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29May20201第二章女性生殖系统解剖TheAnatomyoftheFemaleReproductiveSystem中山二院妇产科张清学29May20202FemaleReproductiveSystem内、外生殖器血管、淋巴和神经骨盆和骨盆底、临近器官29May20203§1外生殖器Externalgenitalorgans生殖器官的外露部分,位于两股内侧,前为耻骨联合pubis,后为会阴perineum,统称外阴pudendaorvulva.29May202041.阴阜Monspubis(ormonsveneris)耻骨联合前面的皮肤隆起,皮下脂肪组织丰富,青春期后开始生长倒三角形阴毛,第二性征存在个体差异。29May20205阴阜Monspubis29May202062.大阴唇Labiummajus(labiamajora)两个纵行隆起的皮肤皱襞,自阴阜到会阴后联合posteriorcommissure,上端连接圆韧带。有色素沉着和阴毛。皮下有一层致密结缔组织,富含弹性纤维和脂肪组织,几乎不含肌肉组织富含血管、淋巴管和神经,外伤后血管丛(静脉)破裂易形成血肿。未产妇自然合拢,产后分开,绝经后萎缩。29May202072.大阴唇Labiummajus29May202083.小阴唇Labiumminus(labiaminora)大阴唇内侧的一对薄皮肤皱襞,表面湿润,无毛,富含神经末梢,前端融合包绕阴蒂,形成阴蒂包皮frenulum和阴蒂系带prepuce。后方形成阴唇系带fourchet和舟状窝navicularfossa。29May202093.小阴唇Labiumminus29May2020104.阴蒂Clitoris海绵体构成,可以勃起,富含神经纤维。由3部分组成:阴蒂头glans,阴蒂体body(corpus),两个阴蒂脚crura附着于耻骨支上。仅阴蒂头可见,约6~8mm长。29May2020114.阴蒂Clitoris29May2020125.阴道前庭Vaginalvestibule小阴唇内侧的菱形区,前为阴唇系带,后为阴唇系带和舟状窝fossanavicularis(阴道前庭窝),产后消失。有阴道口和尿道口。29May2020135.阴道前庭Vaginalvestibule29May202014前庭球Vestibulebulb又称球海绵体(bulbocavernosusbody),为勃起组织,表明被球海绵体肌覆盖。29May202015前庭球Vestibulebulb29May202016前庭大腺Majorvestibuleglands又称巴多林腺或巴氏腺(Bartholin’sgland),位于大阴唇后部,被球海绵体覆盖,直径大约0.5~1cm。腺导管长约1~2cm开口于前庭后部。性交时可分泌粘液起润滑作用,平时不可触及,导管闭塞可以形成前庭大腺囊肿或脓肿Bartholin’sglandabscessorcyst。29May202017前庭大腺Majorvestibuleglands29May202018尿道外口ExternalUrethralorificeorurethra位于阴蒂后下方,其有一对尿道旁腺para-urethralorskene’sglands,容易潜伏细菌。29May202019阴道口Vaginalorifice和处女膜hymen阴道口位于尿道口后方的前庭下部。处女膜是膜状结构,含有结缔组织、血管和神经,覆盖鳞状上皮。可于性交或剧烈运动后破裂,形成处女膜痕myrtiformcaruncles。29May202020阴道口Vaginalorifice处女膜hymen29May202021§2内生殖器Internalgenitalorgans29May202022§2内生殖器Internalgenitalorgans真骨盆内:阴道、子宫、输卵管和卵巢29May202023阴道Vagina位于盆腔中部,性交器官,月经血排出和胎儿分娩的通道。邻近器官:子宫颈cervix(形成前、后和侧穹窿fornix),前庭vestibule,膀胱和尿道口urinarybladder&urethra,and直肠rectum。阴道后穹窿Posteriorvaginalfornix位于道格拉斯窝Douglaspouch(recto-uterinepouchorcul-de-sac)下方。29May202024内生殖器Internalgenitalorgans29May202025阴道Vagina阴道壁:粘膜、肌肉和纤维组织。阴道皱襞Transversemucosalridge:伸展性大,富含静脉丛,外伤易形成血肿和出血。阴道粘膜Vaginalmucosa:非角化复层鳞状上皮----阴道脱落细胞学cytology29May202026Internalgenitalorgans29May202027子宫Uterus梨形中空器官,容积约5ml,子宫内膜Endometrium受卵巢性激素调控产生周期性月经。功能:1.内膜脱落产生月经menstruation;2.精子通道;3.孕育胚胎fetus;4.分娩胚胎和胎盘placenta。29May202028大小7-8×4-5×2-3cm,重量50g。上部子宫体Uterinebodyorcorpusuteri,子宫底fundusuteri;子宫角cornuauteri。下部为子宫颈cervixwithcylindershape.年轻女性:thebodyofuterusisonlyhalfaslongasthecervix;成年妇女:thebodyofuterusistwotimeslongerthanthecervix.子宫Uterus29May202029子宫Uterus29May202030Uterusofdifferentstages29May202031子宫Uterus子宫峡部Isthmusuterus:isanarrowsegmentbetweenthecorpusandcervix.非孕妇女长1cmbecomestheloweruterinesegment子宫下段in孕妇。上部解剖学内口anatomicalinternalos;下部为组织学内口histologicalos.29May202032子宫Uterus29May202033子宫体组织机构内层Innerlayer:mucosallayer,子宫内膜endometrium.性激素调控,基底层&功能层;中层Middlelayer:子宫肌层myometrium.muchofbloodvessel,宫缩压迫止血(decreasinguterinebleeding);外层Outerlayer:浆膜层serosallayer,子宫直肠窝recto-uterinepouch(orcul-de-sacorDouglaspouch)andbroadligament的腹膜延续。29May202034子宫颈Cervix阴道上部和阴道部Supra-vaginal&vaginalportion:fusiformshapecavityofcervix—宫颈管3cm长。粘液栓Mucousplug:protectuterinecavityfrominfection.宫颈内口和外口internal&externalosofcervix.29May202035子宫颈Cervix外口Theexternalos:分娩前为小圆口,分娩后撕裂为前后唇anteriorandposteriorlipsofcervix。29May202036子宫颈Cervix平滑肌和胶原组织;宫颈管粘膜Cervicalmucosa:单层柱状上皮;Vaginalportionofcervix披覆鳞状上皮。多数宫颈癌好发于junctionofsquamous-columnarepithelium鳞柱上皮交界区29May202037子宫颈Cervix29May202038子宫韧带圆韧带Roundligament:10-12厘米,平滑肌和结缔组织,宫角前面,maintainstheuterusatanteversionposition.主韧带Cardinalligament(宫颈横韧带transversecervicalligament):宫颈到盆侧壁,fastenstheuterus.宫骶韧带Uterosacralligament:fromthebackofcervixtothe2ndand3rdsacralfascia,maintainingtheuterusatantevertionposition.阔韧带Broadligament29May202039子宫韧带29May202040阔韧带Broadligament宫旁到盆壁的翼状双层腹膜皱襞。Itsinnertwo-thirdenclosedoviduct,outerone-thirdis骨盆漏斗韧带infundibulo-pelvicligament(or卵巢悬韧带suspensoryligamentofovary),ovarianartery&veinpassthroughthisligament.输卵管系膜Mesosalpinx,卵巢韧带ovarianligament,宫旁组织parametrium.子宫血管和输尿管passunderthebroadligament.29May202041子宫韧带29May202042输卵管Fallopiantube(oviduct)长8-14厘米,输卵管的四部分:1.间质部Interstitialor宫角部intramuralportion,shortandnarrow.2.峡部Isthmicportion(isthmus),narrowandshort.3.壶腹部Ampulla,widelumen.4.伞端Fimbraeor漏斗部infundibulum,opensintoabdominalcavity.29May202043输卵管Fallopiantube(oviduct)29May202044输卵管Fallopiantube(oviduct)Infundibulum,fimbrem,1-1.5cmAmpulla,5-8cmIsthmus,2-3cmInterstitial,1cm29May202045三层组织外层Outerlayer:peritoneum,serosallayer.中层Middlelayer:muscularlayer.Ovacanbemovedtowarduterinecavitybythemusclecontracting.内层Innerlayer:mucosacomposedofasinglelayerofcolumnarcellswithcilia,secretoryfunction.受性激素影响。29May202046卵巢OvaryAlmond-shaped.大小4×3×1cm,重量5-6g,绝经后萎缩.功能:卵泡发育和排卵(生育),性激素合成和分泌(内分泌)。表面为tunicaalbuginea(whitish)无腹膜;Ovarianbloodvesselsandnervesinthe卵巢门hilum.Infundibulo-pelvicligament.29May202047卵巢Ovary29May202048卵巢Ovary29May202049卵巢皮质Cortexofovary格拉夫卵泡graafianfollicles和不同阶段的卵泡:始基卵泡primordialfollicles,初级卵泡primaryfollicles,窦卵泡antralfollicles,成熟卵泡maturefollicles—发育卵泡。血体Hemorrhagecavity(bloodfilledcavity)and黄体corpuslu
本文标题:女性生殖系统解剖
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