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Female sex system:
Histological structure and uterine pipe functions, uterus, vagina

The fallopian tubes

The uterine pipes (eggs, foolopiev pipes) are paired organs for which the egg is from going to the uterus.

Development. The uterine pipes are developing from the top of the paramesonephral ducts (muller channels).

Structure. The wall of the egg has three shells: mucous membrane, muscular and serous. The mucous membrane is assembled into large branched longitudinal folds. It is covered with a single-layer prismatic, which consists of two types of cells - recycled and glandssecreted mucus. The own plate of the mucous membrane is presented. The muscular shell consists of an inner circular or spiral layer and outdoor longitudinal. Outside, the eggs are covered with a serous shell.

The distal end of the egg is expanding to the funnel and ends with a fringe (phimnia). At the time of ovulation, the vessels are increasing in volume and the funnel at the same time tightly covers the ovary. The movement of the gender cell in the egg is ensured not only by the movement of the cilia of epithelial cells, lining the cavity of the fallopian tube, but also by peristaltic abbreviations of its muscle shell.

Uterus

Uterus ( uterus.) - Muscle body designed to implement the intrauterine development of the fetus.

Development. The uterus and the vagina develop in the embryo from the distal department of the left and right paramenevonephral ducts at the place of their merger. In this regard, at first, the body of the uterus is characterized by some cougium, but by the 4th month of intrauterine development, the merger ends and the uterus becomes a pear shape.

Structure. The wall of the uterus consists of three shells:

• mucous membrane - endometrial;
• muscular shell - myometrium;
• serous shell - perimetry.

IN endometry distinguish two layers - basal and functional. The structure of the functional (surface) layer depends on the ovarian hormones and undergoes deep adjustment throughout the menstrual cycle. The mucous membrane of the uterus is lined with single-layer prismatic epithelium. As in the uterine pipes, semiconductor and ferrous epithelial cells are isolated. Cells are located mainly around the mouth of the uterine glands. The intrinsic plate of the uterine mucous membrane is formed by a loose fiber junction tissue.

Some connective tissue cells are developing into special decidual cells Large size and rounded shape. Decidual cells contain in its cytoplasm Glycogen's lock and lipoprotein inclusions. The number of decidual cells increases when forming the placenta during pregnancy.

There are numerous mucous membranes uterine glandsextending through the entire endometrium crowd and even penetrating the surface layers of myometrium. Out of the form of uterine glands belong to simple tubular.

The second membrane of the uterus - myometrium - consists of three layers of smooth cells - internal subphony ( stratum Submucosum), medium vascular with the Kosopodol location of myocytes ( stratum Vasculosum), rich vessels, and outdoor supervisory ( stratum Supravasculosum) Also with the orthodoxy arrangement of muscle cells, but cross in relation to the vascular layer. This arrangement of muscle beams has a certain value in the regulation of blood circulation intensity during the menstrual cycle.

Between the bunches of muscle cells, there are interlayers of the connective tissue, replete with elastic fibers. Smooth muscle cells of myometrium about 50 μm long during pregnancy are very hypertrophy, reaching sometimes in a length of 500 microns. They are slightly branched and connected by the process to the network.

Perimetry covers most of the surface of the uterus. Not covered with peritonean only the front and side surfaces of the overall part of the cervix. In the formation of perimetry, the mesothelium, lying on the surface of the organ, and loose fibrous connecting tissue, which make up a layer, adjacent to the muscle membrane of the uterus. However, this interlayer is not in all places. Around the cervix, especially from the sides and in front, there is a large cluster of the adipose tissue, which was called pyrometry. In other parts of the uterus, this part of perimetry is formed by a relatively thin layer of loose fibrous connective tissue.

Cervix ( cervix Uteri.)

The mucous membrane of the cervix is \u200b\u200bcovered, as well as the vagina, a multi-layer flat epithelium. The cervical canal is lined with prismatic epithelium, which secretes the mucus. However, the largest amount of secrets are produced by numerous relatively large branched glands, located in the stroma of the folds of the cervical canal mucosa. The muscular shell of the cervix is \u200b\u200brepresented by a powerful circular layer of smooth muscle cells, which make up the so-called uterine sphincter, with a reduction of the mucus of the cervical glands. With the relaxation of this muscular ring, only a kind of aspiration (suction) arises, contributing to the grip in the umbrella in the vagina.

Features of blood supply and innervation

Vascularization. The blood supply system of the uterus is well developed. Arterys carrying blood to myometrium and endometrial, in the circular layer of myometrium spirals are twisted, which contributes to their automatic compression when cutting the uterus. This feature is particularly important during childbirth, since the possibility of severe uterine bleeding is prevented due to the placenta separation.

Entering endometrials that bring arteries give the beginning of the small arteries of two types, one of them, straight, do not go beyond the boundary layer of endometrial, others, spiralSupplies with blood function layer endometrial.

The lymphatic vessels in endometrial form a deep network, which through the lymphatic vessels of the myometrium is connected to the outer network, located in perimetry.

Innervation. The uterus gets nerve fibers, mostly sympathetic, from the grave plexus. On the surface of the uterus in perimetry, these sympathetic fibers form a well-developed uterine plexus. From this surface plexus, sprigs are departed, supplying the myometrium and penetrating into the endometrium. Near the cervix in the surrounding fiber is a group of large ganglia, in which, in addition to sympathetic nerve cells, there are chromaffine cells. In the thickness of myometrium, ganglionary cells are absent. Recently, data is obtained indicating that the uterus is in practice both sympathetic and some parasympathetic fibers. At the same time, the endometrium discovered a large number of receptor nerve endings of various structures, the irritation of which not only causes shifts in the functional state of the uterus itself, but also reflected on many common features of the body: blood pressure, breathing, the overall metabolism, hormone-forming activities of the pituitary and other Endocrine glands, finally, on the activities of the central nervous system, in particular the hypothalamus.

Vagina ( vagina.)

The wall of the vagina consists of mucous, muscular and advential shells. As part of the mucous membrane, there is a multi-layered flat non-illuminating, in which three layers are distinguished: basal, intermediate and superficial, or functional.

The epithelium of the mucous membrane of the vagina undergoes significant rhythmic (cyclic) changes in the consecutive phases of the menstrual cycle. In the cells of the surface layers of the epithelium (in its functional layer), the grains of keratogial are minimized, but the total energization of the cells is not at normal. The cells of this epithelium layer are rich in glycogen. The decay of glycogen under the influence of microbes that always live in the vagina leads to the formation of lactic acid, so the vaginal muculence has a weakly acidic reaction and has bactericidal properties, which protects the vagina from the development of pathogenic microorganisms in it. The glands in the wall of the vagina are absent. The basal border of the epithelium is uneven, as the proper plate of the mucous membrane shapes the nipples of the wrong shape, walking into the epithelial layer.

The basis of the proper plate of the mucous membrane is loose fibrous connecting fabric with a network of elastic fibers. The own plate is often infiltrated by lymphocytes, sometimes single lymph nodes occur in it. The submucosal base in the vagina is not expressed and the own plate of the mucous membrane directly moves into the interlayer of the connective tissue in the muscular shell, which mainly consists of longitudinally reaching the beams of smooth muscle cells, between the beams of which in the middle part of the muscular shell there are a small number of circularly arranged muscle elements.

The adventitious wrapper of the vagina consists of a loose fibrous unformed connective tissue that connects the vagina with adjacent organs. In this shell there is venous plexus.

Some terms of practical medicine:

• hystero- (Greek. hystera uterus) - an integral part of complex words meaning "related to the uterus"; N.B. - The origin of the term "hysteria" also applies to the uterus;
• hysteroscopy (hysteroscopia.; hystero- + Greek. skopeo. treat, explore) - method of studying the inner surface of the uterus by examining it with a hysteroscope;
• metrosalpingography (Metro-Greek. metra. Matter + Anat. salpinx, salpingos. Column Pipe + Greek. gRAPHO. write, depict; syn. hysterosalpingography) - radiography of the uterine cavity and uterine pipes after filling them with a contrasting agent through the cervical channel;

Embryogenesis of pipes. The uterine pipes are derivatives of muller ducts. It is known that the embryo is about 8 mm long the development of muller ducts in the form of a groove on the outer surface of the primary kidney. A few later, the grooves deepen with the formation of the channel, the upper (head) end of which remains open, and the lower (tail) ends blindly. Gradually occurs the growth of tail pair of minor ducts by the book, while they are approaching the medial (median) embryo department, where they merge among themselves. The uterus and the top department of the vagina are subsequently formed from the spilled muller ducts. Thus, Muller Channels with growth first have a vertical, and then a horizontal direction. The place where the direction of their growth is shown, corresponds to the place of revering of the uterine pipes from the uterus.

The head ends of Muller Channels form uterine pipes with a hole - the abdominal holes of the pipes around which epithelial grows are developing - future phimes. Often with the main hole (funnel) several sidelies are formed, which or disappear or remain in the form of additional windows of the uterine pipes.

The lumen of the pipe is formed by melting the centrally located areas of the Muller's channel. Starting from the 12th week of embryonic development in the abdominal end of pipes, longitudinal folds are formed, which are gradually moving along the entire pipe and by the 20th week reach the uterine end (N. M. Kakushkin, 1926; K. P. Stroganova, 1939) . These folds, being primary, gradually increase, giving additional grows, lacuna, which necessitates the complex folding of the pipe. By the time of the birth of the girl, the epithelial fever of the uterine pipes forms cilia.

The growth of pipes in the embryonic period with simultaneously lowering the ovarian to the cavity of the pelvis leads to the spatial rapprochement of the uterus and pipes (the abdominal and uterine bodies of pipes are on the same horizontal line). This rapprochement causes the formation of torture, which gradually disappears. By the time of the birth of the girl, a tortuousness is determined only in the region of abdominal holes, it completely disappears on the occurrence of puberty (Fig. 1). The wall of the pipe is formed from the mesenchym, and by the 20th week of intrauterine development, all muscle layers are well defined. The mesenchymal part of the Wolf bodies and the abdominal epithelium (peritone) form a wide bunch of uterus and the outer (serous) cover of the pipe.

Congenital absence of both uterine pipes occurs in non-visual fruits with the anomalies of development and other bodies.

Although pipes and uterus are derivatives of mulle channels, i.e. they have the same embryonic source, when aplasia, the pipes are always well developed. There may be such congenital pathology, when a woman has no one ovary, there is an aplasia of the uterus and the vagina, but the structure of the pipes is normal. It may be due to the fact that the pipes are developing into a full-fledged formation in earlier stages of embryogenesis than the uterus and the vagina, and if they do not develop, the factors that caused this pathology simultaneously act on other foci of organogenesis, which leads to the emergence of deformities, incompatible with life.

At the same time, it is proved that with the anomalies of the development of the uterus and vagina, the embryonic development of vital organs and the central nervous system is mainly completed, therefore women with the anomalies of the uterus and the vagina in normal pipes are not so rarely.

Normal pipe anatomy. Starting in the corners of the uterus, the uterine tube (Tuba Uterina S. Salpinx) permeates the thickness of the myometrium almost in a strictly horizontal direction, then somewhat deflects the stop and upstairs and is sent as part of the top section of the wide bundle to the lateral pelvis walls, rich on the way the ovary. On average, the length of each pipe is 10-12 cm, less often 13-16 cm.

In the pipe distinguish four parts [show] .

Parts of the uterine pipe

1. intermediate (interstitial, intramural, Pars Tubae IntersTitialis), about 1 cm long, is located in the thickness of the uterus wall, has the most narrow lumen (about 1 mm),
2. armful (eastic, Isthmus Tubae), about 4-5 cm long and a lumen of 2-4 mm,
3. ampular (ampula Tubae), 6-7 cm long and a lumen, gradually increasing in diameter up to 8-12 mm as in the lateral direction,
4. the abdominal end of the pipe, which is also the name of the funnel (Infundibulum Tubae), is a short expansion discovering in the abdominal cavity. The funnel has several epithelial growths (Fimbria, Fimbria Tubae), one of which is sometimes a length of 2-3 cm, often located on the ovarian edge, is fixed to it and is called ovarian (Fimbria Ovarica)

The wall of the uterine tube consists of four layers [show] .

Molding Pipe

• Outdoor, or serous, shell (Tunica Serosa) is formed from the top edge of a wide uterine bundle, covers the pipe from all sides, with the exception of the lower edge, which is free from the peritoneal cover, since here the duplicature of the peritoneum is a wide bundle forms a mesentery of the pipe (Mesosalpinx).
• Pedaroic fabric (Tela Subserosa) - a loose coupling shell, weakly expressed only in the region of the iste and ampoules; In the uterine part and in the field of the pipe funnel, the suberotic fabric is practically absent.
• The muscular shell (Tunica Muscularis) consists of three layers of smooth muscles: a very thin outdoor - longitudinal, more significant average - circular and internal - longitudinal. All three layers are closely intertwined between themselves and directly switch to the corresponding layers of myometrium. In the interstitial pipe of the pipe, the thickening of muscle fibers is detected mainly due to the circular layer with the formation of the pipe sphincter (Sphincter Tubae Uterinae). It should also be noted that as the uterine moves to the abdominal end in the pipes, the number of muscle structures is reduced until almost their absence in the pipe funnel area, where muscle formations are determined as separate beams.
• The mucous membrane (Tunica Mucosa, Endosalpinx) forms four longitudinal folds along the entire length of the pipe, between which the secondary and tertiary smaller folds are located. This leads to the fact that on the section of the pipe has a festral shape. Especially a lot of folds in an ampular department and in the funnel pipe.

  The inner surface of the phimberry is lined with a mucous membrane, an outdoor - abdominal mesothelium, moving into a serous sheath of the pipe.

Histological structure of the pipe.

• The serous shell consists of a connective tissue of the base and mesodermal epithelial cover. In the connective tissue base, bugs of collagen fibers and fibers of the longitudinal layer of muscles are found.

  Some researchers (V. A. Tshstab, 1896) were found in serous, subero and muscular layers elastic fibers, while K. P. Ulzko-Stroganova (1939) denies their presence, with the exception of the walls of the pipe vessels.

• The mucous membrane includes a stromb consisting of a network of thin collagen fibers with spindle-shaped and overgrown cells, wandering and obese cells are found. High cylindrical mucosa epithelium with familiar cilia. The closer the pipe plot is located to the royal corners, the less the ciliation length and the height of the epithelium (R. N. Bubes, 1949).

  Research N. V. Yastrebova (1881) and A. A. Zavarzina (1938) showed that the glaired pipe mucosa does not have, the secretory elements are epithelial cells, which at the time of secretion are discouraged, and after release, they become narrow, elongated.

  S. B. Edelman-Reznik (1952) distinguishes several types of uterine pipes epithelial: 1) semi-cake, 2) secretory, 3) basal, 4) Cambinal, considering the last type of the main production of the remaining cells. Exploring in the culture of tissues Features of the epithelial of pipes, Sh. D. Galygyan (1936) found that it is strictly deterministic.

Repeatedly arose about the cyclic transformations of the endosalpincess throughout the two-phase menstrual cycle. Some authors (E. P. Maizel, 1965) believe that these transformations are absent. Other researchers found so characteristic of the epithelium of the pipes could make a conclusion about the menstrual cycle phase [show] .

In particular, A. Yu. Shmeil (1943) discovered the same proliferation processes in the pipes that are observed in endometrials. S. B. Edelman-Reznik determined that in the folliculine phase of the cycle there is a differentiation of the cambial elements in the semiconductors and secretory cells; At the beginning of the lutein phase, the growth of cilia is enhanced and a pronounced secretory swelling of cells is manifested; At the end of this phase, the reproduction of cambial cells is observed; Rejection of the mucous membrane of the pipe in the menstrual cycle does not occur, but they develop hyperemia, swelling and swelling of the stromium of endosalpinck.

It seems to us that by analogy with other derivatives of mulle ducts, in which cyclic transformations (uterus, vagina) are clearly recorded, cyclic transformations are made in the pipes, trapped with thin microscopic (including histochemical) methods. Confirmation We are in the work of N. I. Kondrikova (1969), which explored pipes in various phases of the menstrual cycle, using a number of various methods for these purposes. In particular, it was determined that the number of different ENDOSALPICTION epithelial cells (secretory, basal, flickering, pin-shaped) is not the same throughout the long tube. The number of fliccity cells, especially numerous in the mucous membrane of the phimberry and an ampular department, gradually decreases to the uterine end of the pipe, and the number of secretory, minimal in the ampular department and in the phimnia, increases towards the royal end of the pipe.

In the first half of the menstrual cycle, the surface of the epithelium is smooth, no pin-shaped cells, the amount of RNA by the end of the follicular phase is gradually increased, the glycogen content increases in fliccity cells. The secretion of the uterine pipes, which is determined throughout the menstrual cycle, is located along the apical surface of the secretory and flicker cells of the epithelium of the endosalpinse and contains mucopolysaccharides.

In the second half of the menstrual cycle, the height of the epithelial cells is reduced, pinch cells appear (the result of exemption from the content of secretory cells). The amount of RNA and the glycogen content decreases.

In the menstrual cycle phase, there is a non-terrible swelling of the pipe, there are lymphocytes, leukocytes, red blood cells, which allowed some researchers to name such changes in "physiological endosalpinting" (NASBERG E.), with which N. I. Konders (1969) is not true Agree, relating similar changes to the endosalpinse reaction to enter the erythrocyte tubes.

Blood supply of uterine pipes [show] .

The blood supply to the uterine pipes occurs at the expense of the branches of the royal and ovarian arteries. O. K. Nikonchik (1954), using the method of thin-casting vessels, found that there are three options for blood supply pipes.

1. The most commonly found such a vascular supply when the pipeline is moving in the bottom area from the bottom branch of the uterine artery, then passes through the lower edge of the pipe and supplies the proximal half it with it, while the ampular department gets a twig that leaves the ovarian artery in the ovarian gate area.
2. It is less common when the pipe artery is moving directly from the uterine in the area of \u200b\u200bthe bottom branch, and the branch of the ovarian artery is suitable for an ampular end.
3. Very rarely pipe all over the entire extent is supplied with blood due to vessels that are separated only from the uterine artery.

Throughout the tube, the vessels have predominantly perpendicular to her long direction and only the most Fambri takes the longitudinal direction. This feature of the architectonics of vessels should be taken into account in conservative operations on pipes, at stomatoplasty (V. Pichuyev, 1961).

The venous pipe system is located in the suberozic and muscle layers in the form of plexuses that are mainly in the course of a round uterine ligament and in the mesosalpinse area.

Lymph from all layers of the fallopian tube is assembled into subserosaceous plexus, from where after 4-11 extraorganic disgusting lymphatic vessels is sent to the sublictic lymphatic plexus, and then in the course of the ovarian lymphatic vessels to para-soldered lymph nodes. Outdoorian architectonics of the lymphatic vessels of the fallopian tubes, as shown by L. S. Umanskaya (1970), is quite complex and in each layer has its own characteristics, it changes and depending on age.

Innervation of uterine pipes [show] .

The innervation of uterine pipes was studied in detail by A. S. Blind (1960). According to him, the main source of innervation should be considered a repayment-vaginal plexusion, which is part of the pelvic plexus. Most of the source is internal portion of the uterine pipe, with the exception of the fimbrial end.

Postganglionic fibers, emanating from the uterine-vaginal plexus, reach the uterine pipes in two ways. For the most weight, they, taking the beginning in the ganglia, located on the sides of the cervix, rise up on the posterior wall of the uterus and reach the tubing angle, where they change their direction to the horizontal, making the bend at right angles. These nerve trunks give fibers suitable to the pipe, and branch up in the thickness of its wall, ending on the epithelium in the form of butt-shaped thickening. Some of the nerve fibers, leaving the same ganglia, is sent directly to the free part of the pipe, following between a wide bundle sheets parallel to the edge of the uterus.

The second source of innervation of uterine pipes is the ovarian plexus, which, in turn, is derived from the caudally located ganglia of the solar plexus.

The third source of innervation of uterine pipes - the fiber of the outer seed nerve.

The largest number of nervous fibers have an interstitial and foreform part of the pipe. The innervation of uterine pipes is mixed, they are obtained both sympathetic and parasympathetic fibers.

Kubo et al. (1970) they expressed the idea of \u200b\u200bthe autonomy of the innervation of uterine pipes. They examined pipes in 16 women aged 22 to 41 years. It has been established that the fluorescence of norepinephrine is different in fimbrial, ampular and foreframes and is not observed in the endosalpinse (epithelial cells). Holinesterase, usually detected in nerve fibers, rarely detected in ampular and fimbrial departments. Monoaminoxidase was found only in the cytoplasm of epithelial cells. These data served as the basis for the conclusion of the authors that the muscular fabric of uterine pipes is similar to the muscular tissue of the vessels and that the transfer of pulses in the nerve endings is likely to have adrenergic nature.

Physiology of uterine pipes. The main function of the uterine pipes should be considered the transport of a fertilized egg to the uterus. Back in 1883, A. Affitations found that the advancement of the egg takes place is not passively, but through the pipe peristalsis.

The overall picture of the contractile activity of the uterine pipes can be represented as follows: peristaltic cuts of pipes occur with the overall wave of peristaltics directed to the ampoule or the uterus, the pipes can perform the pendulum movements, the ampular department is a complex movement, denoted as a turbine. In addition, thanks to the abbreviations of a predominantly ring layer of muscles, a change in the lumen of the pipe itself, i.e. the reduction wave can move along the axis of the pipe, then increasing the tone in one place, then reducing it in the other.

Already in the earliest stages of studying the transport of eggs in the pipes, it was found that the nature of pipe cuts, its movement in space is dependent on the influence of the ovary. So, in 1932, Dyroff found that the woman's pipe for the ovulation period changes its position and shape, the funnel expands it, the phimes cover the ovary and the egg at the moment of ovulation falls directly into the lumen of the pipe. This process was called the "Egg Perception Mechanism." The author found that an average occurs to 30-40 pipe cuts per minute. These data were confirmed by a number of other studies.

A very significant contribution to this section was introduced by A. I. Osyakina-Christmas (1947). Using the Cerera Magnus technique, it discovered that if there are no influences of the ovary (menopause), the pipe does not respond to irritation and is not reduced (Fig. 2). In the presence of growing follicles, the tone and the excitability of the pipe increases sharply, the pipe reacts to the slightest exposure to changes in the number of abbreviations and the movement of intrigues, lifting and reliefing towards the ampular end. Abbreviations often become spastic, without a wave aimed at the abdominal or uterine department, i.e. there are no contractions that could provide an egg progress. At the same time, it is established that the movement of the ampoule can provide the "phenomenon of the perception of eggs", as the ampoule in response to irritation approaches the ovary (Fig. 3).

If there is a functioning yellow body in the ovaries, the tone and the excitability of pipes are reduced, and muscle contractions acquire some rhythm. A wave of reduction can move along a long, for example, a poppy grain passes during this period through the middle and foreskin departments for 4-6 h (Fig. 4), while in the first phase of the cycle, the grain almost does not move. Often, during this period, the so-called peculiar wave is determined - from the ampoule of the pipe to the uterus.

A.I. The okey-Christmas-christmas is also found that, depending on the predominance of this or another ovarian hormone, various deviations in the rhythm of the engine function are possible.

R. A. Osipov (1972) conducted experimental observation on 24 uterine pipes remote during the operation. The spontaneous reductions and the influence of oxytocin and electrostimulation on them with a pulsed direct current are studied. It was found that under normal conditions in the first phase of the cycle, the longitudinal is most active, in the second phase - circular muscles. With the inflammatory process of reducing the pipe muscle weakened, especially in the second phase of the cycle. Stimulation of reduction in oxytocyne and pulsed electric shock turned out to be effective.

Similar studies were conducted in women with kimographic perturbation. The resulting tubograms were evaluated by the magnitude of the tone (minimum pressure), at maximum pressure (maximum amplitude), in the frequency of abbreviations (the number of abbreviations per minute). In healthy women (control group), spontaneous cuts in pipes in the first and second phases of the menstrual cycle were directly dependent on the hormonal activity of the ovaries: in the first phase they were more frequent, but weaker than in the second, tone and maximum amplitude compared to the second phase Were higher. In the second phase, the reduction was more rare, but strong, the tone and the maximum amplitude decrease (Fig. 5).

The inflammatory process caused a decrease in the frequency and strength of abbreviations. Oxytocin has improved pipe cuts only in women with unchanged tone; In the presence of Saktosalpimks, oxytocin did not affect at all. Similar data obtained and with respect to electrical stimulation.

In 1974, Hauschild and Seewald repeated the experiments A. I. Ojakina-Christmas on pipes remote during operations in women. They showed that antispasmodic agents cause almost complete braking of contractual activity of pipes. In addition, it was found that the intensity and amplitude of spontaneous contractions was the highest during pregnancy and the lowest in women in the menopausal period.

The mandatory participation of the ovarian hormones in the implementation of the motor function of the pipes confirmed other studies performed at a later time. So, E. A. Semenova (1953), applying the method of kimography, found a high tone cycle in the first phase, and the antiperistalistic nature of abbreviations, in which the movement of iodolipol in the abdominal cavity occurred very quickly, in the second phase it was delayed due to peristaltic pipe cuts Direction from ampular end to the foreform.

Blanco et al. (1968) conducted a direct study of the reductions of the fallopian tubes during operations in 13 patients. A method of direct registration of changes in innder-tube pressure was used by introducing a thin catheter into the pipe filled with saline. The cuts of pipes had a certain rhythm, every 20 with intra-tube pressure increased by about 2 mm RT. Art. Periodically, this basal activity was interrupted by the appearance of 1-3 more intensive abbreviations, and an increase in the tone of the tubular muscles, which gives a wave with a duration of 6-8 minutes. In several cases, at the same time the intrauterine and intra-tube pressure was recorded: any parallelism between the cuts of the uterus and the pipes was not detected, but when the contraceptive in the cavity, the contraceptive was noted a sharp increase in pipe cuts, an increase in their tone. An intravenous administration of oxytocin has a similar effect.

Coutinho (1973) found that the contractile ability of longitudinal and circular muscle fibers autonomous. The shortening of the pipe as a result of the reductions of the longitudinal layer asynchronously narrowing its lumen caused by the reduction of the circular layer. The latter is more sensitive to pharmacological stimulation by adrenergic agents than the longitudinal layers.

In 1973, A. S. Pekki, applying the method of film-changing simultaneous observation on the television screen, determined that in the second phase of the menstrual cycle, on the one hand, the relaxation of uterine pipe sphincters, on the other - the slow motion movement of iodolipol in pipes. It was created that the movement of the contrast agent in this cycle phase occurs due to the pressure created in the injection of the liquid, and not its own pipe cuts. Such a state is quite explained by the fact that in the second phase of the cycle, the wave of pipe cuts is directed mainly to the uterus.

ERB and Wenner (1971) studied the impact of hormonal and neurotropic substances on the reduction in the uterine pipes. It turned out that the sensitivity of the tube muscles to adrenaline in the secretion phase is 9 times lower than in the proliferation phase. This reduction depends on the level of progesterone in the blood. Comparison of pipe reaction with the reaction of myometrium revealed their identity in responses to neurotropic effects. In the phase of the secretion of pipe movement and sensitivity to acetylcholine, the ovarian hormones do not oppress.

Special kimographic studies of the function of the uterine pipe sphincter, depending on the use of hormonal and intrauterine contraceptives, KAMAL (1971) were carried out. It was found that the introduction of steroids increases the tone of the sphincter, and intrauterine contraceptives are able to cause its spasm.

Interesting observations of Mikulicz-Radecki, which during operations observed that by the time of the ovulation of the furgling of the pipe due to the strengthening of blood supply to swell, they become elastic and covered the ovary, which ensures eggs after breaking the follicle directly into the lumen of the pipe. These were confirmed Dyroff data (1932).

It is possible that in the mechanism of the perception of the egg plays a certain role and the current of the fluid arising after ovulation and directed towards the phympria. At the VII International Congress in Fruitness and Infertility (1971), a movie was shown in which the moment of ovulation in animals was filmed. It was clearly visible, as a broken follicle literally flies the egg, surrounded by granolascent cells, and how this tangle is directed towards the fiber of the pipe, located at some distance from the follicle.

It is important to the question of the time during which the egg cell, which fell into the pipe moves into the uterus. Croxato and Fuentealba (1971) Detected the time of transport of an egg from the ovulating ovary to the uterus in healthy women and those who were treated by acetate Megastol (Progestin). It turned out that healthy women have the smallest duration of the egg transport amounted to 3 days, the largest - 4 days after ovulation, whereas when receiving Megorstol, this duration increased to 8 days.

In recent years, attention has been attracted to the study of the role of prostaglandins in the reproductive function of the woman. According to the Pauerstein literary summary, it has been established that Prostaglandin E causes the relaxation of pipes, while Prostaglandin F stimulates their contractile activity in humans. The reaction of the muscle tissue of the uterine pipes into prostaglandins is depending on the level and nature of steroids produced by ovaries. Thus, progesterone increases the susceptibility of the uterine pipes to the action of prostaglandin E 1 and reduces it to the prostaglandin F 2α. During the preventive increase in estradiol content, the synthesis of prostaglandins in the uterine pipe tissue is enhanced. This process achieves the highest level by the time when the Effective Division of Eggs becomes the most sensitive to the effects of Prostaglandin F 2α. The development of this mechanism leads to an increase in the muscle tone of the exhaust pipe and the closure of them, which prevents the premature receipt of the fetal egg to the uterine cavity. Increased progesterone products enhances susceptibility to prostaglandin, it causes the opposite state of muscle tissue of the Eggs of the Eggs and contributes to the arrival of a fetal egg in the uterus.

Thus, the transport of eggs from the ovary in the uterus is carried out due to the active cuts in the muscles of the pipes, which in turn under the influence of the ovary hormones. These data simultaneously explain such a large difference between the frequency of restoring uterine pipes under the influence of conservative or surgical treatment and frequency of pregnancy. Little to restore the permeability, it is necessary to save or restore the transport function of the pipe.

Does any role of cilia of the flicker epithelium play in the movement of an egg? Opinions on this issue are different. Some authors believe that cilia contribute to the movement of the egg, while others deny this possibility.

N. I. Kondrikov (1969), based on the definition of the characteristics of the structure of various departments of uterine pipes and detecting the various composition of the secret of the epithelium, comes to the same opinion that Decker expressed. It comes down to the fact that different parts of the pipes are inherent in various functions: FMMMI, apparently, is carried out by the grip of eggs, a complex branchy relief of the folds of the mucous membrane sheath of an ampular department contributes to the egg cavitation (release from the shells, ripening); The functional importance of the igrant department is the secretion of substances necessary for the vital activity of the fetal egg.

Mognissi (1971) believes that the uterine pipes not only perform a transport function, but also the place in which the egg cell and developing embryo is powered in the first stages due to intratubar fluid. In the latter, the author defined protein and amino acids. The total amount of protein turned out to be equal to 3.26%. Immunoelectroporetical study of fluid revealed the presence of 15 types of proteins. Α-glycoprotein was discovered, which is absent in the blood and therefore can be attributed to a specific pipe protein. 19 free α-amino acids were also detected. The content of amino acids in the intratubar fluid was higher in proliferative and lower - in the lutein phase of the menstrual cycle.

Chang studies (1955), etc. showed that there is a special phenomenon of spermatozoa ripening, which is happening in the genital female trait and called by clause. Without the process of ripening it is impossible to penetrate the spermatozoa through the egg shell. The time that is required for claying from different animals is different and ranges from 4 to 8 hours. Edwards et al. (1969) found that human-like monkeys and man also occur also a cycling process, in which at least two factors participate: one of them has an impact in the uterus, the other is in the eggs. Thus, another factor has been established that affects the phenomenon of fertilization and the origin of which is associated with the function of pipes.

So, the uterine pipes carry out the function of the perception of an egg, in which it occurs its fertilization and they also carry a fertilized egg to the uterus; During the passage of pipes, the egg cell is located in a medium that supports its livelihood and provides optimal conditions for the initial stages of the embryo development. These conditions can be observed in the anatomical and functional fullness of the uterine pipes, which depends on the correctness of their structure and normal hormonal activity of the ovary.

Pathological anatomy and physiology of pipes. Congenital absence or underdevelopment of one of the pipes occurs extremely rarely. The underdevelopment of both pipes is necessarily combined with uterine hypoplasia, ovaries. A characteristic feature of the pipes in this case is the preservation of spiral winding and a higher arrangement of ampular departments compared to the norm. Pipes are located not strictly horizontally, but have oblique (up) direction and are called infantile. Due to insufficient contractual activity during salpingography, the contrast agent in a similar pipe is not divided into separate sections, the diameter of the lumen of the pipe all over the same way. With aquailography (A. S. Pekki), the contrast agent is poured out of the ampoule not frequent drops, but a thin, slowly moving trickle. The described picture normally happens in girls to the period of puberty.

In menopause, pipes become subtle, straight, with sluggishly lowered to the depth of pelvis by ampular departments, they do not react to mechanical and other irritations, the contrasting agent moves only due to the increasing pressure in the filled uterus.

Thus, in some cases, the inferiority of the development and function of the normal pipeline can be the cause of infertility at the soil of the egg traffic disorder. However, the main reason for the impairment of the uterine pipe function should be recognized by the anatomical changes, developing directly in the layers of the pipe or in the surrounding (or close to pipes) tissues and organs. To such reasons, first of all, it is necessary to include a variety of inflammatory changes.

Features of the topography of pipes cause their most frequent damage to the inflammatory process. This equally applies to specific diseases (tuberculosis) and a total septic infection.

In the development of an infectious inflammatory process, it is primarily an endosalpingitis. Due to the thin wall of the pipe, the change is very quickly distributed to its muscle and serous layers, which leads to the development of salpingitis. At the beginning of the inflammation of the peritoneum, the process also spreads to the entire pipe. The appearance of the pipe is changed: it is unevenly thickened, it becomes a clear-like species, drove, in the course of the channel, closed cameras can form, since swelling of the folds of the mucous membrane can, the lunch of the epithelium leads to the folding of the folds among themselves.

At first, with inflammation, hyperemia and tissue swells arise with the formation of leukocyte or lymphocytic infiltrates, located mainly on the tops of the folds of the mucous membrane, the fine-cell infiltrate penetrates into muscle layers, in the lumen of the pipe accumulates with a large admixture of the destroyed epithelium. When an acute period, the leukocyte reaction decreases and monocytoid and plasma cells are beginning to prevail in infiltrate, as well as lymphocytes. In the chronic stage in the endosalpinse and in muscle layers, small-cell infiltrates are determined, located mainly around the vessels whose intima is thickened (endovasculit). The swelling of the pipe layers is expressed slightly, but the configuration of the increasing mucosa changes - they become flattened, and sometimes glued together. In some cases, epithelial islands penetrate into muscle layers.

N. I. Kondrikov (1969) in chronic salpingitis found morpho-functional changes in all layers of uterine pipes. As the progression of the chronic inflammatory process is progressing, collagen fibers increase in the stroma of the folds of the mucous membrane, the muscular wall of the uterine pipes and under the serous cover. Blood vessels are gradually subjected to obliteration, and acid mucopolysaccharides are accumulated around them. Functional changes are developed, expressed in reducing RNA and glycogen levels and reduce the content of glycoproteins in the secrecy of the uterine pipes. All these changes may disrupt the transport of an egg or cause its death.

Finally, it is necessary to dwell on the consequences of the inflammation in the form of scar-and-bearing changes. If, with an inflammatory process, there were no sections of significant necrosis in the pipe, there is a gradual restoration of the mucous membrane with the restoration of the pipes and its function. If the process of tissue destruction was significant, inflammation ends with a scarring.

V. K. Rymashevsky and D. S. Zaprudskaya (1975) studied the content of acidic mucopolysaccharides in 43 uterine pipes remote in women with chronic salpingooforitis. It turned out that with a relatively low duration of the disease, their content is quite high, and then somewhat decreases. With the duration of the disease up to 10 years and more it rises again, which confirms the inflammatory and gradually increasing disorganization of the connective tissue.

L. P. Drobyzko et al. (1970) We subjected to serial microscopic examination of 32 uterine pipes, remote during operations about infertility. According to the nature of the morphological changes, three groups are highlighted in the walls of the uterine tube.

In the first group (8 observations), macroscopically uterine pipes were winding pipes, slightly thickened with the presence of dense blocks of the peritoneal cover. With microscopy, the intelligence of the uterine pipe was deformed, the folds of the mucous membrane of some - where hypertrophies, branching, in places struck each other; In some cases, the mucous membrane of the pipe was somewhat atrophing, with poorly developed folds. Muscular layer mainly without features, sometimes atrophig. From the side of the peritoneal cover in some cases, moderate edema and fibrin sediments were revealed, in others - extensive sprouting of connective tissue. In all cases, moderate lymphocytic infiltration is noted. Thus, in this group there were phenomena of chronic salpingitis with more or less pronounced structural changes that prevail in the mucous membrane and serous shells of the uterine tube. It should be noted that most women of this group had no data on the transferred inflammatory process of genitals, infertility was more often a secondary, duration up to 5 years.

In the second group (11 observations), pronounced macroscopic changes of uterine pipes were noted: the presence of peritabar battles distorting the shape of the pipe, focal seals with the lumen of the lumen of the pipe or in places with its expansion. Microscopically, the deformation of the lumen of the pipe was observed. The folds of the mucous membrane in some areas were atrophichnically, in places in the form of branched expansions performed into the extended lumen of the pipe. Often they were hypertrophyed, edema, struck with each other, formed closed small cells filled with serous exudate. In small cells, the metaplasia of the cylindrical epithelium into cubic, in large - in flat style. In most hypertrophied folds, an overpressure of connective tissue with a plurality of newly formed small vessels is noted. In the sublifted layer expressed phenomena of sclerosis. The muscular layer is unevenly developed - places atrophigne, places hypertrophied with interlayers of connective tissue of varying degrees of maturity. Sometimes there were scattered, different magnitude and forms of anti-cubic epithelium in the muscular and stratin layers. On the same background there is a significant number of lymphatic slots and a different caliber of blood vessels, more small, with a thickened sclerized wall. In the peritoneal cover, the excess breakdown of the connective tissue was observed. In all layers of the pipe wall, focus lymphoid infiltration was essential with the presence of single plasma cells. In some cases, the accumulations of neutrophilic leukocytes, eosinophils were found. Consequently, in the second group, phenomena of chronic salpingitis with pronounced sclerosis of all layers of the pipe wall, especially mucous membrane and submissible are noted. In this group, more than in the first, the adhesive process of the peritoneal cover, deformation and obliteration of the lumen of the pipe are expressed. All women of this group were postponed in the past at the presence of the appendages of the uterus. Most of the infertility was primary, some - secondary, after transferred abortion. The duration of infertility is 5 years and more.

In the third group (13 observations) of the macroscopically, the walls of the fallopian tubes were thickened, the fimbrial ends are posted. More often than in the previous group, there were focal seals, narrowing, and sometimes obliterating the lumen of the pipe. The adhesion process was more common with the involvement of uterus and ovaries. With microscopic examination of the folds of the mucous membrane, all trades were thickened, resulting from each other. In places of the greatest thickens of the pipe, its lumen is either absent or was narrowed and deformed. As a result of the battles, the mucous membrane formed networking structures, their epithelium was flattened. Cells are made with a small number of cells of the raised epithelium, red blood cells, leukocytes. Muscular layer is hypertrophied, part of atrophically with an overhaul of the connective tissue of varying degrees of maturity: in the form of the delicate, network-shaped fibrils, then more coarse and thickness with signs of hyalinosis. In the muscular and abnormal layers, scattered, various forms of cystal formations were often encountered, rounded, oval, jealous. The walls consisted of the connective tissue of the base, were laid out with cubic or flat epithelium, a serous secret was revealed in the lumen with a small number of shaped elements. Along with this, a large number of lymphatic cracks and a different caliber of blood vessels, more often than small ones, was noted. The walls of the vessels are thickened due to the development of coarse connecting gkani with partial hyaline and the almost complete absence of smooth muscle elements. From the side of the peritoneal cover, there was a massive development of fibrous tissue with significant hyaline. In some preparations, concentric deposits of lime (psammozny tales) were met in the mucous membrane and submembrance of the layers. All layers had uneven lymph and leukocyte infiltration. In some cases, focal accumulations of leukocytes were observed.

In the third group, rather coarse morphological changes were found: sharply pronounced deformation, more often the lack of a lumen of the pipe as a result of the growth of the mucous membrane, significant sclerosis of all layers of the sump tube wall, smaller and massive development of fibrous tissue in the peritoneal cover. In each observation of this group, cystal formations were noted in the muscular and stiffitish layers, fibrosis and hyaline vascular walls.

In some cases, the phenomenon of purulent salpintingitis, combined with rude irreversible changes in the wall of the pipe with rude irreversible changes.

All patients of this group moved inflammation of uterus's appendages with pronounced clinical manifestations. In some women, the disease was long and often aggravated, some in the past had purulent inflammation of the appendages of the uterus. Infertility, both primary and secondary, lasted from 6 to 9 years.

Bidges of pipe formations (SACTOSALPINX) arise as a result of gluing frmps among themselves and closing the lumen of the pipe in an ampular separation. In this case, inflammation products are delayed, stretching the resulting cavity sometimes to quite large sizes. According to the nature of the content, pyosalpinx (PM), hydrosalpinx (serous fluid), hematosalpinx (blood), oleosalpinx (oral contrasting liquid introduced with a radiographic study). The walls of the bag formation may have different thickness; As a rule, the inner surface is either a velvety, somewhat thickened or, on the contrary, an atrophied en-dallypinx without folds.

Pipe-ovarian inflammatory formations arise due to topographic proximity of pipes and ovaries, the community of their blood and lymphatic systems. Sometimes, when inspection it is difficult to distinguish between the borders of pipes and ovaries in these conglomerates, often involving common inflammatory cavities for them.

It is difficult to identify any specific pathological changes in pipes, pathognomonic for a certain type of infection, with the exception of tuberculosis, in which these changes are very characteristic. From the organs of the sexual system, tuberculosis is striking the pipes most often. As a rule, the process begins with the defeat of phimbry and their gluing, which leads to the formation of a sashosalpinx with the accumulation of decomposition products (caseaseous masses). Very quickly in inflammation involve a muscular layer and a serous shell. Detection in this period of elements of productive inflammation - specific granuloma - is undoubted proof of the current tuberculosis process. It is much more difficult to diagnose posttuberculosis phenomena, when scarring, sclerosing changes covering all layers of pipe come to replace infiltrative and productive. Sometimes obstructed foci are found.

The patency of pipes may affect the foci of endometriosis, the development of which is associated with the endometrium implantation in the pipes due to the antiperistalistic cast of menstrual blood or intrauterine manipulations (scraping of the mucous membrane, purge, hysterography, etc.). Endometrium heterotopia in pipes whose frequency in recent years increases, can cause infertility (complete occlusion of the pipe) or the development of tubular pregnancy.

The change in the conditions of the transport of an egg cell due to the immediate change of the lumen as a result of the development of the tumor process inside the pipe occurs relatively rarely. Single cases of detection of fibromics, mixing and lymphangiomas of uterine pipes are described.

The lumen of the pipe, its length, the location in space may vary in tumor processes in the uterus (fibromyoma) or ovaries (cystoma), when, on the one hand, the topography of the organ changes, on the other, the resulting effect of the tumor itself affects. Changes in pipes in these cases will depend on the change in the form and volume of neighboring organs.

To determine the cause of ectopic or frozen pregnancy, doctors can be directed to analyze histology. With this method, it is possible to know why deviations occur in the body.

Very often, for setting a more accurate diagnosis in gynecology, the doctor sends a patient for analysis on histology. It is in this medical field that such a study helps with the definition of an accurate diagnosis and causes of the appearance of a disease or pathology. There are certain testimony by which the doctor sends to histology, for example, after scraping frozen pregnancy. The most popular reasons for analysis are:

• To identify the presence of an inflammatory process, malignant tumor;
• Interrupted or frozen pregnancy;
• Determination of the nature of the neoplasm: cysts, polypa, papillom;
• After scraping the uterus;
• Determination of the cause of female infertility;
• Study of the pathologies of the cervix and other readings.

Deciphering the result of histology in gynecology

If you have surrendered fabric samples to explore the State Hospital, then you will learn about the results in the doctor's office. In the event of an analysis in a private clinic, the conclusion will be issued to you. But independently you will not be able to decipher the histology, and it does not matter, after frozen pregnancy or for other indications there was a study. On the form you can read your data, which drugs were used to conduct analysis, and the results will be indicated below in Latin. In conclusion, not only detected malignant cells will be indicated, but also all identified tissues. Depending on the testimony for histological examination, different data will be indicated. For example, in the results of histology after measuring pregnancy or after the study of the uterus, due to infertility, the reason for this pathology will be indicated in addition. Only a medical specialist can decipher the conclusion. He will give the necessary recommendations for subsequent treatment.

Histology when measuring pregnancy

Not always the pregnancy ends favorably. There are reasons for the interruption of pregnancy. Measuring pregnancy recently becomes a popular phenomenon. The fruit ceases to develop, but the miscarriage may not occur until certain points. To understand the reason, the analysis of histology after measuring pregnancy. This procedure is done to identify the cause of unpleasant pathology immediately after cleaning the uterine. The fabrics of the dead embryo are investigated, but in some cases specialists can take uterine epithelium or uterine tubes for analysis. The histology of the fetus after frozen pregnancy will be able to show the real cause of pathology, which can be eliminated using medicines.

Histology ovarian cysts

In gynecology there are many diseases that can lead to serious complications, including infertility. The cyst of the ovary in some cases is evident asymptomatic and can be detected either when accidentally examined, or when manifest pronounced symptoms. The removal of cyst can occur by different methods, but the laparoscopy is most often used. After removing the neoplasm, it is sent to histological examination. The results of histology of ovarian cysts are usually ready after 2-3 weeks. They will allow to find out the nature of education, whether it was malignant, as well as the doctor will prescribe the necessary treatment.

Histology of ectopic pregnancy

Ovulation of an egg can occur not only in the uterus, but also in the uterine tube. In this case, the probability of developing the fetus and favorable pregnancy is zero. When discovered ectopic pregnancy, experts hold a special procedure called Laparoscopy. From the uterine tube, it is deleted all the excess and tissue samples for a histological examination. Histology after ectopic pregnancy will be able to determine the cause of the development of pathology. Most often, the results show that in the uterine pipes there was an inflammatory process. But there are other reasons for ectopic pregnancy, which can identify histological examination.

THE FALLOPIAN TUBES (tubae Uteri., salpinx; syn.: fallopiev pipes, eggs) - A pair tubular organ that performs the functions of transporting egg and spermatozoa, creating a favorable environment for the process of fertilization, the development of eggs in the early periods of pregnancy and promoting the introduction of the first days of development in the uterus.

Embryology

In embryos 8 - 9 mm of length at the cranial department of the primary kidney over the gonads laying, symmetrical invagination of the niculic epithelium in the mesenchym at the level of the first vertebra appears. These areas form blind tubes that grow along the primary kidney ducts, forming paramsemenephral (Muller's) channels (Fig. 1, a); The cells of the lining their epithelium acquire an elongated shape, and the epithelium becomes later false-row. Paramesenefral channels (Dukes, T.) pass in parallel with primary kidney ducts from the lateral side and are somewhat outside of them and open into the clock with separate holes. At the opposite end, the channel ends with a blind expansion. This end continues to grow and then acquires clearance. Uterine, uterine pipes and the upper part of the vagina are developing from paramenephral channels; M. t. Forms from the upper third of the paramesonephral channels. Within 11 -12 weeks. The intrauterine development from the clusters of the mesenchyma around these channels is formed muscular and connective layers of their walls. All structural elements of the wall M. t. Clearly determined by 18-22 weeks. intrauterine development; During this period, longitudinal folds of the mucous membrane are already well expressed (Fig. 1, b). By 28 weeks. The folds are increasing, and in a newborn girl the mucous membrane M. t. Already represented by tree formations, epithelium is a single-layer prismatic form (Fig. 1, B, g). The first cilia on the cells of the epithelium of frozen pipes appear on 16 weeks. intrauterine development. The maximum development of the epithelial layer of the mucous membrane M. t. Reaches on the 30-31st weeks. intrauterine development. Muscular shell M. T. develops simultaneously with the muscular sheath of the uterus from the mesenchym, surrounding the paramzenefral channel. Circular, and then the longitudinal muscle layers are formed by the 26-27th week. In the outer connectivecloth layer, vessels develop; Later, this layer decreases in volume. The left tube (as well as the ovary) is developing slightly later.

Age peculiarities

By the time of birth, the formation of M. t. Anatomically mainly ends; The pipes have a view of convulsions with a length of about 3 cm. Histologically formed three shells, but the mucous membrane has not yet mature, the differentiation of its components is not completed. The formation of the outer longitudinal layer has not yet been completed in the muscular sheath. In the carriage of M. t. You can note 4-5 low primary folds, through the pipe to the ampoule, the folds are becoming higher and branched. The height of the epithelium cells increases towards the abdominal hole M. T.; Especially many high cylindrical cells with narrow elongated nuclei and single flicker cilia, often glued together. Secretor major cells with lighter nuclei are more often found at the base of the primary folds, while on top of the folds they are single. In low, small, with large nuclei and light bubble cytoplasm cells, figures of mitotic divisions (Cambinal elements) are found. The connecting tissue is formed by gentle collagen fibers and a large number of cellular elements, rich in chic-positive substances and acidular mucopolysaccharides. Subsequently, especially during puberty, M., as well as all separations of the sexual system, significantly increase, although under adverse conditions the infantile type M. t. May remain in an adult girl and women.

Anatomy

One end of M. t. Opens in the uterus - the winding hole of the pipe (Ostium Uterinum Tubae), and the other (free) ending hole (Ostium Abdominale Tubae Uterinae) - in the abdominal cavity near the ovaries (Fig. 2) and during ovulation Tightly touch with the ovary. Each pipe is enclosed in the abdominas fold, which makes up the top of a wide bundle of the uterus and the name of the mesentery of M. T. (Mesosalpinx). More often the length of M. T. The adult woman is equal to 10- 12 cm, right M. t. Usually somewhat longer than the left; M. t. May have options for the structure. The following departments distinguish: Part M. T., concluded in the wall of the uterus - the uterine part (Pars Uterina); Isthmus Tubae Uterinae) - a narrow department closest to the uterus (dia.-3 mm); Ampoule M. T. (AMPULLA TUBAE Uterinae) - the department following the curtain of the dodge, gradually increasing in diameter (6-10 mm) and the component of half the length of the entire M. T.; The distal end of M. t., expanding to the funnel of M. T. (Infundibulum Tubae Interinae), is the immediate continuation of the ampoule, the free edge of the frog ends with numerous turbine-frowns (Fimbriae Tubae). One of the ovarian fringe (Fimbria Ovarica), the longest and large, stretches in the folds of the peritoneum to the ovary itself, approaching his pipe end. The abdominal hole M. t., Diaz, to-now 2-3 mm, is usually closed, the opening of the lumen is associated with the processes of ovulation. Through M. t., And then the uterus and vagina abdominal cavity communicates with the external environment.

Blood supply M. t. Occurs due to 3-4 sprigs coming from the tubular and ovarian branches of the uterine artery (a. Uterina), which occur in the mesentery of M. t. Vienna in the mucous membrane of the funnel near its outer edge are arranged ring-shaped and enter the fringe. At the time of ovulation, the veins are overwhelmed with blood, fringe M. t. At the same time, the funnel is strained and the funnel approaches the ovary, covering it. Lymph, vessels follow mostly in the course of the blood, heading to the inner iliac (NODI Lymphatici ILIACI INT.) And inguinal (nodi lymphatici inguinales) lymph, nodes. M. t. Innervated from the branches of pelvic and ovarian plexuses (Plexus Pelvicns Et Plexus Ovaricus).

Histology

The wall M. T. consists of three shells: mucosa, muscle and serous (color. Fig. 5). The mucous membrane of M. t. An adult woman has a protrusion in the form of long longitudinal folds along the entire length of the pipe, there are shorter transverse folds between K-Ry. On the cross section, each fold has the form of a branched tree (Fig. 3). In the ampoule M. t. Folding is most pronounced, in the uterine part it is insignificant.

The mucous membrane consists of epithelium and loose connective tissue - the own plate of the mucous membrane (Lamina Propria Mucosae). Epithelium - single-layer cylindrical; It distinguishes four types of cells: flickering, secretory, basal (indifferent), pine-shaped (so called. Red-cells); The number of cells varies depending on the phase of the menstrual cycle (see). Cleaning cells make up half of all cells; They are all through M. T., the number of them increases towards the ampoule. These cells contain cilia, fewer orgelles and inclusions compared to secretory. In the pre-deputy period, the number of ciliations increases, their movements are recorded. Secretor cells are part of the epithelium of all departments of M. t., Their number increases, but the direction to the royal end. Cyclic changes in the structure of secretory cells are significant; In the first half of the menstrual cycle, their size and number of organelles, especially mitochondria, increases, a large number of pellets appear. The maximum secretory activity of these cells is detected after ovulation; In the second half of the menstrual cycle, the height of these cells decreases and the nature of secretory granules changes. Basal and pine-like cells appear in the second half of the menstrual cycle, especially at the end of the lutein phase. Basal cells of a rounded form with a weaklyoosinophilic cytoplasm and a large core; They are cambial backup cells. Physiol, regeneration of flickering and secretory cells is carried out by dividing basal cells. Basal, like pin-shaped, cells make up approx. 1% of all epithelial cells. Pin-shaped cells are considered as dystrophically changed flickering and secretory cells, further subjected to autolysis.

The own plate of the mucous membrane is a loose fibrous unformed connective tissue, rich vessels and nerve endings. The connecting tissue during the menstrual cycle also undergoes changes similar to changes in the functional layer of the endometrial of the uterus (see). The muscular shell consists of smooth muscles located in the form of a circular layer (most powerful) and longitudinal. Muscular bundles penetrate into the folds of the mucous membrane. In the direction of the ampoule, the muscular layer becomes thinner and, on the contrary, as it approaches the uterus it is thickened. The serous shell consists of a mesothelium and a serous shell's own plate.

Physiology

Activities M. t. Located in connection with age and function, the state of the female organism. Functional changes M.T. They are carried out. arr. Under the influence of neurohumoral regulation (see). Thus, the dependence of the structural and functional state of the epithelial cells of the mucous membrane from the hormonal status of the body was established. In experiments, it has been established that castration causes partial and complete destruction of flicker cilia and flattening their surface, and with the introduction of genital hormones, the cell structure is restored. Reduced muscles M. T. and the type of contractual activity of the organ of unequal in different phases of the menstrual cycle. It is possible to distinguish three main types of abbreviations M. t. In the proliferation phase, the excitability of musculature M. t. Increased, there is an inclination to long-term spastic abbreviations with a simultaneous change in the shape and position of M. T. Regardless of the ovary with the ampoule lifting and leading to the side of the free end; Such reductions of M. t. Provide an egg perception mechanism. In the secretory phase, the tone and excitability of musculature M. t. Reduced, reductions acquire peristaltic character. Different departments M. t. Reducing autonomously and asynchronously. The most expressed abbreviations in the variety of M. T. in ampoule M. t. Only pendulum movements occur.

The direction of the wave of abbreviations M. T. is associated with the place of application of irritation (egg, spermatozoa); They can be directed from the ampoule to the uterus (Item) and from the uterus to M. T. (antiperistaltics); These reductions provide the movement of the egg or the embryo in the uterus. With a reduction in the longitudinal muscles of M. t. Crocheted, with a reduction in circular muscles, their lumen is narrowed. Reducing the tone of the muscles of the Isthmus M. T., facilitating the passage of the zygotes in the uterus, can occur under the influence of the prostaglandin E2 contained in the seed fluid that fell into the genital path of the woman. With an insufficient content of estrogen (see) the excitability of M. t. Reduced, the reaction to irritation is weakened, as a result of which the mechanism of perception of an egg may not occur; It may also not arise in connection with the inhibitory influence of adverse psychosexual influences. The fertilization of the egg usually occurs in the ampoule of M. t. Moving the egg, the zygotes and the embryo in the uterus takes place mainly as a result of the cutting of the muscles of M. t., As well as the flickering movements of the cilia of the epithelial cells of the endosalpinse, which in the second phase of the menstrual cycle are directed towards the uterus (rice . four). With the occurrence of menopause (see) the tone of the muscle membrane M. T. sharply decreases, the excitability of the muscles almost completely disappears, the reduction of M. T., besides the ampoule, are absent.

Histol, structure M. t. Also subjected to pronounced changes in different phases of the menstrual cycle. The height of the epithelial cells of the mucous membrane M. T. is minimal during menstrual bleeding, and by the time of ovulation - maximum. In the proliferation phase, an increase in the number of fixed and secretory cells occurs. The core cell of the focusing epithelium is shifted up. In the second phase of the menstrual cycle, secretory cells acquire a glass-shaped or pear-shaped form and protrude over focusing due to the simultaneous decrease in the height of the fliccity cells. In the same phase there is an increase in the number of basal and pistorate cells. The core of flicker cells acquire an elongated form, move the book. The secretory activity of epithelial cells becomes maximum; The secret generated by them provides the necessary conditions for fertilization and the development of an egg in the first days of pregnancy (see). The phase of proliferation increases the activity of alkaline phosphatase in secretory and flickering cells, the content of RNA and protein compounds increases; In the secretory phase increases the activity of acid phosphatase. Such changes can be considered as a consequence of the increase in the intensity of metabolic processes in epithelial cells in the first phase of the menstrual cycle and destructive changes - to the second phase. In the uterine part of M. T. Histochim, changes in different phases of the menstrual cycle are expressed significantly weaker. In the lumen of M. t. There is a certain amount of liquid containing glycoproteins, as well as prostaglandin F2α (see Prostaglandins).

Research methods

M. t. Usually investigated by the bimanual method. Unchanging M. t. Painted with difficulty and are determined only with a thin and sufficiently pliable abdominal wall. For the study of M. t. The following methods are also used: metrosalpingography (see), peritoneoscopy (see), perturbation (see), hydrotubation (see), pneumoperitoneum (see), ultrasound diagnostics (see).

Pathology

Development defects

Development defects are rare and due to the main impaired in the period of embryonic development. M. t. May be excessively long or short. There may also be added holes in the area of \u200b\u200bthe distal end and the addition of M. T. in the form of small polypose formations with a cavity in the center, which are connected by a thin leg with the funnel M. T. or with a wide bundle of the uterus. There may be splitting the lumen of the pipe, the lack of a lumen in some areas, as well as the addition straight, non-branching, blind moves. Less often meets the full doubling of the pipe. Pipe splitting, as a rule, is combined with the presence of additional fringe, additional side holes on the ampoule, cyst, etc. As a rule, malformations of M. t. Do not require treatment.

Violations of the contractile activity of the uterine pipes and the violation of the movement of the egg and the embryo can be a consequence of a mechanical obstacle in the form of adhesions in a lumen of the organ arising from the inflammatory process, after an artificial interruption of pregnancy, as well as neuroendocrine disorders in the body of a woman. Through M. T. In abortion, menstruation, endometrial particles can throw into the abdominal cavity, which can lead to the so-called. Endometrioid heterotopia. It is possible to move tumor cells from the abdominal cavity through M. t. In the uterus, and from it in the vagina.

Pipe pregnancy may arise as a result of implantation and development of the embryo in M. t. Followed by its gap. Pipe pregnancy, as well as a break

M. t. They have a pronounced wedge, a picture (see ectopic pregnancy).

Diseases

Inflammatory diseases of M. t. Most often flow in the form of Salpingitis, which usually cause staphylococcus, streptococcus, gonococcus, intestinal wand, and tuberculosis mycobacter. At the same time, the gonorial salpingitis always develops as a rising path, staphylococci, streptococci penetrate M. t. Ascending, and tuberculous lesion M. t. Develops when the infection is hematogenically distributed from the lungs, lymphogenic - from bronchial and mesenteric lymph, nodes, from peritoneous . Sometimes causative agents of infection spread from appendix, a sigmoid gut. Inflammatory disease M. t. It is rarely isolated, usually the ovaries are involved in the process (see); In such cases, the disease is combined under the term "adnexit". Salpingitis usually begins with inflammation of the mucous membrane of M. t. And quickly applies to the muscular shell of the wall and the abnormal cover. The result of inflammation (at the beginning of the catarrhal, which, however, can go to purulent) is obliterated or the entire M. t., Or its uterine part and the ampoule, which causes persistent infertility (see); The accumulation of exudate leads to the formation of the sactosalpinx (hydraulic acid, hematosalpins, pyosalpins). Wedge, painting, treatment, prevention - see adnexitis.

As a result of the inflammatory process, especially with gonorly, in the lumen of M. t. Polyps may form, which in some cases are subjected to malignations and are considered as a prejudition process.

Tumors

Tumors M. t. There are rarely found. Benign tumors (mioma, lymphangioma, polyps, lipoms) are detected very rarely; As casuism is described in chondroofibrome, dermoid and teratom. Usually they do not reach large sizes, are not clinically detected and detected only during operations on the organs of the small pelvis. The frequency of damage to M. t. Malignant tumors does not exceed 1% in relation to all malignant tumors of female genital organs. Among the malignant tumors of M. t. In the first place there is a cancer, first described by Ortman (E. G. Orthmann) in 1886, and in the domestic Liter ATU P E S. D. Mikhnov (1891). Rarely meets sarcoma and even less often chorionepitheloma (the result of tubular pregnancy). The role of inflammatory processes as ethiol, factor in the development of cancer M. t. Doubtful, although the malignation of polyps, especially emerging due to gonorrhea, no doubt causes. The age of patients with cancer M. t. Mostly 40-50 years old, and approximately half of the sick cancer were fruitless.

Pathoanatomically malignant tumors M. t. Usually represent the formation of pear, retort-like shape, a tagoelastic consistency or dense consistency with softening foci, besides tumor growths, serous or serous-bleeding content. They can resemble gyroidalpinx, featuring the fact that on the surface of the tumor there are usually suggested growths, often extending to neighboring organs. Funnel M. T. Tosted, tumor is usually one-sided, fascinated with surrounding organs (with ovary, uterus, peritoneum, gland). Histologically, this is more often papillary-solid, less often papillary, papillary form of cancer. Metastasation occurs according to lymph, vessels, as a rule, in lumbar lymph, nodes; The hematogenic path of metastasis in various organs is not excluded. Metastases in M. t. Of the primary tumors of other organs, they are especially commonly combined with metastasis into ovaries; They are found in the form of diffuse thickening of pipes or noded formations, or in the form of projected nodules under the serous cover. In the lymph, vessels are often observed embossing of tumor cells.

Wedge, symptomatics: Patients note abundant light yellow (amber) or serous-bloody discharges, which are usually poured periodically, and their appearance is preceded by grabs-like pain. In the blockage of the uterine hole of the pipe with tumor separations of the discharge may not be, but the pain due to the stretching of the pipe growing tumor is enhanced and are characteristic and fairly early symptom of cancer M. T. Typically, pain is localized at the bottom of the abdomen, in the lower back, the sacrum. With a gap of M. t. Due to its separators of the growing tumor or germination, the tumor of the pipe wall occurs the phenomena of an acute abdomen (see).

Early diagnosis of cancer M. t., Unfortunately, rarely is rare; Usually malignant tumors M. t. Recognized only during operation. However, with a rapid increase in the tumor, grapple-shaped pains, serous-bloody or amber sections in significant quantities (especially during menopause), in the absence of pronounced inflammatory phenomena, it is always necessary to think about M. Cancer Cancer. The cytol has a large diagnostic value. Research outcome. Required rectovaginal, bimanual study, although the obtained data is not always distinct at small tumor sizes. In case of suspected Cancer M. t. Of course, the metrosalpingography has a certain meaning; Sometimes they resort to diagnostic laparotomy (see).

Treatment of cancer M. t. Preferably combined - operational removal of the tumor and ovaries with supravaginal amputation of the uterus. Extractation of the uterus, if there is no special testimony, is not desirable to prevent the possibility of implantation of tumor cells in the vagina. Most clinicians recommend the use of radiation therapy in the postoperative period. The forecast is more often bad, because the diagnosis is usually placed late.

Operations

Removal M. t. Make the tumor (see Salpingectomy) and for the purpose of sexual sterilization (see); Surgical interventions are used to eliminate infertility, as well as a gap of M. T. with pipe pregnancy.

A prerequisite for operation on M. T. On infertility is a preliminary wrench, a woman examination and a sperm study of a husband, as well as the establishment of the obstruction of M. t. Metrosalpingography. Operations about infertility are aimed at eliminating adhesions, restoring M. T. T. and their normal mobility. Salpingolasis (XI. Fimbriolysis) is an operational intervention undertaken to eliminate peritabar battles and giving M. t. Normal mobility. The technique of operation is the following. After opening the abdominal cavity, peritabar spikes are carefully destroyed by acute way, after which they inspect the state of the funnel M. T.; In the presence of a partial sticking of the edges of the hole of the pipe funnels, they should be carefully breed by anatomical tweezers. Patency M. t. You can check either by blowing air through the ampoule (Fig. 5), or from the uterine side by perturbation or hydrotubation. It is necessary to carefully carry out peritonization of damaged areas of M. T. To prevent the formation of battles in the postoperative period. The favorable result of the operation (the occurrence of pregnancy) is according to L. S. Persianinov to 30-40%.

Operation of salpingostomy (sin. Dentallasty) lies in the opening of M. t. In the inad-free end; The contraindication to this operation are acute and subacute inflammatory processes of internal genital organs, as well as pronounced volatile changes in the form of hydraulpinx. The technique of operation is as follows: a hole in M. t. It can be created terminally at the free end, laterally - on the side wall or by transverse (transverse) resection of the free end of the pipe. After opening the abdominal cavity, M. t. Caution acute is isolated from adhesions and dissect the wall of the pipe (Fig. 6, 1); The mucous membrane of M. t. Slightly turned and thin seams are connected to the peritoneum M. t. (Fig. 6, 2). With pronounced changes, the ampoules produce its partial resection (Fig. 7, 1 and 2). To restore the passability of M. T. In the region of the ampoule, a method can be used with the imposition of four ketgut ligats around the circumference of the ampoule and the subsequent cross-sectional incision between them (Fig. 8, 1). Pulling the thread leads to the unfolding of the wound and the formation of the four flasks of the wall M. t. The flaps are connected by separate seams from the peritoneum pipe (Fig. 8, 2). In order to facilitate the ingress of eggs in M. t. The edges of the newly formed opening are fixed at the ovary. In order to avoid secondary scarring and closing the lumen of the pipe, testers are used from biologically inactive materials (Fig. 9 and 10). After Salpingostomy, pregnancy occurs, according to S. Ya. Mikladze and M. G. Serdyukov, in 10-20% of women; The lack of effect can be associated both with the infection of the newly formed opening and with large anatomical and functional changes M. T., against the background of which the operation was made.

Salpingoanastomoz operation can be resorted to the presence of obstruction M. t. Only in the iste. With this operation, the obliedment plot of M. t. We resets (Fig. 9, 1) of its lumen, the protector is introduced; Dissected areas of the pipe wall are crossped with separate seams or with a compositive machine (Fig. 9, 2). Transplant operation M. T. The uterus is produced in cases where M. T. It is impassable in the uterine part or in the initial part of the iste. M. t. Cross on the border with the oblusting site; The impassable part is excised, her mesenter is ligated. The angle of the uterus is excised by a narrow scalpel or a special tool (implanter) to the entire thickness of the body of the organ before the uterus cavity with such a calculation so that through the resulting opening it was possible to carry out a passing segment of the fallopian tube (Fig. 10, 1). Using tweezers, scissors used in ophthalmol, practice, the uterine part of the passable pipes are cut into two flap; Then each flap is stacked to the wall of the uterus with the introduction into the lumen of the pipe and the cavity of the tread uterine (Fig. 10, 2). The end of the tread is removed either through the cervical channel and the vagina, or through the abdominal wall for a period of 4 to 6 weeks. According to L. S. Persianinova, pregnancy after the operation occurs in 20% of patients.

Bibliography: Gynecological endocrinology, ed. K. N. Shmakina, p. 5, M., 1976, Bibliogr.; Golovin D. I. Atlas of man tumors, p. 231, L., 1975; Davydov S. N., Chromov B. M. and Sheiko V. 3. Atlas of gynecological operations, L., 1973, bibliogr.; Malignant tumors, ed. N.N. Petrova and S. A. Hetina, vol. 3, part 2, p. 298, L., 1962; Kai of love and the city of J. and Kondrikov N.I. On the question of the functional state of the uterine pipes in patients with the uterus, Akush, and Gynech., No. 9, p. 33, 1976, bibliogr.; Mandelshtam A. E. Semiotik and the diagnosis of female diseases, L., 1976; Multi-volume manual for obstetrics and gynecology, ed. L. S. Persianinova, vol. 1, p. 343, M., 1961; Nikonchik O. K. Blood supply of the uterus and appendages of the uterus of a woman, M., 1960, bibliogr.; Persianinov L. G. Operational Gynecology, M., 1976, Bibliogr.; Guide to the pathologist diagnosis of human tumors, ed. N. A. Kraevsky and A. V. Smolyannikova, p. 212, M., 1976; Blind A. S. Development of innervation of uterine pipes, Chisinau, 1960, bibliogr.; S s s g a n o-in A K.N. Treatment of female infertility, Kiev, 1971, bibliogr.; ACKERMAN L. V. A. D E 1 R E G a T about J. A. Cancer, St. Louis, 1970; A Ref I. a. Hafez E. S. E. Utero-Oviductal Motility with Emphasis on Ova Transport, Obstet, Gynec. Surv., V. 28, p. 679, 1973, BIBLIOGR.; David A., S E R R D. M. A. S Z EG N O-B I 1 S K at B. Chemical Composition of Human Oviduct Fluid, Pertil. and Steril., v. 24, p. 435, 1973; F 1 i with k i n g E R G. L., Muechler E. K. a. Mikhail G. Estradiol Receptor in the Human Fallopian Tube, Ibid., V. 25, p. 900, 1974; SED- 1 I S A. Primary Carcinoma of the Fallopian Tube, in the book: Gynecol, Oncol., ED. By H. R. K. Barber a. E. A. Graber, p. 198, Amsterdam, 1970, Bibliogr.

V.P. Kozachenko; O. V. Volkov (An., Hist.), A. I. Serebrov (ONK.).

Myometrium It consists of three layers of smooth muscle tissue, between which layers of loose connective tissue are located. Due to the lack of the submembrance base, the myometrium is fixedly connected to the basal layer of the proper plate of the uterine mucous membrane. The inner muscular layer located under the mucous membrane consists of space-oriented beams of smooth myocytes, in the middle layer they have a circular direction, and in the outer-subserosnous - also the orthodox direction opposite to the direction in the inner layer. There are no sudden boundaries between the layers of muscle tissue. Here are large blood vessels. When cutting the uterus, the vessels are clarified, which prevents bleeding during menstruation and childbirth. Estrogens increase the electrical excitability of smooth myocytes, and progesterone, on the contrary, increases the cell data threshold.

Perimetry - Serous membrane of the uterus, covers a significant part of the organ, with the exception of the front and side surfaces of the overall area. In the formation of perimerium, mesothelium and loose fibrous connecting fabric are involved.

Cervix It is a lower narrowed part and has a muscle cylinder. In the center of the neck, the cervical, or cervical canal, which begins in the uterine body cavity inner zev. The distal part of the cervix performs in the vagina and ends with an external zev. The cervix consists of the same shells as the body. The cervical channel was lined with a single-layer prismatic epithelium, which in the area of \u200b\u200bthe distal (vaginal) part of the cervix connects with a multi-layer flat-non-refined epithelium. The latter continues in the epithelium of the mucous membrane of the vagina. The border between the multi-layer and single-layer prismatic epithelium of the mucous membrane is always clear and approximately located at the level of the distal part of the cervix.

The fallopian tubes

Color tube (egg) - a paired tubular organ, the distal end of which, having a view of the funnel, is open and in contact with the surface of the ovary, and the proximal - the uterus is performed in the region of the lateral surfaces of its bottom and reports the pipes with the uterine cavity. The man's surface length is about 10-12 cm. The uterine pipes capture the ovocyte during ovulation, they carry out its transport towards the uterine cavity, create conditions for the unimpeded progress of sperm to meet Ovilis, ensure the environment necessary for fertilization and crushing the embryo, transport the embryo in The uterus cavity. The uterine tubes are developing from the top of the paramesonephral (muller) ducts.

Oviduct It is divided into 4 departments: a funnel - the distal pipe ending with fringe (phimnia) and opening into the ovarian bag, the ampoule - the most wide and extended perched by the funnel (about 2/3 of the length of the pipe), the experiencies, or the Eastmus, and interstitial ( Intrama-rally) department, the scent of the uterus.

Power pipe wall Consists of three shells: mucosa, muscle and serous.

Mucous membrane It consists of a single-layer prismatic epithelium of a nuclear type and its own plate. The epithelium is formed by cells of two species - with eyelashes and secretory. In the course of the uterine tube, wilderness and secretory epithelialocytes are located uneven-eyelashes predominate in the funnel and ampoule of the pipes, and the secretory - in the cowichk area. For secretory epithelialocytes of uterine pipes are characterized by apo and frozen secretion types. The main components of the secret are prehastbuisans, transferrin, globulin and lipoproteins, as well as global coinoglycans, prostaglandins, uteroglobin.

Own record mucous membrane pipe Thin and formed by loose fibrous connective tissue. In addition to typical cell species typical tissue, cells capable of decidual transformation are found in its composition.

Muscular shell of uterine pipes Two non-viewed layers of smooth muscle tissue are formed - internal circular (thicker) and outdoor longitudinal (more subtle). The thickness of the muscular shell increases from the funnel to the carriage. In the region, the inner circular layer forms a circular sump of the fallopian tube. In the case of implantation of the embryo in the wall of the pipe, the latter is easily injured and bursts.
Serous shell represented by mesothelium and connective tissue.