Uterus: structure, anatomy, photo. Anatomy of the uterus, fallopian tubes and appendages

The fallopian tube (tuba uterina (salpinx), the fallopian tube in women is a paired organ, located almost horizontally on both sides of the fundus of the uterus, in the free (upper) edge of the broad ligament of the uterus.

They are cylindrical channels (tubes), one (lateral) end of which opens into the peritoneal cavity, the other (medial) into the uterine cavity. The length of the fallopian tube is adult woman on average reaches 10-12 cm, and the width is 0.5 cm. The right and left fallopian tubes are of unequal length.

What is the fallopian tube for?

The fallopian tubes ensure the movement of the egg released from the ovary during ovulation towards the uterus, and the movement of sperm in the opposite direction. They serve as the place where the conception of a child occurs - fertilization female egg male sperm, creating a favorable environment for initial stage development of the embryo and ensure its further advancement into the uterine cavity.

Picture 1.

1- fallopian tube;
2- epididymis (ovarian epididymis);
3- ovarian artery;
4- fringe tube (uterine tube);
5- ligament that suspends the ovary;
6- arteries and veins;
7- ovary.

DIVISIONS OF THE FALLOPY TUBE

There are several sections of the fallopian tube: the funnel, the extension - the ampulla, the isthmus and the uterine (interstitial) part.

1. Outer end, funnel, bears the ventral opening of the pipe, bordered by a large number of pointed projections - the fimbriae of the pipe. Each fringe bears small clippings along its edge. The longest of them, the ovarian fimbria, follows the outer edge of the mesentery of the tube and is like a groove going to the tubal end of the ovary, where it is attached. Sometimes at the free ventral end of the tube there is a small bubble-like appendage that hangs freely on a long stalk. The abdominal opening has a diameter of up to 2 mm; this opening communicates the peritoneal cavity through the fallopian tube, uterus and vagina with the external environment.

2. Lateral, extended part, ampoule, is its longest part, has a curved shape; its lumen is wider than that of other parts, thickness up to 8 mm.

3. The medial, straighter and narrower part, its isthmus, approaches the corner of the uterus at the border between its fundus and body. This is the thinnest section of the pipe, its clearance is very narrow, the thickness is about 3 mm.

4. It continues into the section of the tube that is located in the wall of the uterus - the uterine part. This part opens into the uterine cavity through the uterine opening of the tube, which has a diameter of up to 1 mm.

STRUCTURE AND ANATOMY OF THE FALLOPIAN TUBE

The fallopian tube is well closed from the sides and from above by the serous membrane, which makes up the superolateral surfaces of the broad ligament of the uterus, and the part that is directed into the lumen of the broad ligament is free from peritoneum. Here the anterior and posterior layers of the broad ligament join to form a ligament between the tube and the ovary, called the mesentery of the fallopian tube. Under the serous membrane there is loose connective tissue such as adventitia, the subserosal base.

The muscular layer lies deeper; it consists of smooth muscle fibers arranged in three layers: a thinner outer longitudinal layer (subperitoneal), a middle, thicker circular layer and an inner longitudinal layer (submucosal); the fibers of the latter are best expressed in the area of ​​the isthmus and uterine part. The muscular layer is more developed in its medial section and in the uterine end and gradually decreases towards the distal (ovarian) end. Muscle tissue surrounds the innermost layer of the wall - the mucous membrane, the characteristic feature of which is longitudinally located tubular folds.

The folds of the ampoule are well defined, they have greater height and form secondary and tertiary folds; The folds of the isthmus are less developed, they are lower and do not have secondary folds, and, finally, in the interstitial (intrauterine) section the folds are the lowest and very weakly expressed. At the edges of the fimbriae, the mucous membrane of the fallopian tube borders the peritoneal covering. The mucous membrane is formed by a single-layer cylindrical ciliated epithelium, the cilia of which flicker towards the uterine end of the tube; some epithelial cells lack cilia; these cells contain secretory elements. The section of the isthmus of the fallopian tube from the uterus runs at a right angle and almost horizontally; the ampulla is located in an arc around the lateral surface of the ovary (a bend is formed here); the end section of the tube, passing along the medial surface of the ovary, reaches the level of the horizontally running part of the isthmus.

Epididymis(epophoron) - located between the layers of the peritoneum of the broad ligament of the uterus in the lateral part of the mesentery of the fallopian tube, between the ovary and the end of the tube. It consists of a delicate network of convoluted transverse ducts and a longitudinal duct of the epididymis. The transverse ducts represent the remains of the urinary tubules of the cranial part of the middle kidney; they go from the hilum of the ovary to the fallopian tube and open into the longitudinal canal of the epididymis, which represents the remnant of the mesonephric duct. Vesicular appendages are one or more unstable vesicles, sometimes suspended on a very long stalk, which is located lateral to the epididymis and suspended on one of the fimbriae. They are the size of a small pea and filled with liquid. The periovary is a yellowish nodule of convoluted tubes, which is a remnant of the tubules of the lower part of the middle kidney. It looks like small tubes, closed at the ends, located medially from the epididymis between the layers of the peritoneum.

Useful information on the topic:

TREATMENT OF FALLOPY TUBES

According to medical statistics, out of 100 women who first develop inflammation of the ovaries and tubes, approximately 15 will develop adhesions. If the inflammation recurs, a chronic process in the walls of the fallopian tube will develop in 35 women. After the third episode, the figure will increase to 75%! This implies the importance of a timely response from both the patient and the treating gynecologist to any trouble on the part of reproductive organs. Traditional treatment of the fallopian tubes, along with traditional medicines, best helps in eliminating the problem.

Our center offers a comprehensive program early diagnosis gynecological diseases, including adhesions in the fallopian tubes, chronic inflammation of the uterine appendages using gentle ultrasound techniques. It is well known that complex, good treatment Fallopian tube examination performed at an early stage is always more effective. Our doctors will conduct a comprehensive examination and, if necessary, develop a therapeutic plan.

WHAT WE CAN OFFER YOU:

Healthy fallopian tubes are good! Find out about a way to restore and stimulate their work, prevent obstruction and adhesions during infections, inflammations, after abortions and operations:

The structure of the fallopian tube is something like a tunnel, inside it has a very delicate, elegant and thin structure. The fimbriae of the fallopian tubes meet the egg that has ovulated from the ovary, hug it, wrap it in fringe and lure it into the tunnel. The tunnel is covered with a kind of pile (ciliated epithelium), the oscillatory movements of which favor the meeting of sperm with the egg, and then the transportation of the already fertilized egg into the uterine cavity. As you can see, the fallopian tubes play a huge role in conceiving a child, and obstruction of the fallopian tubes is the main cause of infertility in 40% of women diagnosed with this condition.

Where are the fallopian tubes located?

Very often you can come across the question: “Where are the fallopian tubes?” The normal location of the fallopian tubes in a woman’s body is on both sides of the uterine fundus. One side of the fallopian tube is almost horizontally connected to the uterus, and the other side is adjacent to the ovary. You can often find an abnormal location of the fallopian tubes and their underdevelopment, which in most cases leads to infertility.

Fallopian tube length

The length of the fallopian tube depends on the individual characteristics of the organism; on average, the length of the fallopian tube is 10-12 cm. Interestingly, the length of the left fallopian tube can differ significantly from the length of the right fallopian tube. There are frequent cases of abnormal development of the tubes, when the length of the fallopian tubes is excessive, they are often tortuous, have narrow clearance and the peristalsis of the tubes is reduced, which leads to disturbances in the transport of the egg.

The structure of the fallopian tube

Fimbriae of the fallopian tubes

In the top picture on the left, the ovary is not covered by the fallopian tube, but is located next to it. The fallopian tube is conventionally attached to the ovary by a long ovarian fimbria. The fimbriae of the fallopian tubes resemble a fringe, turned towards the ovary and awaiting ovulation. On a wave of follicular fluid, the egg emerging from the ovary is deftly captured by the fimbriae of the fallopian tubes and carried into the tunnel of the fallopian tube.

Ciliated epithelium

Next, the egg enters the very delicate and finely organized space of the fallopian tube, the mucous membrane of which is lined with ciliated epithelium, each of its cells has a long outgrowth. Thanks to the oscillatory movements of the villi (cilia) along the fallopian tube, the egg moves towards the uterus and towards the sperm. Under favorable circumstances, the egg is fertilized, and the newly created embryo continues to travel through the fallopian tube for about seven more days before implanting in the uterus.

So, drawing conclusions from the above, we can say that the structure of the fallopian tube is very delicate and thin. Without exception, all inflammatory processes in the fallopian tubes cause colossal damage, damaging and sometimes leading to death of the finely organized villi.

The consequence of inflammatory processes in the tubes may be the formation of “bald patches” in the ciliated epithelium and the inability of the fertilized egg to move through the tube, which leads to ectopic pregnancy and often with such a diagnosis one fallopian tube can be removed.

Gonorrhea, tuberculosis and chlamydia cause severe inflammation due to its extremely aggressive pathogenic flora, which certainly leads to a pronounced adhesive process, constriction of the fallopian tubes occurs, which can also lead to ectopic pregnancy. Constriction of the fallopian tubes with adhesions often leads to infertility. Chlamydia very often settles in the fimbriae (in the fimbriae of the fallopian tubes), which leads to their complete gluing; accordingly, no one is waiting for the ovulated egg, and it simply dies without ever getting into the fallopian tube.

Genital endometriosis, especially in chronic form, causes inflammatory processes with the formation of adhesions, which can also lead to tubal constriction, ectopic pregnancy, and subsequently one fallopian tube may be removed. Often, in chronic inflammatory processes, adenocarcinoma of the fallopian tube is diagnosed - this is a classic cancer, the symptoms of which begin to appear only in the last stages.

How can you protect yourself from problems with the fallopian tubes, since tubal constriction or death of the ciliated epithelium is so difficult to diagnose? In modern gynecology there is great amount research methods with which timely medical intervention is possible.

Methods used include laparoscopy, echohysterosalpingography (HSG echo) of the fallopian tubes and sonohysterography of the fallopian tubes (ultrasound methods), hysterosalpingography of the fallopian tubes and metrosalpinography (MSG) of the fallopian tubes (X-ray methods). Also, some methods are often used not only as diagnostic: when liquid is injected with a syringe under pressure into the uterine cavity, the fallopian tubes are washed or the fallopian tubes are cleaned; according to statistics, pregnancy occurs in 15% of cases after diagnosis.

Methods for examining the fallopian tubes

Tubal hysterosalpinography (HSG) or metrosalpinography (MSG) of the fallopian tubes.

Tubal hysterosalpinography (HSG) or tubal metrosalpinography (MSG) is an X-ray diagnosis of the fallopian tubes for the presence of tubal constrictions (for patency). This is the method most often used in examining patients diagnosed with infertility. The accuracy of the study reaches 80%.

The essence of the procedure for tubal hysterosalpinography (or tubal MSG) is the introduction contrast agent into the cervix, then it fills the uterine cavity and fallopian tubes, flowing into the abdominal cavity. Afterwards, an x-ray is taken, from which the specialist can assess the condition of the uterine cavity and the location of the fallopian tubes, dilation, tortuosity and constriction of the fallopian tubes, etc. (if any).

But, despite the widespread use of this research method by specialists, it has its drawbacks. Hysterosalpinography of the fallopian tubes (or MSG of the fallopian tubes) is carried out only in the absence of inflammatory processes, because when a sterile contrast liquid is introduced into the uterine cavity (for example: a patient diagnosed with endometriosis), the liquid transfers individual fragments of the endometrium into the abdominal cavity and after a few months Patent fallopian tubes become completely impassable.

The disadvantages include the fact that the procedure is quite unpleasant, to say the least, many patients simply scream out loud when the contrast liquid is administered. Also, don't forget about radiation exposure. x-rays, which is why the procedure is prescribed on the 5-9th day of the cycle, in order to avoid irradiation of the egg, or it is recommended to use protection during intimacy for the next month.

Echohysterosalpingography (Echo-HSG) of the fallopian tubes or sonohysterography of the fallopian tubes.

Echohysterosalpingography (Echo-HSG) of the fallopian tubes, or sonohysterography of the fallopian tubes, is a method for diagnosing the uterine cavity and fallopian tubes based on the ultrasound method. When using this method, the highest accuracy is achieved: from 80 to 90%, while it does not involve radiation exposure, and is also less painful and minimally invasive.

The essence of the tubal echo-HSG procedure or tubal sonohysterography is the introduction of a special contrast agent into the uterine cavity, then into the fallopian tubes and abdominal cavity, which indicates the patency of the fallopian tubes. Afterwards, a transvaginal and abdominal ultrasound of the uterus is performed with 3D reconstruction, which allows the specialist to assess the shape of the uterine cavity, the surface of formations in the uterus and the condition of the fallopian tubes (their patency).

Also, the use of both of these methods often leads to pregnancy due to lavage of the fallopian tubes or a kind of cleaning of the fallopian tubes with a contrast liquid, but, unfortunately, the effect does not last long. These methods are most effective for detecting fallopian tube adenocarcinoma. Leading experts insist on diagnosing the fallopian tubes even at the slightest suspicion of adenocarcinoma of the fallopian tube, because this disease is extremely difficult to diagnose, and symptoms appear only in the last stages.

At the same time, obstruction of the fallopian tubes can also be considered as separate disease. This is due to the presence of characteristic manifestations and symptoms, as well as an individual approach to treatment.

Anatomy of the uterine appendages

The following anatomical structures are usually classified as uterine appendages:

• the fallopian tubes;
• ligaments of the uterus.

The fallopian tubes

Each fallopian tube has the following four sections:

• Intramural department– located closest to the uterus and limited muscle fibers uterine walls.
• Isthmus- the place where the fallopian tube bends and its channel narrows as much as possible.
• Winding department– is the longest; the pipe channel here widens compared to the isthmus. Normally, this is where the egg and sperm meet.
• Funnel- a specific extension, equipped with special formations - fimbriae. These are fringed processes in contact with the ovary.

Ovaries

Ligaments of the uterus

All parts are ok reproductive system interact harmoniously with each other. The egg, after leaving the ovary, ends up in the pelvic cavity for a short time. There it is captured by fimbriae in the funnel area and directed into the lumen of the tube. Having passed through all sections of the fallopian tubes ( this may take from 2 to 24 hours), the egg ends up in the uterine cavity.

Causes of fallopian tube obstruction

• STD ( sexually transmitted diseases);
• mechanical damage to the uterine mucosa and fallopian tubes;
• inflammation of neighboring organs;
• squeezing the pipe from the outside;
• functional disorders;
• surgical tubal ligation;
• birth defects.

Sexually transmitted diseases

Sexually transmitted infections include:
If any of these diseases is present, the patient's risk of developing fallopian tube obstruction increases greatly. Basically, this occurs when the infection is chronic, when we are not talking about acute inflammation, but about structural changes in tissues. Thus, timely diagnosis and treatment of sexually transmitted diseases can prevent the development of tubal obstruction in the future.

Uterine polyps

Mechanical damage to the uterine mucosa and fallopian tubes

In more rare cases, scars on the lining of the uterus form after hysteroscopy ( examination of the uterine cavity using a special camera) or others diagnostic procedures.

Mechanical damage to the mucous membrane is often observed in patients who have resorted to methods intrauterine contraception. First of all, we are talking about spirals that are inserted into the organ cavity to prevent pregnancy. Despite the fact that these devices are made from special safe materials, the risk of injury is still present. Damage often occurs when attempting to insert or remove coils on your own.

In response to mechanical damage, an inflammatory process develops. The uterine cavity is not normally sterile. This means that it contains a fairly large number of opportunistic microbes. With a healthy mucous membrane, these microorganisms do not cause disease. However, mechanical damage makes the uterine tissue vulnerable. After prolonged and widespread inflammatory processes, adhesions may remain in the organ cavity, which, as mentioned above, often contribute to tubal obstruction.

Inflammation of neighboring organs

In medical practice, the formation of connective tissue cords between internal organs in the abdominal or pelvic cavity is called adhesions. Over time, adhesions gain strength, become denser and can lead to deformation of anatomical structures or disruption of the normal position of organs.

Adhesions that cause tubal obstruction can form as a result of inflammation of the following organs:

• ovary ( with a cyst or neoplasm of the ovary);
• rectum;
• lower loops of the small intestine;
• appendix ( in his pelvic position);
• ureters;
• actually, inflammation of the peritoneum ( peritonitis, pelvioperitonitis).

Operations that can lead to adhesive obstruction of the fallopian tubes are:

• myomectomy ( removal of uterine fibroids);
• perforated appendicitis;
• curettage of the uterine cavity ( curettage);
• removal of ovarian cysts;
• operations for ectopic pregnancy;
• rupture of an ovarian cyst;
• laparoscopic surgical interventions;
• other interventions on the pelvic organs.

In addition to the adhesive process, the patency of the fallopian tubes can also be disrupted by ordinary acute inflammation neighboring organs. One of the signs of an inflammatory reaction is swelling. The tissues become overfilled with blood and lymph due to the expansion of capillaries, which leads to compression of neighboring structures. Obstruction of the fallopian tubes can occur with acute inflammation of the rectum or sigmoid colon ( obstruction of the left fallopian tube) or when acute appendicitis (obstruction of the right fallopian tube). Patency is often impaired due to a specific complication of appendicitis - appendiceal infiltrate ( plastron). In this case, inflamed appendix adheres to adjacent structures, including the right fallopian tube.

As a rule, tubal obstruction that develops due to acute inflammation is temporary nature. If after treatment and inflammation subsides there are no adhesions left in the area of ​​the fallopian tubes, then the patency of the tubes is restored. Otherwise, surgical treatment may be required to cut the resulting adhesions.

Squeezing the pipe from the outside

The pipe is compressed only on one side. That is, women in this case retain their reproductive function. However, it is recommended to remove such tumors, as they may complicate the course of pregnancy in the future.

Functional disorders

The main causes of functional disorders are:

• Hormonal changes. The amount of estrogen in the blood affects many different processes at different levels of the reproductive system. One of these levels is the mucous membrane lining the lumen of the fallopian tube. At normal level estrogen villi work normally, pushing the egg along the tube. If there is a hormonal imbalance, they may be inactive. Because of this, the egg will not enter the uterine cavity.
• Innervation disorders. Nervous regulation plays a large role in pushing the egg through the fallopian tube. First of all, we are talking about maintaining smooth muscle tone. Circular and longitudinal contractions of the tube contribute to the movement of the egg. In case of innervation disorders of various origins, these contractions do not occur, which is why symptoms of tubal obstruction may be observed. Cause of the disorder nervous regulation there may be prolonged stress, injuries in the pelvis and lumbar spine, neurodegenerative diseases.

Surgical tubal ligation

There are four groups of operations to create artificial obstruction of the fallopian tubes:

• Methods of ligation and separation. In this case, ligation of the fallopian tube will be performed with an ordinary suture material. In this case, the tube is usually ligated in several places, after which it is additionally cut with a scalpel.
• Mechanical methods. Mechanical methods involve the artificial introduction of mechanical obstacles into the lumen of the pipe. Typically, special silicone plugs or rings are used for this. To exclude ectopic pregnancy, they are placed as close as possible to the body of the uterus ( 1 - 2 cm from its wall).
• Thermal energy impact. The method is based on gluing the pipe walls at a certain interval. To achieve this effect, special lasers or electrocoagulators are used. With their help, a layer of connective tissue is artificially formed, covering the lumen of the pipe.
• Other methods. In rare cases, to form a scar in the lumen of the tube, special sclerosing drugs are injected there, which stimulate the growth of connective tissue.

Most often, artificial tubal ligation is a voluntary desire of the patient. However, in some cases, in addition to the woman’s desire, certain diseases may be indications for creating artificial obstruction of the fallopian tubes. First of all, these are those pathologies in which the onset of pregnancy itself can pose a threat to the patient’s life. Then the operation is performed for preventive purposes.

Tubal ligation for medical reasons is performed for the following pathologies:

• severe malformations and disorders of the cardiovascular, respiratory, urinary and nervous systems;
• malignant neoplasms;
• some blood diseases.

Birth defects

Teratogenic factors can be divided into two large groups:

• external;
• internal.

External teratogenic factors include:

• Radiation. Radiation directly affects the baby's tissues, easily penetrating the mother's abdominal walls. The radiation, consisting of a stream of tiny particles, bombards developing cells, slowing their growth and even changing their genetic structure individual cells.
• Medications. Many medications cross the placental barrier. This means that they can easily pass from the mother's blood into the baby's blood. If these drugs have a cytostatic effect, cells will stop dividing, which will lead to underdevelopment of organs.
• Chemical factors. Chemical environmental factors are associated mainly with occupational risks if the mother worked in production during pregnancy. Chemicals that have a cytostatic effect can enter the body through inhalation or direct contact with the skin.
• Atmospheric factors. Atmospheric factors that can affect the development of a child are exposure of the mother's body to excessively high or low temperatures, as well as lack of oxygen. In practice, these factors are quite rare.
• Poor nutrition. Poor nutrition implies a deficiency of vitamins and nutrients that should be supplied to the body during pregnancy. large quantities. With a severe lack of such substances, the growth and development of the fetus slows down, and the child does not have time to fully develop by the time of birth.

Diseases that pose a particular danger to the fetus during pregnancy are:

• nervous disorders ( neuroses and stress);
• intrauterine infections ( usually venereal);
• heart failure, kidney failure, or liver failure;
• hypertension ( high blood pressure).

The development of tubal obstruction due to the above-mentioned influences is a very common phenomenon. There are many options for changes in the structure of the pipe - from the banal absence of an organ ( uterus with one tube or no tubes at all), until there is no muscle layer in the pipe wall. The latter will also be considered an obstruction, since the egg will not be able to enter the uterine cavity from the ovary. Anomalies in the development of the fallopian tubes are very often accompanied by anomalies in the development of the uterus and vagina, since these organs develop in the same period from the same areas of embryonic tissue.

Types of tubal obstruction

Tubal obstruction is classified according to the following criteria:

• affected side;
• level of lumen blockage;
• degree of closure of the pipe lumen;
• cause of blockage.

Affected side

In this classification, there are two main types of tubal obstruction:

• Unilateral obstruction. Unilateral obstruction is not divided into right or left, since this is not particularly significant for the clinical course of the disease. Exact indication of the affected side ( right or left pipe ) is necessary only before surgery. Based on the physiology of the reproductive system, it is clear that with a unilateral blockage, the possibility of conception remains, although it is approximately halved. On the healthy side, there are no obstacles to the passage of the egg from the ovary to the uterus. On the affected side, the passage of the egg is impossible. Symptoms include dysmenorrhea ( irregular menstruation). Periodic moderate pain or heaviness in the lower abdomen can appear only when the ovary has produced an egg on the affected side, and it has not entered the uterine cavity. Unilateral obstruction is much more common than bilateral obstruction and often does not require mandatory surgical treatment. The appearance of such obstruction can be caused by adhesions or compression of the fallopian tube from the outside ( usually a tumor), because these structural anomalies are not symmetrical.
• Bilateral obstruction. For bilateral fallopian tube obstruction clinical picture will be more pronounced. In this case, the egg will not reach the uterine cavity from any of the ovaries. Bilateral obstruction is often accompanied by significant discomfort and stable dysmenorrhea or even amenorrhea ( absence of menstruation long time ). With this variant of the disease they talk about tubal infertility. A possible cause may be a widespread inflammatory process affecting the mucous membrane of both tubes, or physiological disorders ( innervation disorders, hormonal imbalances). Bilateral tubal obstruction is much less common than unilateral tubal obstruction.

Level of lumen occlusion

According to the level of blockage of the lumen, obstruction of the fallopian tubes is divided into 4 types:

• Obstruction of the intramural area. In this case, the lumen closes at the very beginning of the fallopian tube, in fact, even at the level of the uterine wall. It can occur with spasm of the uterine muscles or polyps in the fundus of the uterus. In both cases, it is the lumen of the pipe that goes into the cavity of the organ that will be blocked.
• Obstruction of the isthmus of the tube. In this place, the lumen closes due to inflammation of the mucous membrane. This is explained by the fact that even normally its width here does not exceed 1 - 2 mm. It is logical that the entry of various infections into the mucous membrane in this place will cause a temporary closure of the lumen.
• Obstruction in the tortuous part. At this level, obstruction may be caused by external compression. Although the width of the pipe lumen is greater here, due to the considerable length of this section, pathology is often localized here.
• Obstruction of the funnel. This type of disease almost never occurs, because the funnel itself is very wide. Obstruction here is observed extremely rarely, with congenital developmental disorders.

Degree of closure of the pipe lumen

Based on the degree of closure of the tube lumen, two types of obstruction are distinguished:

• Partial obstruction. Partial obstruction is, rather, not a closure of the lumen of the pipe, but its narrowing. It is usually considered a pathology in cases where a fertilized egg cannot pass through the site of narrowing. Then she lingers at this level. If the egg has not yet been fertilized, then the possibility of its fertilization is not excluded. Spermatozoa, due to their small size and greater degree of mobility, are quite capable of penetrating through the narrowed area. Thus, partial obstruction of pipes is often associated with increased risk ectopic pregnancy.
• Complete obstruction. With complete obstruction, we are talking about closing the lumen without the possibility of even liquid penetration. In such cases, fertilization is excluded, since the egg and sperm will not meet. Symptoms of the disease will be more pronounced.

Cause of blockage

All causes of fallopian tube obstruction can be divided into the following groups:

• Anatomical obstruction. In this case, we are talking about any type of blockage of the tube lumen - swelling of the mucous membrane, neoplasms in the tube, compression from the outside ( tumor or adhesions). What they all have in common is the presence of structural changes. In most cases, a surgical solution to such obstruction is indicated ( except for inflammation of the mucous membrane, which is relieved with medication).
• Functional obstruction. This type of obstruction is characterized by the absence of structural changes. As noted above, in order for an egg to enter the uterine cavity, rhythmic and directed contraction of the muscles in the walls of the fallopian tubes is necessary. In addition, the directional movement of the villi that line the lumen plays a certain role. In certain diseases or pathological conditions, these mechanisms for pushing the egg do not work. For example, rhythmic muscle contraction may be absent due to damage to the nervous system, including during prolonged stress. The movement of the villi of the mucous membrane depends to some extent on the level of estrogen in the blood and may be absent due to hormonal imbalance. Thus, the tube becomes impassable for the egg, although its lumen is actually open. Symptoms in this case will be minimal, and treatment will mainly be medication.

Symptoms of tubal obstruction

Clinical manifestations in patients with tubal obstruction may be as follows:

• symptoms of isolated tubal obstruction;
• symptoms of obstruction caused by acute inflammation;
• symptoms of obstruction caused by adhesions;
• symptoms of ectopic pregnancy.

Symptoms of isolated tubal obstruction

Symptoms of obstruction caused by acute inflammation

Symptoms of obstruction caused by adhesions

Symptoms of ectopic pregnancy

Late symptoms of an ectopic pregnancy may include:

• sharp pain in the lower abdomen;
• massive bleeding;
• pain shock ( sharp drop blood pressure );
• urinary disorders;
• temperature increase ( due to rupture of the fallopian tube and the development of pelvioperitonitis).

Diagnosis of fallopian tube obstruction

The main methods used in the diagnosis of fallopian tube obstruction are:

• Ultrasound of the pelvic organs;
• endoscopic methods;
• radiocontrast methods.

Ultrasound of the pelvic organs

During ultrasound Special attention is given to structures located in close proximity to the fallopian tubes. A search is underway for adhesions or neoplasms. In case of massive tissue swelling or intense inflammatory process, the specialist will also note these changes. The device makes it possible to establish the exact dimensions and location of various anatomical formations. Thus, the doctor will receive data to confirm or refute the diagnosis.

Ultrasound is a painless and safe method. It is allowed at any stage of pregnancy and for almost any chronic disease. The examination usually lasts from 5 to 15 minutes and gives immediate results.

Endoscopic methods

Typically, the procedure lasts about half an hour if the camera is inserted through the body's natural orifices ( vagina, cervix). If we are talking about introducing a camera into the pelvic cavity, then for this it is necessary to make several incisions on the anterior abdominal wall. Then the procedure may be delayed.

The following pathological processes can be detected using endoscopic examination:

• adhesions in the pelvic or uterine cavity;
• congenital defects in the development of fallopian tubes;
• twisted pipes;
• neoplasms of the pelvic organs;
• acute inflammatory processes;
• mechanical damage to the mucous membrane.

X-ray contrast methods

Contrast is injected through a special probe into the uterine cavity. In the absence of mechanical obstacles, the liquid penetrates into all natural openings, including the fallopian tubes. Stopping the spread of contrast in any direction indicates a blockage of the pipe flow.

The advantage of these methods is their low cost and ease of implementation. The result is very reliable and can be obtained within a few minutes after the procedure.

The disadvantages of radiopaque methods are:

• Inability to use in pregnant women(especially in early pregnancy). The reason is that radiation can disrupt the process of cell division in the embryo, which will lead to congenital malformations.
• Relatively low information content. Despite the fact that the contrast image clearly visualizes the fallopian tubes, this image does not provide information about the nature of the pathological process. An accurate diagnosis is impossible. Only the fact of obstruction is stated.
• Allergy danger. Some radiocontrast agents can cause allergic reactions in patients, including anaphylactic shock.

The following methods are secondary in the diagnosis of fallopian tube obstruction:

• laboratory blood test and urine test;
• bacteriological smear from the vagina;
• hormone analysis.

Laboratory analysis of blood and urine

Bacteriological smear

Taking a smear is a virtually painless procedure, provided that the infection is localized at the level of the vagina and cervix. Taking a sample directly from the area of ​​the fallopian tube is only possible using endoscopic methods. Test results are usually obtained a few days after the swab is taken.

Hormone analysis

Treatment of fallopian tube obstruction

• The presence of pronounced symptoms and manifestations of the disease. First of all, these include infertility, dysmenorrhea and abdominal pain. In such cases, fight the manifestations of the disease for a long time very difficult and recommended radical solution Problems ( surgery).
• Threat to the patient's life. If the appearance of tubal obstruction is influenced by pathologies such as acute inflammation in the abdominal cavity or neoplasms of the pelvic organs, then treatment should not only be radical, but also carried out in as soon as possible.
• Presence of chronic diseases. Some chronic diseases, such as heart disease ( renal, hepatic) deficiency or diabetes mellitus may be contraindications to surgical treatment.
• Patient's wishes. Since tubal obstruction often occurs without significant symptoms and does not bother the patient much, her desire to undergo treatment can be decisive.

Drug treatment

The first stage in conservative ( non-surgical) treatment is to exclude exposure to factors such as cold, high humidity, infections genitourinary tract. The latter implies abstinence from sexual intercourse for the entire duration of treatment.

For the conservative treatment of fallopian tube obstruction, the following groups of drugs are used:

• Anti-inflammatory drugs. Anti-inflammatory drugs are prescribed for fallopian tube obstruction caused by inflammation ( salpingitis, adnexitis, etc.). The following drugs are most often prescribed: indomethacin, aspirin, phenylbutazone, diclofenac, cortisone. These drugs have anti-inflammatory, antipyretic and analgesic effects, and can be used as suppositories ( candles), and in tablet form.
• Antibacterial drugs (antibiotics) . Antibiotics are prescribed when the bacterial flora that causes the inflammatory process is identified. If an antibiogram has not been performed and the doctor does not know which antibiotic the microbes are sensitive to, the drug is prescribed empirically. In such cases, kanamycin, gentamicin, chloramphenicol, tetracycline, metronidazole are often used. These drugs have wide range actions, that is, they fight germs different types, which increases the chances of success.
• Hormonal drugs . Hormonal drugs are prescribed for the treatment of trophic and vascular disorders associated with the inflammatory process. The fact is that these disorders are often directly related to hormonal imbalance ( This mainly concerns the level of sex hormones). More often, such treatment is prescribed for inflammation of the fallopian tubes associated with menstrual irregularities.

Drug treatment is often combined with physiotherapeutic procedures. The advantage of physiotherapy is that it can be effective even with chronic inflammation and adhesions, which are often the causes of the development of fallopian tube obstruction. In the later stages of the disease, physiotherapeutic procedures cannot lead to resorption of the adhesions, but they soften the adhesions, reduce the inflammatory process, and relieve acute symptoms.

In case of obstruction of the fallopian tubes, the following types of physiotherapy are prescribed:

• Balneotherapy has a beneficial effect on the body's reactivity ( its ability to fight infection) and reduces functional disorders resulting from the inflammatory process. Directions to resorts with hydrogen sulfide waters, sodium chloride waters, and nitrogen-siliceous waters are shown.
• Ultrasound therapy carries out a kind of micromassage of cells and tissues using sound waves. A course of such treatment usually provides a good analgesic effect, stretching and softening of adhesions, and improved tissue circulation.
• Drug electrophoresis using calcium and magnesium salts, enzyme preparations ( lidase), biogenic stimulants. With electrophoresis, drugs are injected into the pelvic cavity under the influence of an electromagnetic field. This provides a quick therapeutic effect and reduces the toxicity of the drugs used for other organs and systems.
• Electrical stimulation of the uterus and appendages- This is a kind of massage in which muscle contraction occurs under the influence of electrical impulses. Monopolar pulses with a frequency of 12.5 Hz are widely used. The intensity of the current is usually limited to a self-reported sensation of painless vibration. The duration of the effect of this procedure is up to five minutes, starting from the 5th - 7th day of the menstrual cycle. The duration of the course is 8 - 10 procedures.
• Gynecological massage. The purpose of the massage is to improve blood circulation in the pelvic organs, stretch and eliminate adhesions. It is recommended to combine massage with taking anti-inflammatory drugs and other physiotherapeutic procedures. In the presence of an acute inflammatory process or neoplasms, massage is contraindicated.

Surgery

The main types of surgical treatment for tubal obstruction are:

• Laparoscopic methods. This type of operation is performed most often. To reduce the risk to the patient, surgeons use special equipment. It is inserted into the pelvic cavity transvaginally ( through the vagina), transrectally ( through anal hole ) or through specially made incisions on the front wall of the abdomen. The number of holes may vary ( at least three), depending on how large the planned volume of the operation is. If new pathology findings or unexpected complications arise during surgery, the surgeon may decide to proceed to laparotomy.
• Laparotomy methods. Laparotomy involves incision of the anterior abdominal wall ( usually in the midline). Its advantage is the incomparably greater scope for carrying out therapeutic manipulations. Laparotomy is necessary, for example, when developing peritonitis, or to remove tumors in the abdominal or pelvic cavity. After this intervention, the patient remains with a scar. In addition, the recovery time after abdominal surgery significantly longer than after laparoscopic intervention ( at least 4 – 5 days in the absence of postoperative complications).
• Reconstructive surgery. Reconstructive surgery for tubal obstruction involves the use of synthetic materials. It allows you to artificially expand the lumen of the pipe. However, due to the lack of uniform requirements for materials and surgical techniques, it is impossible to talk about the reliability of such methods. However, reconstructive surgery in some cases is a woman’s last hope for restoring reproductive function. This type of operation can also include a uterus transplant. In 2014, the first case of successful birth by a woman with a transplanted uterus was reported.

The main indications for surgery for fallopian tube obstruction are:

• Infertility. If a woman cannot become pregnant for a long time, and during the examination she was diagnosed with obstruction of the fallopian tubes, surgery is certainly necessary to restore reproductive function.
• Adhesive process. The formed dense cords of connective tissue deform the organ and can cause long-term lingering pain in the lower abdomen. Such adhesions are difficult to treat with medications or physiotherapeutic methods. The exception is patients who are not bothered by the presence of adhesions and who have preserved reproductive function.
• Neoplasms in the pelvic cavity. It is recommended to remove both malignant and benign tumors. In the first case, this helps to avoid the spread of metastases and is directly related to the threat to the patient’s life. Benign formations tend to grow. Sometimes they can reach several kilograms in weight. There is always a risk of certain complications caused by such tumors ( malignancy, compression of neighboring organs).
• Ectopic pregnancy. With partial tubal obstruction, fertilization of the egg in the tube and the development of an ectopic pregnancy are possible. Then there is a risk of profuse ( very intense and massive) bleeding and ruptures of organ walls. To prevent these complications, it is recommended to surgically terminate such a pregnancy.
• Acute inflammatory processes. In rare cases, inflammatory processes in the area of ​​the fallopian tubes do not respond to drug and physiotherapeutic treatment. Then an opening of the abdominal cavity is indicated to eliminate the source of inflammation. Often this requires cutting off a section of the fallopian tube.

After surgical treatment rehabilitation period may last from several days to several weeks ( depending on the type of operation and the development of postoperative complications). In this case, the woman must remain in bed, limit physical activity and follow other recommendations of the attending physician. Usually, obstruction of the fallopian tubes can be successfully restored, and the woman regains the opportunity to have children.

In cases where reproductive function is certain not to return after surgery, or the chance of this is very low, the patient must sign informed consent for the operation. This legal document, which assumes that the patient was aware of all the risks, dangers and consequences that could occur both in consenting and in refusing surgical treatment. If at the time of the operation the patient was unable to take this decision (was unconscious), consent is signed by the husband, parents or close relatives. Depriving a woman of reproductive function without this document is regarded as causing serious harm to health and may become a reason for legal action and criminal proceedings.

Traditional methods of treatment

Herbal medicines based on boron uterus can have a certain effect. This plant affects the level of estrogen in the blood, which can promote a speedy recovery. It is advisable to discuss the use of such medications with your doctor, as they may affect the effect of other medications.

The slightest disturbances in a woman’s reproductive system provoke the development of pathological processes, which, depending on the complexity, can lead to infertility - one of the most pressing problems of modern humanity. Most cases of dysfunction of the reproductive system are associated with malfunctions in the fallopian tubes. And what this organ is, and what pathologies can arise in it, we will now understand.

The fallopian tubes are a tube-shaped pair of organs that connect the uterus to the ovaries. In medicine, the tube also has other names - canal, oviduct.

The anatomy of this organ is simple: it is a pair of tubular canals that have a cylindrical shape, one part of which enters the abdominal cavity, and the other into the uterine cavity. The oviducts consist of mucous, muscular and serous membranes.

The central part of the fallopian canals is quite narrow, its outer diameter is no thicker than a cocktail straw, and its inner diameter is slightly larger than the thickness of a hair. Closer to the appendages, the channels expand like a funnel. The edge that approaches the ovaries is covered with fibria, small processes that are constantly in motion.

Important! Without normal operation uterine canals, natural conception cannot take place. Some women are unable to conceive because their oviducts are blocked by scar tissue or have some other abnormality.

MT departments

The oviducts consist of several sections:

1. The mouth of the fallopian tubes. The segment of the oviduct adjacent to the wall of the uterus. It opens into the uterine cavity with a hole whose diameter is about 2 mm.
2. Isthmus. The central part of the channels.
3. Fallopian tube ampulla. The next section of the organ after the isthmus, gradually increasing in diametrical size. In the ampullary section of the fallopian tube, the folded structure of the mucous membrane of the organ is clearly visible.
4. Funnel. A continuation of the ampulla, which is an expansion of the canal, resembling a funnel in appearance, along the edges of which there is a huge number of fimbriae, having irregular shape. The largest one stretches in the fold of the peritoneum to the appendage. The top of the funnel is a rounded hole that opens into the peritoneum, through which the fertilized egg, through pulsed movements of the canal, enters the ampulla. And due to the fact that the cilia of the fimbria epithelium are in constant motion towards the uterus, they attract the egg from the peritoneum and gradually transport it to the uterine cavity.

The blood supply to the fallopian tube is realized through the ovarian and tubal branches of the arteries.

Functions of the organ

What are the uterine tubes for? The main function of the uterine canals is to move the egg into the uterine cavity.

If we talk about the reproductive function of the organ, then it is in it that the meeting of the egg and sperm occurs, which are immediately fertilized. In the event of conception, the fertilized egg begins to actively divide and, once in the uterus, is attached to its wall, where, in fact, the process of embryo development begins. This process in obstetrics is called embryo implantation. You can find more about this in one of our previous ones.

Dimensions

So, we have figured out the structure and function of the uterine canals. Let's discuss the size of this reproductive organ.

Despite such an important function, the size of the fallopian tube is small. The length of each oviduct is about 10-12 cm, and the minimum diametrical size in the isthmus region does not exceed 5 mm.

If there is any pathology of this reproductive organ, the size of any part of the organ may go beyond the normal limits due to swelling or inflammation.

Possible diseases of the uterine canals

There are a number of diseases of the uterine tubes that negatively affect their functionality:

1. Chronic salpingitis, or as it is also called in medicine – salpingoophoritis. Inflammation of the fallopian canals and ovaries, accompanied by the appearance of adhesions in or around these organs. The presence of adhesions prevents the movement of eggs into the uterine cavity. Fallopian tube obstruction is diagnosed, which is one of the causes of infertility in women.
2. Ectopic pregnancy. Abnormal development of the embryo, which results in a threat to the woman’s life. In this case, emergency assistance from a gynecologist is required. Normal fetal development occurs inside the uterine cavity, but in the case of an ectopic pregnancy, the fertilized egg is implanted in the fallopian canal, ovary, and even in the abdominal cavity. VD can occur due to inflammatory diseases, after artificial termination of pregnancy, hormonal disorders, congenital underdevelopment of the oviducts, etc. The tubes are not intended for fetal development, therefore, in the case of an ectopic pregnancy, without proper attention and surgical intervention, they can rupture due to rapid growth embryo, which is dangerous for the woman’s life.
3. Endometriotic cyst. This disease is characterized by the appearance of cystic neoplasms on the endometrium.
4. Tumor. It is rarely diagnosed, but in most cases it is characterized by the development of benign tumors, such as fibroids, lipoma, lymphangioma, etc., which require surgical treatment. As a rule, diseases of this type do not manifest themselves clinically; they are discovered accidentally during surgical interventions on the pelvic organs.
5. Pathology. In medicine, this phenomenon is associated with congenital disorders anatomical structure or with functional impairments acquired during life.
6. Cancer. Malignant tumors localized primarily in the epithelial lining layer of the canals or appendages. Treatment depends on the degree of organ damage and the individual characteristics of the patient.

It’s worth saying a little more about developmental defects. They are as follows:

• too long or, conversely, short oviducts;
• the presence of additional blind passages;
• lumen splitting.

The cause of acquired pathologies may be previously suffered inflammatory diseases pelvic organs, surgical interventions on the abdominal organs, etc.

Bottom line

At the end of the publication, let’s summarize: the uterine tubes play a key role in the reproductive function of the female body. Due to their physiology, these channels ensure the transport of the egg from the appendages to the uterine cavity, and fertilization of the egg by the sperm occurs in them.

There are a number of diseases of the fallopian tubes that can negatively affect their functionality. Therefore, if you detect any signs of their illness, you must consult a doctor. This will help to timely determine the condition of the oviducts and, if necessary, prescribe therapy to restore their full functioning.

What interesting things have you heard about this organ? Perhaps you know some other features of the fallopian tubes?

The uterus is the reproductive unpaired internal organ of the female individual. It is composed of plexuses of smooth muscle fibers. The uterus is located in the middle part of the small pelvis. It is very mobile, so it can be in different positions relative to other organs. Together with the ovaries, it makes up the female body.

General structure of the uterus

This internal muscular organ of the reproductive system has a pear-shaped shape that is flattened in front and behind. In the upper part of the uterus on the sides there are branches - the fallopian tubes, which pass into the ovaries. The rectum is located behind, and the bladder is located in front.

The anatomy of the uterus is as follows. The muscular organ consists of several parts:

1. Dna is top part, having a convex shape and located above the line of origin of the fallopian tubes.
2. A body into which the bottom smoothly passes. It has a cone-shaped appearance. It narrows downwards and forms an isthmus. This is the cavity leading to the cervix.
3. Cervix - consists of an isthmus and a vaginal part.

The size and weight of the uterus vary from person to person. Average weight values ​​for girls and nulliparous women reach 40-50 g.

Anatomy of the cervix, which is a barrier between internal cavity and the external environment, is designed so that it protrudes into the anterior part of the vaginal vault. At the same time, her posterior arch remains deep, and the front - vice versa.

Where is the uterus?

The organ is located in the pelvis between the rectum and bladder. The uterus is a very mobile organ, which also has individual characteristics and shape pathologies. Its location is significantly influenced by the condition and size of neighboring organs. The normal anatomy of the uterus in terms of the place it occupies in the small pelvis is such that its longitudinal axis should be oriented along the axis of the pelvis. Its bottom is tilted forward. When the bladder is full, it moves back a little, and when emptying, it returns to its original position.

The peritoneum covers most uterus, except for the lower part of the cervix, forming a deep pocket. It extends from the bottom, goes to the front and reaches the neck. Rear end reaches the vaginal wall and then passes to the anterior wall of the rectum. This place is called the pouch of Douglas (recess).

Anatomy of the uterus: photo and wall structure

The organ is three-layered. It consists of: perimeter, myometrium and endometrium. The surface of the uterine wall is covered by the serous membrane of the peritoneum - the initial layer. At the next - middle level - the tissues thicken and have a more complex structure. Plexus of smooth muscle fibers and elastic connective structures form bundles that divide the myometrium into three internal layers: internal and external oblique, circular. The latter is also called the average circular. It received this name in connection with the structure. The most obvious is that it is the middle layer of the myometrium. The term “circular” is justified by a rich system of lymphatic and blood vessels, the number of which increases significantly as it approaches the cervix.

Bypassing the submucosa, the uterine wall after the myometrium passes into the endometrium - the mucous membrane. This is the inner layer, reaching a thickness of 3 mm. It has a longitudinal fold in the anterior and posterior region of the cervical canal, from which small palm-shaped branches extend at an acute angle to the right and left. The rest of the endometrium is smooth. The presence of folds protects the uterine cavity from the penetration of vaginal contents that are unfavorable for the internal organ. The endometrium of the uterus is prismatic; on its surface there are uterine tubular glands with glassy mucus. The alkaline reaction they provide preserves the viability of sperm. During ovulation, secretion increases and substances enter the cervical canal.

Uterine ligaments: anatomy, purpose

IN in good condition In the female body, the uterus, ovaries and other adjacent organs are supported by the ligamentous apparatus, which is formed by smooth muscle structures. The functioning of the internal reproductive organs largely depends on the condition of the muscles and fascia pelvic floor. The ligamentous apparatus consists of suspension, fixation and support. The combination of the properties of each of them ensures the normal physiological position of the uterus among other organs and the necessary mobility.

The anatomy of the uterus and appendages, as well as other organs of the female reproductive system consists of a developed muscle tissue and fascia that play significant role in the normal functioning of the entire reproductive system.

Characteristics of the hanging apparatus

The suspensory apparatus consists of paired ligaments of the uterus, thanks to which it is “attached” at a certain distance to the walls of the pelvis. The broad uterine ligament is a transverse fold of the peritoneum. It covers the body of the uterus and the fallopian tubes on both sides. For the latter, the structure of the ligament is an integral part of the serous covering and mesentery. At the lateral walls of the pelvis it passes into the parietal peritoneum. The suspensory ligament arises from each ovary and has a wide shape. Characterized by durability. The uterine artery runs inside it.

The own ligaments of each of the ovaries originate from the uterine fundus on the posterior side below the branch of the fallopian tubes and reach the ovaries. The uterine arteries and veins pass inside them, so the structures are quite dense and durable.

One of the longest suspensory elements is the round ligament of the uterus. Its anatomy is as follows: the ligament looks like a cord up to 12 cm long. It originates in one of the corners of the uterus and passes under the anterior sheet of the broad ligament to the internal opening of the groin. After which the ligaments branch into numerous structures in the tissue of the pubis and labia majora, forming a spindle. It is thanks to the round ligaments of the uterus that it has a physiological inclination anteriorly.

Structure and location of fixing ligaments

The anatomy of the uterus should have suggested its natural purpose - bearing and giving birth to offspring. This process is inevitably accompanied by active contraction, growth and movement of the reproductive organ. In this connection, it is necessary not only to fix the correct position of the uterus in the abdominal cavity, but also to provide it with the necessary mobility. Fixing structures arose precisely for such purposes.

The main ligament of the uterus consists of plexuses of smooth muscle fibers and connective tissue, radially located to each other. The plexus surrounds the cervix in the area of ​​the internal os. The ligament gradually passes into the pelvic fascia, thereby fixing the organ to the position of the pelvic floor. The vesicouterine and pubic ligamentous structures begin at the lower anterior part of the uterus and attach to bladder and pubis, respectively.

The uterosacral ligament is formed by fibrous fibers and smooth muscles. It extends from the back of the cervix, envelops the rectum on the sides and connects to the fascia of the pelvis on the sacrum. In a standing position, they have a vertical direction and support the cervix.

Supporting apparatus: muscles and fascia

The anatomy of the uterus implies the concept of “pelvic floor”. This is a set of muscles and fascia of the perineum that make it up and perform a supporting function. The pelvic floor consists of an outer, middle and inner layer. The composition and characteristics of the elements included in each of them are given in the table: