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Morphology of the ligamentary Apparatus of the Uterus


Author: Olga Belic
Degree:doctor of medicine
Speciality: 14.00.02 - Human Anatomy
Year:2005
Scientific adviser: Mihail Ştefaneţ
doctor habilitat, professor, State University of Medicine and Pharmacy "Nicolae Testemitanu"
Scientific consultant: Efim Aramă
doctor habilitat, professor
Institution:
Scientific council:

Status

The thesis was presented on the 10 March, 2005
Approved by NCAA on the 21 April, 2005

Abstract

Adobe PDF document0.14 Mb / in romanian

Thesis

CZU 612.815 + 611.66 + 618.131

Adobe PDF document 16.00 Mb / in romanian
158 pages


Keywords

uterine ligaments, ligamentary apparatus, microscopic, macromicroscopic methods, rami bands, nervous plexuses, nervous-vascular complexes

Summary

The purpose of this research is to study the morphology of the uterine nervous apparatus and its correlations and structure and certain biometric parameters of the uterine ligament apparatus in different periods of postnatal ontogenesys and of morphological changes inducted by the uterin prolapse. The study was carried out using the complex of macro-, macro-microscopic, histological, including neurohistological and tensometric methods. By the goal of determinind the relationship between the frequence of the genital prolapses and the age of the pacientes as and the number of deliveries and aborts in anamnesis, the retrospective analysis were submited some recent data from the archives of the Municipal Hospital nr 1 (Chisinau) and of the Institute of Scientific Research in the domain of Health Assistance of Mother and Child.

The main sources of the innervation of the uterine ligamentary apparatus were revealed by means of the macromicroscopic method of preparation by V. P. Vorobiev and B. Z. Perlin: a) the round ligament is innervated by the lumbar, utero-vaginal and ovarian plexuses; b) the wide ligament – by the aortal, lower hypogastric, utero-vaginal, ureteral and sacral plexuses; c) the cardinal ligament is innervated by the nerves of the upper and lower hypogastric, utero-vaginal, sacral and ureteral plexuses; d) the sacro-uterine ligament is innervated by the upper and lower hypogastric, lower mesenteric, sacral and utero-vaginal plexuses; e) the pubo-uterine ligament is innervated by the lower hypogastric, utero-vaginal, sacral and ureteral plexuses. The nerves of the pelvian plexus participate at the innervation of all ligaments of the uterus.

The results of the complex study of the total anatomical preparations in the macromicroscopic field of vision showed that the uterine ligaments possess a well developed nervous apparatus with rami and fibers that interweave forming plexuses, areas of intersections and regions with the possible cross innervation. The presence of nervous ganglia is characteristic to the ligamentary apparatus and, apparently, represents a certain phenomenon of adaptation of the nerve structures to various physical changes of the uterus.

The nervous apparatus of the uterine ligaments is characterized by the presence of a great number of arcades that are morphological substrates contributing to the multiplication of nerve rami on the change of the functional state of an organ at various age periods. Some of the nerves run independenthy, while the others that acompany blood vessels form well manifested para- and perivassal nervous ganglia. Nerve conductors, receptors and microganglia were revealed microscopically. The receptor apparatus is presented by encapsulated and non-encapsulated endings; Doghiel’s cells I, II were revealed in the structure of micronodes.

The study of the uterine ligamentary apparatus morphology showed the presence of bands of smooth muscular tissue, collagenous elastic and reticular fibers in their structure. In case of cardinal ligament prolapse, the decrease of the smooth muscular tissue amount is noted, the vessel lumen becomes narrower, the specific volume of collagenous fibers increases. The analysis of biomechanical properties of round and wide ligaments showed the limit of reliability to be 3,96±2,1 ~!~ and ~!~ 2 (over 49 years) and that of the wide ligament to be ~!~ and ~!~ (longitudinal measurement) and ~!~ (transverse measurement).

The analysis of case histories of patients with internal genitalia prolapse showed the dependence of this pathology on the age, number of deliveries and abortions. The results of this research can be used in prevention medicine, surgical gynecology and training.