplies the cervix and upper part of the vagina, and the ascending branch, which goes to the upper corner of the uterus. Having reached the bottom, the uterine artery divides into two terminal branches going to the tube (ramus tubarius) and to the ovary (ramus ovaricus). In the thickness of the uterus, the branches of the uterine artery anastomose with the same branches of the opposite side. The artery of the round uterine ligament (a.ligamenti teres uteri) is a branch of the a.epigastrica inferior. It approaches the uterus as part of the round uterine ligament.

The division of the uterine artery can be carried out according to the main or scattered type. The uterine artery anastomoses with the ovarian artery; this fusion occurs without visible changes in the lumens of both vessels, so it is almost impossible to determine the exact location of the anastomosis.

In the body of the uterus, the direction of the branches of the uterine artery is predominantly oblique: from outside to inside, from bottom to top and to the middle;

In various pathological processes, deformation of the normal direction of the vessels occurs, and the localization of the pathological focus, in particular in relation to one or another layer of the uterus, is of significant importance. For example, with subserous interstitial fibroids of the uterus that protrude above the level of the serous surface, the vessels in the tumor area seem to flow around it along the upper and lower contours, as a result of which the direction of the vessels, usual for this section of the uterus, changes and their curvature occurs. Moreover, with multiple fibroids, such significant changes occur in the architecture of the vessels that it becomes impossible to determine any pattern.

Anastomoses between the vessels of the right and left halves of the uterus at any level are very abundant. In each case, 1-2 direct anastomoses can be found in the uteri of women between the large branches of the first order. The most permanent of these is a horizontal or slightly arcuate coronary anastomosis in the area of ​​the isthmus or lower part of the uterine body.

Rice. 1.6. Arteries of the pelvic organs:

1 - abdominal aorta; 2 - inferior mesenteric artery; 3 - common iliac artery; 4 - external iliac artery; 5 - internal iliac artery; 6 - superior gluteal artery; 7 - inferior gluteal artery; 8 - uterine artery; 9 - umbilical artery; 10 - cystic arteries; 11 - vaginal artery; 12 - inferior genital artery; 13 - perineal artery; 14 - inferior rectal artery; 15 - clitoral artery; 16 - middle rectal artery; 17 - uterine artery; 18 - pipe branch

uterine artery; 19 - ovarian branch of the uterine artery; 20 - ovarian artery; 21 - lumbar artery

Blood supply to the ovary carried out by the ovarian artery (a.ovarica) and the ovarian branch of the uterine artery (g.ovaricus). The ovarian artery arises in a long, thin trunk from the abdominal aorta below the renal arteries (see Fig. 1.6). In some cases, the left ovarian artery may arise from the left renal artery. Descending retroperitoneally along the psoas major muscle, the ovarian artery crosses the ureter and passes in the ligament that suspends the ovary, giving a branch to the ovary and tube and anastomosing with the terminal part of the uterine artery.

The fallopian tube receives blood from the branches of the uterine and ovarian arteries, which pass in the mesosalpinx parallel to the tube, anastomosing with each other.

Rice. 1.7. Arterial system of the uterus and appendages (according to M. S. Malinovsky):

1 - uterine artery; 2 - descending section of the uterine artery; 3 - ascending uterine artery; 4 - branches of the uterine artery going into the thickness of the uterus; 5 - branch of the uterine artery going to the mesovarium; 6 - tubal branch of the uterine artery; 7 - ordinal ovarian branches of the uterine artery; 8 - tubo-ovarian branch of the uterine artery; 9 - ovarian artery; 10, 12 - anastomoses between the uterine and ovarian arteries; 11 - artery of the round uterine ligament

The vagina is supplied with blood by the vessels of the a.iliaca interna basin: the upper third receives nutrition from the uterine artery cervicovaginalis, the middle third - from a. vesicalis inferior, the lower third is from a. haemorraidalis and a. Pudenda interna.

Thus, the arterial vascular network of the internal genital organs is well developed and extremely rich in anastomoses (Fig. 1.7).

Blood flows from the uterus through the veins that form the uterine plexus - plexus uterinus (Fig. 1.8).

Rice. 1.8. Veins of the pelvic organs:

1 - inferior vena cava; 2 - left renal vein; 3 - left ovarian vein; 4 - inferior mesenteric vein; 5 - superior rectal vein; 6 - common iliac vein; 7 - external iliac vein; 8 - internal iliac vein; 9 - superior gluteal vein; 10 - inferior gluteal vein; 11 - uterine veins; 12 - vesical veins; 13 - vesical venous plexus; 14 - inferior genital vein; 15 - vaginal venous plexus; 16 - veins of the legs of the clitoris; 17 - inferior rectal vein; 18 - bulbocavernosus veins of the entrance to the vagina; 19 - clitoral vein; 20 - vaginal veins; 21 - uterine venous plexus; 22 - venous (pampiniform) plexus; 23 - rectal venous plexus; 24 - median sacral plexus; 25 - right ovarian vein

From this plexus blood flows in three directions:

1) v. ovarica (from the ovary, tube and upper uterus); 2) v. uterina (from the lower half of the uterine body and the upper part of the cervix); 3) v. Iliaca interna (from the lower part of the cervix and vagina).

Plexus uterinus anastomoses with the veins of the bladder and rectum. The veins of the ovary correspond to the arteries. Forming a plexus (lexus pampiniformis), they are part of the ligament that suspends the ovary and flow into the inferior vena cava or renal vein. Blood flows from the fallopian tubes through the veins that accompany the tubal branches of the uterine and ovarian arteries. Numerous veins of the vagina form a plexus - plexus venosus vaginalis. From this plexus, blood flows through the veins accompanying the arteries and flows into the v. system. iliaca interna. The venous plexuses of the vagina anastomose with the plexuses of neighboring pelvic organs and with the veins of the external genitalia.

Lymphatic system of the uterus

The lymphatic system of the uterus and the closely related lymphatic system of the fallopian tubes and ovaries are very abundant. It is conventionally divided into intraorgan and extraorgan. and the first gradually turns into the second.

Intraorgan(intravisceral) lymphatic system begins with the endometrial network of lymphatic vessels; this network is abundantly anostomosing each other with the corresponding draining lymphatic systems, which explains the fact that tumors do not spread along the plane of the endometrium, but mainly outward, towards the uterine appendages.

Extraorgan (extravisceral) drainage lymphatic vessels of the uterus are directed primarily outward from the uterus, along the blood vessels, in close contact with them.

The draining extraorgan lymphatic vessels of the uterus are divided into two groups.

1. Lymphatic vessels of the first (lower) group, draining lymph from approximately the upper two thirds of the vagina and the lower third of the uterus (mainly from the cervix), are located at the base of the broad ligament of the uterus and flow into the internal iliac, external and common iliac, lumbar, sacral and anorectal lymph nodes.

2. Lymphatic vessels of the second (upper) group drain lymph from the body of the uterus, ovaries and fallopian tubes; they begin predominantly from the large subserous lymphatic sinuses and go mainly in the upper part of the broad ligament of the uterus, heading to the lumbar and sacral lymph nodes, and partially (mainly from the fundus of the uterus) along the round uterine ligament to the inguinal lymph nodes.

3. The central location of the lymph nodes of the third stage are the common iliac lymph nodes and the nodes located in the area of ​​the aortic bifurcation.

Lymph nodes of the fourth and subsequent stages are most often located: on the right - on the anterior surface of the inferior vena cava, on the left - near the left semicircle of the aorta or directly on it (the so-called para-aortic nodes). On both sides, the lymph nodes lie in the form of chains.

Lymphatic drainage from the ovaries carried out through the lymphatic vessels in the area of ​​the organ's hilum, where the subovarian lymphatic plexus (plexus lymphaticus subovaricus) is secreted, to the para-aortic lymph nodes.

The lymphatic system of the right ovary is connected with the lymphatic system of the ileocecal angle and the appendix.

Innervation of the female genital organs

Innervation of the internal genital organs is carried out by the autonomic nervous system. Autonomic nerves contain sympathetic and parasympathetic fibers, as well as efferent and afferent fibers. One of the largest efferent autonomic plexuses is the abdominal aortic plexus, which is located along the abdominal aorta. A branch of the abdominal aortic plexus is the ovarian plexus, which innervates the ovary, part of the fallopian tube and the broad ligament of the uterus.

Another branch is the inferior hypogastric plexus, which forms the organ autonomic plexuses, including the uterovaginal plexus. Frankenheuser's uterovaginal plexus is located along the uterine vessels as part of the cardinal and uterosacral ligaments. This plexus also contains afferent fibers (roots Th1O - L1).

FIXING APPARATUS OF THE INTERNAL GENITAL ORGANS OF A WOMAN

The fixing apparatus of the internal genital organs of a woman consists of a hanging, securing and supporting apparatus, which ensures the physiological position of the uterus, tubes and ovaries (Fig. 61).

Hanging apparatus

It combines a complex of ligaments that connect the uterus, tubes and ovaries with the walls of the pelvis and with each other. This group includes the round, wide ligaments of the uterus, as well as the suspensory and proper ligaments of the ovary.

Round ligaments of the uterus (lig. teres uteri, dextrum et sinistrum) are a paired cord 10-15 cm long, 3-5 mm thick, consisting of connective tissue and smooth muscle fibers. Starting from the lateral edges of the uterus, slightly lower and anterior to the beginning of the fallopian tubes on each side, the round ligaments pass between the leaves of the broad uterine ligament (intraperitoneal) and are directed to the side wall of the pelvis, retroperitoneally.

Then they enter the internal opening of the inguinal canal. Their distal third is located in the canal, then the ligaments exit through the external opening of the inguinal canal and branch in the subcutaneous tissue of the labia.

Broad ligaments of the uterus (lig. latum uteri, dextrum et sinistrum) are frontally located duplications of the peritoneum, which are a continuation of the serous cover of the anterior and posterior surfaces of the uterus away from its “ribs” and split into sheets of parietal peritoneum of the side walls of the small pelvis - from the outside. At the top, the broad ligament of the uterus is closed by the fallopian tube, located between its two layers; below, the ligament splits, passing into the parietal peritoneum of the pelvic floor. Between the leaves of the broad ligament (mainly at their base) lies fiber (parametrium), in the lower part of which the uterine artery passes on one side and the other.

The broad ligaments of the uterus lie freely (without tension), follow the movement of the uterus and cannot, naturally, play a significant role in maintaining the uterus in a physiological position. Speaking about the broad ligament of the uterus, one cannot fail to mention that with intraligamentary tumors of the ovaries located between the leaves of the broad ligament, the usual topography of the pelvic organs is disrupted to one degree or another.

Suspensory ligaments of yaichi ika(lig. suspensorium ovarii, dextrum et. sinistrum) go from the upper (tubal) end of the ovary and fallopian tube to the peritoneum of the side wall of the pelvis. These relatively strong ligaments, thanks to the vessels passing through them (a. et v. ovagisae) and nerves, keep the ovaries suspended.

Own ligaments ovary A(1ig. Ovarii proprimu, dextrum et. sinistrum) are a very strong short fibrous-muscular cord connecting the lower (uterine) end of the ovary with the uterus, and pass through the thickness of the broad ligament of the uterus.

Fixing, or actually fixing, apparatus (retinaculum uteri) is a “zone of compaction” consisting of powerful connective tissue cords, elastic and smooth muscle fibers.

The fastening apparatus consists of the following parts:

The anterior part (pars anterior retinaculi), which includes the pubovesical or pubovesical ligaments (ligg. pubovesicalia), which continue further in the form of vesicouterine (vesicocervical) ligaments (ligg. Vesicouterina s. vesicocervicalia);

The middle part (paras media retinaculi), which is the most powerful in the fastening apparatus system; it mainly includes the system of cardinal ligaments (1igg. cardinalia);

The posterior part (pars posterior retinaculi), which is represented by the uterosacral ligaments (1igg. sacrouterina).

Some of the links listed above should be discussed in more detail.

1. Vesico-uterine, or vesico-cervical, ligaments are fibromuscular plates that surround the bladder on both sides, fixing it in a certain position, and keeping the cervix from moving posteriorly.

2. The main, or main (cardinal) ligaments of the uterus are a cluster of intertwined dense fascial and smooth muscle fibers with a large number of vessels and nerves of the uterus, located at the base of the wide uterine ligaments in the frontal plane.

3. The uterosacral ligaments consist of muscular-fbrous bundles and extend from the posterior surface of the cervix, arcuately covering the rectum from the sides (weaving into its side wall), and are fixed to the parietal layer of the pelvic fascia on the anterior surface of the sacrum. Raising the overlying peritoneum, the sacrouterine ligaments form rectal-uterine folds.

Supporting (supporting) apparatus united by a group of muscles and fascia that form the floor of the pelvis, above which the internal genital organs are located.