Epithelium of the mucous membrane of the fallopian tubes. Histology in gynecology. Histological structure of the tube

Uterine(another term is fallopian) pipes- these are two very thin tubes with a lining layer of ciliated epithelium, going from the ovaries of female mammals to the uterus through the utero-tubal anastomosis. In non-mammalian vertebrates, the equivalent structures are the oviducts.

Story

Other name fallopian tubes"fallopian" is given to them in honor of their discoverer, the 16th-century Italian anatomist Gabriele Fallopio.

Video about fallopian tubes

Structure

In a woman's body, the fallopian tube allows the egg to travel from the ovary to the uterus. Its various segments (lateral, medial): the infundibulum and associated fimbriae near the ovary, the ampulla-like region which represents the main part of the lateral segment, the isthmus which is the narrower part connecting to the uterus, and the interstitial region (also known as the intramural), which crosses the musculature of the uterus. The uterine orifice is the place where it meets the abdominal cavity, while its uterine opening is the entrance to the uterine cavity, the uterine-tubal anastomosis.

Histology

IN cross section The organ can be seen in four separate layers: serous, subserous, lamellar proper and internal mucous layer. The serous layer originates from the visceral peritoneum. The subserous layer is formed by loose outer tissue, blood vessels, lymphatic vessels, external longitudinal and internal circular layers of smooth muscle. This layer is responsible for the peristaltic activity of the fallopian tube. The lamellar layer proper is vascular connective tissue. There are two types of cells in the simple columnar epithelium of the fallopian tube (oviduct). Ciliated cells predominate everywhere, but they are most numerous in the funnels and ampoules. Estrogen increases the production of cilia on these cells. Scattered between the ciliated cells are secretory cells that contain apical granules and produce a tubular fluid. This fluid contains nutrients for sperm, eggs and zygotes. The secretions also promote sperm capacitation by removing glycoproteins and other molecules from the sperm plasma membrane. Progesterone increases the number of secretory cells, while estrogen increases their height and secretory activity. The tubular fluid flows against the action of the cilia, that is, towards the fimbrial end.

Due to longitudinal variation in histological features, the isthmus has a thick muscular layer and simple mucous folds, while the ampulla has complex mucous folds.

Development

Embryos have two pairs of canals to admit gametes from the body; one pair (Müllerian ducts) develops into the female fallopian tubes, uterus and vagina, while the other pair (Wolffian ducts) develops into the male epididymis and vas deferens.

Typically, only one pair of these canals will develop, while the other regresses and disappears in the womb.

The homologous organ in men is the vestigial appendix testis.

Function of the fallopian tubes

The main function of these organs is to assist in fertilization, which occurs as follows. When an oocyte develops in the ovary, it is enclosed in a spherical collection of cells known as a follicle. Just before ovulation, the primary oocyte completes meiosis I phase to form the first polar body and the secondary oocyte, which arrests in meiosis II metaphase. This secondary oocyte is then ovulated. Rupture of the follicle and the ovarian wall allows the release of the secondary oocyte. The secondary oocyte is captured by the fimbriated end and moves into the ampulla of the fallopian tube, where, as a rule, it meets the sperm and fertilization occurs; Stage II of meiosis is completed immediately. The fertilized egg, which has now become a zygote, moves towards the uterus, facilitated by the activity of the cilia and muscles of the uterus. After about five days, the new embryo enters the uterine cavity and is implanted into the uterine wall on the 6th day.

The release of the egg does not alternate between the two ovaries and appears to be random. If one of the ovaries is removed, the remaining one produces an egg every month.

Sometimes the embryo implants in the fallopian tube instead of the uterus, creating an ectopic pregnancy, commonly known as a “tubal pregnancy.”

Clinical significance

Although full analysis tubal function in patients with infertility is not possible, great importance has tubal patency testing, since tubal obstruction is the main cause of infertility. Hysterosalpingography, dye laparoscopy, or contrast hysterosalpingosonography will demonstrate that the tubes are open. Blowing pipes is a standard procedure for patency testing. During surgery, their condition can be checked by injecting a dye, such as methylene blue, into the uterine cavity and seeing it pass through the tubes when the cervix is ​​blocked. Since tubal disease is often associated with chlamydial infection, testing for antibodies to Chlamydia has become a cost-effective form of screening for pathologies of these organs.

Inflammation

Salpingitis is a disease of the fallopian tubes accompanied by inflammation, which can occur independently or be part of an inflammatory disease of the pelvic organs. Saccular expansion of the fallopian tube in its narrow part, due to inflammation, is known as adenosalpingitis. How inflammatory diseases pelvic organs and endometriosis, it can lead to obstruction of these organs. Obstruction is associated with infertility and ectopic pregnancy.

Fallopian tube cancer, which usually develops in the epithelial lining of the fallopian tube, has historically been considered a very rare malignancy. Recent evidence suggests that it is likely to be largely what was classified in the past as ovarian cancer. While this problem may be misdiagnosed as ovarian cancer, it is not special significance, since cancer of the ovaries and fallopian tubes is treated in the same way.

Surgery

A salpingectomy is an operation to remove the fallopian tube. If removal occurs on both sides, it is called a bilateral salpingectomy. An operation that combines the removal of an organ with the removal of at least one ovary is called a salpingo-oophorectomy. Surgery to correct the obstruction is called a fallopian tubeplasty.

Myometrium consists of three layers of smooth muscle tissue, between which are layers of loose muscle tissue connective tissue. Due to the absence of a submucosa, the myometrium is immovably connected to the basal layer of the lamina propria of the uterine mucosa. The inner muscular layer, located under the mucous membrane, consists of obliquely oriented bundles of smooth myocytes; in the middle layer they have a circular direction, and in the outer subserous layer they also have an oblique longitudinal direction, opposite to the direction in the inner layer. There are no sharp boundaries between the layers of muscle tissue. Large blood vessels are located here. When the uterus contracts, the vessels are pinched, which prevents bleeding during menstruation and childbirth. Estrogens increase the electrical excitability of smooth muscle cells, and progesterone, on the contrary, increases the excitability threshold of these cells.

Perimetry- the serous membrane of the uterus, covers a significant part of the organ, with the exception of the anterior and lateral surfaces of the supravaginal region. Mesothelium and loose fibrous connective tissue participate in the formation of perimetry.

Cervix represents the lower narrowed part and has the appearance of a muscular cylinder. In the center of the cervix passes the cervical, or cervical, canal, which begins in the cavity of the uterine body with the internal os. The distal part of the cervix protrudes into the vagina and ends at the external os. The cervix consists of the same membranes as the body. The cervical canal is lined with single-layer prismatic epithelium, which in the area of ​​the distal (vaginal) part of the cervix is ​​connected to multilayered squamous non-keratinizing epithelium. The latter continues into the epithelium of the vaginal mucosa. The border between multilayer and single-layer prismatic epithelium of the mucous membrane is always clear and is approximately located at the level of the distal part of the cervix.

The fallopian tubes

Fallopian tube (oviduct)- a paired tubular organ, the distal end of which, shaped like a funnel, is open and in contact with the surface of the ovary, and the proximal end pierces the wall of the uterus in the area of ​​the lateral surfaces of its bottom and communicates the tubes with the uterine cavity. In humans, the length of the fallopian tubes is about 10-12 cm. The fallopian tubes capture the oocyte during ovulation, transport it towards the uterine cavity, create conditions for the unhindered movement of sperm towards the oocyte, provide the environment necessary for fertilization and fragmentation of the embryo, transport the embryo to uterine cavity. The fallopian tubes develop from the upper part of the paramesonephric (Müllerian) ducts.

Oviduct is divided into 4 sections: the infundibulum - the distal section of the tube, ending with fimbriae (fimbriae) and opening into the ovarian bursa, the ampulla - the widest and longest part following the infundibulum (about 2/3 of the length of the tube), the isthmus, or isthmus, and the interstitial ( intramural) section that pierces the wall of the uterus.

Fallopian tube wall consists of three membranes: mucous, muscular and serous.

Mucous membrane consists of a single-layer prismatic epithelium of the coelomic type and the lamina propria. The epithelium is formed by two types of cells - ciliated and secretory. Along the fallopian tube, ciliated and secretory epithelial cells are located unevenly ciliated, predominating in the infundibulum and ampulla of the tube, and secretory epithelial cells in the isthmus region. Secretory epithelial cells of the fallopian tubes are characterized by apo- and merocrine types of secretion. The main components of the secretion are prealbumin, transferrin, globulin and lipoproteins, as well as glycosaminoglycans, prostaglandins, uteroglobin.

Own record tubal mucosa thin and formed by loose fibrous connective tissue. In addition to the types of cells typical for this tissue, cells capable of decidual transformation are found in its composition.

Muscular lining of the fallopian tubes formed by two vaguely demarcated layers of smooth muscle tissue - the inner circular (thicker) and the outer longitudinal (thinner). The thickness of the muscular layer increases from the infundibulum to the isthmus. In the area of ​​the isthmus, the inner circular layer forms the circular muscle of the fallopian tube. If the embryo is implanted into the wall of the pipe, the latter is easily injured and ruptured.
Serosa represented by mesothelium and connective tissue.

Lecture 29: Female reproductive system.

Sources, formation and development of the organs of the female reproductive system.

Histological structure, histophysiology of the ovaries.

Histological structure of the uterus and oviducts.

Histological structure, regulation of mammary gland functions.

Embryonic development of the organs of the female reproductive system. The organs of the female reproductive system develop from the following sources:

a) coelomic epithelium covering the first kidney (splanchnotomes)  follicular cells of the ovaries;

b) endoderm of the yolk sac  oocytes;

c) mesenchyme  connective tissue and smooth muscles of organs, interstitial cells of the ovaries;

d) paramesonephric (Müllerian) duct  epithelium of the fallopian tubes, uterus and parts of the vagina.

The formation and development of the reproductive system is closely connected with the urinary system, namely with the first kidney. The initial stage of the formation and development of organs of the reproductive system in females and males proceeds in the same way and is therefore called the indifferent stage. At the 4th week of embryogenesis, the coelomic epithelium (visceral layer of splanchnotomes) on the surface of the first kidney thickens - these thickenings of the epithelium are called genital ridges. Primary germ cells, gonoblasts, begin to migrate into the genital ridges. Gonoblasts first appear as part of the extraembryonic endoderm of the yolk sac, then they migrate to the wall of the hindgut, and there they enter the bloodstream and reach and penetrate into the genital ridges through the blood. Subsequently, the epithelium of the genital ridges, together with gonoblasts, begins to grow into the underlying mesenchyme in the form of cords - they are formed sex cords. The reproductive cords consist of epithelial cells and gonoblasts. Initially, the sex cords retain contact with the coelomic epithelium, and then break away from it. Around the same time, the mesonephric (Wolffian) duct (see embryogenesis of the urinary system) splits and the paramesanephric (Müllerian) duct is formed parallel to it, which also flows into the cloaca. This is where the indifferent stage of development of the reproductive system ends.

As the mesenchyme grows, it divides the sex cords into separate fragments or segments - the so-called egg balls. In the oviparous balls, gonocytes are located in the center, surrounded by epithelial cells. In the egg-bearing balls, gonocytes enter the first stage of oogenesis - the stage of reproduction: they begin to divide by mitosis and turn into Oogonia, and the surrounding epithelial cells begin to differentiate into follicular cells. The mesenchyme continues to crush the egg-bearing balls into even smaller fragments until 1 remains in the center of each fragment. sex cell, surrounded by 1 layer of flat follicular cells, i.e. is being formed premordial follicle. In premordial follicles, oogonia enter the growth stage and transform into oocytesIorder. Soon the growth of first order oocytes in the premordial follicles stops and subsequently the premordial follicles remain unchanged until puberty. The combination of premordial follicles with layers of loose connective tissue between them forms the ovarian cortex. The surrounding mesenchyme forms a capsule, connective tissue layers between the follicles and interstitial cells in the cortex and connective tissue of the medulla of the ovaries. From the remaining part of the coelomic epithelium of the genital ridges, the outer epithelial cover of the ovaries is formed.

The distal parts of the paramesonephric ducts come together, merge and form the epithelium of the uterus and parts of the vagina (if this process is disrupted, the formation of a bicornuate uterus is possible), and the proximal parts of the ducts remain separate and form the epithelium of the fallopian tubes. From the surrounding mesenchyme, connective tissue is formed as part of all 3 membranes of the uterus and fallopian tubes, as well as the smooth muscles of these organs. The serous membrane of the uterus and fallopian tubes is formed from the visceral layer of splanchnotomes.

II.Histological structure and histophysiology of the uterus. On the surface, the organ is covered with mesothelium and a capsule of dense, unformed fibrous connective tissue. Under the capsule is the cortex, and in the central part of the organ is the medulla. The cortex of the ovaries of a sexually mature woman contains follicles of different stages development, atretic bodies, corpus luteum, corpus alba and layers of loose connective tissue with blood vessels between the listed structures.

Follicles. The cortex mainly consists of many premordial follicles - in the center there are first-order oocytes, surrounded by a single layer of flat follicular cells. With the onset of puberty, premordial follicles, under the influence of the adenohypophysis hormone FSH, take turns entering the maturation path and go through the following stages:

The first order oocyte enters the phase of large growth, increases in size approximately 2 times and acquires secondary – zona pellucida(both the egg itself and follicular cells are involved in its formation); the surrounding follicular ones transform from a single-layer flat first to a single-layer cubic, and then to a single-layer cylindrical. This follicle is called Ifollicle.

Follicular cells multiply and from a single-layer cylindrical become multi-layered and begin to produce follicular fluid (contains estrogens), which accumulates in the developing cavity of the follicle; An oocyte of the first order, surrounded by I and II (pellucid) membranes and a layer of follicular cells, is pushed to one pole (oviferous tubercle). This follicle is called IIfollicle.

The follicle accumulates a lot of follicular fluid in its cavity, therefore it greatly increases in size and protrudes on the surface of the ovary. This follicle is called IIIfollicle(or vesicular or Graafian bubble). As a result of stretching, the thickness of the wall of the third follicle and the covering albuginea of ​​the ovary sharply thins. At this time, the first-order oocyte enters the next stage of oogenesis - the maturation stage: the first meiotic division occurs and the first-order oocyte turns into a second-order oocyte. Next, the thinned wall of the follicle and the tunica albuginea rupture and ovulation occurs - an oocyte of the second order, surrounded by a layer of follicular cells (corona radiata) and membranes I and II, enters the peritoneal cavity and is immediately captured by fimbriae (fimbriae) into the lumen of the fallopian tube.

In the proximal part of the fallopian tube, the second division of the maturation stage quickly occurs and the second-order oocyte turns into a mature egg with a haploid set of chromosomes.

The ovulation process is regulated by the adenohypophysis hormone lutropin.

As the premordial follicle begins to enter the maturation path, an outer shell gradually forms from the surrounding loose connective tissue around the follicle - theca or tire. Its inner layer is called vascular theca(has many blood capillaries) and contains interstitial cells that produce estrogens, and the outer layer of the theca consists of dense, irregular connective tissue and is called fibrous theca.

Yellow body. After ovulation, at the site of the burst follicle, under the influence of the adenohypophysis hormone lutropin, the corpus luteum is formed in several stages:

Stage I – vascularization and proliferation. Blood flows into the cavity of the ruptured follicle, blood vessels grow into the blood clot (hence the word “vascularization” in the name); At the same time, multiplication or proliferation of follicular cells in the wall of the former follicle occurs.

Stage II – ferruginous metamorphosis(rebirth or restructuring). Follicular cells turn into luteocytes, and interstitial thecal cells turn into thecal luteocytes and these cells begin to synthesize the hormone progesterone.

Stage III – dawn. The corpus luteum reaches a large size (diameter up to 2 cm) and progesterone synthesis reaches a maximum.

IV stage – reverse development. If fertilization has not occurred and pregnancy has not begun, then 2 weeks after ovulation the corpus luteum (called the menstrual corpus luteum) undergoes reverse development and is replaced by a connective tissue scar - it is formed white body(corpus albicans). If pregnancy occurs, the corpus luteum increases in size to 5 cm in diameter (corpus luteum of pregnancy) and functions during the first half of pregnancy, i.e. 4.5 months.

The hormone progesterone regulates the following processes:

Prepares the uterus to receive the embryo (the thickness of the endometrium increases, the number of decidual cells increases, the number and secretory activity of the uterine glands increases, the contractile activity of the uterine muscles decreases).

Prevents subsequent premordial ovarian follicles from entering the maturation pathway.

Atretic bodies. Normally, several premordial follicles simultaneously enter the maturation path, but most often 1 follicle matures to the third follicle, the rest undergo reverse development at different stages of development - atresia(under the influence of the hormone gonadocrinin, produced by the largest of the follicles) and in their place are formed atretic bodies. With atresia, the egg dies, leaving behind a deformed, wrinkled zona pellucida in the center of the atretic body; follicular cells also die, but the interstitial cells of the tegmentum multiply and begin to actively function (estrogen synthesis). Biological significance of atretic bodies: prevention of superovulation - the simultaneous maturation of several eggs and, as a consequence, the conception of several fraternal twins; endocrine function - in the initial stages of development, one growing follicle cannot create the required level of estrogen in female body, therefore atretic bodies are necessary.

Histological structure of the uterus. The uterus is a hollow muscular organ in which the embryo develops. The wall of the uterus consists of 3 membranes - endometrium, myometrium and perimeter.

Endometrium (mucous membrane)– lined with single-layer prismatic epithelium. The epithelium is immersed in the underlying lamina propria of loose fibrous connective tissue and forms the uterine glands - simple tubular unbranched glands in structure. In the lamina propria, in addition to the usual cells of loose connective tissue, there are decidual cells - large round cells rich in glycogen and lipoprotein inclusions. Decidual cells take part in providing histotrophic nutrition to the embryo during the first time after implantation.

There are features in the blood supply to the endometrium:

Arteries - have a spiral course - this structure of the arteries is important during menstruation:

spastic contraction of the spiral arteries leads to malnutrition, necrosis and rejection of the functional layer of the endometrium during menstruation;

Such vessels thrombose faster and reduce blood loss during menstruation.

Veins - form expansions or sinuses.

In general, the endometrium is divided into a functional (or receding) layer and a basal layer. When determining the approximate boundary between the functional and basal layers, the main reference point is the uterine glands - the basal layer of the endometrium covers only the very bottoms of the uterine glands. During menstruation, the functional layer is rejected, and after menstruation, under the influence of estrogens of the follicle, due to the preserved epithelium of the bottoms of the uterine glands, regeneration of the uterine epithelium occurs.

Myometrium (muscular membrane) The uterus has 3 layers of smooth muscle:

Inner – submucosal layer.

The middle layer is the vascular layer.

The outer layer is the supravascular layer.

Perimetry– the outer lining of the uterus, represented by connective tissue covered with mesothelium.

The functions of the uterus are regulated by hormones: oxytocin from the anterior part of the hypothalamus - muscle tone, estrogens and progesterone from the ovaries - cyclical changes in the endometrium.

Fallopian tubes (oviducts)– have 3 shells:

The mucous membrane is lined with a single-layer prismatic ciliated epithelium, beneath it is the lamina propria of loose fibrous connective tissue. The mucosa forms large branched longitudinal folds.

The muscular layer consists of longitudinally and circularly oriented myocytes.

The outer shell is serous.

Mammary gland. Since the function and regulation of functions is closely related to the reproductive system, the mammary glands are usually studied in the section on the female reproductive system.

The mammary glands are complex in structure, branched alveolar glands; consist of secretory sections and excretory ducts.

Terminal secretory sections in the non-lactating mammary gland they are represented by blindly ending tubes - alveolar mammary ducts. The wall of these alveolar mammary ducts is lined with low-prismatic or cuboidal epithelium, with branched myepithelial cells lying on the outside.

With the onset of lactation, the blind end of these alveolar milk ducts expands and takes the form of vesicles, i.e. turns into alveoli. The alveolar wall is lined with one layer of low-prismatic cells—lactocytes. At the apical end, lactocytes have microvilli; granular and agranular EPS, a lamellar complex and mitochondria, microtubules and microfilaments are well expressed in the cytoplasm. Lactocytes secrete casein, lactose, and fats in an apocrine manner. From the outside, the alveoli are covered by stellate myoepithelial cells, which promote secretion into the ducts.

Milk is secreted from the alveoli into milky ducts (2-row epithelium), which further in the interlobular septa continue into the milk ducts (2-layer epithelium), flowing into the milk sinuses (small reservoirs lined with 2-layer epithelium) and short excretory ducts open at the apex of the nipple.

Regulation of mammary gland functions:

Prolactin (adenohypophysis hormone) – enhances milk synthesis by lactocytes.

Oxytocin (from the supraoptic paraventricular nuclei of the hypothalamus) - causes the secretion of milk from the gland.

Glucocorticoids from the zona fasciculata of the adrenal gland and thyroxine from the thyroid gland also promote lactation.

To determine the cause of an ectopic or frozen pregnancy, doctors may order a histology analysis. Using this method, it is possible to find out why abnormalities occur in the body.

Very often, to make a more accurate diagnosis in gynecology, the doctor refers the patient to a histology analysis. It is in this medical field that such research helps in determining an accurate diagnosis and the causes of the disease or pathology. There are certain indications for which the doctor refers for histology, for example, after curettage of a frozen pregnancy. The most popular reasons for analysis are:

• To identify the presence inflammatory process, malignant tumor;
• Interrupted or frozen pregnancy;
• Determination of the nature of the neoplasm: cysts, polyps, papillomas;
• After curettage of the uterine cavity;
• Determining the cause of female infertility;
• Study of cervical pathologies and other indications.

Decoding the result of histology in gynecology

If you donated tissue samples for testing at a public hospital, you will hear the results at your doctor's office. If the analysis is submitted to private clinic, the conclusion will be handed to you. But you won’t be able to decipher the histology on your own, and it doesn’t matter whether the study was done after a frozen pregnancy or for other indications. On the form you can read your data, which drugs were used for the analysis, and below the results themselves will be indicated. Latin. The report will indicate not only the malignant cells detected, but also all the tissues identified. Depending on the indication for use histological examination, different data will be indicated. For example, the histology results after a frozen pregnancy or after examination of the uterus due to infertility will additionally indicate the cause of this pathology. Only a medical specialist can decipher the conclusion. He will give necessary recommendations for subsequent treatment.

Histology of frozen pregnancy

Pregnancy does not always end favorably. There are reasons why pregnancy is terminated. Frozen pregnancy Lately is becoming a popular phenomenon. The fetus stops developing, but a miscarriage may not occur until certain moments. To understand the reason, a histology analysis is performed after a frozen pregnancy. This procedure is done to identify the cause of an unpleasant pathology immediately after cleaning the uterine cavity. Tissue from a dead embryo is examined, but in some cases, specialists may take uterine epithelium or fallopian tube tissue for analysis. Histology of the fetus after a frozen pregnancy will be able to show the real cause of the pathology, which can be eliminated with the help of medications.

Histology of ovarian cyst

There are many diseases in gynecology that can lead to serious complications, including infertility. In some cases, an ovarian cyst develops asymptomatically and can be detected either during a random examination or when severe symptoms appear. Cyst removal may occur different methods, but laparoscopy is most often used. After removal of the tumor, it is sent for histological examination. The histology results of an ovarian cyst are usually ready in 2-3 weeks. They will allow you to find out the nature of the formation, whether it was malignant, and the doctor will prescribe the necessary treatment.

Histology of ectopic pregnancy

Ovulation of an egg can occur not only in the uterus, but also in the fallopian tube. In this case, the probability of fetal development and a favorable pregnancy outcome is zero. When found ectopic pregnancy, specialists perform a special procedure called laparoscopy. All excess is removed from the fallopian tube and tissue samples are taken for histological examination. Histology after an ectopic pregnancy will be able to determine the cause of the development of the pathology. Most often, the results show that an inflammatory process has occurred in the fallopian tubes. But there are other causes of ectopic pregnancy that histological examination can reveal.

Embryogenesis of tubes. The fallopian tubes are derivatives of the Müllerian ducts. It is known that in an embryo about 8 mm long, the development of the Müllerian ducts in the form of a groove on the outer surface of the primary kidney is already planned. Somewhat later, the groove deepens to form a channel, the upper (head) end of which remains open, and the lower (tail) end ends blindly. Gradually, the tail paired sections of the Müllerian ducts grow downward, and they approach the medial (middle) section of the embryo, where they merge with each other. The uterus and upper vagina are subsequently formed from the fused Müllerian ducts. Thus, when the Müllerian canals grow, they first have a vertical and then a horizontal direction. The place where the direction of their growth changes corresponds to the place where the fallopian tubes depart from the uterus.

The head ends of the Müllerian canals form the fallopian tubes with an opening - the abdominal openings of the tubes, around which epithelial outgrowths - future fimbriae - develop. Often, with the main opening (funnel), several side openings are formed, which either disappear or remain in the form of additional openings of the fallopian tubes.

The lumen of the tube is formed by melting the centrally located sections of the Müllerian canal. Starting from the 12th week of embryonic development, longitudinal folds are formed at the abdominal end of the tubes, which gradually move along the entire tube and by the 20th week reach the uterine end (N. M. Kakushkin, 1926; K. P. Ulezko-Stroganova, 1939) . These folds, being primary, gradually increase, giving additional outgrowths and lacunae, which determines the complex folding of the pipe. By the time a girl is born, the epithelial lining of the fallopian tubes forms cilia.

The growth of the tubes in the embryonic period, with the simultaneous descent of the ovary into the pelvic cavity, leads to spatial convergence of the uterus and tubes (the abdominal and uterine sections of the tubes are on the same horizontal line). This convergence causes the formation of tortuosity, which gradually disappears. By the time a girl is born, tortuosity is detected only in the area of ​​the abdominal openings; by the onset of puberty, it completely disappears (Fig. 1). The wall of the tube is formed from mesenchyme, and by the 20th week of intrauterine development all muscle layers are well defined. The mesenchymal part of the Wolffian bodies and the epithelium of the abdominal cavity (peritoneum) form the broad ligament of the uterus and the outer (serous) covering of the tube.

Congenital absence of both fallopian tubes occurs in nonviable fetuses with developmental anomalies of other organs.

Although the tubes and uterus are derivatives of the Müllerian canals, i.e., they have the same embryonic source, with aplasia of the uterus the tubes are always well developed. There might be one like this congenital pathology, when a woman is missing one ovary, there is aplasia of the uterus and vagina, but the structure of the tubes is normal. Perhaps this is due to the fact that the tubes develop into a full-fledged formation at earlier stages of embryogenesis than the uterus and vagina, and if they do not develop, the factors that caused this pathology simultaneously act on other foci of organogenesis, which leads to the appearance of deformities, incompatible with life.

At the same time, it has been proven that in cases of developmental anomalies of the uterus and vagina, embryonic development is vital important organs and the central nervous system is basically completed, so it is not so rare to encounter women with abnormalities of the uterus and vagina with normal tubes.

Normal tubal anatomy. Starting in the corners of the uterus, the fallopian tube (tuba uterina s. salpinx) penetrates the thickness of the myometrium almost in a strictly horizontal direction, then deviates slightly backward and upward and is directed as part of the upper part of the broad ligament to the lateral walls of the pelvis, bending around the ovary along the way. On average, the length of each pipe is 10-12 cm, less often 13-16 cm.

There are four parts in the pipe [show] .

Parts of the fallopian tube

1. interstitial (interstitial, intramural, pars tubae interstitialis), about 1 cm long, located in the thickness of the uterine wall, has the narrowest lumen (about 1 mm),
2. isthmic (isthmic, isthmus tubae), about 4-5 cm long and 2-4 mm in lumen,
3. ampullary (ampula tubae), 6-7 cm long and with a lumen gradually increasing in diameter to 8-12 mm as it moves in the lateral direction,
4. the abdominal end of the tube, also called the funnel (infundibulum tubae), is a short extension that opens into abdominal cavity. The funnel has several epithelial outgrowths (fimbria, fimbria tubae), one of which is sometimes 2-3 cm long, often located along the outer edge of the ovary, fixed to it and called ovarian (fimbria ovarica)

The wall of the fallopian tube consists of four layers [show] .

Layers of the wall of the fallopian tube

• The outer, or serous, membrane (tunica serosa) is formed from the upper edge of the broad uterine ligament, covers the tube on all sides, with the exception of the lower edge, which is free from the peritoneal cover, since here the duplication of the peritoneum of the broad ligament forms the mesentery of the tube (mesosalpinx).
• Subserosal tissue (tela subserosa) is a loose connective tissue membrane, weakly expressed only in the area of ​​the isthmus and ampulla; on the uterine part and in the area of ​​the funnel of the tube, subserosal tissue is practically absent.
• The muscular layer (tunica muscularis) consists of three layers of smooth muscle: a very thin outer layer - longitudinal, a larger middle layer - circular and inner layer - longitudinal. All three layers are closely intertwined and directly pass into the corresponding layers of the myometrium. In the interstitial part of the tube, condensation of muscle fibers is detected mainly due to the circular layer with the formation of the sphincter tubae uterinae. It should also be noted that as we move from the uterus to the abdominal end, the number of muscle structures in the tubes decreases until they are almost completely absent in the funnel area of ​​the tube, where muscle formations are determined in the form of separate bundles.
• The mucous membrane (tunica mucosa, endosalpinx) forms four longitudinal folds along the entire length of the tube, between which there are secondary and tertiary smaller folds. This results in the pipe having a scalloped shape when cut. There are especially many folds in the ampullary section and in the funnel of the tube.

  The inner surface of the fimbriae is lined with mucous membrane, the outer surface is lined with abdominal mesothelium, which passes into the serous membrane of the tube.

Histological structure of the tube.

• The serous membrane consists of a connective tissue base and mesodermal epithelial cover. In the connective tissue base there are bundles of collagen fibers and fibers of the longitudinal layer of muscle.

  Some researchers (V.A. Bukhshtab, 1896) found elastic fibers in the serous, subserous and muscle layers, while K.P. Ulezko-Stroganova (1939) denied their presence, with the exception of the walls of the tube vessels.

• The mucous membrane includes a stroma, consisting of a network of thin collagen fibers with spindle-shaped and process cells, and there are vagus and mast cells. The epithelium of the mucous membrane is high cylindrical with ciliated cilia. The closer the section of the tube is located to the uterine angles, the shorter the length of the cilia and the height of the epithelium (R. N. Bubes, 1949).

  Studies by N.V. Yastrebov (1881) and A.A. Zavarzin (1938) showed that the mucous membrane of the tubes does not have glands; the secretory elements are epithelial cells, which swell at the moment of secretion, and after being released from the secretion they become narrow and elongated.

  S. B. Edelman-Reznik (1952) distinguishes several types of fallopian tube epithelium: 1) ciliated, 2) secretory, 3) basal, 4) cambial, considering the latter type to be the main producer of the remaining cells. Studying the features of the tubal epithelium in tissue culture, Sh. D. Galsgyan (1936) found that it is strictly determined.

The question has repeatedly arisen about the cyclic transformations of the endosalpinx during the two-phase menstrual cycle. Some authors (E.P. Maisel, 1965) believe that these transformations are absent. Other researchers found such characteristic changes that they could make a conclusion about the phase of the menstrual cycle based on the epithelium of the tubes [show] .

In particular, A. Yu. Shmeil (1943) discovered in the tubes the same proliferation processes that are observed in the endometrium. S. B. Edelman-Reznik determined that in the follicular phase of the cycle, differentiation of cambial elements into ciliated and secretory cells occurs; at the beginning of the luteal phase, the growth of cilia increases and pronounced secretory swelling of cells appears; at the end of this phase, an increase in the proliferation of cambial cells is observed; rejection of the mucous membrane of the tube does not occur in the menstrual phase of the cycle, but hyperemia, edema and swelling of the endosalpinx stroma develop.

It seems to us that, by analogy with other derivatives of the Müllerian ducts, in which cyclic transformations are clearly recorded (uterus, vagina), cyclic transformations should occur and occur in the tubes, captured by fine microscopic (including histochemical) methods. We find confirmation of this in the work of N.I. Kondrikov (1969), who studied the tubes in various phases of the menstrual cycle, using a number of different techniques for these purposes. In particular, it was determined that the number of different epithelial cells of the endosalpinx (secretory, basal, ciliated, pin-shaped) is not the same along the entire length of the tube. The number of ciliated cells, especially numerous in the mucous membrane of the fimbriae and ampullary section, gradually decreases towards the uterine end of the tube, and the number of secretory cells, minimal in the ampullary section and in the fimbriae, increases towards the uterine end of the tube.

In the first half of the menstrual cycle, the surface of the epithelium is smooth, there are no pin-shaped cells, the amount of RNA gradually increases towards the end of the follicular phase, and the glycogen content in ciliated cells increases. The secretion of the fallopian tubes, determined throughout the menstrual cycle, is located along the apical surface of the secretory and ciliated cells of the endosalpinx epithelium and contains mucopolysaccharides.

In the second half of the menstrual cycle, the height of the epithelial cells decreases, and pin-shaped cells appear (the result of the release of secretory cells from the contents). The amount of RNA and glycogen content decrease.

In the menstrual phase of the cycle, mild swelling of the tube is noted; lymphocytes, leukocytes, and erythrocytes are found in the lumen, which allowed some researchers to call such changes “physiological endosalpingitis” (Nassberg E. A.), with which N. I. Kondrikov (1969) rightly did not agrees, attributing such changes to the reaction of the endosalpinx to the entry of red blood cells into the tube.

Blood supply of the fallopian tubes [show] .

The blood supply to the fallopian tubes occurs through the branches of the uterine and ovarian arteries. O.K. Nikonchik (1954), using the method of thin filling of vessels, found that there are three options for blood supply to the pipes.

1. The most common type of vascular supply is when the tubal artery departs in the fundus from the bottom branch of the uterine artery, then passes along the lower edge of the tube and supplies blood to its proximal half, while the ampullary section receives a branch extending from the ovarian artery in the area of ​​the ovarian hilum.
2. A less common option is when the tubal artery departs directly from the uterine in the area of ​​the bottom branch, and a branch from the ovarian artery approaches the ampullary end.
3. Very rarely, the entire length of the tube is supplied with blood due to vessels extending only from uterine artery.

Throughout the entire length of the tube, the vessels have a predominantly perpendicular direction to its length and only at the very fimbriae do they take a longitudinal direction. This feature of vascular architectonics must be taken into account during conservative operations on pipes and stomatoplasty (V.P. Pichuev, 1961).

The venous tubal system is located in the subserous and muscular layers in the form of plexuses, running mainly along the round uterine ligament and in the mesosalpinx area.

Lymph from all layers of the fallopian tube is collected in the subserous plexus, from where, through 4-11 extraorgan outlets lymphatic vessels is sent to the subovarian lymphatic plexus, and then along the ovarian lymphatic vessels to the para-aortic lymph nodes. The intraorgan architecture of the lymphatic vessels of the fallopian tubes, as shown by L. S. Umanskaya (1970), is quite complex and each layer has its own characteristics; it also changes depending on age.

Innervation of the fallopian tubes [show] .

The innervation of the fallopian tubes was studied in detail by A. S. Slepykh (1960). According to him, the main source of innervation should be considered the uterovaginal plexus, which is part of the pelvic plexus. Most of the fallopian tube is innervated from this source, with the exception of the fimbrial end.

Postganglionic fibers emanating from the uterovaginal plexus reach the fallopian tubes in two ways. In greater numbers, they, originating in the ganglia located on the sides of the cervix, rise up the posterolateral wall of the uterus and reach the tubal-uterine angle, where they change their direction to horizontal, bending at a right angle. These nerve trunks give off fibers that approach the tube and branch in the thickness of its wall, ending on the epithelium in the form of button-shaped thickenings. Part of the nerve fibers, leaving the same ganglia, goes directly to the free part of the tube, following between the leaves of the broad ligament parallel to the rib of the uterus.

The second source of innervation of the fallopian tubes is the ovarian plexus, which in turn is a derivative of the caudally located ganglia of the solar plexus.

The third source of innervation of the fallopian tubes is the fibers of the external spermatic nerve.

The interstitial and isthmic parts of the tube have the largest number of nerve fibers. The innervation of the fallopian tubes is mixed; they receive both sympathetic and parasympathetic fibers.

Kubo et al. (1970) expressed the idea of ​​autonomy of the innervation of the fallopian tubes. They examined the tubes of 16 women aged 22 to 41 years. It has been established that the fluorescence of norepinephrine is different in the fimbrial, ampullary and isthmic parts and is not observed in the endosalpinx (epithelial cells). Cholinesterase, usually found in nerve fibers, was rarely detected in the ampullary and fimbrial regions. Monoamine oxidase was found only in the cytoplasm of epithelial cells. These data served as the basis for the authors to conclude that the muscle tissue of the fallopian tubes is similar to the muscle tissue of blood vessels and that the transmission of impulses in nerve endings, probably has an adrenergic nature.

Physiology of the fallopian tubes. The main function of the fallopian tubes should be considered to be the transport of a fertilized egg to the uterus. Back in 1883, A. Ispolatov established that the advancement of the egg does not occur passively, but due to the peristalsis of the tubes.

The general picture of the contractile activity of the fallopian tubes can be presented as follows: peristaltic contractions of the tubes occur with a general wave of peristalsis directed towards the ampulla or uterus, the tubes can perform pendulum-like movements, while the ampullary section has a complex movement, designated as turbinal. In addition, due to contractions of the predominantly annular layer of muscles, a change in the lumen of the tube itself occurs, i.e., the wave of contraction can move along the axis of the tube, either increasing the tone in one place or decreasing it in another.

Already at the very early stages of studying the transport of the egg through the tubes, it was discovered that the nature of the contractions of the tube and its movements in space depend on the influence of the ovary. Thus, back in 1932, Dyroff established that by the period of ovulation a woman’s tube changes its position and shape, its funnel expands, the fimbriae cover the ovary and the egg at the moment of ovulation enters directly into the lumen of the tube. This process was called the "egg perception mechanism." The author found that on average up to 30-40 contractions of the tube occur per minute. These data were confirmed by a number of other studies.

A very significant contribution to this section was made by A. I. Osyakina-Rozhdestvenskaya (1947). Using the Kehrer-Magnus technique, she discovered that if there are no ovarian influences (menopause), the tube does not react to irritation and does not contract (Fig. 2). In the presence of growing follicles, the tone and excitability of the tube increase sharply, the tube reacts to the slightest influence by changing the number of contractions and moving the convolutions, lifting and moving towards the ampullary end. Contractions often become spastic, without a wave directed towards the abdominal or uterine region, that is, there are no contractions that could ensure the advancement of the egg. At the same time, it was established that movements of the ampulla can provide the “egg perception phenomenon”, since the ampulla, in response to irritation, approaches the ovary (Fig. 3).

If there is a functioning corpus luteum in the ovaries, the tone and excitability of the tubes decrease, and muscle contractions acquire a certain rhythm. The wave of contraction can move along the length, for example, during this period, a poppy grain passes through the middle and isthmic sections in 4-6 hours (Fig. 4), while in the first phase of the cycle the grain almost does not move. Often during this period, the so-called properistaltic wave of contractions is determined - from the ampulla of the tube to the uterus.

A.I. Osyakina-Rozhdestvenskaya also established that, depending on the predominance of one or another ovarian hormone, various deviations in the rhythm of the motor function of the tubes are possible.

R. A. Osipov (1972) conducted an experimental observation on 24 fallopian tubes removed during surgery. Both spontaneous contractions and the influence of oxytocin and pulsed electrical stimulation on them were studied. DC. It was found that under normal conditions, in the first phase of the cycle, the longitudinal muscles are most active, and in the second phase, the circular muscles are most active. During the inflammatory process, contractions of the tube muscles are weakened, especially in the second phase of the cycle. Stimulation of contractions with oxytocin and pulse electric shock turned out to be effective.

Similar studies have been conducted in women using kymographic pertubation. The resulting tubegrams were assessed by the value of tone (minimum pressure), maximum pressure (maximum amplitude), and contraction frequency (number of contractions per minute). In healthy women (control group), spontaneous contractions of the tubes in the first and second phases of the menstrual cycle were directly dependent on the hormonal activity of the ovaries: in the first phase they were more frequent, but weaker than in the second, tone and maximum amplitude compared to the second phase were higher. In the second phase, contractions were more rare, but strong, and the tone and maximum amplitude decreased (Fig. 5).

The inflammatory process caused a decrease in the frequency and strength of contractions. Oxytocin improved tubal contractions only in women with unchanged tone; in the presence of sactosalpimx, oxytocin had no effect at all. Similar data were obtained regarding electrical stimulation.

Hauschild and Seewald in 1974 repeated the experiments of A.I. Osyakina-Rozhdestvenskaya on tubes removed during surgery in women. They showed that antispasmodics cause almost complete inhibition of the contractile activity of the tubes. In addition, it was found that the intensity and amplitude of spontaneous contractions were highest during pregnancy and lowest in menopausal women.

The obligatory participation of ovarian hormones in the motor function of the tubes was confirmed by other studies performed at a later time. Thus, E. A. Semenova (1953), using the kymography method, discovered in the first phase of the cycle a high tone and antiperistaltic nature of the contractions, during which the movement of iodolipol into the abdominal cavity occurred very quickly, in the second phase it was delayed due to peristaltic contractions of the tubes direction from the ampullary end to the isthmic end.

Blanco et al. (1968) conducted a direct study of contractions of the fallopian tubes during operations in 13 patients. A method was used to directly record changes in intratubal pressure by inserting a thin catheter filled with saline into the tube. The contractions of the tubes had a certain rhythm; every 20 s the intratube pressure increased by approximately 2 mm Hg. Art. Periodically, this basal activity was interrupted by the appearance of 1-3 more intense contractions, and there was also an increase in the tone of the tubal muscles, giving a wave lasting 6-8 minutes. In several cases, intrauterine and intratubal pressure were recorded simultaneously: no parallelism was detected between contractions of the uterus and tubes, but when a contraceptive was introduced into the uterine cavity, a sharp increase in contractions of the tubes and an increase in their tone were noted. A similar influence had intravenous administration oxytocin.

Coutinho (1973) found that the contractility of longitudinal and circular muscle fibers is autonomous. The shortening of the pipe as a result of contractions of the longitudinal layer is asynchronous with the narrowing of its lumen caused by the contraction of the circular layer. The latter is more sensitive to pharmacological stimulation by adrenergic agents than the longitudinal layers.

In 1973, A. S. Pekki, using the cine-radiography method with simultaneous observation on a television screen, determined that in the second phase of the menstrual cycle, on the one hand, there is relaxation of the sphincters of the fallopian tubes, and on the other, a slow movement of iodolipol through the tubes. It seemed that the movement of the contrast agent in this phase of the cycle was due to the pressure created when the fluid was pumped, and not due to the tube's own contractions. This condition is quite explainable by the fact that in the second phase of the cycle the wave of contractions of the tubes is directed primarily towards the uterus.

Erb and Wenner (1971) studied the effects of hormonal and neurotropic substances on fallopian tube contractions. It turned out that the sensitivity of the tubal muscles to adrenaline in the secretion phase is 9 times lower than in the proliferation phase. This decrease depends on the level of progesterone in the blood. A comparison of the reaction of the tubes with the reaction of the myometrium revealed their identity in responses to neurotropic effects. In the secretion phase, tubal movements and sensitivity to acetylcholine are not inhibited by ovarian hormones.

Special kymographic studies of the function of the sphincter of the fallopian tubes depending on the use of hormonal and intrauterine contraceptives were carried out by Kamal (1971). It has been found that the administration of steroids increases the tone of the sphincter, and intrauterine contraceptives can cause its spasm.

Interesting are the observations of Mikulicz-Radecki, who during operations observed that by the time of ovulation, the fimbriae of the tube, due to increased blood supply, swell, become elastic and cover the ovary, which ensures that the egg, after rupture of the follicle, enters directly into the lumen of the tube. This confirmed the data of Dyroff (1932).

It is possible that the fluid flow that occurs after ovulation and directed to the fimbriae also plays a certain role in the mechanism of egg perception. At the VII International Congress on Fertility and Infertility (1971), a film was shown in which the moment of ovulation in animals was filmed. It was clearly visible how an egg literally flies out of the ruptured follicle, surrounded by granulosa cells, and how this ball is directed towards the fimbriae of the tube, located at some distance from the follicle.

An important question is the time during which an egg that enters the tube moves to the uterus. Croxato and Fuentealba (1971) determined the time of transport of the egg from the ovulated ovary to the uterus in healthy women and in those treated with megestrol acetate (a progestin). It turned out that in healthy women the shortest duration of egg transport was 3 days, the longest - 4 days after ovulation, while when taking megestrol this duration increased to 8 days.

IN last years attention is drawn to the study of the role of prostaglandins in female reproductive function. As reported in the literature summary by Pauerstein, prostaglandin E has been found to cause tubal relaxation, while prostaglandin F stimulates tubal contractility in humans. The response of fallopian tube muscle tissue to prostaglandins depends on the level and nature of the steroids produced by the ovaries. Thus, progesterone increases the susceptibility of the fallopian tubes to the action of prostaglandin E 1 and reduces it to prostaglandin F 2α. During the period of preovulatory increase in estradiol content, the synthesis of prostaglandins in the tissue of the fallopian tubes increases. This process reaches its highest level at the moment when the isthmic section of the oviduct becomes most sensitive to the effects of prostaglandin F 2α. The development of this mechanism leads to an increase in the muscle tone of the isthmic section of the tubes and their closure, which prevents the premature entry of the fertilized egg into the uterine cavity. An increase in progesterone production increases susceptibility to prostaglandin E, causes an opposite state in the muscle tissue of the isthmic section of the oviducts and promotes the entry of the fertilized egg into the uterus.

Thus, the transport of the egg from the ovary to the uterus is carried out due to active contractions of the muscles of the tubes, which in turn are under the influence of ovarian hormones. These data simultaneously explain such a large difference between the frequency of restoration of fallopian tube patency under the influence of conservative or surgical methods treatment and pregnancy rates. It is not enough to restore patency; it is necessary to preserve or restore the transport function of the pipe.

Do the cilia of the ciliated epithelium play any role in the movement of the egg? Opinions on this issue vary. Some authors believe that cilia contribute to the movement of the egg, while others deny this possibility.

N.I. Kondrikov (1969), based on the determination of the structural features of various parts of the fallopian tubes and the discovery of the different composition of the epithelial secretion, comes to the same opinion as expressed by Decker. It boils down to the fact that different sections of the tubes have different functions: fimbriae, apparently, capture the egg, the complex branched relief of the folds of the mucous membrane of the ampullary section promotes capacitation of the egg (release from the membranes, ripening); functional value The isthmic department consists in the secretion of substances necessary for the life of the fertilized egg.

Mognissi (1971) believes that the fallopian tubes not only perform a transport function, but are also the place where the egg and developing embryo are nourished in the first stages due to intratubal fluid. In the latter, the author determined protein and amino acids. The total amount of protein was found to be 3.26%. Immunoelectrophoretic study of the liquid revealed the presence of 15 types of proteins. An α-glycoprotein was discovered that is absent in the blood and can therefore be classified as a specifically tubal protein. 19 free α-amino acids were also identified. The content of amino acids in intratubal fluid was higher in the proliferative and lower in the luteal phase of the menstrual cycle.

Research by Chang (1955) and others showed that there is a special phenomenon of sperm maturation that occurs in the female genital tract and is called capacitation. Without the ripening process, it is impossible for sperm to penetrate the membranes of the egg. The time required for capacitation varies between animals and ranges from 4 to 8 hours. Edwards et al. (1969) found that in apes and humans there is also a process of capacitation, in which at least two factors participate: one of them acts in the uterus, the other in the oviducts. Thus, another factor has been established that influences the phenomenon of fertilization and the origin of which is related to the function of the tubes.

So, the fallopian tubes perform the function of receiving the egg, fertilization occurs in them, and they also transfer the fertilized egg to the uterus; During the period of passage through the tubes, the egg is in an environment that supports its vital activity and provides optimal conditions for the initial stages of embryo development. These conditions can be met with the anatomical and functional usefulness of the fallopian tubes, which depends on the correctness of their structure and the normal hormonal activity of the ovary.

Pathological anatomy and physiology of pipes. Congenital absence or underdevelopment of one of the tubes is extremely rare. Underdevelopment of both tubes is obligatory in combination with hypoplasia of the uterus and ovaries. Characteristic feature pipes in this case is the preservation of spiral tortuosity and a higher location of the ampullary sections compared to the norm. The pipes are not located strictly horizontally, but have an oblique (upward) direction and are called infantile. Due to insufficient contractile activity during salpingography, the contrast agent in such a tube is not divided into separate sections; the diameter of the tube lumen is the same throughout. During cinosalpingography (A.S. Pekki), the contrast agent flows out of the ampoule not in frequent drops, but in a thin, slowly moving stream. The described picture normally occurs in girls before puberty.

During menopause, the tubes become thin, straight, with ampullary sections sluggishly descending into the depths of the pelvis; they do not respond to mechanical and other irritations; the contrast agent moves only due to increasing pressure in the filling uterus.

Thus, in some cases, inferior development and function of a normal tube structure can cause infertility due to impaired egg transport. However, the main cause of dysfunction of the fallopian tubes should be recognized as their anatomical changes that develop directly in the layers of the tube or in the surrounding (or close to the tubes) tissues and organs. Such reasons primarily include various inflammatory changes.

Features of the topography of the pipes determine their most frequent damage by the inflammatory process. This applies equally to both specific diseases (tuberculosis) and general septic infection.

With the development of an infectious inflammatory process, endosalpingitis occurs first. Due to the thin wall of the tube, changes very quickly spread to its muscular and serous layers, which leads to the development of salpingitis. When inflammation begins from the peritoneum, the process also quickly spreads to the entire tube. Appearance At the same time, the tube changes: it thickens unevenly, takes on a distinct appearance, bends, closed chambers can form along the channel, since the swelling of the folds of the mucous membrane and the desquamation of the epithelium leads to gluing of the folds together.

Initially, during inflammation, hyperemia and swelling of tissues occur with the formation of leukocyte or lymphocytic infiltrates, located mainly at the tops of the folds of the mucous membrane, the small cell infiltrate penetrates into the muscle layers, and pus with a large admixture of destroyed epithelium accumulates in the lumen of the tube. When subsiding acute period the leukocyte reaction decreases and monocytoid and plasma cells, as well as lymphocytes, begin to predominate in the infiltrate. IN chronic stage in the endosalpinx and in the muscle layers, small cell infiltrates are detected, located mainly around the vessels, the intima of which is thickened (endovasculitis). The swelling of the layers of the tube is insignificant, but the configuration of the outgrowths of the mucous membrane changes - they become flattened, and sometimes glued together. In some cases, penetration of epithelial islands into the muscle layers is noted.

N.I. Kondrikov (1969) found morpho-functional changes in all layers of the fallopian tubes in chronic salpingitis. As the chronic inflammatory process progresses, collagen fibers grow in the stroma of the folds of the mucous membrane, the muscular wall of the fallopian tubes and under the serous cover. Blood vessels gradually undergo obliteration, and acidic mucopolysaccharides accumulate around them. Functional changes also develop, expressed in a decrease in the level of RNA and glycogen and a decrease in the content of glycoproteins in the secretion of the fallopian tubes. All these changes can disrupt the transport of the egg or cause its death.

Finally, we should dwell on the consequences of the inflammation in the form of scar-adhesive changes. If during the inflammatory process there were no areas of significant necrosis in the tube, a gradual restoration of the mucous membrane occurs with the restoration of the patency of the tube and its function. If the process of tissue destruction was significant, the inflammation ends with scarring.

V.K. Rymashevsky and D.S. Zaprudskaya (1975) studied the content of acidic mucopolysaccharides in 43 fallopian tubes removed from women with chronic salpingoophoritis. It turned out that with a relatively short duration of the disease, their content is quite high, and then decreases somewhat. When the disease lasts up to 10 years or more, it increases again, which confirms the gradually increasing disorganization of connective tissue that occurs during inflammation.

L. P. Drobyazko et al. (1970) subjected 32 fallopian tubes removed during infertility surgery to serial microscopic examination. Based on the nature of the morphological changes found in the wall of the fallopian tube, three groups were distinguished.

In the first group (8 observations), macroscopically the fallopian tubes were tortuous, slightly thickened with the presence of dense adhesions of the peritoneal cover. During microscopy, the lumen of the fallopian tube was deformed in places, the folds of the mucous membrane were hypertrophied in some places, branching, and in places fused together; in some cases, the mucous membrane of the tube was somewhat atrophic, with poorly developed folds. The muscle layer is mostly without features, sometimes atrophic. On the part of the peritoneum, in some cases moderate swelling and fibrin deposits were detected, in others - extensive growths of connective tissue. In all cases, moderate lymphocytic infiltration was noted. Thus, in this group there were phenomena of chronic salpingitis with more or less pronounced structural changes, predominant in the mucous and serous membranes of the fallopian tube. It should be noted that the majority of women in this group had no data on previous inflammatory process of the genitals; infertility was more often secondary, lasting up to 5 years.

In the second group (11 observations), pronounced macroscopic changes in the fallopian tubes were noted: the presence of peritubar adhesions distorting the shape of the tube, focal compactions with obliteration of the tube lumen or, in places, with its expansion. Microscopically, deformation of the tube lumen was more often observed. The folds of the mucous membrane in some areas were atrophic, in some places they protruded into the expanded lumen of the tube in the form of branched growths. Often they were hypertrophied, swollen, fused together, forming closed small cells filled with serous exudate. Metaplasia was detected in small cells columnar epithelium in cubic, in large ones - in flat. In most hypertrophied folds, excessive growth of connective tissue with many newly formed small vessels is noted. Sclerosis is evident in the submucosal layer. The muscle layer is unevenly developed - in some places it is atrophic, in others it is hypertrophied with layers of connective tissue of varying degrees of maturity. Sometimes scattered, cyst-like formations of various sizes and shapes, lined with cuboidal epithelium, were found in the muscular and subperitoneal layers. Against the same background, a significant number of lymphatic clefts and different sizes were noted blood vessels, more small, with a thickened sclerotic wall. Excessive growth of connective tissue was more often observed in the peritoneum. In all layers of the tube wall there was focal lymphoid infiltration with the presence of single plasma cells. In some cases, accumulations of neutrophilic leukocytes and eosinophils were found. Consequently, in the second group, the phenomena of chronic salpingitis with pronounced sclerosis of all layers of the pipe wall, especially the mucous and submucosal layers, were noted. In this group, the adhesions of the peritoneal covering, deformation and obliteration of the lumen of the tube are more pronounced than in the first group. All women in this group had suffered B1 inflammation of the uterine appendages in the past. For the majority, infertility was primary, for some it was secondary, after an abortion. The duration of infertility is 5 years or more.

In the third group (13 observations), macroscopically the walls of the fallopian tubes were thickened, the fimbrial ends were sealed. More often than in the previous group, focal compactions were encountered, narrowing and sometimes obliterating the lumen of the tube. Adhesive process was more common with involvement of the uterus and ovaries. On microscopic examination, the folds of the mucous membrane were thickened throughout and fused together. In places of greatest thickening of the pipe, its lumen was either absent or narrowed and deformed. As a result of adhesions, the mucous membrane formed network-like structures, their epithelium was flattened. The cells are filled with contents containing a small number of desquamated epithelial cells, erythrocytes, and leukocytes. The muscle layer is hypertrophied, partly atrophic with excessive development of connective tissue of varying degrees of maturity: in the form of either delicate, network-like fibrils, or coarser and thicker layers with signs of hyalinosis. In the muscular and subperitoneal layers, scattered, various shapes cyst-like formations - round, oval, bay-shaped. Their walls consisted of a connective tissue base, were lined with cubic or squamous epithelium, and a serous secretion with a small number of formed elements was revealed in the lumens. Along with this it was noted a large number of lymphatic slits and blood vessels of different sizes, often small. The walls of the vessels are thickened due to the development of rough connective tissue with partial hyalinosis and an almost complete absence of smooth muscle elements. On the part of the peritoneum, massive development of fibrous tissue with significant hyalinosis was observed. In some preparations, concentric deposits of lime (psammotic bodies) were found in the mucosal and submucosal layers. There was uneven lympho-leukocyte infiltration in all layers. In some cases, focal accumulations of leukocytes were observed.

In the third group, rather gross morphological changes were found: pronounced deformation, often the absence of a tube lumen as a result of the proliferation of the mucous membrane, significant sclerosis of all layers of the wall of the fallopian tube, a rougher and more massive development of fibrous tissue in the peritoneal cover. In each observation of this group, cyst-like formations were noted in the muscular and subperitoneal layers, fibrosis and hyalinosis of the vascular walls.

In some cases, phenomena of purulent salpingitis were observed, combined with gross irreversible changes in the pipe wall.

All patients in this group suffered inflammation of the uterine appendages with pronounced clinical manifestations. In some women, the disease was long-lasting and often worsened; in some, it had occurred in the past. purulent inflammation uterine appendages. Infertility, both primary and secondary, lasted from 6 to 9 years.

Saccular formations of tubes (sactosalpinx) arise as a result of gluing fimbriae together and closing the lumen of the tube in the ampullary section. In this case, the products of inflammation are retained, sometimes stretching the resulting cavity to quite large sizes. Based on the nature of the contents, there are pyosalpinx (pus), hydrosalpinx (serous fluid), hematosalpinx (blood), and oleosalpinx (oily contrast fluid injected during an X-ray examination). The walls of the saccular formation can have different thicknesses; as a rule, the inner surface is either a velvety, somewhat thickened or, conversely, an atrophied endosalpinx without folds.

Tubal-ovarian inflammatory formations arise due to the topographic proximity of the tubes and ovaries, the commonality of their circulatory and lymphatic systems. Sometimes, upon examination, it is difficult to distinguish the boundaries of the tubes and ovaries in these conglomerates, which often include inflammatory cavities common to them.

It is difficult to identify any specific pathomorphological changes in the tubes that are pathognomonic for a certain type of infection, with the exception of tuberculosis, in which these changes are very characteristic. Of the organs of the reproductive system, tuberculosis most often affects the tubes. As a rule, the process begins with damage to the fimbriae and their gluing, which leads to the formation of sactosalpinx with the accumulation of decay products (caseous masses). Very quickly the muscle layer and serous membrane are involved in inflammation. The detection during this period of elements of productive inflammation - specific granulomas - is undoubted evidence of the ongoing tuberculosis process. Post-tuberculosis phenomena are much more difficult to diagnose, when infiltrative-productive ones are replaced by cicatricial, sclerosing changes that cover all layers of the tube. Sometimes calcified lesions are found.

The patency of the tubes can be influenced by foci of endometriosis, the development of which is associated with implantation of the endometrium in the tubes due to antiperistaltic reflux of menstrual blood or intrauterine manipulations (curettage of the mucous membrane, blowing, hysterography, etc.). Endometrioid heterotopias in the tubes, the frequency of which has been increasing in recent years, can cause infertility (complete occlusion of the tube) or the development of tubal pregnancy.

Changes in the conditions of egg transport due to a direct change in the lumen as a result of the development of a tumor process inside the tube occur relatively rarely. Isolated cases of detection of fibroma, myxoma and lymphangioma of the fallopian tubes have been described.

The lumen of the tube, its length, and location in space can change during tumor processes in the uterus (fibroids) or ovaries (cystoma), when, on the one hand, the topography of the organ changes, on the other, the oppressive influence of the tumor itself affects. Changes in the pipes in these cases will depend on changes in the shape and volume of neighboring organs.