第二节内生殖器 Section internal genitalia

女性内生殖器 ，包括阴道 、 子宫 、输卵管及卵巢 ，后二者常被称为子宫附件 Female internal genitalia , including the vagina , uterus , fallopian tubes and ovaries , the latter two are often called uterine attachment

一、 阴道为性交器官及月经血排出与胎儿娩出的通道，呈扁平管状，外窄内宽，顶端有子宫颈凸出，环绕子宫颈周围的部分，称“阴道穹窿”。 First, the vagina for sexual organs and menstrual blood and fetus discharge channel was flat tubular outer narrow width, the top cervical bulge around the cervix partially around, saying "the vaginal vault." 分为前后左右四个部分，以后穹窿较深。 Is divided into four parts around, after deep vault. 阴道前壁长约7～9cm，以一层较薄的疏松结缔组织与尿道及膀胱相隔。 The anterior vaginal wall is about 7 ~ 9cm, with a thin layer of loose connective tissue and the urethra and bladder apart. 后壁长约10～12cm，上段仅有很薄的组织（仅有阴道壁和子宫直肠陷凹的一层腹膜）和腹腔隔开，中段为一层较薄的疏松结缔组织与直肠相隔，上段和出口与直肠及会阴相毗邻。 The back wall is about 10 ~ 12cm, the only thin tissue sections (only the vaginal wall and uterus rectum layer of the peritoneum) and separated from the abdominal cavity, the middle of a thin layer of loose connective tissue and rectum is separated from the upper section and an outlet adjacent to the rectum and perineum. 阴道粘膜有很多皱折，粘膜下肌肉层及疏松结缔组织，伸展性很大。 There are a lot of wrinkles vaginal mucosa, muscle layer of loose connective tissue and mucous membrane, stretching a lot. 阴道粘膜无分泌腺，细胞含有糖元，经阴道杆菌分解后产生乳酸，使阴道保持一定的酸度（pH4.5），有防止致病菌繁殖的作用。 Vaginal mucosa without glands, cells contain glycogen, lactic acid produced by the decomposition of vaginal bacteria, so the vagina to maintain a certain acidity (pH4.5), to prevent bacteria breeding role. 阴道上皮细胞受卵巢性激素的影响而发生周期性变化。 Vaginal epithelial cells affected by ovarian hormones influence the cyclical changes occur. 因此，将脱落的阴道上皮细胞作涂片染色检查，是了解卵巢功能的方法之一。 Thus, the loss of vaginal epithelial cells as smear staining, is to understand ovarian one functionality.

二、 子宫是产生月经和孕育胎儿的器官，位于骨盆腔中央，在膀胱与直肠之间，如倒置、前后略扁的梨形， 子宫大小与年龄及生育有关，未产者约长7.5cm、宽5cm、厚3cm， 子宫可分为底、体与颈三个部分，上三分之二为“ 子宫体部”；体的上部两侧输卵管入口线以上稍隆突部为“ 子宫底部”，下三分之一为“ 子宫颈部”， 子宫颈下半部伸入阴道称“宫颈阴道段”，上半部为“宫颈阴道上段”。 Second, the uterus and the fetus is to produce menstruation organ, located in the center of the pelvic cavity, between the bladder and rectum, such as upside down, back and forth a little flat pear-shaped, uterine size and age and birth-related, not producers about long 7.5cm, width 5cm, thick 3cm, uterus can be divided into the bottom of the body and the neck of three parts, the two-thirds " of the uterus body "; the upper sides of the fallopian tube inlet line body bulge slightly above the" womb bottom " Under the third as " cervical Department, " the cervix into the vagina lower half called "cervical vaginal segment" upper half "segment on the cervix and vagina." 宫腔呈倒置三角形，深约6cm，上方两角为“ 子宫角”，通向输卵管。 Uterine cavity was inverted triangle, a depth of about 6cm, the top corners as " uterine horn ", leading to the fallopian tubes. 下端狭窄为“峡部”，长约1cm，其下通向宫颈管（图5）。 For the lower end of a narrow "isthmus", about 1cm, under which leads to cervical (Figure 5). 峡部上界因解剖上较狭窄，有人称之为“宫颈解剖内口”，下界因粘膜在此由子宫内膜转变为宫颈内膜，称“宫颈组织内口”。 The upper bound of the isthmus anatomy because relatively narrow, it was called "cervical anatomy inside the mouth," because the lower bound by the mucous membrane in the uterine lining for endocervical transformation, called "cervical tissue in the mouth." 峡部在妊娠期逐渐扩展，临产时形成子宫下段。 Isthmus gradually extended during pregnancy, the formation of labor when uterine lower segment. 宫颈管为梭形上为内口，下开口于阴道，为宫颈外口，未产者呈圆点状，已产者因分娩时裂伤，多呈“一”字形（图6）。 Cervical canal for the spindle of the mouth, the lower opening in the vagina, cervix, mouth is not produced by a circular dot, who has been producing laceration during delivery due, mostly, "a" shape (Figure 6). 宫颈以外口为界，分为上下两唇。 Outside of the cervix as the boundary is divided into upper and lower lips. 宫颈宽约1.5～2.5cm，硬度如软骨。 Cervical width 1.5 ~ 2.5cm, hardness as cartilage. 输尿管由上向下在距宫颈侧仅约2～2.5cm处，在子宫动脉的后方与之交叉，再向下经阴道侧穹窿顶端绕向前方进入膀胱壁。 Ureter down by the side away from the cervix at only about 2 ~ 2.5cm, the uterine artery with a cross behind, and then down through the top of the vagina around to the front side of the dome into the bladder wall. 在此区域内行妇科手术时，必须警惕，防止损伤输尿管。 When the experts in this area of ​​gynecological surgery, must be vigilant to prevent damage to the ureter. 宫体与宫颈比例因年龄而异,婴儿期为1:2,青春期为1:1，生育期为2:1， 子宫正常稍向前弯曲，前壁俯卧于膀胱上，与阴道几乎成直角，位置可随膀胱直肠充盈程度的不同而改变。 Palace and cervical proportions depending on age, the infant is 1: 2, puberty is 1: 1, the growth period is 2: 1, the uterus normally slightly bent forward, prone on the anterior wall of the bladder, the vagina is almost at right angles, location can vary the degree of filling of the bladder and rectum change.

子宫壁由外向内为浆膜、肌层及粘膜(即内膜)三层。 Uterine wall from outside to inside as serous, muscular and mucosal (ie intima) three. 粘膜又分功能层（致密层与海绵层）与基底层两部分。 Mucosal divided functional layer (dense layer and a sponge layer) and the substrate layer in two parts. 青春期开始，受卵巢激素的影响，功能层发生周期性变化（增殖、分泌及脱落），而基底层无周期性变化。 The onset of puberty, by ovarian hormones, functional layer changes periodically (proliferation, secretion and shedding), while non-cyclical changes in the basal layer. 肌层最厚，分为内、中、外三层。 Muscular thickest, divided into inner, middle and outer layers. 外层多纵行，内层环行，中层肌纤维交织如网，分娩后收缩可压迫贯穿其间的血管，起止血作用。 More longitudinal outer and inner ring, middle muscle fibers interwoven as net contraction after delivery may compress the blood vessels throughout the meantime, from the hemostasis. 浆膜层紧紧覆盖宫底及宫体，在前方相当于峡部下界处折向膀胱，形成“ 子宫膀胱皱襞”。 Serosa tightly cover the fundus and the Palace, in front of subordinates boundary off the equivalent of the gorge to the bladder, forming a " womb bladder folds. " 浆膜疏松地覆盖着峡部，在行子宫下段剖宫产术及子宫切除术时，即在此切开腹膜，推开膀胱，露出子宫下段及颈部。 Serous loosely covered isthmus line uterine segment cesarean section and uterine surgery, that in this peritoneal incision, open bladder, exposing the uterus and lower neck. 子宫后壁浆膜则向下掩盖宫颈上段及阴道后壁上段，反折至直肠，形成“ 子宫直肠陷窝”，此为腹腔最低部分。 Uterine serous posterior wall of the cervix and down obscure segment vaginal wall segment, reflexed to the rectum, forming a " uterus rectum lacuna ", this is the lowest part of the abdominal cavity. 与阴道后穹窿仅有阴道壁、少量结缔组织及一层腹膜相隔。 Only with the posterior fornix of the vaginal wall, a small amount of connective tissue and separated by a layer of peritoneum. 临床上，当腹腔内出血或感染化脓时，血液或脓液多积于此，可从阴道后穹窿进行穿刺抽吸或切开引流，以达诊断、治疗目的。 Clinically, when purulent abdominal bleeding or infection, the blood or pus much plot here, aspiration or incision and drainage can be performed from the posterior fornix to reach the diagnosis, therapeutic purposes.

三、 子宫韧带 子宫共有三对韧带支持 Third, uterine ligament of the uterus to support a total of three pairs of ligaments

1． 1. 阔韧带是子宫浆膜前后叶在子宫两侧会合后形成如翼形的腹膜皱襞，两侧向盆壁伸展，与腹膜壁层相延续，其间主要含有少量结缔组织及丰富的血管。 Broad ligament is uterine serosa around leaves the uterus after the two sides meet to form a wing-like folds of peritoneum, extending on both sides of the pelvic wall, and parietal peritoneum is continuous, during which mainly contains a small amount of connective tissue and blood vessels rich. 阔韧带的上缘为游离部分，内侧2/3包绕输卵管，外侧1/3由输卵管伞端延达盆壁，称“骨盆漏斗韧带”（简称盆漏斗韧带）， 卵巢动、静脉由此韧带穿过。 On the edge of the free part of the broad ligament, medial 2/3 surrounding the fallopian tubes, the outer one-third of the tubal end up Pelvic extension, called "pelvic ligaments funnel" (the basin funnel ligament), ovarian artery and vein, thus ligament through. 在阔韧带下部，横行于子宫两侧和骨盆侧壁之间为一对坚韧的平滑肌与结缔组织纤维束，是固定宫颈，维持子宫位置的主要结构，称“主韧带”。 In the lower part of the broad ligament, transverse to the uterus and pelvic sidewall between the two sides for a pair of tough muscle and connective tissue fibers, is fixed cervix, maintain uterine position of the main structure, called the "main ligaments." 子宫动、静脉及输尿管贯穿其间。 Uterine artery and vein and ureter through the meantime.

2． 2. 圆韧带为一对近圆形的肌纤维束，有腹膜覆盖。 Round ligament is a nearly circular muscle fibers, peritoneal coverage. 起于子宫底两角输卵管的前下方，向前向外延续，通过腹肌沟管止于阴阜及大小阴唇内，有维持子宫前倾的作用。 Starting in the womb before the end of the bottom corners of the fallopian tubes, the forward continuation outwards, beyond the inner tube through the abdominal ditch mons pubis and labia size, have to maintain the uterus forward role.

3． 3. 子宫骶骨韧带由宫颈后上方两侧向后伸延，绕过直肠两侧止于第二、第三骶骨前的筋膜，将宫颈向后上方牵引，有间接维持子宫前倾的作用。 Uterus sacral ligament extending from both sides of the top of the cervix backwards, bypassing both sides of the rectum beyond the fascia of the second and third sacral before pulling back the top of the cervix, have an indirect maintain the uterus forward role.

四、输卵管　输卵管位于子宫底的两侧，长约8～14cm，由内向外分为四部，即间质部，为通过子宫肌壁的部分，管腔狭窄，长约1cm；峡部，为紧连子宫角的较狭窄部分，长约2～3cm;壶腹部，为外侧较宽大部分，长约5～8cm；伞端或漏斗部，为输卵管末端，形似漏斗，游离端有很多细伞，开口于腹腔。 Fourth, Tubal located uterus bottom sides, about 8 ~ 14cm, divided into four from the inside out, that interstitial, through the uterine muscle wall section, stenosis, about 1cm; isthmus, is tightly connected Uterine narrow angle section, about 2 ~ 3cm; Vater, a wide majority of the outside, about 5 ~ 8cm; umbrella or funnel end portion of the fallopian tube end, the shape of the funnel, the free end has a lot of fine umbrella, opening in abdominal cavity. 输卵管由腹膜、肌织膜及粘膜三层组成，粘膜有很多皱襞，愈近伞端愈厚，皱襞也愈多。 Oviduct by peritoneum, mucous membrane composed of three layers of muscle tissue, mucous membrane has many folds, the thicker the closer umbrella side, but also the more folds. 炎症可造成粘膜粘连，致管腔变窄或堵塞，可引起输卵管妊娠或不孕。 Adhesions can cause inflammation of the mucous membrane, causing luminal narrowing or blockage, which can cause ectopic pregnancy or infertility. 粘膜表面为单层高柱状细胞，其中有分泌细胞及纤毛细胞，纤毛向宫腔方向摆动。 Mucosal surfaces as a single high columnar cells, which have secretory cells and ciliated cells, ciliary beat the uterine cavity direction. 肌织膜与粘膜相反，愈近子宫愈厚，收缩时使输卵管向宫腔方向蠕动，加上纤毛的摆动，有助于卵子或受精卵向宫腔输入。 In contrast with the mucous membranes of muscle tissue, the closer the uterus thicker, tubal motility to uterine contraction direction, plus swing cilia help or fertilized egg to the uterine cavity input.

五、 卵巢为女性生殖腺，有产生卵子及女性性激素的功能。 Fifth, the ovaries of the female gonads, have to produce eggs and female sex hormone function. 卵巢呈扁椭圆形，左右各一，成年妇女的卵巢约3.5×2.5×1.5cm大小，色灰白，位于阔韧后方输卵管之下，由卵巢系膜与阔韧带后叶相连，内侧借卵巢固有韧带与子宫相接，外侧与盆漏斗韧带相连。 Ovarian Chengbian oval, so each one, adult women ovarian approximately 3.5 × 2.5 × 1.5cm size, color gray, tough wide located beneath the rear fallopian tubes, by the ovaries after connecting with the broad ligament mesangial leaves the inside by ovarian inherent ligament and uterine phase, connected to the outside of the bowl funnel ligament. 卵巢由里向外为髓质、皮质、白膜及生发上皮。 Ovary from the inside out as the medulla, cortex, albuginea and germinal epithelium. 髓质内含大量血管、神经和淋巴管；皮质含有大量处于不同发育阶段的卵泡及黄体和白体等。 Medulla contains a large number of blood vessels, nerves and lymphatic; cortex contains large amounts at different developmental stages of follicular and luteal and white body and so on. 白膜为一层白色纤维组织，外覆单层立方形上皮细胞，为生发上皮。 Albuginea is a white fibrous tissue, covered with a single layer cuboidal epithelial cells, germinal epithelium.