Simply put, the uterus is the cradle of life.
The ovary is where eggs grow.
Uterus: It is a single muscular organ, mainly composed of smooth muscle, with small wall thickness and rich expansibility. Its shape, size, position and structure change with age and are influenced by menstrual cycle and pregnancy.
(1) Position and fixation of uterus: The uterus is located in the center of pelvic cavity, adjacent to bladder in front and rectum in the back. Its long axis is generally consistent with the pelvic axis. Normal uterus leans forward and bends forward in the pelvic cavity, but tends to lean slightly to one side. It is more common to lean to the right, and the lower end of the second uterus is connected with the vagina and protrudes into the vaginal cavity. The so-called forward tilt is the angle formed between the long axis of uterus and the long axis of vagina; This angle is formed because the inclination of the uterine body is slightly greater than that of the cervix. The uterus leans forward and bends slightly forward, which belongs to the normal position; If the uterus leans forward, forward, backward or backward, the position of the uterus is abnormal. The position of uterus usually changes slightly due to the influence of surrounding organs, especially the filling of bladder and rectum. When the bladder is full and the rectum is empty, the bottom of the uterus moves backward and upward, and the inclination of the uterine body becomes smaller. When the bladder is full, the bottom of the uterus can extend to the sacrum, and even the uterine flexion can disappear. On the contrary, when the rectum is full and the bladder is empty, the uterus moves slightly forward and downward, and the uterus is mostly in a forward flexion position, and the uterus is located above the bladder. When the bladder and rectum are filled, the uterus moves slightly upward and straightens. The position of pregnant uterus changes with the time of pregnancy. The fixation of uterus depends not only on pelvic floor tissues, namely pelvic diaphragm, urogenital diaphragm and its fascia, but also on ligaments connecting uterus with bladder, rectum and pelvic wall. Some of these ligaments belong to peritoneal folds, while others are composed of smooth muscle and fibrous tissue. There are four pairs of ligaments around the uterus, which play an important role in maintaining the slight anteversion and anteversion of the uterus. The main ligament of uterus can fix the cervix, and together with the broad ligament of uterus can prevent the uterus from tilting and lateral flexion; Ligamentum teres uteri and bladder-uterine plica can prevent uterine retroversion and retroflexion; Sacro-uterine ligament and recto-uterine muscle can make the uterus lean forward and inhibit the uterus from moving forward.
(2) Morphology of uterus: The uterus of unfertilized adult women is inverted pear-shaped, slightly flat at the front and back, weighing 40-50g, with a total length of 7-8cm, a maximum transverse diameter of 4cm and a thickness of 21.3ct. The uterus can be divided into four parts. The front is opposite to the bladder, which is called the bladder surface, and there is a bladder uterus depression between the bladder and the bladder; The posterior part of the uterus is adjacent to the rectum, which is called the rectal surface. There is a rectocele between the rectum and the rectum. Because the rings of the small intestine (ileum) and sigmoid colon extend to this depression, the posterior part of the uterus is also called the intestinal surface. Both sides of the uterus are convex, which are called left margin {uterus and right margin {uterus, respectively, facing the pelvic wall and attached by broad ligament of uterus.
The uterus can be divided into four parts: fundus, cervix, corpus uteri and isthmus. Uterus fundus: Uterus fundus is the part where the upper end of uterus protrudes upward above the level of uterine horns on both sides. This part is blunt and free, and comes into contact with ileal loop and sigmoid colon. Cervix: The cervix is a thin part of the lower end of the uterus, about 2.5 cm long, cylindrical, flat at the front and back, thick in the middle, with a transverse diameter of 2.2-2.5 cm, and a front-back diameter (thickness) 1.5 cm. The lower part of the cervix extends into the vagina, so it is divided into upper and lower parts by the vagina. The lower part 1/3 extends into the vagina, which is called Vaginalpartofcervix. Its end is round and smooth, and there is an opening in the center, called cervix. Maternal mouth is oval; Multiple warps are irregular transverse cracks. The front edge of uterine orifice is short and thick, called anterior lip; The trailing edge is long and round, called the posterior lip. The position of the front lip is lower than that of the rear lip. Because the uterus is in the anterior position, both the anterior labia and the posterior labia are in contact with the posterior vaginal wall. The upper 2/3 of the cervix is located above the vagina, which is called vaginal upper cervix. Both sides of this part are connected with the main ligament of the uterus. Uterus: Uterus is the largest part between the bottom of uterus and cervix. It is wide at the top and narrow at the bottom, flat at the front, convex at the back, round at both sides, with broad uterine ligament attached. Uterine isthmus (1sthmusofuterus): Uterine isthmus is the part of cervix and upper vagina that is phase-shifted from uterine body. This part actually belongs to the cervix, which is narrow. Under normal circumstances, the length of this part is only 0.6- 1.ocm, and it can grow to 6 lOcm in the third trimester of pregnancy, which is clinically called the lower uterine segment and is the place where the uterus is cut by caesarean section. ?
(3) Relationship between uterus and peritoneum and its ligaments: The uterus belongs to peritoneal mesothelial organ, and most of its surface is covered by peritoneum, but only the two side walls of uterus and the front wall of cervix and vagina are not covered by peritoneum. The peritoneum covering the surface of the bladder moves backward and downward in the isthmus of the uterus (the plane of the internal orifice of the uterus), then turns upward, bypasses the front and bottom of the uterus, turns back to the back of the uterus, then descends along the back to the lower ends of the upper part of the cervix and vagina and the upper part of the posterior wall of the vagina, and finally turns back and forth to cover the front part of the middle part of the rectum. '
In the process of peritoneal migration, peritoneal cavities are formed between bladder and uterus and between uterus and rectum. The former is Vesi—‘couterinepouch, which is shallow and of little clinical significance. The latter is called recto-uterine bag, also known as Douglasi'scavity, which is quite deep. Its bottom is roughly flush with the external opening of the cervix; The upper part is bounded by rectovaginal folds. Because the bottom of the rectocele is the lowest part of the peritoneal cavity, when there is effusion in the peritoneal cavity or ectopic pregnancy ruptures, liquid or blood will first accumulate in this cavity. Clinically, digital diagnosis and detection of vagina can be used to extract the contents through puncture of posterior fornix of vagina to assist diagnosis. Rectal uterine folds are arc-shaped peritoneal folds extending from both sides of rectum to the back of uterus. There are a lot of smooth muscle and fiber bundles in rectovesical folds, so it is also called sacrococcygeal ligament or rectovesical ligament. Among them, the smooth muscle tissue starts from the muscularis at the upper end of the cervix, goes backwards around both sides of the rectum, interweaves with the muscularis of the rectum, and ends in front of the sacrum 2- sacrum 3. This smooth muscle bundle is also called rectovaginal muscle.
The peritoneum covering the bottom of the uterus and the front and back of the uterus is closely combined with the myometrium of the uterus to form a perimeter, which extends outward from the lateral edge of the uterus to the lateral wall of the pelvic cavity, forming a coronal double-layer peritoneal fold called broad ligament of uterus. The broad ligament is approximately quadrangular, with free upper edge and fallopian tubes; The lower edge is attached to the pelvic floor and is phase shifted from the peritoneum of the pelvic floor. The upper part of the outer margin is free, forming ovarian suspensory ligament; The lower part of the outer edge and the inner edge migrate with the pelvic peritoneum and the anteroposterior peritoneum of the uterus respectively. Between the anterior and posterior leaves of the broad ligament of uterus, there are not only the upper fallopian tubes, but also ovaries, ovarian crowns, cystic appendages, paraovarian corpuscles, ovarian proper ligaments, ligamentum teres uteri, connective tissues, blood vessels, lymphatic vessels and nerves. The ligamentum teres and ligamentum proprium of the ovary are equivalent to the testicular band of men. Ligamentum teres uteri is a pair of round cords, composed of smooth muscle and connective tissue, with a total length of 12- 14 cm. Ligamentum teres uteri starts from the upper part of the lateral margin of uterus, slightly lower than the attachment of fallopian tube, initially goes forward and outward, passes through the upper part of bladder blood vessels, obturator blood vessels and nerves, umbilical artery cord and external iliac blood vessels, passes through the abdominal ring of inguinal canal, bypasses the initial part of inferior epigastric artery, enters the inguinal canal, passes through the subcutaneous ring, and ends at the subcutaneous tissue of labia majora and pubic mound. The part of this ligament in the pelvic cavity is called the pelvic region and contains many smooth muscles. A section of the inguinal canal, called the inguinal region, is mainly fibrous tissue, surrounded by muscle fibers at the free edge of the internal oblique muscle and transverse abdominis muscle, accompanied by branches of small blood vessels, lymphatic vessels, ilioinguinal nerve and reproductive femoral nerve. The broad ligaments of the uterus on both sides form a barrier with the uterus, which divides the pelvic cavity into two parts, with the bladder in the front and a part of rectum and sigmoid colon in the back.
In addition to salpingitis and mesangium, the broad ligament of uterus is also called mesangium, and contains loose connective tissue rich in fat, called paracervical tissue, which develops especially around the cervix, and also called accessory cervix, which connects paracervical tissue downwards, then connects paracervical tissue, and finally connects paracervical tissue. These paraorgan tissues often induce inflammation due to pathological changes in nearby organs, that is, pelvic inflammatory disease. On both sides of the cervix and uterine body, there are abundant venous plexus in the tissues around the uterus, namely, the uterovaginal plexus-there are uterine main ligaments in the lower part of the broad ligament of the uterus, in the upper part of the cervix and vagina, on both sides of the vaginal vault, and between the lateral walls of the pelvic cavity. Futerus), also known as Transverseligamento {cervix (cervix). It is mainly composed of connective tissue bundles and a small amount of smooth muscle fibers, and its lower part heals with the fascia above the pelvic diaphragm, which has a fixing effect on the cervix. Bladder uterine folds are formed by peritoneal folds from the front of the uterus to the bladder.
(4) Blood vessels, nerves and lymphatic vessels in uterus:
① Arteries: mainly uterine arteries. Besides nourishing uterus, it also branches into round ligament, broad ligament, fallopian tube, ovary and vagina. Uterine artery and ovarian artery coincide with each other in different forms between the ovary and the beginning of ovarian proper ligament, among which the ovarian branch artery of uterine artery most commonly coincides with the trunk of ovarian artery. The uterine fundus branch also branches to the round ligament of uterus, runs along the round ligament, and finally coincides with the inferior epigastric artery. There are 20-40 arterial branches (secondary branches) in the uterine wall, and their movements are straight or curved, and the blood vessels on both sides are anastomosed at the midline of the uterus.
② Veins: Uterine veins are well developed, forming venous plexus at the lateral corner of uterus and both sides of the lower part of uterus. The former collects venous blood from the upper part of uterine body, the bottom of uterus and fallopian tube, which is called cornual venous plexus of uterus and joins the superior uterine vein, and belongs to an important branch of ovarian vein. The latter collects venous blood from the lower part of uterine body, cervix and upper part of vagina, and feeds into uterine vein (inferior uterine vein), with 1-2 branches, and feeds into internal iliac vein. The inferior uterine venous plexus is connected with the anterior bladder venous plexus, and then with the rectal venous plexus. The rectal venous plexus overlaps with the uterine horn venous plexus upward and communicates with the vaginal venous plexus downward, so it is collectively called the hysterovaginal venous plexus. The arterial branches of the pregnant uterus transport blood to the placental villous space, and then return to the internal iliac vein through the uterine vein. .
③ Lymphatic vessels: There are abundant lymphatic vessels in uterus, which are divided into shallow and deep groups. Superficial lymphatic vessels are located under the uterine serosa; Deep lymphatic vessels are in the uterine wall. Lymphatic vessels at the bottom and upper part of the uterus are anastomosed with those from fallopian tubes and ovaries, and finally injected into lumbar lymph nodes and iliac lymph nodes. The bottom and upper part of the uterine body; Part of lymphatic vessels enter the superficial inguinal lymph nodes along the round ligament of uterus. Lymphatic vessels in the lower part of the uterine body accompany those in the cervix and enter the external iliac lymph nodes. The lymphatic vessels of the cervix enter not only the external iliac lymph nodes, but also the internal iliac lymph nodes and sacral lymph nodes. During pregnancy, the lymphatic vessels in the uterus will also expand.
④ Nerve: The nerve of uterus comes from pelvic plexus (composed of lower abdominal plexus, ovarian plexus and pelvic visceral nerve, that is, from sacrum 2- sacrum 4). Branches (myelinated and unmyelinated fibers) emanate from the pelvic plexus, forming the hysterovaginal plexus and entering the myometrium and endometrium. The terminal branches of individual nerves can reach endometrial epithelium. In the myometrium of cervix, there are plexiform and cystic sensory nerve endings; In the uterus, villous receptors can be seen.
Ovary: The position is the same as that of testis, and only the left side develops (the right side has degenerated), showing a grape shape. All follicles are at different stages of development, the follicles are yellow, and the surface of the ovary is densely covered with blood vessels. The size of the ovary is related to age and spawning period.
The ovary is located on the posterolateral side of the uterine fundus and connected with the pelvic side wall. During pregnancy, due to the movement of the uterus, its position has also changed greatly. After the fetus is delivered, the ovaries generally do not return to their original positions. Ovary belongs to abdominal organs. It is completely wrapped by the posterior lobe of the broad ligament of uterus, forming an ovarian capsule. The peritoneal fold between the ovary and the broad ligament of uterus is called mesentery. The mesangium of the ovary is very short, with blood vessels, lymphatic vessels and nerves passing through it. Ovary is very fluid, and its position is mostly affected by the filling degree of large intestine. Generally located in the ovarian fossa, the lateral side is connected with the peritoneum of the pelvic side wall. Ovarian fossa is located at the junction of the starting point of internal iliac artery and external iliac artery, with umbilical cord as the front boundary and ureter and internal iliac artery as the back boundary. The base of ovarian fossa consists of obturator internus, pelvic fascia and peritoneal wall covering its surface. Obturator blood vessels and nerves pass through the extraperitoneal tissue at the bottom of ovarian fossa. The position of fetal ovary is similar to that of male testis, which is located near the waist and kidney. The position of the newborn's ovary is higher and slightly oblique. The position of adult ovary is low, and its long axis is close to vertical position. Its fallopian tube end is located slightly below the plane of the pelvic upper mouth, near the external iliac vein, just opposite to the sacroiliac joint. The cervix is downward, slightly higher than the pelvic floor peritoneum, and meets the lateral corner of the uterus. Mesangial margin is located behind umbilical artery cord. The free edge is located in front of the ureter. The ovarian position of elderly women is low. The position of the ovary is affected by the position of the uterus. When the uterus leans to the left, the left ovary slightly shifts downward and the uterine end slightly turns inward; When you are right, the other way around is right. The fallopian tube end of the ovary and the upper part of its posterior edge are covered by oviduct umbrella and oviduct funnel.
The shape of the ovary: the left and right ovaries are gray-red, tough, flat and oval, and the surface is convex. The surface of young girls is smooth. After sexual maturity, the surface is often uneven due to follicular expansion and scarring after ovulation. The size and shape of the ovary also change with age. The same person, the left and right ovaries are inconsistent, generally the left side is larger than the right side. The average length of adult ovary is 2.93 cm on the left and 2.88 cm on the right. It's on the right. The average width on the left side is1.48 cm; ; The average value on the right side is1.38 cm; ; The average thickness of the left side is f-0.82 cm, the average thickness of the right side is 0.83cm, and the weight of the ovary is 3-4 g. At the age of 35-45, the ovary begins to shrink gradually, and the postmenopausal ovary can gradually shrink to 1/2 of its original volume. Usually the size of an adult's ovary is equivalent to the size of my thumb and fingers. With repeated ovulation of the ovary, follicular rupture atrophied and was replaced by connective tissue, and its essence gradually hardened.
Ovary is divided into medial and lateral, upper and lower ends, and anterior and posterior edges. The medial side of the ovary faces the pelvic cavity, which is mostly adjacent to the ileum, also known as the intestinal surface, and the lateral side is in contact with the pelvic side wall. The upper end of the ovary is blunt and round, called Tubalex—tremity, which is connected with the umbrella-shaped end of the fallopian tube, and the lower end points slightly to the uterus, which is called the uterine end. Ovarian mesoembryo is attached to the front edge of ovary. This edge is relatively straight, and there is a fissure in the center, called Hilumofovary, where the blood vessels, lymphatic vessels and nerves of the ovary come in and out. The posterior margin of ovary is free, called free zone, which is relatively convex and faces backward and inward.
Fixation of ovary: The ovary is not only fixed with broad ligament of uterus through ovarian mesothelium, but also connected with pelvic side wall and uterus through suspensory ligament and proper ligament of ovary.