教案09级-妇产科学3anatomy of the female

1、Anatomy of the FemaleReproductive SystemDepartment of Obstetric and Gynecology of the second Affiliated Hospital of Chongqing Medical UniversityIntroductionPelvis Pelvic floorExternal genitaliaInternal genitaliaAdjacent organsVessel and nerve and lymphBony pelvisBony pelvis1.Bones: ilium coxae ischi

2、um pubissacrumcoccyx ilium pubis ischium sacrumcoxaecoccyxBony pelvis2.Joint: A: symphysisB: sacrococcygeal jointC: sacroiliac joint ABCBony pelvis3.Ligaments: A: the iliolumbar ligament connects the 4th and 5th lumber vertebrae with the iliac crest. BCACBABony pelvis3.Ligaments:B: the sacrotuberous

3、 ligament above: attached to the crest of the ilium and posterior iliac spines and to the posterior aspect of the lower 3 sacral vertebrae. below: attached chiefly to the medial border of the ischial tuberosity.BCACBABony pelvis3.Ligaments:C: the sacrospinous ligament extending from the lateral bord

4、er of the sacrum and coccyx to the spine of the ischium. BCCBA4.Pelvis major and pelvis minorPelvis major consists of the space superior to the iliopectineal line, including the 2iliac fossae and the region between themPelvis minor below the iliopectineal line, anteriorly by the pubic bones, posteri

5、orly by the sacrum and coccyx, laterally by the ischium and a small segment of the iliumBony pelvisBony pelvis4.The pelvis minor: (bony birth canal) pelvic inlet pelvic cavity pelvic outlet Bony pelvis4.The pelvis minor: the pelvis inlet: ( promontory iliopectineal line crest of the pubis symphysis

6、) diameter: the anteroposterior diameter the transverse diameter the diagonal diameter Bony pelvis4.The pelvis minor: the pelvis outlet: ( arcuate ligament of the pubis ischiopubic arch ischial tuberosity sacrotuberous ligament coccyx ) diameter: the anteroposterior diameter the transverse diameter

7、5. Types of pelvis: The gynecoid type a round, slightly ovoid inlet. adequate sacrosciatic notch. wide interspinous diameters(10cm). 52%-58.9% The platypelloid type a distinct oval inlet. very wide retropubic angle. sacrosciatic notch is narrow. 23.2%-29%Bony pelvis5. Types of pelvis: The anthropoid

8、 type long, narrow, oval inlet. narrow anterior and posterior segment. wide sacrosciatic notch. long , narrow sacrum. Straight side walls is the characteristic. The android type wedge-shaped inlet, a narrow forepelvis,flat posterior segment, narrow sacrosciaticnotch, with the sacrum inclining forwar

9、d, the side walls converge.Bony pelvisBony pelvis5. Types of pelvis:The tissues closing down the pelvic outlet (muscles and fasciae) suspend and support the pelvic organs, such as uterus and bladder and rectumAnterior part (urogenital triangle) urethra and vagina pass through Posterior part (anal tr

10、iangle) rectum pass throughPelvic floorQuestion: which tissue will be cut off ?Median episiotomypostero-lateral episiotomyPelvic floor1. The outer layer of pelvic floor:ischiocavernosus muscleBulbocavernosus muscleSuperficial transverse perineal muscleExternal anal sphincter Pelvic floor2. The middl

11、e layer of pelvic floor: ( urogenital diaphragm) superior fasciaexternal urinary sphincter deep transverse perinealinferior fascia Pelvic floor3. The inner layer of pelvic floor: ( pelvic diaphragm ) extends from the upper part of the pelvic surface of the pubis and ischium to the rectum; the main s

12、upport of the pelvic floor, suspends the rectum and the uterus; the urethra, vagina and rectum pass through it. Pelvic floor3. The inner layer of pelvic floor: ( pelvic diaphragm )Levator ani: pubococcygeal iliococcygeal Ischiococcygeal coccygeal muscles covering fasciae. External genitalia 1. The r

13、ange of pudendum: Forward: symphysisAfterward: perineumLaterally: thigh External genitalia2. The consists of vulva: mons pubis labium majora labium minora clitoris vaginal vestibule vestibular bulb major vestibular glands urethral orifice vaginal orifice hymen Mons pubis before the pubic symphysis;

14、many fats under the skin; pubic hair grow from the adsolescence and distributed in an inverted triangle; the size, shape, coloration of the hair vary between individuals and racial groups.External genitalia2. The consists of vulva:Labia majora The labia majora are comprised of 2 rounded mounds of ti

15、ssue, originating from the mons pubis and terminating at the perineum. Hair is distributed over their surfaces, but not the inner surface. extending superiorly in the area of the mons pubis from one side to the other.External genitalia2. The consists of vulva:Labia minora The labia minora are 2 fold

16、s of skin that lie within the majora, with multiple corrugations over the surface. The labia minora begin at the base of the clitoris,where fusion of the labia is continuous with the prepuce,extending posteriorly and medially to the labia majora at the posterior commissure. The skin on the labia min

17、ora is smooth and pigmented.External genitalia2. The consists of vulva:Clitoris The clitoris is the homologue of the penis and consists of 2 small erectile cavernous bodies, terminating in a rudimentary glans clitoridis.Vaginal vestibule The area of the vestibule is bordered : the labia minora later

18、ally the frenulum labiorum pudendi posteriorly the urethra and clitoris anteriorly.External genitalia2. The consists of vulva:Internal genitalia Internal genitaliaInternal genitaliavaginaone of the organs for sex.the road of labor and menstruous blood.abundant plexiform veins in vaginal wall, easy t

19、o form hematoma when be hurtedInternal genitaliavaginal fornixthe circular cul-de-sac formed around the cevix is vaginal fornix which is divided into 4 regions: anterior, posterior and 2 lateral fornicesthe posterior fornix is covered by the peritoneum of the rectovaginal pouch where the doctor can

20、do puncture through it.Vaginal fornixInternal genitaliauterus Pear-shaped, thick-walled, muscular organ, situated between the bladder and the rectum. It communicates above with the fallopian tubes and below with the vagina Covered on each side by the 2 layers of the broad ligament Internal genitalia

21、Uterus Body or Corpus Isthmus Cervix fundus uteri corpus uteri uterine cavity cervical canalInternal genitaliauterusisthmus uteri anatomical internal os histological internal oscervix uteri the supravaginal portion the vaginal portionInternal genitaliathe body of the uterus: in the adult who has nev

22、er borne children, it is 7-8 cm long and 4-5 cm at its widest point uterus of children Corpus:cervix 1:2 uterus of adult Corpus:cervix 2:1Internal genitaliauterus-layers of uterine wall the serous layer is simply the peritoneal covering, it is thin and firmly adherent over the fundus and most of the

23、 body the mucous layer is soft and spongy, composed of tissue resembling embryonic connective tissue. The tissue is rather delicated and friable and contains many tubular glands that open into the cavity of the uterus Internal genitaliauterus-layers of uterine wall the muscular layer is extremely th

24、ick and continuous with that of the tubes and vagina Internal genitaliauterus-ligaments round ligament broad ligament cardinal ligament utero-sacral ligamentThe uterine ligament: the round ligaments : from a point of attachment to the uterus immediately below that of ovarian ligament, downward, late

25、rally, forward, to terminate in a fanlike manner in the labia majora. may assist in maintaining the body of the uterus in its typical position over the bladder. Internal genitaliaThe uterine ligament: the broad ligments : consisting of a transverse fold of peritoneum that arises from the floor of th

26、e pelvis between the rectum and the bladder. provides minimal support.Internal genitaliaThe uterine ligament: the cardinal ligaments : superiorly from the uterus and inferiorly from the vagina, fanning out toward the lateral bones, at the level of internal os of the cervix. the primary support of th

27、e uterus. Suspends the uterus from the lateral walls of the pelvis minor.Internal genitaliaThe uterine ligament: the uterosacral ligaments : the inferior posterior folds of peritoneum from the broad ligament. draw the cervix backward and upward.Internal genitaliaInternal genitaliafallopian tube ( ov

28、iduct）Interstitial portionampullafimbriaisthmic portionfallopian tube serve to convey the ova to the uterus; extend from the superior angles of the uterus to the region of the ovaries, running in the superior border of the broad ligament. Each tube is 7-14cm long and may be divided into 4 parts: Int

29、ernal genitaliafallopian tube Interstitial portion（间质部）:Isthmic portion（峡部）: is the narrow and nearly straight portion Ampulla（壶腹部）: wide and tortuousFimbria（伞部）: funnel-shaped mouth and is attached to the ovary. It can pick up the ova and convey it to the uterus via the fallopian tube.Internal geni

30、taliaInternal genitaliaovaryPaired organs, elliptic（椭圆）, the endocrine and reproductive functionsuspended by the mesovarium the suspensory ligament ovary ligament connect the lower pole of the ovary with the lateral wall of the uterus.Internal genitalia ovary-the structure of ovary germinal epitheli

31、um cortex(皮质）: oocytes in various Stages of maturity corpus luteum（黄体） corpus albicans（白体） medulla（髓质） in the middle of the ovary including the fibers, smooth muscle cells, blood vessel, nerves.Adjacent organs A: bladder C: urethra D: rectum DCAAdjacent organs A: bladder B: ureters D: rectum E: verm

32、iform appendix AEDBDbladder the bladder lies posterior to the pubic bones and anterior to the uterus and broad ligament. the peritoneum passes onto the uterus at the junction of the cervix and corpus, contiuing upward on the anterior surface of the bladder to form the vesico-unterine pouch. the blad

33、der must be empty before gynecological operation or examination because it can influence the position of uterus and vagina. Adjacent organs urethra the urethra is closely applied to the anterior wall of the vagina, especially in the lower 2/3, where it is intergrated with the wall, forming the ureth

34、ral carina. the urethra and vagina are so closely that they are easy to infected by each other. Adjacent organsrectum the rectum lies posterior to the uterus and vagina and anterior to the sacrum. the peritoneum（腹膜） form the recto-vaginal pouch between the rectum and uterus, which is the lowest part

35、 of the pelvic cavity. there are parts of muscles of pelvic floor around it, so it is important to avoid hurting the rectum in labor and gynecological operation. Adjacent organsAdjacent organsB: ureters BBureter the ureter is a slightly tube that extends from the renal pelvis to the base of the blad

36、der. the ureter has closely relationship with the uterine artery. In the hystero-salpingectomy（子宫输卵管切除术）, it is important to avoid hurting the ureter. Adjacent organsBlood vessel, lymphatics and nervesin the pelvic cavity1. Blood vessel : arteries the ovarian artery the uterine artery the vaginal ar

37、tery the pudenda internal arteryThe ovarian arteryOrginated as branches of the abdominal aortaeote, (left: left renal artery).It is turn over the common iliac artery and ureter, descend into the pelvis. Then enter into ovary through the mesovarium（卵巢系膜）Blood vessel, lymphatics and nervesin the pelvic cavity1. Blood vessel :The uterine arterya terminal branch of the hypogastric arteryCross the ureter near the cervix (2cm)Ascend along the lateral border of the uterusDivided into uterine body branch and cervix-vagina branchBlood vessel, lymphati