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            女性生殖系統-2019年專升本醫學綜合復習重點-福建成教

            福建成人高考信息網www.laiwobuy.com 發布時間: 2019年01月10日

              第一節 總論


              女性生殖系統包括女性內生殖器和女性外生殖器兩部。女性內生殖器由生殖腺(卵巢)、輸卵管道(輸卵管、子宮和陰道)以及附屬腺體(前庭大腺)組成。外生殖器即女陰。卵巢產生卵子和分泌女性激素,卵巢產生的卵子成熟后,以破潰卵巢表面的生殖上皮的方式排至腹膜腔,再經輸卵管腹腔口進入輸卵管,在輸卵管壺腹內受精后移至子宮腔,植入子宮內膜發育成胎兒。分娩時,胎兒出子宮口,經陰道娩出。


              第二節 生殖腺


              一、卵巢的位置

              卵巢位于小骨盆側壁,由髂內、外動脈所夾成的卵巢窩內,外被漿膜,為腹膜內位器官。卵巢呈扁橢圓形,分為內側、外側兩面;上、下兩端和前、后兩緣。上端借卵巢懸韌帶連于髂總動脈分叉處,下端借一條由平滑肌和結締組織組成的卵巢固有韌帶連于子宮底的兩側。卵巢后緣游離,前緣借卵巢系膜連于子宮闊韌帶的后面,其系膜內有分布于卵巢的血管、神經和淋巴管出入。


               第三節 生殖管道

               一、輸卵管的位置和分部

              未孕成人的輸卵管位于盆腔內,約呈冠狀位被包裹于子宮闊韌帶上緣內。其內側端穿子宮角開口于子宮腔稱輸卵管子宮口,外側端以輸卵管腹腔口開口于腹膜腔,故女性腹膜腔可經輸卵管、子宮和陰道與外界相通。

              輸卵管的分部

              輸卵管較為彎曲,各段形態不同,由內側向外側可分為四部。

                1.輸卵管壺腹 約占輸卵管游離部的外則2/3,管腔膨大而彎曲,血管豐富,是精子與卵子受精之處。

                2.輸卵管子宮部 為輸卵管穿過子宮壁的部分,管腔最狹窄,以輸卵管子宮口通子宮腔。

                3.輸卵管峽 占輸卵管游離部的內側1/3,短直而狹窄,壁較厚,血管較少,是輸卵管結扎術的常選部位。

                4.輸卵管漏斗是輸卵管外側的擴大部分,呈漏斗狀。末端游離緣可見許多指狀突起,稱輸卵管傘,手術時常以此作為識別輸卵管的標志。  

              臨床上把卵巢和輸卵管統稱為子宮附件。

              二、子宮的分部、位置和固定裝置

              (一)子宮的分部

              子宮呈前后略扁、倒置的鴨梨形,長約8cm,最大寬徑約4cm,壁厚約2cm,重約40~50g。

              子宮可分為3部:上端圓凸部分為子宮底;下端細圓的部分稱為子宮頸;底與頸之間的部分稱為子宮體。子宮頸又分為兩部:子宮頸伸入陰道內的部分,稱為子宮頸陰道部;在陰道以上的部分,稱為子宮頸陰道上部。子宮頸與子宮體連接的部位,稍狹細,稱為子宮峽,長約1cm,在妊娠期子宮峽逐漸擴張伸長,可達7~11cm,形成子宮下段,是產科進行剖腹產手術的部位。

              子宮腔可分為上、下兩部:上部由底、體圍成的為子宮腔;下部為子宮頸管。子宮腔一般為前后略扁的三角形,底向上,兩側有輸卵管子宮口;尖向下通子宮頸管。子宮頸管呈棱形,其上口通子宮腔,下口稱子宮口。

              (二)子宮的位置

              子宮位于盆腔的中央,膀胱與直腸之間。下端接陰道,兩側有輸卵管和卵巢。未妊娠時,子宮底位于小骨盆入口平面以下,子宮頸的下端在坐骨棘平面稍上方。正常成年未孕女子的子宮呈前傾前屈位。前傾指整個子宮向前傾斜,子宮的長軸與陰道的長軸形成一個向前開放的鈍角,稍大于90°。前屈指子宮體與子宮頸之間形成的一個向前開放的鈍角,約為170°。子宮有較大的活動性,膀胱和直腸的充盈程度可影響子宮的位置。

              (三)子宮的固定裝置

              子宮的正常位置依賴盆膈的承托和韌帶的牽引固定,若這些結構松馳或損傷,可引起子宮位置的改變。子宮的韌帶有:

              1.子宮闊韌帶是連與子宮體兩側的雙層腹膜皺襞,呈冠狀位將子宮固定于盆腔側壁,限制子宮向兩側移位。

              2.子宮圓韌帶是由平滑肌和結締組織構成的圓索狀結構,起于子宮角輸卵管子宮口的下方,于子宮闊韌帶兩層腹膜之間,循盆側壁前行,穿腹股溝管出皮下環,下行止于大****皮下,是維持子宮前傾的主要韌帶。

              3.子宮主韌帶 由平滑肌和結締組織構成,位于闊韌帶下方,連于子宮頸陰道上部兩側和盆腔側壁之間,是防止子宮下垂的主要韌帶。

              4.子宮骶韌帶(骶子宮韌帶) 由平滑肌和結締組織構成,從子宮頸后面的上外側向后彎行,繞過直腸的兩側,止于骶骨前面的筋膜。此韌帶向后上方牽引并固定子宮頸,與子宮圓韌帶一起維持子宮的前傾前屈位。

              三、陰道穹及其臨床意義

              陰道為連接子宮和外生殖器的肌性管道,是女性的交接器官,也是排出月經和分娩胎兒的管道。陰道的七端寬闊,包繞子宮頸的陰道部,兩者之問的環形陷凹稱陰道穹,分為前穹、后穹和側穹。其中以陰道后穹最深,其后上方即為直腸子宮陷凹,兩者問僅隔以陰道后壁和覆蓋其上的腹膜。臨床上可經陰道后穹行腹膜腔穿刺抽液,以協助診斷和治療。


              第四節 外生殖器


              女性外生殖器通常稱女陰,包括陰阜、大****、小****、****、陰道前庭和前庭大腺。 陰阜是位于恥骨聯合前方的皮膚隆起,成年時生有陰毛。

              大****為一對縱行的皮膚皺襞,構成女陰的外側界。

              小****位于大****的內側,是一對較薄的皮膚皺襞。

              ****由兩條陰帶海綿體構成,其裸露于兩側小****前端連接處的部分,稱****頭。

              陰道前庭魁兩側小****之間的裂隙,其前部有尿道外口,后部有陰道口。

              前庭大腺位于陰道口后外側的深部,能分泌黏液,滑潤陰道口。


              第五節 會陰


              一、會陰的境界和組成

              會陰是指甕膈以下封閉骨盆下口的所有軟組織而言。盆膈作為盆腔的底,將上方的盆腔與下方的會陰分開。廣義的會陰呈菱形,其境界:前方為恥骨聯合下緣,后方為尾骨尖,兩側界為恥骨下支、坐骨支、坐骨結節和骶結節韌帶。兩側坐骨結節的連線將會陰分為前、后兩部分:前部為尿生殖區,男性有尿道穿過,女性有尿道和陰道穿過。后部為肛區,有肛管通過。

              臨床上常將肛門和外生殖器之間的區域稱會陰,即狹義的會陰,婦女分娩時期要保護此區以免造成會陰撕裂。


              二、盆膈

              封閉小骨盆下口的后份,它主要由兩側的肛提肌以及覆蓋在它上、下兩面的筋膜構成,其中部有直腸穿過。


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