Ovaries Blood supply: arterial blood supply. Visceral branches: testicular artery, inferior mesenteric artery The ovarian artery arises from

1. Testicular artery, atesricularis. It starts from the aorta at the level of L 2, crosses the ureter in front and, with the vas deferens, passes through the inguinal canal to the testicle. Rice. IN.
2. Ureteral branches, rami ureterici. They are directed to the ureter. Rice. B. 2a Branches of the epididymis, rami epididymides.
3. Ovarian artery, a. ovarica. It starts from the aorta at the level of L 2 and reaches the ovary as part of lig. suspensorium ovarii. Anastomoses with the uterine artery. Rice. IN.
4. Ureteral branches, rami ureterici. They are directed to the ureter. Rice. B. 4a Trumpet branches, rami tubarii (tubaks). They are directed to the funnel of the fallopian tube and anastomose with the branches of the uterine artery.
5. Bifurcation of the aorta, bifurcatio aortae. Located in front of L 4, approximately at the level of the navel. Rice. IN.
6. Common iliac artery, a. Shasa communis. From the aortic bifurcation at level L4 it continues to the sacroiliac joint, where it divides into the external and internal iliac arteries. Rice. IN.
7. Internal iliac artery, and Shasa interna. From the bifurcation of the common iliac artery it goes into the small pelvis to the upper edge of the greater sciatic foramen. Rice. IN.
8. Iliopsoas artery, a. iliolumbalis. It passes under the psoas major muscle posteriorly and laterally to the iliac fossa. Rice. IN.
9. Lumbar branch, ramus lumbalis. Supplies blood to the psoas major and quadratus lumborum muscles. Rice. IN.
10. Spinal branch, ramus spinalis. Enters the spinal canal through the opening between the sacrum and L 5. Fig. IN.
11. Iliac branch, ramus iliacus. It branches in the muscle of the same name and anastomoses with the deep circumflex artery of the ilium. Rice. IN.
12. Lateral sacral arteries, aa sacrales laterales. They descend from the side of a.sacralis mediana. May begin from the superior gluteal artery. Rice. IN.
13. Spinal branches, rami spinales. Through the pelvic openings the sacrum enters the canalis sacralis. Rice. IN.
14. Obturator artery, a. obturatoria. It runs along the lateral wall of the pelvis and passes through the obturator foramen to the adductor muscles of the thigh. Rice. B, V.
15. Pubic branch, ramus pubieus. Connects with the obturator branch of the inferior epigastric artery []. Fig. B.
16. Acetabular branch, ramus acetabulis. Passes through the notch of the same name to the ligament of the head of the femur. Rice. B.
17. Anterior branch, ramus anterior. It is located on the adductor brevis muscle and anastomoses with the medial circumflex femoral artery. Rice. B.
18. Posterior branch, ramus posterior. Located under the adductor brevis muscle. Rice. B.
19. Superior gluteal artery, a. glutealis superior. It exits the pelvis through the greater sciatic foramen above the piriformis muscle. Rice. A, V.
20. Superficial branch, ramus superficialis. Located between the gluteus maximus and gluteus medius muscles. Anastomoses with the inferior gluteal artery. Rice. A.
21. Deep branch, ramus profundus. Located between the gluteus medius and minimus muscles. Rice. A.
22. Upper branch, ramus superior. It runs along the upper edge of the gluteus minimus muscle to the m.tensor fasciae latae. Rice. A.
23. Lower branch, ramus inferior. In the gluteus medius muscle it reaches the greater trochanter of the femur. Rice. A.
24. Inferior gluteal artery, o. glutealis inferior. It passes through the greater sciatic foramen under the piriformis muscle and branches under the m.gluteus maximus. Anastomoses with the superior gluteal and obturator arteries, as well as with the lateral and medial circumflex femoral arteries. Rice. A, V.
25. The artery accompanying the sciatic nerve, a. comitans n. ischiadici (sciatici). In phylogeny, the main artery of the lower limb. Accompanies and supplies blood to nischiadicus. Anastomoses with the medial circumflex femoral artery and perforating arteries. Rice. A, V.
26. Umbilical artery, a. umbilicalis. Branch of the internal iliac artery. After birth, its lumen above the origin of the superior abdominal arteries is obliterated. Rice. B. 26a Open part, pars patens. Unobliterated part of the umbilical artery.
27. Artery of the vas deferens, a. ductus deferentis. It descends into the pelvic cavity to the bottom of the bladder, from where, accompanied by the vas deferens, it goes to the testicle, where it anastomoses with a. testicularis. Rice. IN.
28. Ureteral branches, rami ureterici. Three branches to the ureter. Rice. IN.
29. Superior vesical arteries, aa vesicates superiores. They supply blood to the upper and middle sections of the bladder. Rice. B. 29a Obliterated part, pars occlusa. The part of the umbilical artery that becomes the medial umbilical ligament after birth.
30. Medial umbilical ligament, lig. umbilicale mediale []. Replaces the umbilical artery and passes in the fold of the peritoneum of the same name. Rice. IN.

Blood supply to the appendages very developed and carried out mainly by the uterine and ovarian arteries.

Both ovarian arteries(aa. ovaricae, dextra et sinistra) depart from the anterior surface of the aorta immediately below the renal arteries (in some cases from the renal arteries); often depart from the aorta with a common trunk (a. ovarica communis). Directing downward and laterally, along the anterior surface of the psoas major muscle, each ovarian artery crosses the ureter in front (giving it branches - Messrs. ureteric!), the external iliac vessels, the border line and enters the pelvic cavity, located here in the suspensory ligament of the ovary. Following in the medial direction, the ovarian artery (its diameter ranges from 0.1 to 1.7 mm, averaging 0.5 mm) passes between the leaves of the broad ligament of the uterus under the fallopian tube, giving it branches, and then goes to the mesentery of the ovary; entering the hilum of the ovary, it is divided into 2-5 branches, from which 14-20 thinnest branches extend into the ovarian tissue in a direction transverse to its axis.

Branches of the ovarian artery widely anastomose with the ovarian branches of the uterine artery, which is of significant practical importance. Thus, the ovary receives arterial blood mainly from two sources: from the uterine and ovarian arteries. However, the predominant blood supply to the ovary is carried out mainly by the uterine artery, which, even in the area of ​​the ovarian hilum, has a significantly larger diameter than the ovarian artery.

In addition to the uterine and ovarian arteries, the blood supply to the right ovary often involves the appendicular-ovarian artery (a. apendiculoovarica), passing in the ligament of the same name, which is the connecting link between the artery of the appendix (a. appendicular! s) and the ovarian artery (a. ovrica).

Venous drainage from the ovaries is carried out primarily in the ovarian (grape-shaped) venous plexus (plexus venosus ovaricus s. pampiniformis), located in the area of ​​the ovarian hilum. From here, the outflow of blood is directed through two systems: through the uterine veins (vv. uterine) and the ovarian veins (w. ovaricae). The right ovarian vein has valves and flows into the inferior vena cava. The left ovarian vein flows into the left renal vein, and there are no valves in it.

It should be recalled once again that the uterine and ovarian arteries, their tubal and ovarian branches vary extremely, both in caliber, depending on one or another type of branching (main, scattered, transitional forms), age and number of former genera, and in their location in relation to the fallopian tube.

In the collateral circulation of the uterus and its appendages can take part, in addition to the vessels described above, also numerous arterial branches of the tissue of the parametrium and broad ligaments of the uterus (aa. parametrales et aa. ligamentorum latorum uteri), extending from the uterine artery along its entire length and its anastomosis with the ovarian artery in area of ​​the mesentery of the ovary. These arterial branches are directed outward, to the lateral wall of the pelvis, and anastomose with the internal and external iliac arteries, with the obturator, inferior epigastric and inferior epigastric superficial arteries, with the perineal artery, as well as with the branches of the unobliterated part of the umbilical artery. In cases of blockade of the main trunks of the uterine or ovarian arteries (inflammatory process, tumors), the vessels of the ligamentous apparatus of the uterus and parametrium increase in diameter and abundant anastomoses are formed between them (B. V. Ognev and V. X. Frauchi). The practical significance of these anastomoses lies in the possible restoration of blood circulation during various surgical interventions on the uterine appendages (resection of the ovary or fallopian tube, implantation of the tube into the lumen of the uterine cavity, etc.).

Educational video of anatomy and topography of the uterus, appendages, vagina

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The main source of blood supply to the organs and walls of the pelvis is the internal iliac artery and its branches passing in the subperitoneal floor of the pelvis.

Additional sources of blood circulation include: the superior rectal artery (a. rectalis superior), extending from the inferior mesenteric artery (a. mesenterica inferior); ovarian arteries (aa. ovaricae) - in women and testicular (aa. testiculares) - in men, extending from the abdominal aorta; the middle sacral artery (a. sacralis medialis), which is a continuation of the terminal aorta.

The internal iliac artery is the medial branch of the common iliac artery. From the common iliac artery a. iliaca interna, as a rule, extends on the right at the level of the body of the fifth lumbar vertebra, on the left - outside and below the middle of the body of this vertebra. The place where the abdominal aorta divides into the right and left common iliac arteries is most often projected onto the anterior abdominal wall, at the intersection of the anterior wall with the line connecting the most prominent points of the iliac crests. However, the level of aortic bifurcation often varies from the middle of the third to the lower third of the fifth lumbar vertebrae.

Syntopy of the internal iliac artery and its branches. More often, the internal iliac artery arises from the common iliac arteries at the level of the sacroiliac joint and is its medial branch, which is directed downward and outward and posteriorly, located along the posterolateral wall of the small pelvis. The internal iliac vein passes posterior to the artery. The trunk of the internal iliac artery varies both in length and in the type of branching. The average length of the artery in children is up to 2.7 cm, in men and women up to 4 cm or more (V.V. Kovanov 1974). The internal iliac artery lies on top of the venous trunks and trunks of the sacrolumbar plexus and spinal nerves.

The division of the internal iliac artery into the anterior and posterior trunks occurs at the level of the upper and middle third of the sacroiliac joint and at the level of the upper edge of the greater sciatic foramen. Visceral branches extend from these trunks to the pelvic organs and to the pelvic sencus (parietal branches).

The main parietal branches are: the iliopsoas artery (a iliolumbalis), which arises from the posterior trunk, goes posteriorly and upward under the psoas major muscle, and to the region of the iliac fossa, where it forms an anastomosis with the deep circumflex iliac artery (external iliac artery ). The lateral sacral artery (a. sacralis lateralis), located medial from the anterior sacral foramina, departs outward from the posterior branch, giving off branches to the trunks of the sacral plexus, which emerge from these foramina.

Of the parietal branches, the most superficial is the umbilical artery, which has a lumen at the very beginning, and then is located under the medial peritoneal fold in the form of an obliterated cord on the inner surface of the anterior abdominal wall. From the initial part of this artery, a visceral branch departs - the superior cystic artery (a. vesicalis superior) to the apex of the bladder. Parallel to the umbilical artery, below it along the lateral wall of the small pelvis, the obturator artery (a. obturatoria) - the parietal branch - goes to the internal opening of the obturator canal.

Two other branches of the anterior trunk of the internal iliac artery: the parietal branch - the lower gluteal artery (a. glutea inferior) and the visceral branch - the internal pudendal artery (a. pudenda interna) often run along the piriformis muscle to its lower edge with one trunk. Through the subpyriform opening they enter the gluteal region. From here, the internal pudendal artery, together with the vein of the same name and the pudendal nerve, passes through the small sciatic foramen into the lower floor of the pelvis - into the ischiorectal fossa. The neurovascular bundle in the fossa is located in its outer wall, in the splitting of the fascia of the obturator internus muscle (in the Alcock canal).

From the anterior trunk of the internal iliac artery at the level of the spine of the ischium, the visceral branch of the middle rectal artery (a. rectalis media) departs to the ampullary part of the rectum. Above the origin of the middle rectal artery, the uterine artery (a. uterina) departs; in men, the artery of the vas deferens (a. ductus deferentis).

The uterine artery varies in the place of its origin, in the angle of origin, in diameter, in the direction of its course from the side wall of the pelvis to the lateral edge of the uterus, at the border of its body and the cervix. In practical medicine, knowledge of the topography of the uterine artery and ureter—knowledge of the “surgical risk” zones—deserves special attention.

The ureters enter the pelvic cavity at the level of the bifurcation of the common iliac arteries. The right ureter often crosses the external iliac artery, while the left ureter crosses the common iliac artery. The intersection of the ureters with the iliac arteries belongs to the first zone of “surgical risk”. In the subperitoneal pelvis, the ureters descend down and in front of the internal iliac arteries and in front of the uterine artery - at the place of its origin (the “surgical risk” zone).

At the level of the ischial spine, the ureter turns medially and anteriorly, passes under the base of the broad ligament of the uterus, where it crosses the uterine artery for the second time, located behind it, at a distance of 1-3 cm (the most important intersection of the ureter with the uterine artery is the “surgical risk” zone). This proximity of the ureter and the uterine artery is an important anatomical fact that must be taken into account when performing surgery in this area in order to avoid injuries to the ureter, especially when performing endoscopic supravaginal amputation of the uterus or uterine extirpation, etc.

The level of location of “surgical risk” zones is influenced by the variability of the topography of the uterine artery and variations in the position of the bladder relative to the uterus. With a relatively low position of the bladder, the intersection of the ureter with the uterine artery is close to the rib of the uterus. If the bladder is located high - at the level of the fundus of the uterus or above - the intersection of the ureter with the uterine artery will be at some distance from the rib of the uterus.

Indications for ligation of the internal iliac artery and its arteries often arise as a preliminary stage when performing operations on the uterus, in which massive bleeding may develop, in case of uterine ruptures, uterine injuries, injuries of the gluteal region with damage to the gluteal arteries; like ligation of a vessel throughout.

The ovarian artery (a. ovaricae) arises from the anterior surface of the aorta, below the renal arteries, sometimes from the renal arteries. Often, the ovarian arteries depart from the aorta through a common trunk (a. ovarica communis).

The artery runs downward and laterally along the anterior surface of the psoas major muscle. The ovarian artery crosses the ureter in front, gives off branches to it (rr. uterici), external iliac vessels, the border line and enters the pelvic cavity, located here in the suspensory ligament of the ovary (lig. suspensorium ovarii). The ovarian artery follows in the medial direction, passes between the leaves of the broad ligament of the uterus under the fallopian tube, along the course of the ovarian artery branches depart to the fallopian tube and then the artery goes to the mesentery of the ovary, enters the gate of the ovary, where it divides into terminal branches that widely anastomose with ovarian branches of the uterine artery.

The ovarian artery and its tubal branches and anastomoses with the uterine artery vary extremely, both in the caliber of these vessels, in their branching options, and in their location in relation to the fallopian tube.

Abundant vascularization of the organs and walls of the pelvis with the presence of numerous anastomoses makes it possible to perform unilateral or bilateral ligation of the internal iliac artery to stop bleeding.

Indications for ligation of the internal iliac artery often arise - as a preliminary stage when performing operations in which massive bleeding may develop, and to stop bleeding in case of injuries to the gluteal region with damage to the gluteal arteries, when performing operations on the uterus.

V. D. Ivanova, A. V. Kolsanov, S.S. Chaplygin, P.P. Yunusov, A.A. Dubinin, I.A. Bardovsky, S. N. Larionova

Blood supply to the uterus occurs due to the uterine arteries, arteries of the round uterine ligaments and branches of the ovarian arteries (Fig. 1.6).

The uterine artery (a.uterina) arises from the internal iliac artery (a.illiaca interna) in the depths of the small pelvis near the lateral wall of the pelvis, at a level of 12-16 cm below the innominate line, most often together with the umbilical artery; Often the uterine artery begins immediately below the umbilical artery and approaches the lateral surface of the uterus at the level of the internal os. Continuing further up the side wall of the uterus (“rib”) to its corner, having a pronounced trunk in this section (with a diameter of about 1.5-2 mm in nulliparous women and 2.5-3 mm in parous women), the uterine artery is located almost at along its entire length next to the “rib” of the uterus (or at a distance of no more than 0.5-1 cm from it. The uterine artery along its entire length gives off from 2 to 14 (on average 8-10) branches of unequal caliber (with a diameter of 0. 3 to 1 mm) to the anterior and posterior walls of the uterus.

Next, the uterine artery is directed medially and forward under the peritoneum above the levator ani muscle, to the base of the broad ligament of the uterus, where branches usually extend from it to the bladder (rami vesicales). Not reaching 1-2 cm from the uterus, it intersects with the ureter, located above and in front of it and giving it a branch (ramus utericum). The uterine artery then divides into two branches: the cervicovaginal branch, which supplies the cervix and upper part of the vagina, and the ascending branch, which goes to the upper corner of the uterus. Having reached the bottom, the uterine artery divides into two terminal branches going to the tube (ramus tubarius) and to the ovary (ramus ovaricus). In the thickness of the uterus, the branches of the uterine artery anastomose with the same branches of the opposite side. The artery of the round uterine ligament (a.ligamenti teres uteri) is a branch of the a.epigastrica inferior. It approaches the uterus as part of the round uterine ligament.

The division of the uterine artery can be carried out according to the main or scattered type. The uterine artery anastomoses with the ovarian artery; this fusion occurs without visible changes in the lumens of both vessels, so it is almost impossible to determine the exact location of the anastomosis.

In the body of the uterus, the direction of the branches of the uterine artery is predominantly oblique: from outside to inside, from bottom to top and to the middle;

In various pathological processes, deformation of the normal direction of the vessels occurs, and the localization of the pathological focus, in particular in relation to one or another layer of the uterus, is of significant importance. For example, with subserous interstitial fibroids of the uterus that protrude above the level of the serous surface, the vessels in the tumor area seem to flow around it along the upper and lower contours, as a result of which the direction of the vessels, usual for this section of the uterus, changes and their curvature occurs. Moreover, with multiple fibroids, such significant changes occur in the architecture of the vessels that it becomes impossible to determine any pattern.

Anastomoses between the vessels of the right and left halves of the uterus at any level are very abundant. In each case, 1-2 direct anastomoses can be found in the uteri of women between the large branches of the first order. The most permanent of these is a horizontal or slightly arcuate coronary anastomosis in the area of ​​the isthmus or lower part of the uterine body.

Rice. 1.6. Arteries of the pelvic organs:

1 - abdominal aorta; 2 - inferior mesenteric artery; 3 - common iliac artery; 4 - external iliac artery; 5 - internal iliac artery; 6 - superior gluteal artery; 7 - inferior gluteal artery; 8 - uterine artery; 9 - umbilical artery; 10 - cystic arteries; 11 - vaginal artery; 12 - inferior genital artery; 13 - perineal artery; 14 - inferior rectal artery; 15 - clitoral artery; 16 - middle rectal artery; 17 - uterine artery; 18 - pipe branch

uterine artery; 19 - ovarian branch of the uterine artery; 20 - ovarian artery; 21 - lumbar artery

Blood supply to the ovary carried out by the ovarian artery (a.ovarica) and the ovarian branch of the uterine artery (g.ovaricus). The ovarian artery arises in a long, thin trunk from the abdominal aorta below the renal arteries (see Fig. 1.6). In some cases, the left ovarian artery may arise from the left renal artery. Descending retroperitoneally along the psoas major muscle, the ovarian artery crosses the ureter and passes in the ligament that suspends the ovary, giving a branch to the ovary and tube and anastomosing with the terminal part of the uterine artery.

The fallopian tube receives blood from the branches of the uterine and ovarian arteries, which pass in the mesosalpinx parallel to the tube, anastomosing with each other.

Rice. 1.7. Arterial system of the uterus and appendages (according to M. S. Malinovsky):

1 - uterine artery; 2 - descending section of the uterine artery; 3 - ascending uterine artery; 4 - branches of the uterine artery going into the thickness of the uterus; 5 - branch of the uterine artery going to the mesovarium; 6 - tubal branch of the uterine artery; 7 - ordinal ovarian branches of the uterine artery; 8 - tubo-ovarian branch of the uterine artery; 9 - ovarian artery; 10, 12 - anastomoses between the uterine and ovarian arteries; 11 - artery of the round uterine ligament

The vagina is supplied with blood by the vessels of the a.iliaca interna basin: the upper third receives nutrition from the uterine artery cervicovaginalis, the middle third - from a. vesicalis inferior, the lower third is from a. haemorraidalis and a. Pudenda interna.

Thus, the arterial vascular network of the internal genital organs is well developed and extremely rich in anastomoses (Fig. 1.7).

Blood flows from the uterus through the veins that form the uterine plexus - plexus uterinus (Fig. 1.8).

Rice. 1.8. Veins of the pelvic organs:

1 - inferior vena cava; 2 - left renal vein; 3 - left ovarian vein; 4 - inferior mesenteric vein; 5 - superior rectal vein; 6 - common iliac vein; 7 - external iliac vein; 8 - internal iliac vein; 9 - superior gluteal vein; 10 - inferior gluteal vein; 11 - uterine veins; 12 - vesical veins; 13 - vesical venous plexus; 14 - inferior genital vein; 15 - vaginal venous plexus; 16 - veins of the legs of the clitoris; 17 - inferior rectal vein; 18 - bulbocavernosus veins of the entrance to the vagina; 19 - clitoral vein; 20 - vaginal veins; 21 - uterine venous plexus; 22 - venous (pampiniform) plexus; 23 - rectal venous plexus; 24 - median sacral plexus; 25 - right ovarian vein

From this plexus blood flows in three directions:

1) v. ovarica (from the ovary, tube and upper uterus); 2) v. uterina (from the lower half of the uterine body and the upper part of the cervix); 3) v. Iliaca interna (from the lower part of the cervix and vagina).

Plexus uterinus anastomoses with the veins of the bladder and rectum. The veins of the ovary correspond to the arteries. Forming a plexus (lexus pampiniformis), they are part of the ligament that suspends the ovary and flow into the inferior vena cava or renal vein. Blood flows from the fallopian tubes through the veins that accompany the tubal branches of the uterine and ovarian arteries. Numerous veins of the vagina form a plexus - plexus venosus vaginalis. From this plexus, blood flows through the veins accompanying the arteries and flows into the v. system. iliaca interna. The venous plexuses of the vagina anastomose with the plexuses of neighboring pelvic organs and with the veins of the external genitalia.

The ovary is a paired female reproductive gland.

Anatomy. The ovary has a dense consistency and is shaped like a peach pit. Average dimensions of the ovary: length 3-4 cm, width 2-2.5 cm, thickness 1-1.5 cm. The ovaries are located on both sides of the uterus, each on the posterior layer of the broad uterus (Fig.), at the side wall of the pelvis, slightly below the terminal line and approximately in the middle of it. The ovary is connected to the uterus by its own ligament. It is attached to the lateral wall of the pelvis by means of a ligament that suspends the ovary.

The blood supply to the ovary is carried out by the ovarian arteries, which arise from the abdominal aorta or from the left renal artery. Part of the ovary is supplied with blood by branches of the uterine artery. The veins of the ovary correspond to the arteries. Lymphatic drainage occurs in the para-aortic lymph nodes. Innervation comes from the solar, superior mesenteric, and hypogastric plexuses.

Most of the ovary is located extraperitoneally. Under the tunica albuginea of ​​the ovary is its cortical zone. It contains a large number of primordial follicles at different stages of maturity. The primordial follicle is formed by an egg cell surrounded by flattened epithelial cells. A mature follicle has a diameter of 6-20 mm and is called the Graafian vesicle; its cavity is lined from the inside with a granulosa membrane and filled with follicular fluid.

During ovulation, the Graafian vesicle bursts and an egg is released from the follicle, and a corpus luteum is formed from the granulosa membrane, which is 2-3 times larger than the size of the Graafian vesicle. In the yellow body, the former cavity of the Graafian vesicle is filled, and along the periphery there is a rim of a scalloped structure of a yellowish color (see).

Normally, during a two-handed (vaginal-abdominal) examination, the ovary is usually palpated only in thin women.

The ovary (ovarium, oophoron) is a paired female reproductive gland (gonad).

Embryology
The formation of the gonads, initially the same for the ovary and testicles, occurs at the 6th week of the embryo’s life. On the inner surface of the Wolffian body (primary kidney; develops at the beginning of the second month of embryonic life), growths of the germinal (coelomic) epithelium appear, initially in the form of a ridge (genital fold), which later, as it develops, differentiates and turns into an ovary or testis.

Rice. 1. Development of the ovary: a - rudimentary epithelium (1 - epithelium, 2 - mesenchyme); b - proliferation of the rudimentary epithelium, indifferent stage (1 - Pfluger's cords, 2 - mesenchyme); c - development of the ovary from an indifferent sex gland (1 - egg balls, 2 - oogonia, 3 - follicular cells, 4 - mesenchyme).

The development of the sexual germ (ridge) in the direction of the ovarian gonad consists in the fact that its epithelium begins to grow into the underlying mesenchyme in the form of dense cellular cords (Fig. 1). As the gonad grows, it gradually separates from the Wolffian body. At this stage of development, the primary gonad still has an indifferent character. The special development of the ovary begins at the end of the second month of embryonic life and ends only in the postembryonic period. Dense epithelial strands of the indifferent sex gland, growing into the mesenchyme, are separated by the latter into separate cell groups (“egg” balls). The cells of each of these groups are arranged in such a way that one of them, the primary egg (ovogonia), is located in the center, and the rest are located along the periphery of the cell in one row (ovarian epithelial cells). The entire formation as a whole is called the primary (primordial) follicle. Initially, the follicles are scattered in large numbers throughout the ovary. Subsequently, the centrally located follicles die, leaving only the follicles located in the peripheral parts of the gonad (cortical layer of the definitive ovary).

Anatomy
Dimensions of the ovary: length 3-4 cm, width 2-2.5 cm, thickness 1-1.5 cm. Weight 6-8 g. The right ovary is usually slightly larger and heavier than the left.

The ovary is distinguished: two surfaces - the internal, or middle (facies medialis), and the external, lateral (facies lateralis); two edges - internal free (margo liber) and mesenteric, or straight (margo mesovaricus, s. rectus). The outer surface of the ovary (lateral) is adjacent to the side wall of the pelvis, located here in a depression or fossa (see fossa ovarica below). The internal free edge of the ovary is directed posteriorly (into the pouch of Douglas).

The mesenteric (straight) edge faces anteriorly, borders the mesentery of the ovary (short duplication of the peritoneum, mesovarium) and takes part in the formation of the ovarian hilus (hilus ovarii), through which arteries, veins, lymphatic vessels, and nerves enter the ovary.

Rice. 1. Female internal genital organs. On the left - the ovary, fallopian tube, uterus and vagina are opened; on the right - the peritoneum has been partially removed: 1 - uterus (uterus); 2 - lig. ovarii proprium; 3 - ramus ovaricus (a. uterinae); 4 - tuba uterina (fallopian tube at the end of the fimbria); 5 - ramus tubarius (a. uterinae); 6 - plexus ovaricus; 7 - ovarium (ovary); 8 - lig. suspensorium ovarii; 9 - a. et v. ovaricae; 10 - lig. latum uteri (broad ligament of the uterus); 11 - margo liber; 12 - stroma ovarii; 13 - margo mesovaricus; 14 - appendix vesiculosa; 15 - extremltas tubaria; 16 - ductuli transversi; 17 - ductus longitudinalis epoophori; 18 - mesosalpinx (mesentery of the fallopian tube); 19 - mesovarium; 20 - extremitas uterina and own ligament of the ovary; 21 - plexus uterovaginal; 22 - a. et v. uterinae; 23 - vagina ().

Typical normal position of the ovary (tsvetn. fig. 1). The ovary lies at the side wall of the pelvis, approximately in the middle of the terminal line (below it). It is freely and movably connected by its own ligament (lig. ovarii proprium) to the uterus. With its mesenteric edge, the ovary is inserted into the posterior layer of the broad uterine ligament. The place of transition of the ovarian integumentary epithelium into the endothelium (mesothelium) of the peritoneum of the broad ligament is clearly visible: it appears as a whitish line (Farr-Waldeyer line). The ovary is not adjacent to the broad ligament; it is located in a depression (fossa) on the peritoneum (fossa ovarica). The fossa is located under the terminal line in the corner between the divergence a. iliaca ext. and a. iliaca int. Posteriorly, the fossa is limited by the ureter and common iliac vessels, above by the external iliac vessels, below by the uterine arteries (aa. uterinae). The free convex edge of the ovary is facing backward and inward, the mesenteric edge is facing forward and somewhat posteriorly. The inner surface of the ovary is covered by the funnel of the corresponding tube and its mesentery (mesosalpinx), due to which the so-called ovarian sac (bursa, s. saccus ovarica) is formed here.

Ligaments. The proper ligaments of the ovary (ligg. ovarii propria) start from the fundus of the uterus, posteriorly and below the junction of the tube with the uterus, and end at the uterine poles of the right and left ovary. Proper ligaments, in terms of fixation, have little effect on the position of the ovary.

Paired infundibulopelvic or suspensory ligaments (ligg. infundibulopelvica, s. suspensoria ovariorum) are parts of the wide uterine ligament (its folds) that no longer contain a tube. Each ligament begins at the tubal pole of the right and left ovary and from the abdominal opening of the tube. The infundibulopelvic ligaments essentially also cannot be considered a truly fixing factor that maintains the normal typical position of the ovary.

Tubal-ovarian ligaments (ligg. tuboovarica) - paired folds of the peritoneum (parts of the broad uterine ligament) extending from the abdominal opening of the right and left tubes to the tubal pole of the corresponding ovary. Large ovarian fimbriae (fimbriae ovaricae) lie on these ligaments.

Blood supply. There are 2 arteries going to the ovary, anastomosing with each other: a. ovarica and ramus ovaricus (branch of a. uterinae). The ovarian arteries, departing from the abdominal aorta (usually a. ovarica dextra) or from the left renal artery (usually a. ovarica sinistra), descend into the small pelvis, reach the broad ligament of the uterus, continuing its path in the thickness of the infundibulopelvic ligament (lig. infundibulopelvicum) towards the uterus. Here a. ovarica is divided into several branches, one of which (the main trunk of a. ovarica) continues into the mesentery of the ovary, into its gate. A series of branches a. ovarica goes directly to the ovary.

The part of the ovary (half or third) corresponding to the uterine end is supplied with blood mainly by the branches of the uterine artery, and the part corresponding to the tubal end is supplied by the ovarian artery system.

The veins of the ovary (vv. ovaricae) correspond to the arteries. Forming a pampiniform plexus (plexus pampiniformis), they pass through the infundibulopelvic ligament, often flowing into the inferior vena cava (right) and left renal (left) veins. In the ovary itself, the veins form a plexus in the medullary zone and at the hilum of the ovary. The center that unites all the venous plexuses of the pelvis is the uterine plexus (V.N. Tonkov).

Lymphatic system. The lymphatic vessels of the ovary begin as capillary networks near its egg-containing follicles. From here the lymph is carried into the lymphatic vessels of the ovarian medulla. At the gate of the ovary, the subovarian lymphatic plexus (plexus lymphaticus subovaricus) is distinguished, from where the lymph is drained through the vessels that follow the plexus of the ovarian artery to the aortic lymph nodes.

Innervation. The ovary has sympathetic and parasympathetic innervation. The latter is disputed by some authors (S. D. Astrinsky). However, parasympathetic innervation cannot be categorically disputed. Sympathetic innervation is provided by postganglionic fibers from the solar plexus (plexus solaris), superior mesenteric (plexus mesentericus superior) and hypogastric (plexus hypogastrics) plexuses. Parasympathetic innervation is carried out by nn. splanchnici pelvici.

The morphology of the ovarian receptor apparatus has not been sufficiently studied. Some authors even argue that the receptors described in the literature should be considered artifacts. However, in recent studies, receptors are described in all layers of the ovary, in its cortex and, more often, in the medulla, as well as in the hilus ovarii.

Pathology