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[根据解剖学、放射学和微血管造影研究,探讨阔韧带内子宫动脉及其分支走行的变异性以及子宫壁血管化与女性年龄的关系]

[Variability of the course of the uterine artery and its branches within the broad ligament and vascularization of uterine walls depending on a woman's age in light of anatomical, radiologic and microangiographic studies].

作者信息

Pilarczyk K

机构信息

Katedry i Zakładu Anatomii Prawidłowej i Topograficznej Pomorskiej Akademii Medycznej w Szczecinie.

出版信息

Ann Acad Med Stetin. 1995;41:43-55.

PMID:8615552
Abstract

The aim of the study was to perform uterus measurements in order to demonstrate variability of size, shape and proportions of each part of uterus. Topography, shape and dimensions of the uterine artery and its organic branches were also analyzed. The main part of the study was to analyze the arterial system in the walls of the human uterus. The study has been performed in order to find correlation between anatomic variety and age, and obstetric history of the investigated females. Internal genital organs taken at autopsy from 105 female cadavers (only unchanged pathologically) aged from 3 to 85, underwent evaluation (Table 1). Material consisted of 8 non menstruating girls, 30 nulliparas (20 premenopausal and 10 postmenopausal) and 67 multiparas (32 and 35, respectively). During postmortem examination topography of the origin sites of the uterine artery originating from the internal iliac artery, its diameters and its position towards ureter have been estimated. External measurements of the uterus have been performed. After excision of the uterus, uterine arteries have been injected with radiologic contrast medium. Radiography of the uterus has been taken using roentgenographic apparatus for structural research, and then arrangement of the uterine arteries in myometrium and their organic branches have been assessed. Uteri have been sectioned horizontally, and finally enlarged radiographs of each layer have been taken to estimate the arrangement of vessels at different levels of the myometrium. Fractionation itself made accurate measurements of the walls of the uterus possible at different levels. It has been stated that shape and size of the uterus changed considerably during the whole individual's life. Changes occurred not only within time, but they were connected with motherhood as well. Variability of the external dimensions of the uterus was always closely connected with variability of the uterus wall's thickness at different levels. Angiographic studies revealed that uterine arteries were present in every case, on both sides, regardless of the age and obstetric history. Topographic investigations proved that the vessels always crossed the ureter superficially on both sides. Considering each of the three segments of the uterine artery, it was stated that the length of the descending part of the vessel varied only within age, while the transverse and ascending parts were elongated within age and also after pregnancies. The number of the uterine artery branches running towards the body and cervix of the uterus was significantly variable and depended not only on age, but on pregnancies as well. Radiographic analysis revealed that connections between uterine vessels on both sides of the same uterus were not constant. Their absence was associated with the presence of the hypovascular, or even avascular zone in the medial part of the fundus and body of the uterus. This situation was evident at any age, regardless of the obstetric history. Artery of the fundus uteri, which had been previously described in many studies, was a rarely existing vessel. In the investigated material no azygos uterine artery has been found. Microangiographic studies (Fig. 1-4) revealed that angioarchitectonics of blood vessels in consecutive layers of the wall of the human uterus at different levels was variable to a great degree. It has been stated that situation depended not only on age, but also on past pregnancies.

摘要

本研究的目的是进行子宫测量,以展示子宫各部分大小、形状和比例的变异性。同时,还分析了子宫动脉及其分支的位置、形态和尺寸。本研究的主要部分是分析人类子宫壁内的动脉系统。进行这项研究是为了找出解剖结构差异与被调查女性的年龄和产科病史之间的相关性。对105具年龄在3至85岁之间(病理状态正常)的女性尸体的内生殖器进行了评估(表1)。材料包括8名非经期女孩、30名未生育女性(20名绝经前和10名绝经后)以及67名经产妇(分别为32名和35名)。在尸检过程中,估计了发自髂内动脉的子宫动脉起始部位的位置、直径及其与输尿管的关系。进行了子宫的外部测量。切除子宫后,向子宫动脉注入放射造影剂。使用用于结构研究的X射线设备对子宫进行造影,然后评估子宫动脉在子宫肌层及其分支中的分布。子宫被水平切片,最后拍摄每层的放大造影照片,以估计不同肌层水平血管的分布。切片本身使得在不同水平对子宫壁进行精确测量成为可能。据指出,子宫的形状和大小在个体的一生中会发生相当大的变化。变化不仅随时间发生,而且与生育情况也有关联。子宫外部尺寸的变异性总是与不同水平子宫壁厚度的变异性密切相关。血管造影研究表明,无论年龄和产科病史如何,两侧子宫动脉在每种情况下均存在。局部解剖学研究证明,血管总是在两侧从输尿管表面穿过。考虑子宫动脉的三个部分中的每一个,据指出,血管下降部分的长度仅随年龄变化,而横向和上升部分在年龄增长以及怀孕后都会延长。朝向子宫体和宫颈的子宫动脉分支数量有显著差异,不仅取决于年龄,还取决于怀孕情况。造影分析显示,同一子宫两侧子宫血管之间的连接并不恒定。它们的缺失与子宫底部和体部内侧低血管甚至无血管区域的存在有关。这种情况在任何年龄都很明显,与产科病史无关。先前许多研究中描述的子宫底动脉是一种罕见的血管。在所研究的材料中未发现奇静脉子宫动脉。微血管造影研究(图1 - 4)表明,人类子宫壁不同水平连续层中血管的血管构筑在很大程度上是可变的。据指出,这种情况不仅取决于年龄,还取决于既往怀孕情况。

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