I- INTRODUCTION :
The uterus is a hollow member, and muscle contractile, whose essential function comes at a time of gestation during which its changes are very important ; indeed it receives the fertilized egg, serves to foster support during pregnancy, and contributes its contractions the expulsion term.
II- Anatomy Descriptive :
1- SITUATION :
This is an odd organ and median, it is located in the middle part of the pelvis, between the bladder forward, rectum back, vagina and perineum down, the abdominal cavity at the top.
2- EXTERNAL MORPHOLOGY :
It can be visualized by laparoscopy
a- external configuration :
It has the shape of a truncated cone has top, flattened back and forth, having three parts :
- The body : includes
– A bladder face (anteroinferior)
– Intestinal face (posterosuperior)
– Two thick foam side edges
– An upper edge : the fundus
– Two side corners : the uterine horns or inosculate or fallopian tubes and fit the round ligaments and proper ovarian ligaments.
- The neck : narrower, little pre cylindrical, it gives attachment to the vagina which divides it into three portions : sus-vaginale, vaginal and sub-vaginal.
The vagina is inserted into the vaginal portion in an oblique plane downwards and forwards.
Intra-vaginal portion is longer behind than in front, it is accessible to the vaginal touch and viewable by the speculum, it has the shape of a perforated truncated cone has its apex an orifice : the external os which gives access to the uterine cavity.
- The Isthmus : is located at the junction between the body and the neck, it becomes the lower segment during pregnancy.
b- Orientation :
- The junction point of the axes of the neck and the body is very fixed and corresponds to the center of the pelvis.
- anteversion : of the whole uterine axis forms with the axis of the vagina in an open angle and low before.
- The anteflexion : the axis of uterine body forms with the axis of the cervical an angle of 120 degrees, open downwards and forwards
- The uterus is anteverted, antéfléchi.
c- Dimensions :
- In nulliparous : length : 6 – 7 cm, width : 3 – 5cm, thickness : 2 – 3 cm.
- In multiparas the body size increases.
d- internal configuration :
- It can be studied by hysteroscopy and hysteroscopy
- This is a hollow member has virtual cavity, roughly flattened back and forth and having a throttle corresponding to the isthmus.
- The body cavity is a lower triangular vertex. Bi-lateral angles open the orifices of the fallopian tubes.
- The cervical canal is fusiform, by relating uterine and vaginal cavities, it has on its walls folds : webbed folds (tree of Life).
e- Structure :
The uterine wall, thick and resistant comprises three tunics
- serous : peritoneum.
- the muscular : with three layers : internal thin, average very thick and richly vascularized, external thin.
- the mucosa :
– Type glandular at the body constituting the endometrium with two layers : basal surface and : functional layer modifying during the menstrual cycle.
– At its narrowest point it has two areas :
* on endocervical (canal cervical) it retains a glandular structure.
* on the ectocervix, intra vaginal segment of the neck has the same structure as the vaginal mucosa (squamous epithelium).
f- Vehicles fixity :
Three ligaments hold the uterus in place
- The broad ligaments : these are two blades peritoneal (double sheet) transverse tensile uterus has the side wall of the pelvis, they contain the vessels destined to the uterus and the ovary and most genital appendices. Moreover their base rests on a dense fibromuscular tissue : the parameter.
- The round ligaments : born of the anterior edge of the uterine horns, head forward and laterally, through the inguinal canal and ends in the cell tissue of the labia.
- The uterosacral ligaments : born to the posterior surface of the isthmus of the uterus and terminate on the anterior surface of the sacrum. The pressure from the abdominal organs. The neck is fixed relative to the uterine body which is movable, it is held stationary by :
- The settings : located on each side of the above-vaginal portion, constituted by a fibro-cellular dense tissue, containing smooth muscle fibers.
- the vagina : inserted on the neck at an oblique plane downwards and forwards, the collar is thus based on the posterior wall of the vagina.
III- REPORTS :
1- PORTION SUS-Vaginale :
peritoneal reports :
The above-vaginal portion is partially covered with peritoneum lining :
- the fundus.
- the entire posterior surface.
- the upper portion of the front face, the peritoneum is reflective facing the isthmus.
- The peritoneal layers will continue :
– Laterally toward the pelvic sidewall constituting the broad ligaments.
– Forward with bladder peritoneum drawing ass vesicouterine bag.
– Back with the peritoneum lining the front of the vagina before being reflected on the front of the rectum drawing ass double-genital bag (DOUGLAS).
Reports through the peritoneum :
– laterally :
– the broad ligaments.
– the settings : delivering passage :
* The urethra.
* uterine artery intersecting the urethra by forward.
* Vaginal artery crossing the urethra by backward.
* veins and lymphatic.
– forward : the bladder.
– backward : rectal ampoule.
2- PORTION INTRA-VAGINAL :
- Laterally :
– the lower part of the parameters.
– the blade sacrosanct double-genito-pubic.
- Forward : has the posterior face of the bladder through the septum vesico-vaginal.
- Back to the front of the rectum through the recto-genital cul de sac at the top and rectovaginal septum down.
WE- VASCULARIZATION AND INNERVATION :
1- THE ARTERIES :
- The uterine artery : it is born of the anterior trunk of the internal iliac artery, long 15 cm and has three segments, retro, sub and intra-ligament (ligament large ). Terminates at the upper-side angle of the uterus by dividing into three terminal branches :
– recurrent branch fundal
– Rameau tubal (artery medial tubal)
– Rameau ovarian (Medial ovarian artery)
In its course the uterine artery provides the following collateral
* Rameau for the broad ligament
* Rameau ureteral
* 5 a 6 bladder and genital branches
* The cervicovaginal artery
* 5 at 6 branches to the cervix
* 8 at 10 branches to the uterine body
- The ovarian artery : it arises from the abdominal aorta of height L2, ends at the superolateral ovarian end by giving two branches :
- which lateral ovarian artery anastomoses with the ovarian medial branch of the uterine artery
- side tubal which anastomoses with the artery tubal medial branch of the uterine artery
- The artery of the round ligament : branch of the artery epigastric lower
2- THE VEINS : Satellite arteries
3- THE lYMPHATIC :
Are formed of four original networks :
They drain into two drainage systems :
→ Higher Network particularly draining the body, with three pedicle :
– ovarian pedicle :
left lumbar lymph nodes and pre lateral-aortic
right lumbar lymph nodes and pre latero-cellars
– pedicle external iliac
– anterior pedicle, satellite round ligament, leading to superficial inguinal nodes
→ less Network particularly draining the cervix and the isthmus, with three pedicle :
– external iliac
– internal iliac
– Anteroposterior :following the utero-sacral, ends in the sacred lymph nodes
4- NERVES :
From the inferior hypogastric plexus and is two pedicles
→ Pedicle Neck isthmus
→ Corporeal pedicle suspensory ligament of the’ovary Posterior view
Dr Dous course – Faculty of Constantine