Normal anatomy of the pelvic organs and mechanisms of fertilization

Fallopian tubes named after the Italian physician Gabriel Fallopius, who first described their structure. These are paired hollow tubes through which fertilized eggs move into the uterine cavity. Each tube lies in a double fold of the peritoneum - the mesentery of the tube. The length of the pipe is approximately 10-12 cm. Normally, the right pipe is slightly longer than the left. Width – about 4-6 mm. The inside of the fallopian tube consists of a mucous membrane with ciliated epithelium. Thanks to the muscular activity of the tube and the oscillatory directed movements of the cilia of the epithelium, the fertilized egg is pushed towards the uterus.

Embryology

Rice.
1. Schematic representation of some stages of development of the fallopian tubes: a - in an embryo of 8-9 weeks, paramesonephric canals are formed (1) - the material of the future fallopian tubes and mesonephric canals (2) of the primary kidney; b - in a fetus of 22 weeks, the muscular (5) and connective tissue (4) layers of the walls of the fallopian tubes are formed; longitudinal folds (3) of the mucous membrane are pronounced; c — in a 28-week fetus, the folds (3) of the mucous membrane increase; d - in a newborn, folds (3) of the mucous membrane are complex tree-like formations; The folding of the mucous membrane increases during the formation of the fallopian tubes. In embryos 8–9 mm in length, at the cranial part of the primary kidney above the gonad anlage, a symmetrical invagination of the coelomic epithelium into the mesenchyme occurs at the level of the first thoracic vertebra. These areas form blind tubes that grow along the ducts of the primary kidney, forming paramesonephric (Müllerian) canals (Fig. 1a); the cells of the epithelium lining them acquire an elongated shape, and the epithelium subsequently becomes pseudostratified. The paramesonephric canals (ducts, T.) run parallel to the ducts of the primary kidney on the lateral side and somewhat outside of them and open into the cloaca with separate openings. At the opposite end, the channel ends in a blind extension. This end continues to grow and then becomes lumen. The uterus, fallopian tubes and upper part of the vagina develop from the paramesonephric canals; The fallopian tubes are formed from the upper third of the paramesonephric canals. Within 11-12 weeks. During intrauterine development, the muscle and connective tissue layers of their wall are formed from the accumulations of mesenchyme around these canals. All structural elements of the fallopian tube wall are clearly visible at 18–22 weeks. intrauterine development; during this period, the longitudinal folds of the mucous membrane are already well defined (Fig. 1, b). By 28 weeks the folds increase, and in a newborn girl the mucous membrane of the M. t. is already represented by tree-like formations, the epithelium is single-layered with a prismatic shape (Fig. 1, c, d). The first cilia on the epithelial cells of the tubal fimbriae appear at 16 weeks. intrauterine development. The epithelial layer of the mucous membrane of the t. reaches its maximum development at 30-31 weeks. intrauterine development. The muscular layer of the uterus develops simultaneously with the muscular layer of the uterus from the mesenchyme surrounding the paramesonephric canal. Circular and then longitudinal muscle layers are formed by the 26-27th week. Vessels develop in the outer connective tissue layer; later this layer decreases in volume. The left tube (like the ovary) develops somewhat later.

Age characteristics

By the time a girl is born, the formation of the Fallopian tubes is anatomically largely completed; the tubes look like convoluted tubes about 3 cm long. Histologically, three membranes are formed, but the mucous membrane is not yet mature, the differentiation of its components is not complete. In the muscular layer, the formation of the outer longitudinal layer has not yet been completed. In the isthmus of the bladder, 4-5 low primary folds can be noted; along the length of the tube towards the ampulla, the folds become higher and densely branch. The height of the epithelial cells increases towards the abdominal opening of the M. t.; there are especially many tall cylindrical cells with narrow elongated nuclei and single ciliated cilia, often glued together. Secretory large cells with lighter nuclei are more often found at the base of the primary folds, while at the top of the folds they are single. In low, small cells with large nuclei and light vesicular cytoplasm, figures of mitotic divisions (cambial elements) are found. Connective tissue is formed by delicate collagen fibers and a large number of cellular elements, rich in CHIC-positive substances and acidic mucopolysaccharides. Subsequently, especially during puberty, M. t., like all parts of the reproductive system, increase significantly, although under unfavorable conditions the infantile type of M. t. can persist in an adult girl and woman.

How to choose the best method?

Many patients are lost in the abundance of diagnostic methods and often do not know what is best to choose for a given study. It is important to understand that you should always consult your doctor. For some, hysterosalpingoscopy is better suited, while others need to additionally remove the cyst from the ovary. In this case, laparoscopy becomes the method of choice. It turns out that the selection of a diagnostic method in most cases is quite individual.

The main criteria that doctors use to evaluate a particular procedure remain:

• Potential reliability of diagnostic information. In this case, laparoscopy often “wins”, since the doctor will be able to see with his own eyes what is happening inside.
• Safety for the patient.
• The need to use additional medications (anesthesia).
• Duration of the procedure.
• The severity of the patient's condition.

By assessing all these criteria, the most appropriate diagnostic method can be selected.

Anatomy

Rice.
2. Schematic representation of the ovarian-uterine-tubal complex of an adult woman: 1 - fallopian tubes; 2 - uterus; 3 - ovaries; 4 - broad ligaments of the uterus. One end of the Fallopian tube opens into the uterus - the uterine opening of the tube (ostium uterinum tubae), and the other (free) end - the abdominal opening (ostium abdominale tubae uterinae) - into the abdominal cavity near the ovaries (Fig. 2) and during ovulation it can be in close contact with an ovary. Each tube is enclosed in a fold of peritoneum, which makes up the upper part of the broad ligament of the uterus and is called the mesentery of M. t. (mesosalpinx). More often, the length of the M. t. in an adult woman is 10-12 cm, the right M. t. is usually slightly longer than the left; M. t. may have structural variations. The following sections are distinguished: the part of the uterus enclosed in the wall of the uterus - the uterine part (pars uterina); isthmus of the uterus (isthmus tubae uterinae) - the narrow section closest to the uterus (diameter 2-3 mm); ampulla tubae uterinae - a section that follows the isthmus outward, gradually increasing in diameter (6-10 mm) and making up half the length of the entire tubae; the distal end of the M. t., expanding into the funnel of the M. t. (infundibulum tubae interinae), is a direct continuation of the ampulla, the free edge of which ends with numerous outgrowths—fimbriae tubae). One of the ovarian fimbria (fimbria ovarica), the longest and largest, stretches in the fold of the peritoneum all the way to the ovary, approaching its tubal end. The abdominal opening of the M. t., with a diameter of 2-3 mm, is usually closed, the opening of the lumen is associated with the processes of ovulation. Through the M. t., and then the uterus and vagina, the abdominal cavity communicates with the external environment.

Blood supply

M. t. occurs due to 3-4 branches coming from the tubal and ovarian branches of the uterine artery (a. uterina), located in the mesentery of M. t. The veins in the mucous membrane of the funnel near its outer edge are arranged in a ring shape and extend into the fimbriae. At the moment of ovulation, the veins fill with blood, the fimbriae of the uterus become tense and the funnel approaches the ovary, enveloping it. Lymphatic vessels follow mainly the course of the blood vessels, heading to the internal iliac (nodi lymphatici iliaci int.) and inguinal (nodi lymphatici inguinales) lymph nodes. M. t. is innervated from the branches of the pelvic and ovarian plexuses (plexus pelvicns et plexus ovaricus).

Hysterosalpingography images

The right fallopian tube is obstructed in the ampullary section.

The left fallopian tube is freely patent.

The "R" on the image indicates the patient's right side.

The arrow indicates an obstruction in the ampullary section of the right fallopian tube.

The right and left fallopian tubes are difficult to pass due to the presence of bilateral valve sactosalpinxes.

The image clearly shows dilated and tortuous fallopian tubes.

The arrow shows the fallopian tube on the left with the presence of a valve sactosalpinx.

The "R" on the image indicates the patient's right side.

The left fallopian tube is freely patent.

The right fallopian tube is obstructed in the intramural section.

The arrow indicates the presence of an obstruction at the mouth of the right fallopian tube.

The letter "R" in the image represents the patient's right side.

The left fallopian tube is obstructed in the ampullary section.

The right fallopian tube is difficult to pass due to the presence of a valve sactosalpinx on the right.

The arrow shows the valve sactosalpinx on the right.

The "R" on the image indicates the patient's right side.

Histology

Rice.
3. Schematic representation of a cross section of the fallopian tube in an adult woman: 1 - lumen of the tube; 2 - lamina propria of the mucous membrane; 3 - folds of the mucous membrane, covered with single-layer epithelium; 4 - vessels in the outer layer of connective tissue; 5 - muscular layer. Rice. 5. Microscopic specimen of the fallopian tube is normal: general view of the various sections of the tube (1) in a cross section (at different levels); In the lumen of the tube, branched folds (2) of the mucous membrane are visible. Staining with hematoxylin-eosin The wall of the Fallopian tubes consists of three membranes: mucous, muscular and serous (color. Fig. 5). The mucous membrane of the M. of the adult woman has protrusions in the form of long longitudinal folds along the entire length of the tube, between which there are shorter transverse folds. In a cross section, each fold has the appearance of a branched tree (Fig. 3). In the ampulla of M., the folding is most pronounced; in the uterine part it is insignificant.

The mucous membrane consists of epithelium and loose connective tissue - the lamina propria mucosae. The epithelium is single-layer cylindrical; it distinguishes four types of cells: ciliated, secretory, basal (indifferent), pin-shaped (so-called red cells); the number of cells varies depending on the phase of the menstrual cycle (see). Ciliated cells make up half of all cells; they are present throughout the M. t., their number increases towards the ampulla. These cells contain cilia and a smaller number of organelles and inclusions compared to secretory cells. In the preovulatory period, the number of cilia increases, and their movements are recorded. Secretory cells are part of the epithelium of all parts of the uterus, their number increases towards the uterine end. Cyclic changes in the structure of secretory cells are significant; in the first half of the menstrual cycle, their size and the number of organelles, especially mitochondria, increase, and a large number of secretion granules appear. The maximum secretory activity of these cells is detected after ovulation; in the second half of the menstrual cycle, the height of these cells decreases and the nature of the secretory granules changes. Basal and peg cells appear in the second half of the menstrual cycle, especially at the end of the luteal phase. The basal cells are round in shape with weakly eosinophilic cytoplasm and a large nucleus; they are cambial reserve cells. Fiziol, regeneration of ciliated and secretory cells is carried out due to the division of basal cells. Basal, like peg-shaped, cells make up approx. 1% of all epithelial cells. Pin-shaped cells are considered as dystrophically altered ciliated and secretory cells, which subsequently undergo autolysis.

The lamina propria of the mucous membrane is a loose, fibrous, unformed connective tissue rich in blood vessels and nerve endings. During the menstrual cycle, connective tissue also undergoes changes similar to changes in the functional layer of the endometrium of the uterus (see). The muscular layer consists of smooth muscles arranged in the form of a circular layer (the most powerful) and longitudinal. Muscle bundles penetrate the folds of the mucous membrane. Towards the ampulla, the muscle layer becomes thinner and, conversely, as it approaches the uterus it thickens. The serosa consists of the mesothelium and the lamina propria of the serosa.

Preparation

Given that most procedures are not simple, they require appropriate preparation on the part of the patient, especially if the use of general anesthesia is envisaged.

The most important points remain:

• Complete preliminary examination (consultation with a doctor and passing all tests).
• 2 days before almost all procedures, you need to abstain from sexual intercourse. The doctor may stop taking certain medications if they affect the final result.
• A week before the relevant procedure, you should stop using vaginal suppositories, douching, and the like.

Thus, it will be possible to obtain the most reliable results of any of the above examinations. You can do sonohysterosalpingoscopy at the AltraVita clinic. Here the examination will be as safe and comfortable as possible for the patient. Our specialists use cutting-edge diagnostic equipment and have extensive experience in this field, which allows us to achieve highly accurate research results.

Physiology

The activity of the Fallopian tubes is related to the age and functional state of the female body. Functional changes in M.t. are carried out ch. arr. under the influence of neurohumoral regulation (see). Thus, the dependence of the structural and functional state of epithelial cells of the mucous membrane on the hormonal status of the body has been established. Experiments have established that castration causes partial and complete destruction of the cilia of ciliated cells and flattening of their surface, and with the introduction of sex hormones, the structure of the cells is restored. Contractions of the muscles of the uterus and the type of contractile activity of the organ are not the same in different phases of the menstrual cycle. Three main types of muscle contractions can be distinguished. During the proliferation phase, the excitability of the muscles of the muscle is increased, there is a tendency to long-term spastic contractions with a simultaneous change in the shape and position of the muscle relative to the ovary with elevation of the ampulla and abduction towards the free end; Such contractions of M. t. provide a mechanism for perceiving the egg. During the secretory phase, the tone and excitability of the muscles of the musculoskeletal system are reduced, and contractions become peristaltic in nature. Different departments of M. t. are reduced autonomously and asynchronously. The most pronounced contractions are in the isthmus of the M. t. In the ampulla of the M. t. only pendulum-like movements occur.

Rice. 4. Schematic representation of the fertilization of the egg in the lumen of the fallopian tube and the advancement of the embryo (in different stages of crushing) to the uterus: 1 - fallopian tube with the embryo; 2 - uterine cavity; 3 - ovary with eggs in different stages of maturation; 4 - egg; arrows indicate the direction of movement of the embryo.

The direction of the wave of M. t. contractions is associated with the place of application of irritation (egg, sperm); they can be directed from the ampoule to the uterus (properistalsis) and from the uterus to the uterus (antiperistalsis); these contractions ensure the movement of the egg or embryo into the uterus. When the longitudinal muscles contract, the muscles become shortened; when the circular muscles contract, their lumen narrows. A decrease in the muscle tone of the isthmus of the uterus, which facilitates the passage of the zygote into the uterus, can occur under the influence of prostaglandin E2 contained in the seminal fluid that has entered the woman’s genital tract. If the content of estrogen is insufficient (see), the excitability of M. of t. is reduced, reactions to irritation are weakened, as a result of which the mechanism of perception of the egg may not arise; it may also not arise due to the inhibitory influence of unfavorable psychosexual influences. Fertilization of the egg usually occurs in the ampulla of the endosalpinx. The movement of the egg, zygote and embryo into the uterus occurs primarily as a result of contraction of the muscles of the uterus, as well as the ciliated movements of the cilia of the epithelial cells of the endosalpinx, which are directed towards the uterus in the second phase of the menstrual cycle (Fig. . 4). With the onset of menopause (see), the tone of the muscle membrane of the muscle tissue decreases sharply, the excitability of the muscles almost completely disappears, and there are no contractions of the muscle tissue, except for the ampoule.

The histological structure of M. t. also undergoes pronounced changes in different phases of the menstrual cycle. The height of the epithelial cells of the mucous membrane of the t. is minimal during menstrual bleeding, and at the time of ovulation it is maximum. During the proliferation phase, the number of ciliated and secretory cells increases. The nuclei of ciliated epithelial cells shift upward. In the second phase of the menstrual cycle, secretory cells acquire a goblet or pear-shaped shape and protrude above the ciliated cells due to a simultaneous decrease in the height of the ciliated cells. During this same phase, the number of basal and peg-shaped cells increases. The nuclei of ciliated cells acquire an elongated shape and move downwards. The secretory activity of epithelial cells becomes maximum; the secretion they produce provides the necessary conditions for fertilization and development of the egg in the first days of pregnancy (see). During the proliferation phase, the activity of alkaline phosphatase in secretory and ciliated cells increases, the content of RNA and protein compounds increases; During the secretory phase, the activity of acid phosphatase increases. Such changes can be considered as a consequence of an increase in the intensity of metabolic processes in epithelial cells in the first phase of the menstrual cycle and destructive changes in the second phase. In the uterine part of M. t. histochemical, changes in different phases of the menstrual cycle are much less pronounced. The lumen of the M. t. constantly contains a certain amount of fluid containing glycoproteins, as well as prostaglandin F2α (see Prostaglandins).

Clinical picture

Symptoms of inflammation of the fallopian tubes are varied. The clinical picture of the disease is influenced by the location of the pathological focus, its type, as well as concomitant diseases.

• Pain is one of the main signs of the disease. Painful sensations are localized mainly in the lower abdomen, although they can radiate to the groin and lumbar region and even to the lower extremities. In addition, pain often intensifies during urination, defecation, during sexual intercourse, and also during menstruation. As a rule, intense pain, aggravated by physical activity, is characteristic of an acute process. Dull pain indicates a chronic form.
• Irregular menstruation
• Mucopurulent discharge with an unpleasant odor appears, as a rule, in an acute form. In a chronic process, there may be no discharge.
• In acute illness, body temperature often rises to 38.5°C, accompanied by chills and intense sweating. With a chronic disease, low-grade fever is noted, but in some cases there is no increase in temperature.
• Weakness, muscle pain, nausea, vomiting, lack of appetite, etc. are also possible - these signs are caused by the effect of toxins on the body.

Pathology

Developmental defects

Developmental defects are rare and are mainly caused by disturbances during embryonic development. The fallopian tubes may be excessively long or short. There may also be additional openings in the area of ​​the distal end and additional M. t. in the form of small polypous formations with a cavity in the center, which are connected by a thin stalk to the funnel of the M. t. or to the surface of the broad ligament of the uterus. There may be splitting of the lumen of the pipe, lack of lumen in some areas, as well as additional straight, non-branching, blind passages. Less common is complete doubling of the tube. Splitting of the tube, as a rule, is combined with the presence of additional fimbriae, additional side holes on the ampulla, cysts, etc. As a rule, malformations of M. t. do not require treatment.

Disturbances in the contractile activity of the fallopian tubes and disturbances in the advancement of the egg and embryo can result from mechanical obstacles in the form of adhesions in the lumen of the organ resulting from the inflammatory process after artificial termination of pregnancy, as well as neuroendocrine disorders in the woman’s body. Through M. t. during abortion, menstruation, endometrial particles can be thrown into the abdominal cavity, which can lead to the so-called. endometrioid heterotopia. It is possible for tumor cells to move from the abdominal cavity through the M. t. into the uterus, and from it into the vagina.

Tubal pregnancy can occur as a result of implantation and development of the embryo in the mast, followed by its rupture. Tubal pregnancy and rupture

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

Diseases

Inflammatory diseases of the Fallopian tubes most often occur in the form of salpingitis, which is usually caused by staphylococcus, streptococcus, gonococcus, Escherichia coli, and Mycobacterium tuberculosis. At the same time, gonorrheal salpingitis always develops in an ascending way, staphylococci and streptococci also penetrate into M. t. in an ascending way, and tuberculous lesions of M. t. develop when the infection spreads hematogenously from the lungs, lymphogenously - from bronchial and mesenteric lymph nodes, from the peritoneum . Sometimes infectious agents spread from the appendix and sigmoid colon. Inflammatory disease of M. t. is rarely isolated, usually the ovaries are involved in the process (see); in such cases, the diseases are combined under the term “adnexitis”. Salpingitis usually begins with inflammation of the mucous membrane of the t. and quickly spreads to the muscular layer of the wall and peritoneal cover. The result of inflammation (initially catarrhal, which, however, can become purulent) is obliteration of either the entire uterus or its uterine part and ampulla, which causes persistent infertility (see); accumulation of exudate leads to the formation of sactosalpinx (hydrosalpinx, hematosalpinx, pyosalpinx). Wedge, picture, treatment, prevention - see Adnexitis.

As a result of the inflammatory process, especially with gonorrhea, polyps can form in the lumen of the tumor, which in some cases undergo malignancy and are considered a precancerous process.

Tumors

Fallopian tube tumors are rare. Benign tumors (fibroids, lymphangioma, polyps, lipoma) are detected very rarely; chondrofibroma, dermoid and teratoma are described casuistically. Usually they do not reach large sizes, are not clinically detected and are detected only during operations on the pelvic organs. The frequency of damage to M. by malignant tumors does not exceed 1% in relation to all malignant tumors of the female genital organs. Among malignant tumors of M. t. in the first place is cancer, first described by EG Orthmann in 1886, and in the domestic literature by S. D. Mikhnov (1891). Sarcoma is rare and even less common is chorionepithelioma (the result of a tubal pregnancy). The role of inflammatory processes as an etiol factor in the development of M. t. cancer is doubtful, although the malignancy of polyps, especially those arising from gonorrhea, is beyond doubt. The age of patients with breast cancer is predominantly 40-50 years, and approximately half of those with cancer were infertile.

Pathoanatomically, malignant tumors of M. of t. usually present as formations of pear-shaped, retort-shaped, tight-elastic consistency or dense consistency with foci of softening, filled, in addition to tumor growths, with serous or serous-bloody contents. They may resemble hydrosalpinx, differing in that on the surface of the tumor there are usually papillary growths, often spreading to neighboring organs. M.'s funnel is sealed, the tumor is usually one-sided, fused with surrounding organs (ovary, uterus, peritoneum, omentum). Histologically, this is often a papillary-solid, less often a papillary, papillary form of cancer. Metastasis occurs through lymph vessels, usually to the lumbar lymph nodes; The hematogenous route of metastasis to various organs cannot be excluded. Metastases to M. from primary tumors of other organs are especially often combined with metastases to the ovaries; they are found in the form of diffuse thickening of tubes or nodular formations, or in the form of millet-like nodules under the serous cover. Emboli from tumor cells are often observed in lymph vessels.

Wedge, symptoms: patients note abundant light yellow (amber) or serous-bloody discharge, which usually flows periodically, and their appearance is preceded by cramping pain. When the uterine opening of the tube is blocked by tumor growths, there may be no discharge, but the pain due to stretching of the tube by the growing tumor intensifies and is a characteristic and rather early symptom of breast cancer. Usually the pain is localized in the lower abdomen, in the lower back, and sacrum. When the tube ruptures due to its overstretching by a growing tumor or tumor germination of the pipe wall, phenomena of acute abdomen occur (see).

Early diagnosis of M. t. cancer, unfortunately, is rare; usually malignant tumors of M. t. are recognized only during surgery. However, with a rapid increase in the tumor, cramping pain, serous-bloody or amber-colored discharge in a significant amount (especially during menopause), in the absence of pronounced inflammatory phenomena, you should always think about M. t. cancer. Tsitol is of great diagnostic importance. study of secretions. A rectovaginal, bimanual examination is mandatory, although the data obtained is not always clear for small tumor sizes. If M.'s cancer is suspected, metrosalpingography is of certain importance; sometimes they resort to diagnostic laparotomy (see).

Treatment of cancer of the uterus is predominantly combined - surgical removal of the tumor and ovaries with supravaginal amputation of the uterus. Extirpation of the uterus, unless there are special indications, is not advisable in order to prevent the possibility of implantation of tumor cells in the vagina. Most clinicians recommend the use of radiation therapy in the postoperative period. The prognosis is often poor, since the diagnosis is usually made late.

What is hydrosalpinx?

Hydrosalpinx occurs when there is excessive accumulation of pathological fluid in the cavity of the tubes during salpingitis due to impaired lymph and blood flow. This transudate has a toxic effect on the embryo and endometrium of the uterus, leading to infertility and the risk of ectopic pregnancy. The sluggish process does not affect the woman’s well-being in any way. It can be detected during an ultrasound of the pelvic organs. Untreated hydrosalpinx can lead to rupture of the fallopian tube. Treatment is mainly surgical; in parallel, anti-inflammatory treatment, physiotherapy and antibiotic therapy are carried out. If it is impossible to restore the function of the tube, it is recommended to remove it and then refer the woman to IVF.

Since the fallopian tubes play an important role in fertilization, it is necessary to carefully monitor your health to prevent the development of inflammatory diseases. If a source of infection is identified, sanitize it promptly. This way you will keep your fallopian tubes healthy and conceiving a baby will not be difficult for you!

Operations

Removal of the Fallopian tubes is carried out for tumors (see Salpingectomy) and for the purpose of sexual sterilization (see); surgical interventions are used to eliminate infertility, as well as rupture of the bladder during tubal pregnancy.

Rice. 5. Schematic illustration of checking the patency of the fallopian tube after salpingolysis by blowing air with a syringe inserted into the ampulla of the fallopian tube.

A prerequisite for surgery on M. t. for infertility is a preliminary wedge, examination of the woman and examination of the husband's sperm, as well as establishing the location of obstruction of M. t. by metrosalpingography. Operations for infertility are aimed at eliminating adhesions, restoring the patency of the bladder and their normal mobility. Salpingolysis (syn. fimbryolysis) is a surgical intervention undertaken to eliminate peritubular adhesions and give the muscle tissue normal mobility. The operation technique is as follows. After opening the abdominal cavity, the peritubar adhesions are carefully destroyed in a sharp way, after which the condition of the M. t. funnel is examined; if there is partial adhesion of the edges of the funnel hole of the pipe, they should be carefully separated with anatomical tweezers. Patency of the uterus can be checked either by blowing air through the ampoule (Fig. 5), or from the side of the uterus - by pertubation or hydrotubation. Peritonization of damaged areas of M. t. should be carefully carried out to prevent the formation of adhesions in the postoperative period. According to L. S. Persianinov, the favorable result of the operation (pregnancy) is up to 30-40%.

Rice. 6. Schematic representation of the stages of salpingostomy: 1 - transverse dissection of the closed ampulla of the fallopian tube; 2 - ampoule after salpingostomy: ligatures are applied connecting the mucous membrane of the tube with the peritoneum; 3 — a protector (indicated by an arrow) is inserted into the lumen of the ampoule in order to prevent the closure of the hole in the ampulla of the fallopian tube. Rice. 7. Schematic representation of the stages of partial resection of the ampulla of the fallopian tube: 1 - dissection of the closed ampulla; 2 - the mucous membrane of the fallopian tube of the remaining part of the ampulla is connected to the peritoneum with separate sutures. Rice. 8. Schematic representation of the stages of restoring the patency of the fallopian tube by making a cross-shaped incision of its ampulla: 1 - application of ligatures followed by a cross-shaped incision of the ampulla; 2 — ampulla flaps (indicated by arrows) are fixed with sutures to the peritoneum. Rice. 9. Schematic representation of the operation of salpingoanastomosis for obstruction of the isthmus of the fallopian tube: 1 - excision of the obliterated section of the fallopian tube with the introduction of a protector into its lumen (indicated by an arrow); 2 — fallopian tube after the operation of creating an anastomosis with a protector inserted into its lumen (indicated by an arrow). Rice. 10. Schematic representation of the stages of the operation of transplanting the fallopian tube into the uterus in case of obstruction of the uterine part of the fallopian tube or the initial part of the isthmus: 1 - the obliterated section of the tube is excised, the proximal end of the transplanted section of the tube is dissected into two flaps, onto which ligatures are applied; a protector is inserted into the lumen of the pipe (indicated by an arrow); the angle of the uterus is excised with a scalpel; 2 — suturing the tube flaps to the corner of the uterus with a needle and suture material; a protector is inserted into the tube and uterus (indicated by an arrow).

The operation of salpingostomy (syn. stomatoplasty) consists of opening the m. at the closed free end; Contraindications to this operation are acute and subacute inflammatory processes of the internal genital organs, as well as pronounced post-inflammatory changes in the form of hydrosalpinx. The surgical technique is as follows: a hole in the tube can be created terminally at the free end, laterally on the side wall, or by transverse (transversal) resection of the free end of the tube. After opening the abdominal cavity, the m. t. is carefully isolated from the adhesions using a sharp method and the wall of the tube is dissected (Fig. 6, 1); the mucous membrane of the M. t. is slightly turned out and connected with the peritoneum of the M. t. with thin sutures (Fig. 6, 2). In case of pronounced changes in the ampulla, partial resection is performed (Fig. 7, 1 and 2). To restore the patency of the tumor in the area of ​​the ampoule, you can use a method with the application of four catgut ligatures around the circumference of the ampoule and subsequent cross-shaped incision between them (Fig. 8, 1). Pulling on the threads leads to the unfolding of the wound and the formation of four flaps of the wall of the m. t. The flaps are connected with separate sutures to the peritoneum of the tube (Fig. 8, 2). In order to facilitate the entry of the egg into the M. t., the edges of the newly formed opening are fixed at the ovary. To avoid secondary scarring and closure of the tube lumen, protectors made of biologically inactive materials are used (Fig. 9 and 10). After salpingostomy, pregnancy occurs, according to Sh. Ya. Mikeladze and M. G. Serdyukov, in 10-20% of women; the lack of effect may be associated both with the fusion of the newly formed hole, and with large anatomical and functional changes in the M. t., against which the operation was performed.

The operation of salpingoanastomosis can be resorted to in the presence of obstruction of the M. t. only in the isthmus. During this operation, the obliterated area of ​​the m. is resected (Fig. 9, 1) and a protector is inserted into its lumen; the dissected sections of the pipe wall are sewn together with separate sutures or using a vascular stapling device (Fig. 9, 2). The operation of transplanting M. t. into the uterus is performed in cases where M. t. are impassable in the uterine part or in the initial part of the isthmus. M. t. is crossed at the border with the obliteration site; the impassable part is excised, its mesentery is ligated. The angle of the uterus is excised with a narrow scalpel or a special instrument (implanter) through the entire thickness of the organ wall to the uterine cavity in such a way that a passable section of the fallopian tube can be passed through the resulting hole (Fig. 10, 1). Using tweezers and scissors used in ophthalmic practice, the uterine part of the patent tube is cut into two flaps; then each flap is sutured to the wall of the uterus with a protector inserted into the lumen of the tube and the uterine cavity (Fig. 10, 2). The end of the protector is brought out either through the cervical canal and vagina, or through the abdominal wall for a period of 4 to 6 weeks. According to L. S. Persianinov, pregnancy after surgery occurs in 20% of patients.

Bibliography:

Gynecological endocrinology, ed. K. N. Shmakina, p. 5, M., 1976, bibliogr.; Golovin D.I. Atlas of human tumors, p. 231, L., 1975; Davydov S.N., Khromov B.M. and Sheiko V. 3. Atlas of gynecological operations, L., 1973, bibliogr.; Malignant tumors, ed. N.N. Petrov and S.A. Holdin, vol. 3, part 2, p. 298, L., 1962; Kaylyubaeva G. Zh. and Kondrikov N. I. On the issue of the functional state of the fallopian tubes in patients with uterine fibroids, Akush, i ginek., No. 9, p. 33, 1976, bibliogr.; Mandelstam A.E. Semiotics and diagnosis of female diseases, L., 1976; Multi-volume guide to obstetrics and gynecology, ed. L. S. Persianinova, vol. 1, p. 343, M., 1961; Nikonchik O.K. Arterial blood supply to the uterus and uterine appendages of a woman, M., 1960, bibliogr.; Persianinov L. S. Operative gynecology, M., 1976, bibliogr.; Guide to pathological diagnosis of human tumors, ed. N. A. Kraevsky and A. V. Smolyannikov, p. 212, M., 1976; Blind A. S. Development of innervation of the fallopian tubes, Chisinau, 1960, bibliogr.; Syzganova K.N. Treatment of female infertility, Kyiv, 1971, bibliogr.; Ackerman LV a. del Regato J. A. Cancer, St Louis, 1970; Aref I. a. Hafez ESE Utero-oviductal motility with emphasis on ova transport, Obstet, gynec. Surv., v. 28, p. 679, 1973, bibliogr.; David A., Serr D. M. a. Szernobilskу B. Chemical composition of human oviduct fluid, Pertil. and Steril., v. 24, p. 435, 1973; Flickinge r GL, Muechler EK a. Mikhail G. Estradiol receptor in the human fallopian tube, ibid., v. 25, p. 900, 1974; Sedlis A. Primary carcinoma of the fallopian tube, in: Gynecol, oncol., ed. by HRK Barber a. E. A. Graber, p. 198, Amsterdam, 1970, bibliogr.

V. P. Kozachenko; O. V. Volkova (an., hist.), A. I. Serebrov (onc.).

Paired organ structure

If we talk about the structure of the fallopian tube, it includes 4 sections along its entire length. They extend to the sides, starting from the body of the uterus in an almost horizontal position and ending in an expanded part that has a fringed structure and is called the funnel.

Recalling the structure of the fallopian tube, it should be said that these funnels are located very close to the ovary, where the egg is born, which subsequently collides with the sperm.

The funnels are followed by the ampullary part of the tube, after which the fallopian tube begins to gradually narrow. This section of the isthmus is called in medicine the isthmic part.

The anatomical features of the fallopian tubes are such that they end in the part of the same name. And it is there that the pipes make the transition to the muscular organ.

Symptoms of fimbriae immobility

Fimbriae immobility is one of the most difficult causes of infertility to diagnose. A routine examination does not reveal any pathologies of the reproductive system. You can suspect fimbriae dysfunction if you have the following picture:

• the ovaries do not have cysts and function normally;
• the monthly cycle is not disrupted, the follicle matures and comes out monthly;
• the fallopian tubes have a normal diameter and are completely patent;
• the endometrium has an optimal thickness for embryo attachment;
• analysis of sex hormones does not reveal abnormalities;
• The man is also healthy and was examined by a urologist.

When a woman cannot become pregnant within a year in good reproductive health, there is a high probability that the cause is immobility of the fimbriae.

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?

Therapy for tubal obstruction

At the initial stage of obstruction, drug therapy is carried out. In the event of the development of an inflammatory process that was provoked, for example, by gonococci, chlamydia, streptococci, etc., antibiotic drugs are prescribed in the form of tablets and injections. In this case, as a rule, Metronidazole, Ceftriaxone, Ofloxacin, etc. are prescribed.

In order to accurately determine the required antibiotic, specialists take a culture of biomaterial from the cervix to assess the sensitivity of existing microorganisms to various groups of antibiotics.

The course of such treatment continues for 14 days. Even if the condition improves, it is recommended to complete it completely. If chlamydia or gonorrhea is detected, treatment will also be required for the sexual partner.

In Vitro Fertilization

If drug therapy does not give the desired effect, that is, pregnancy still does not occur, then the procedure of in vitro fertilization is recommended. For this manipulation, an egg is collected from women, and sperm from men, after which fertilization is carried out in the laboratory.

After 3-5 days, the embryo is placed in the patient’s uterus for subsequent gestation. This method of reproductive technology is recognized as the most effective. It is resorted to in case of complete obstruction of the tubes or in the presence of serious disorders at the cellular or chemical level in the man’s sperm.

In conclusion, it should be added that obstruction of the fallopian tubes cannot in any way be considered a serious pathology for women, but it is still fraught with the development of infertility. If the necessary actions are not taken in time to correct the indicated condition, then an ectopic pregnancy is possible, as a result of which the patient may lose one of the tubes, which significantly reduces the chances of becoming pregnant. Here you cannot rely only on traditional medicine or self-medicate, since such actions can only aggravate the situation. In order to receive adequate help, you need to contact specialists.

Necessary examinations before the HSG procedure under sedation (during sleep)

• complete blood count + platelets + ESR - valid for 2 weeks;
• biochemical blood test (total protein, glucose, bilirubin, ALT, AST, alkaline phosphatase - valid for 1 month;
• coagulogram (APTT, PTI, fibrinogen, INR) - valid for 1 month;
• blood type, Rh factor (on a stamped form, a stamp in the passport is not accepted) - valid for an indefinite period;
• HIV - valid for 3 months;
• Wasserman reaction - valid for 3 months;
• HBs antigen - valid for 3 months;
• HCV antibodies - valid for 3 months;
• ECG - valid for 2 weeks;
• Flora smear is valid for 2 weeks.

How to check patency if for some reason an HSG is not possible? Read about such methods below, but they are outdated and uninformative

. Therefore, we do not recommend resorting to these types of diagnostics, but we consider it necessary to mention them.

Using folk recipes

Traditional medicine is not officially recognized. One of these is borovaya uterus, which was previously widely used, especially in the Siberian region. It is generally accepted that this plant has anti-inflammatory, antimicrobial, and diuretic effects.

Alcohol and water infusions using boron uterus in the treatment of tubal infertility have survived to this day. In the first case, to prepare the product you will need 50 g of a medicinal plant and half a liter of vodka. In the case of a water infusion, you need to brew 1 teaspoon of crushed medicinal herbs in 1 glass of boiled water, and then leave it in a water bath for 15 minutes.

The alcohol infusion must be taken by dissolving 30-40 drops in a small volume of water, 3 times a day before meals. The course of treatment should continue for 6 months. In this case, one week of taking the drug should be followed by a 3-week break. During menstrual bleeding, taking boron uterus is unacceptable.

We must not forget that while taking boron uterus, an allergic reaction may develop. Therefore, before starting treatment, you should consult your doctor.

Perturbation hydroturbation

This method of medical correction is quite outdated, but in some institutions it is still carried out. It can also be quite painful for the patient.

The essence of the manipulation is that a woman in a gynecological chair is inserted into the uterus and air or a special liquid is supplied through the catheter. Under strong pressure, the fallopian tubes straighten, and the adhesions spontaneously break. The manipulation is carried out under the control of an ultrasonic sensor.

The disadvantage of this method of treatment is that severe stretching of the fallopian tubes may occur and displacement from their usual place.