Two fallopian tubes located with. Fallopian tube obstruction - types, causes and solutions

In a healthy woman, mature eggs quietly pass from the ovaries to the uterus through the fallopian tubes. For a woman to become pregnant, at least one of the fallopian tubes must be completely patent. In case of obstruction, the sperm and egg cannot meet in the fallopian tube, where fertilization normally takes place. Obstruction of the fallopian tubes accounts for 40% of all cases of female infertility, so it is extremely important to diagnose the problem in a timely manner and effectively correct it.

Steps

Ways to treat obstruction of the fallopian tubes

Ask your doctor about medical ovarian stimulation. If you only have one fallopian tube blocked and are otherwise healthy, your doctor may prescribe a course of an ovulation inducing drug, such as clomiphene, letrozole, follistim, gonal-f, bravel, fertinex, otvitrel, chorionic gonodotrapine, ganirelix , leuprorelin or pregonal. Some of the listed drugs (leuprorelin, pregonal) reduce the secretion of certain pituitary hormones, after which their level can be controlled medically. These drugs are combined with other medications that stimulate the pituitary gland to produce follicle-stimulating hormone (FSH) and luteinizing hormone (LH), thereby increasing the chance of ovulation and fertilization of an egg (through a functioning fallopian tube).

Consider laparoscopy. If your doctor thinks surgery is best for you, they may recommend a laparoscopy to open blocked fallopian tubes and remove any scar tissue from them. The effectiveness of the procedure will depend on your age, the cause of the blocked tubes, and the severity of the blockage.

Talk to your doctor about a possible salpingectomy. This operation involves the removal of part of the fallopian tube. This procedure is carried out if there is an accumulation of fluid in the fallopian tube (hydrosalpinx). This operation is performed before attempting in vitro fertilization (IVF).

Try selective tubal cannulation. If the fallopian tube is blocked closer to the uterus, the doctor may recommend selective tubal cannulation, a medical procedure in which a catheter (cannula) is inserted into the fallopian tube through the uterus. A catheter is needed to open the blocked section of the fallopian tube.

Consider in vitro fertilization (IVF) surgery. If the above treatments don't work (or if your doctor says they don't work for you), you still have a chance of getting pregnant. The most common variant of artificial insemination is the IVF procedure. In this case, the egg is fertilized with sperm outside the woman's body, and then the finished embryo (or embryos) is injected into the uterus. This method allows you to bypass the fallopian tubes, so their obstruction is not a problem.

Consider sonohysterography. Your doctor may recommend a sonohysterogram, a medical procedure that uses ultrasound to look at abnormal changes in the uterine cavity. First, a saline solution is injected into the uterus so that the doctor can better see the image transmitted by ultrasound. Sometimes excess tissue due to pathological processes in the uterus can block the fallopian tubes.

• Fibroids, polyps, and other neoplasms can lead to obstruction.

1. Get a hysterosalpingogram. Hysterosalpingography (HSG) is a medical procedure in which a special dye is injected into the cervix and fallopian tubes. Then an x-ray is taken, the results of which determine whether the fallopian tubes are passable.

   • A hysterosalpingogram is done without anesthesia, so you will feel mild spasm or discomfort. You will feel better if you take ibuprofen about an hour before your procedure.
   • This procedure takes 15-30 minutes. Potential risks of the procedure include possible pelvic infections or radiation damage to cells or tissues.
   • If your doctor suspects you have a blockage in your tubes, they may use a dye during the procedure. oil based. Sometimes the oil helps clear the blockage.

2. Ask your doctor how appropriate laparoscopy would be in your case. Depending on the results of the sonohysterogram and hysterosalpingography, your doctor may recommend laparoscopy, a medical procedure in which an incision is made near the navel to reveal (and in some cases eliminate) tissue blocking the fallopian tubes.

   • Usually, laparoscopy is done only after the woman has undergone a full examination for infertility by other methods. This is due to the fact that this procedure carries a higher risk, as it is performed under general anesthesia, and includes all the risks associated with major surgical operations.

3. Listen to the diagnosis. The results of analyzes and studies will help to find out the fact of obstruction of one or both fallopian tubes at once. Ask your doctor to explain to you how serious your case is. The most accurate diagnosis will allow you to decide on a plan for further treatment.

Causes of obstruction of the fallopian tubes

Understand that sexually transmitted diseases (STDs) can cause blocked fallopian tubes. Knowing the root cause of a blocked fallopian tube will help your doctor create the most effective treatment plan for you. Sexually transmitted diseases are one of the most common causes of obstruction. Chlamydia, gonorrhea, and other STDs can cause scar tissue to form, blocking the fallopian tubes and preventing pregnancy. The problem may persist even if the STD has been successfully treated.

The female body is full of secrets. It undergoes monthly cyclic changes. This cannot be said about the body of the stronger sex. Also, a woman is able to give birth to children. This process occurs due to the presence of certain organs. These include the ovary, fallopian tube, and uterus. This article will focus on one of these bodies. You will learn what a fallopian tube is and what problems it can cause. Each representative of the fair sex should know how the reproductive system of a woman works.

Fallopian tube: what is it?

This organ is located in the pelvis in women. It is worth noting that from birth, every girl has two. The length of these organs is very small. It is no more than five (in some cases seven) centimeters. The volume of this organ is also very small. The fallopian tube is only a few millimeters in diameter.

The inner layer of the fallopian tube is represented by microscopic fingers called fimbriae. In the normal state, they contract freely.

Fallopian tube functions

The fallopian tubes in women perform a very important transport function. After ovulation, this organ captures the egg and slowly helps it move to the side. reproductive organ. At this time, the spermatozoa that have entered the woman's body fertilize the gamete. The fallopian tube is pushed towards the uterus with the help of fimbriae.

After entering the reproductive organ, the embryo attaches to the endometrium. From this moment on, you can talk about the pregnancy.

Fallopian tube problems

Often, the fair sex has various problems with the fallopian tubes. At timely treatment there are no consequences. However, if you neglect your health, then some diseases can lead to irreparable complications. Consider the most common ailments that occur in the fallopian tubes.

Fallopian tube inflammation

This disease is diagnosed most often. Symptoms may be absent altogether or may be mild. Spicy inflammatory process characterized by fever, failure of the menstrual cycle, pain in the lower part of the peritoneum. The chronic course of this disease has practically no symptoms. However, the consequences of such a disease are very deplorable.

This disease is diagnosed with the help of a routine gynecological examination and some tests. During manual diagnostics, the doctor may note an increase in the reproductive organ. The patient may also complain about pain during menstruation. After such a manipulation, ultrasound diagnostics is most often prescribed. On examination, a specialist can detect an increase in the volume of the fallopian tubes. It should be noted that in the normal state, this organ is not visible on the monitor of the ultrasound machine.

Most often occurs against the background of hypothermia or some kind of infection. With a long absence of treatment, the pathology can move to the area of ​​​​the ovaries or the inner layer of the uterus. In this case, the consequences can be completely unexpected.

Treatment inflammatory process carried out in a conservative way. At the same time, the earlier the correction is started, the better the forecast will be in the future.

Fallopian tube obstruction

Such a pathology in most cases is a consequence of an inflammatory process or an extensive surgical intervention. The inner layer of the fallopian tubes is partially or completely glued together. Adhesions form in the cavity of the organ, which do not allow the egg to enter the uterus.

Shows up this pathology during metrosalpingography or hysterosalpingography. Laparoscopy can also show the condition of the fallopian tubes. The obstruction can then be corrected. During the specialist can not see the internal state of the fallopian tube. Obstruction can only be suspected due to the presence. Also, such a diagnosis can be suspected in the absence of pregnancy for a long time.

Treatment of obstruction can only be surgical. Of course, in our time there are anti-adhesion drugs that help break pathological thin films, but the effect of such a correction is not always positive. Most often, the laparoscopic method is chosen for treatment. The doctor uses miniature devices to separate the adhesions and restore the patency of the tube.

It is worth noting that some cases are very complex. In this case, the adhesive process cannot be cured. Sometimes such a pathology requires the removal of the fallopian tubes. In the presence of one organ, an independent pregnancy can occur. However, if both fallopian tubes are removed, then conception can only occur outside the woman's body.

Fallopian tube rupture

Such a pathology can occur during an ectopic pregnancy. There are also cases when damage to the fallopian tube occurred as a result of hydrosalpinx.

An ectopic pregnancy occurs when this organ malfunctions. Most often leads to this pathology. Before the tube is damaged, a woman may feel fullness, pain in the lower abdomen. There is also slight bleeding against the background of positive treatment in this case, only surgical. It should be noted that with timely correction, there is a chance to save the organ in which the pathological embryo develops.

Hydrosalpinx is a collection of fluid in a tube. It appears as a result of an inflammatory process or due to the occurrence of a neoplasm, which can be benign or malignant. Treatment may be surgical or conservative. The choice of method depends on the complexity of the situation. If the tube ruptures, urgent surgical correction is required.

Conclusion

Now you know what the female fallopian (uterine) tubes are. Remember those ailments that are most often encountered in everyday life. The fallopian tube is the direct route to pregnancy. However, in the absence of these elements in the body of a woman, conception can also occur. Fertilization is carried out artificially.

Take care of your women's health!

Almost 40% of infertility cases are due to blocked fallopian tubes. Very often, only one pipe is clogged, while the other is functioning normally. However, some women may have both tubes blocked. Since blockages in the fallopian tubes are usually asymptomatic, they may go unnoticed until a woman decides to become pregnant and, after failure, tries to understand the cause of infertility. Most cases of blockage in the fallopian tubes are a reversible problem that can be corrected with medication or natural remedies. Skip to the first point of this article to use one or more of the listed natural remedies to help you successfully unblock your fallopian tubes.

Steps

Part 1

Eliminate sources of stress

Quit smoking and drink. Smoking and alcohol are at the top of the list of causes of problems and disorders of this kind. Keep in mind that it's not enough reduce consumption is best to stop completely.

• Smoking and drinking (minus the damage to your fallopian tubes) damage your body, organs, skin, hair, teeth and nails. By getting rid of these addictions, you will improve the quality of life in general.

1. Meditate. Meditation helps to reduce stress levels, thereby improving the health of the whole body. You will get more benefit if you start each day with 10-15 minutes of meditation or relaxation. psychological techniques with breathing exercises.

   • Even a few minutes spent looking for Zen will give you a positive start to the day and make you more resilient to stress until the evening. Stress is reduced - the degree of deterioration of the inflammatory process that blocks your tubes decreases.

2. Take up yoga. Yoga is known for its ability to direct the energy of the body so that it is in harmony; In addition, yoga has a high healing potential. There are two asanas that can help a woman with the problem of infertility - Setu Bandhasana and Viparita Karani; these two poses engage the gluteal and pelvic muscles.

   • To perform the first pose ("bridge pose"), lie on your back, bend your knees and use your muscles to lift your pelvis off the floor. Raising the pelvis from the floor, inhale, hold for 2 seconds; lowering - exhale.
   • Viparita Karani ("foot-to-wall pose") is another asana from the traditional Indian yoga system that helps relieve blockages in the fallopian tubes. To perform this pose, you need to lie on your back close to the wall, raise your legs and lean their entire back surface against the wall - parallel to the plane of the wall and at right angles to your body and floor. After holding for 2 seconds, slowly lower your legs.

3. Consider getting a fertility massage. By massaging the abdominal region, the doctor will help unblock the fallopian tubes, improve their overall health and functioning. Massage improves blood circulation in the area of ​​the tubes, thus destroying scar tissue and adhesions, and reduces inflammation. You can carry out this treatment yourself:

   • Lie on an exercise mat, face up, with a pillow under your lower back.
   • Relax, apply almond, olive or lavender oil and massage the pubic bone, under it is the uterus.
   • Massage gently, going lower and lower, and pull the walls of the abdomen towards the navel. Hold this position, count to 10 and relax your arms. Repeat this maneuver 10-20 times.
     • Do not do this if you are on your period or if you are pregnant. If possible, use the services of a massage therapist who specializes in massaging the abdominal area - this will give the best results.

4. Avoid foods that contain hormones. Try not to eat foods like animal meat - it affects the level female hormone estrogen. For healing purposes, replace them with foods rich in antioxidants.

   • Foods rich in antioxidants include fresh fruits, vegetables (of all kinds), vegetable oil(sunflower, safflower, coconut, mustard seed, and olive oils are the highest in antioxidants).
   • Tea, chocolate, soy, coffee, oregano, and cinnamon are loaded with flavonoids (a type of antioxidant).
   • Carotenoids are plant enzymes with antioxidant properties. They are able to reduce accumulation free radicals in organism. You can replenish carotenoids by eating eggs, red-yellow fruits and vegetables such as: carrots, mangoes, peppers, papayas, citrus fruits, spinach, zucchini, etc.

   Part 2

   Alternative medicine

   1. Take vitamin C. Vitamin C is essential for the absorption of iron. In addition, it improves immunity and the body's ability to cope with infections. If your fallopian tubes are clogged due to infection or inflammation, it will help unblock them. Start with 1000 mg of vitamin C 5-6 times a day. Vitamin C helps especially well in cases where the pipes are clogged due to the fault of Koch's wand.

      • However, if the drug causes you to have diarrhea or other symptoms, reduce your dose or stop taking it completely. And, of course, see a doctor!

   2. Use herbs. Certain herbs can kill bacteria like yeast, which are often the cause of infertility. Among these herbs, the most famous are the following: dong quai, chamomile, garlic, oleander, turmeric, red peony root, frankincense and calendula. Any qualified Traditional Chinese Medicine (TCM) expert, after a thorough examination, will help you decide on the dosage.

   3. Try using herbal tampons. For the treatment of clogged fallopian tubes, various herbal tampons can be used - tampons soaked in herbs that help normalize the reproductive system. However, this method should always be used with caution, as tampons are not always sterile and can cause infection. In addition, when taken orally, these herbs provide a similar healing effect.

      • Goldenseal (hydrastis) works as an antimicrobial agent, reduces inflammation and eliminates infection, further preventing scarring and adhesions.
      • Ginger root improves blood circulation, relieves inflammation and blockages. Hawthorn and bearberry reduce congestion and remove excess fluid by clearing blockages caused by accumulation of fluid or blood.
      • Dong quai (aka angelica sinensis, angelica officinalis) helps reduce spasms in the fallopian tubes.

   4. Apply castor oil. Applying castor oil is believed to help unblock the tubes, improving the circulation of blood and lymph around them. Increased blood supply improves their work and removes blockages, and lymphatic vessels help to remove old and diseased cells, scar tissue.

      • You can apply castor oil directly to lower part belly or use a castor oil-soaked compress (you can also buy it online and at herbal stores). For good results, you need to do this every day for at least 1-2 months.

   5. Consider using charcoal poultices. Activated charcoal poultices - provided you place them on your lower abdomen, just above your uterus and fallopian tubes - will help cure infection and reduce inflammation. You can even make these poultices at home. Here's how to do it:

      • Lay some paper towels on the table.
      • Place activated charcoal mixture on towels and flax seeds, cover it with another portion of paper towels.
      • Place the poultice on the affected area and wrap it in cling film. For best results put such poultices on all night.

   6. Consider using enzymes such as serrapeptase. This treatment uses the natural enzymes your body produces to break down scar tissue and prevent fibrosis. Enzymes also help reduce inflammation, regulate blood circulation in the reproductive organs. Serrapeptase is widely used for these purposes.

      • Serrapeptase helps silkworms dissolve cocoons due to its ability to dissolve tissues. Supplements and polyenzymatic preparations such as Wobenzym N and Advil are available without a prescription. However, always check with your doctor before taking these remedies so you can be sure that you have no contraindications to them.

   7. Think about homeopathy. This holistic science provides an effective cure with few or no side effects. In the problem of blockage of the fallopian tubes and infertility, many homeopathic remedies turn out to be an effective remedy. Here are some of the tools you can use:

      • Pulsatilla nigricans (anemone): It is prescribed for blockage of the fallopian tubes with menstrual irregularities and mood swings. Pulsatilla 30, taken twice a day for 2-3 months, helps to regulate the menstrual cycle and clear blockages in the fallopian tubes.
      • Sepia: This homeopathic remedy is prescribed for menstrual irregularities, painful periods, pain in the vagina, accompanied by a feeling of pressure, as well as repeated miscarriages caused by blockage of the fallopian tubes. Sepia 30 three times a day for 2-3 months should help relieve symptoms.
      • Thyroidin: If you have thyroid dysfunction, lethargy, sluggishness, or a tendency to gain weight along with blockage, Thyroidin 30 can help you a lot.
      • Natrum Muriaticum: This drug will help women suffering from recurring headaches (especially caused by exposure to the sun) and increased cravings for salty and sour foods. Blockage of the fallopian tubes against the background of delayed menstruation, bloating caused by gas formation, and headaches are signs of natrium muriaticum (the same type of patient in the homeopathic classification). Take Natrium Muriaticum 200 twice a day for 2-3 months.

FALLOPIAN TUBES(uterine) (tubae uterinae Fallopii, s. salpinges), or oviducts (oviducti) are paired, 10-12 long cm(minimum-7 cm, maximum-19.5 cm, according to Bischoff "y), approximately cylindrical muscular tubes, directly extending from the corners of the uterus and lying in the upper edge of it broad communication(Fig. 1). Anatomically, in F. t., there are: 1) interstitial part (pars interstitialis), or interstitial, passing in the wall of the uterus (para intramuralis) and communicating with the latter very narrow (not wider than 1 mm) hole (ostium uterinum tubae); this part is delimited from the uterine musculature in the form of a special annular formation (the indicated hair canal is placed in it), which some (Reinberg, Arnstam) take for a sphinc-

Drawing 1. Longitudinal section of the pipe (according to Sappey): i-lig. utero-ovaricum; 2-lig. tubo-ovaricum; 3- fimbria ovarica; 4- limbriae; s- hydatis Morga-gnj; 6 -plicae longitudinales; 7-lig. rotundum; 8- cavum uteri; 9-ostium uterinum.

Ter pipes; 2) cross the new or isthmic part (pars isthmica, s. isthmus tubae), narrow, short, straight, but with thicker walls; 3) ampullar (pars ampullaris, s. ampulla), longer (2/3 of the entire length of the pipe), wider, very winding, ending in a funnel-shaped extension, the so-called. funnel pipe (infun-dibulum). The funnel is surrounded by fringes, or fimbriae (fimbriae tubae), formed by splitting the wall of the funnel into separate lobes. Each fringe has small cuts along its edge, which is why the entire opening of the pipe is made as if bitten, whence the old name is "devil's bite", "morsus dia-boli" (a folk botanical term for the Scabiosa plant, whose roots resemble the free end of F. t. ). One of the fringes, longer, in the form of a tongue stretches to the tubal pole of the ovary (extremitas tubaria ovarii), where it is attached. It is called ovarian fimbria (fimbriaovarica). Under it lies the tubal-ovarian ligament (lig. tubo-ovariale). At the free abdominal end of the tube, a small appendage is often found, the remnant of the Wolffian canal, which hangs freely on a long stalk in the form of a polyp-M organ guide-t and d a (hydatis Morgagni). In their structure, F. t. resemble the uterus. Their walls consist of: 1) peritoneal cover (tunica serosa), 2) muscle layer (t. muscularis) and 3) mucous membrane (t. mucosa). The peritoneum covers the tube from above and from the sides, leaving uncovered that part of the tube wall, which looks into the lumen of the broad ligament. Here are the front and back sheets of lig. lati are interconnected, forming the mesentery of the tube (mesosalpinx). Vessels and nerves go through the mesosalpinx to the tube. The serous cover is closely soldered to the underlying layer of the tube wall. The peritoneum is abundantly supplied with a dense network of lymph vessels. Under the peritoneum lies a layer of loose connective tissue, which surrounds the oviduct like adventitia vessels. Tunica muscularis F. t. consists of smooth muscle fibers located here in three layers (Gruzdev): the outer (subperitoneal) is longitudinal, the middle is circular and the inner (submucosal) is also longitudinal. The latter is usually well expressed only in the interstitial and isthmic parts of F. t. A characteristic feature of the tubal mucosa is the longitudinal folds (plicae) running along its entire length. The folds begin in the interstitial part of the F. t., where they (usually 4) are barely expressed; the farther towards the abdominal opening, the higher the folds become, the main folds begin to divide (into secondary, tertiary, etc.). d.); in the ampullar part, the entire lumen of the tube is folded. It turns out a real labyrinth of folds (Fig. 2); the egg cell released from the ovary must pass through this labyrinth. In section, the tube lumen is a star shape. The mucous tube is lined with a single-layer cylipdriic ciliated epithelium, cilia to-rogo flicker towards the uterine end of the tube. In addition to cells with ciliated cilia, the mucous membrane of the tube contains secretory elements - special glandular cells, without cilia, located mainly in the interstitial part of the tube, in the depressions between the folds. In the stage of secretion, these cells appear club-shaped swollen; freed from the secret, they turn into narrow cells with an elongated nucleus, which occupies most of the protoplasm. These cells do not give reactions to mucus. Scape-

Figure 2. Cross section through the Fallopian tube in the pars ampullaris.

Flowing in certain areas of F. t., secretory cells are formations resembling primitive glands. However, the mucous membrane of the tube, according to the generally accepted idea, does not have true glands. The mucosal stroma consists of a thin, rich in vessels cytogenic connective tissue with a large number of elastic fibers. In the loops of the stromatogenic layer, round and spindle-shaped cells are laid, in places (closer to the uterus) there are mast and plasma cells, as well as lymphocytes. In the isthmic and interstitial parts of F. t. the stroma (submucosal layer) is almost completely absent, so that the elements of the muscularis are in direct contact with the epithelial cover of the mucosa. The latter circumstance plays a significant role in the pathogenesis of tubal rupture during ectopic pregnancy. Blood vessels for F. t. pass in their mesentery (mesosalpinx). The nourishing blood is delivered by the arterial branches of the ovarian artery (a. ovarica, s. spermatica int.) and the ascending segment uterine artery(ramus ascendens a. uterinae). Venous blood is drained / from the tubes in the plexus pampiniformis, 4ff" FALLOSHN(thick venous plexus in the area of ​​the mesentery F. t.) and in the plexus utero-vaginalis (in the thickness of the lig. lati laterally to each rib of the uterus). Lymph. the vessels go in the funnel-pelvic ligament (Hg. infundibulo-pelvicum, s. suspensorium ovarii) and are sent to the lymph, glands of the corresponding lumbar region(gland. lumbales).-Nerv y F. t.: branches of plexus spermatici int. F.'s structure of t. changes in connection with age. In sexually mature women, the pipes have the structure described above. In embryonic life, they appear to be strongly twisted, reminiscent of a corkscrew in their shape, moreover, they lie very high, much higher than the upper edge of the bony pelvis. By the end of uterine life, the epithelium is equipped with ciliated cilia, an unusual abundance of folds is noted in the tubes, the general appearance of the folds already resembles a tube. adult woman. Significant structural changes experience F. t. during menopause. Fibrous degeneration, characteristic of the senile involution of the entire female genital apparatus, gives a picture of gradual morphological withering of F. t. They decrease in volume, wrinkling and reduction of mucosal folds occur, the integumentary epithelium becomes lower, the cilia disappear completely, abundant growth is striking in the muscle layer fibrous connective tissue, blood vessels are sclerosed, undergo hyaline degeneration, etc. F. t. can be conditionally considered as the excretory duct of the ovary. Their purpose is to transport the egg to the uterus after ovulation. In addition, the meeting of the egg with the spermatozoa takes place in the tube (see Fig. Fertilization). The meeting takes place in the ampullar part of the F. t. secretory function is characteristic of all.F. secretion is a cyclic process that occurs in certain animals (rabbit, dog, pig, bat) in the form of correctly and sequentially alternating phases (Moreaux), each of which is characterized by certain changes in the epithelium of the preuterine (isth-mic) part of the tube, where the secretory apparatus of the F. t. is actually concentrated in these animals Cyclic phases: ciliated (ciliary cells predominate), secretion phase (the epithelium of the preuterine part of the F. t. shows the greatest secretory activity), excretory phase (isolation of the finished product) and indifferent ( reverse development towards the first phase). In a woman, the question of the secretory activity of the mucosa F. t. cannot yet be considered completely resolved. According to the observations of a number of authors (Snyder, Iwata, Cahen), during the menstrual cycle, we have a cyclic alternation of secretion and rest phases in the mucous membrane of F., during which the transition of ciliary cells to secretory and vice versa occurs. In the middle of the intermenstrual period, the tubal epithelium is high, with a predominance of ciliated cells; in the pregravid phase, non-flickering cells appear in a significant number, lower ones, from which part of the protoplasm is rejected (secretory PIPES v. . 600 cells); in the first half of the menstrual cycle, these cells again reach their previous size. Some (Schridde), however, deny the secretory function of the tube, not allowing the possibility of the transition of ciliary cells to non-ciliary ones. Most, however, on the basis of careful research (Moreaux, Chasovnikov, Gurvich) consider it established that the ciliary cells are converted into glandular and goblet, secerating mucus. - In addition to secretory F. t. have an active contractile function. In animals, rhythmic contractions of F. t. have long been ascertained, quite frequent (15 per minute) in the days preceding the rupture of the follicle, and slow (5 per minute) at the time of maturation corpus luteum. Studies of Cahen (after injections of lipiodol into the cavity of the tubes) showed similar phenomena in women. The contractile (peristaltic) function of the tubes, according to modern views (Sobotta, Mikulich-Radetsky, etc.), is the main factor in moving the egg through the tube into the uterus. The ciliary theory, which considered the ciliary fluctuations of the cilia to be the main vehicle for the egg, is now abandoned by the majority. The pipe apparently has the ability to anti-peristaltic movements, to-rye in it can occur as a result of mechanical irritation. F.'s malformations of t. Oviducts develop from cranial department of Muller's courses. The latter are laid in the embryo in the form of a funnel, consisting of a cylindrical epithelium, outward from primary kidney(Wolffian body) and laterally from her ureter (Wolfian tract). An opening soon forms in the funnel (the future abdominal opening of the tube), next to the Crimea, folds (future fimbria) begin to form from the epithelium with additional holes (5-6 in number), which communicate with the funnel. Müllerian cords, at first solid, later, by melting epithelial cells, receive a lumen. At the 3-4th month. uterine life in the pipe, the appearance of the first longitudinal folds can be noted, from which secondary and tertiary folds arise. Cylindrical epithelium receives ciliated hairs at the 10th month. pregnancy. The malformations of F. t. include: 1. Aplasia (agenesis) of the tubes, their complete absence is a rare anomaly, more often unilateral (with uterus unicornis), much less bilateral (in the absence of a uterus). 2. Additional tubes (tubae accessoriae) are far from rare. They are either solid (without a gap) or hollow with a well-defined rosette of fimbriae. Additional tubes can serve as a starting point for the development of tubal pregnancy. Valtgard described a young egg in the mesentery (mesosal-pin-giolum) of the accessory tube. 3. Doubling of the tube (doubling of the Müllerian passages) is described in the human fetus by Nagel. In adult women, a doubling of the tube (on one side) is described. 4. Additional holes (ostia accessorla). The multiplicity of pipe holes Holzbaeh considers as a phenomenon of atavism. Richard (Richard) described the additional openings of the pipe as early as 1851. Frankl (Frankl) has in his collection two preparations of F. t. with additional (3-4) openings. 5. Rudimentary tubes are described repeatedly in the form of rudimentary formations extending from one or another corner of the uterus. Sachs described a case where the tube, in the absence of ovaries, was only 5 cm, without lumen and without fimbrial end. In the case of Spencer, there were only hints of tubules in the form of button-like formations in the region of both uterine horns.6. The infantile tubes are long (even Winckel pointed to this sign as congenital), winding, with a large number of folds. Infantile tubes play a role in the etiology of ectopic pregnancy (Freund's theory, see below). Pregnancy, ectopic pregnancy). Anomalies of the position of F. t. It has already been said about long winding pipes with infantilism. Excessive tube length is also noted in ovarian and parovarial tumors. Of more practical interest is the twisting of pipes (torsio). Pipes can be twisted a second time along with twisting of the legs of ovarian tumors or independently, more often due to inflammatory processes. Usually the pipe is twisted in its middle or literal part. A twisted tube in some cases "(extremely rare) can completely unscrew from the uterus and turn into a free body (corpus liberum) lying in the abdominal cavity. Even more often, the tubes change their position due to incorrect positions of the uterus, as well as on the basis of inflammatory processes in the surrounding area their peritoneum (fixing adhesions). congenital causes is rare. Inflammatory processes, see Salpingitis. The fallopian tubes are a favorite site for the development of tuberculous foci (see below). Tube tumors. Among neoplasms of the tubes, one of the first places in frequency is occupied by retention cysts, the so-called sacto-salpinxes or cystosalpinxes. These formations can be classified as tumors only formally; in fact, they are closer to inflammatory processes (non-proliferating tumors). WITH practical side sacto-salpinxes are of great interest (see. Hydrosalpinx, Raematosalpinx, Pyosalpinx). True neoplasms of F. t. (blastomas), except for tube cancer, on the contrary, are extremely rare. In most cases, they have a purely casuistic or stalemate. interest. Among benign connective tissue tumors (mature, differentiated forms) in the tubes there are: 1. Fibroids and fibromyomas. In the literature, together with doubtful cases, there are only about 39 cases (Dietrich). The favorite localization of tubal fibroids is the uterine segment of the tube. There are no reliable cases of myomas of the ampullar part of the tube. Tubal fibroids are usually small in size, rarely reaching the size of an apple (Lindquist observed tubal fibroids at 4 3/4 kg). Histologically, fibroids, resp. tube fibromyomas are no different from uterine fibromyomas. 2. Lymphangiomas F. t. (7 cases in the entire world literature) - tumors the size of a pea or cherry, with well-defined contours, are found mainly in the isthmic section of the tube. On the section, the tumor consists of cavities of various sizes and shapes, lined with endothelium (dilated limf, capillaries); isolated cases(Lefort and Durand, Pape, Parona). 4. Xondromas F. t. The case of chondrofibroma of the tube is described by Outerbridge. 5. Osteomy. True tubal osteomas have not been described. In most of the cases described, it is about metaplastic or heteroplastic bone formations; more often on the basis of inflammatory processes. From malignant stromatogenic tumors F. of t. are described: 1. Sarcomas. Primary tubal sarcomas are a very rare neoplasm, even compared to the relatively rare cases of primary tubal cancer (out of 320 cases of primary tubal cancer, only 12 cases of primary tubal sarcoma have been described). The starting point for the tumor is the mucous membrane of the tube, sometimes the tube wall itself. In their structure (papillary character), tubal sarcomas resemble carcinoma. Under the microscope, a picture common for sarcoma. Pipes can sometimes serve as a site for the development of metastatic sarcomas that had a primary localization in the cervix, in the axillary limf, glands, etc. Clinically, F. sarcoma of t. cannot be recognized, it is usually diagnosed only under a microscope. Wedge, symptomatology-common with cancer of the tubes. The prognosis is worse, even compared to cancer. According to Gosse, (Gosset) from 7 radically operated sarcomatous b-ny wedge, treatment had only one b-naya. 2. Riemann described a case of endothelioma of the tube. Macroscopically, the tumor was a common sacto-salpinx. Only under a microscope was placed correct diagnosis(a picture similar to sarcoma). Tube-formation endotheliomas are highly [malignant. Franke (Franque) described "a case of a mixed tumor-carcino-sarco-endothelioma, which developed partly from the endothelium of blood vessels. Of benign tumors F. t. of epithelial type isolated cases of polyps, papillomas, adenomas, dermoids are described. Tubal polyps are especially rare. The case of polypous adenoma described by Zweifel can be considered reliable (in the isthmic part of the tube, a polyp the size of a cherry). Lam (Lahm) described one case of a tubal polyp. Usually, tumors described as tubal polyps, in fact, were incipient adenocarcinomas, inflammatory neoplasms, sometimes decidual growths, etc. Dermoid tubal cysts are also rare (Ortman described about 20 cases). The macro- and microscopic picture of the tubal dermoids does not represent any features compared to the dermoids of other organs. Recently Aschheim described a case of tubal teratoma (with cartilage, fat, smooth muscle, glands). Among tumors of pipes most often meet and have the greatest practical and a wedge. importance of tubal carcinomas. Primary, secondary and metastatic cancers meet in pipes. - Primary and h ny r and to F. t. time, about 320 cases are described in the literature (for the first time, tube cancer was described by Ortman in 1886). In Russian literature, there are about 15 cases of primary tubal carcinoma. Wedge, picture and stalemate. the anatomy of this neoplasm can be considered sufficiently elucidated. The etiology and pathogenesis, as in cancer in general, remain obscure and unexplained. Nek-ry (Sanger and Barth, Martin, Fromme and Heynemann) consider that hron is the cornerstone of development of a cancer of tubes. inflammatory processes, in particular gonorrhea and tbc. Others (Stolz, Kehrer, Zangemeister, Fischer) dispute this, pointing out the discrepancy between the frequencies of salpingitis, on the one hand, and the rarity of tube carcinoma, on the other. In addition, inflammatory processes and tbc usually affect both tubes, and tube carcinoma, on the contrary, in most cases is unilateral (according to Levitsky in 81%). Among the predisposing moments for primary tubal cancer, the menopause should be considered, although cases of primary tubal carcinoma have been described in young women. The soil for the development of cancer in the pipe can be the formations found in the thickness of the pipe wall, which are included in the concept of salpingitis isthmica nodosa (adenomyosis no Frankl "io, adenomyositis no R. Meyer" y) (see. salpingitis). As if there is a known predisposition to cancer of F. t. from childless or once giving birth to women. Tubal carcinomas are most common at the age of 40 - 55 years. Primary tube cancer is most commonly found in middle third tube and its abdominal segment, the uterine end is affected much less frequently. A macroscopically cancerous tube (Fig. 3) changes its shape

Figure 3. Carcinoma tubae dextrae (d): a-left

Pipe; b- left ovary; c-metastasis to the right ovary. (retort-shaped with a sausage-like swelling on the abdominal end); often has a sealed fimbrial end; the size of the tumor ranges from the thickness of the little finger to the size of the child's head; in some cases, cancerous F. t. reached the size of the head of an adult; the tumor has a tightly elastic consistency, sometimes soft (medudal cancer), smooth surface (until the papillae have grown through the peritoneal cover of the tube); when opening the tube wall with proliferating papillae, the cancerous process spreads not only

Figure 4. Carcinoma tubae: a-tunica muscularis; 6 - primary integumentary epithelium of the tube; s-car-shmomatous expansions in the wall of the truOy; d - papillary growths protruding into the lumen of the tube.

On the surface of the pipe, but per continuitatem and on adjacent tissues; in addition, in these cases, the pipe is soldered to the pelvic peritoneum and neighboring organs; there are inflammatory adhesions on the periphery of the tumor. The content of tubal carcinoma is a whitish papillary mass, in some places of a brain-like nature, closely soldered to the walls of the tube. Microscopically, it is customary to distinguish among tube carcinomas: 1) papillary form (more often) - in the form of multiple nodular growths in the expanded lumen of the tube (Fig. 4), 2) alveolar - in the form of large cell fields that separate the interstitial tissue and give peculiar protrusions to the side, and 3) mixed (carcinoma mixtum) - papillary - alveolar. The sciatic type of tube cancer is much less common - with a sharp development of connective tissue and small alveolar growths. With skyra, hemorrhages and tissue necrosis are often observed. Ortman (1903) and Amreich (1922) described (on one occasion) the primary cancer of F. t. with flat stratified epithelium, which developed as a result of metaplasia (accommodative type) of the columnar epithelium into a flat one. The most characteristic form for primary tube cancer is still the papillary structure of the tumor. Usually cylindrical epithelium (tumor) - without ciliated cilia. Polymorphism is clearly expressed. Clinical picture primary cancer of the tube in the sense of symptomatology does not represent anything characteristic. The disease proceeds with the same symptoms that have to be observed with inflammatory tumors of the tubes. Symptoms to watch out for are the following: 1) Vaginal discharge is watery, "yellowish-amber in color, often mixed with blood (always a suspicious sign in the sense of malignancy of the neoplasm). According to Ruge (Ruge), with tubal carcinoma in 25%, we have about Hydrops tubae profluens, s. hydrosalpinx profluens (periodic emptying of the accumulated contents of the tubes into the uterus and through the vagina outward with preceding cramping pains), which, as is known, occasionally occurs with simple hydrosalpinxes, is observed relatively often in tube cancer (cm. Hydrosalpinx). Pveyfel (Zweifel) PA 121 cases of tube cancer noted the presence of hydrops tubae profluens in 20 cases. In two of his own cases, Zweifel gave the correct recognition only on the basis of the described symptom. 2) early offensive cramping pains (as opposed to cancer of the uterus and ovaries, with Krom pains appear in the later stages of the disease). This symptom is found in tube cancer in about 3/3 of all cases. The intensity of pain is different. Sometimes "they" are convulsive. The pains are localized in the lower abdomen, in the sacrum, and often radiate to one or both legs. Pain is caused by stretching of the wall of the tube, peristaltic contractions of its muscles, pressure of the tumor on neighboring organs and nerve plexuses, as well as the development of inflammation around the neoplasm. 3) The presence of atypical uterine bleeding that does not decrease after curettage. 4) Absence of ascites (very rare and in small sizes). 5) No increase in t° and a history of inflammatory processes. Recognition of primary cancer of the tubes is so difficult that even with abdominal surgery it is not always possible to make a correct diagnosis. According to Fonio (Ropub), the correct diagnosis of tube cancer was made in no more than 6.5% of cases. In differential diagnostic recognition, the possibility of confusion with inflammatory sactosalpinx, tubal pregnancy, ovarian tumors, even uterine myoma (pedunculated) should be taken into account. The presumable diagnosis can be made on the basis of the specified wedge, signs. IN Lately use the Tsondek-Ashheim reaction (positive result) for diagnosis. arr. due to late recognition. According to some clinicians, tubal carcinoma more malignant than cancer uterus. Anat plays a role here. features of the pipes, their thin-walledness, which causes a faster and earlier spread of the cancer process beyond the primary localization. Metastases in tubal cancer spread in all three ways: hematogenous, lymphogenous and canalicular. The uterus, ovaries (37 cases according to Zweifel) and the surrounding peritoneum are more often affected. h e n i e-radical operation followed by radiotherapy. results surgical intervention disappointing (relapses and metastases within the next year). Long-term cure (over 3 years without recurrence) is noted in 4% (Beck, Stanca) and 6% (Franke, Zweifel). During the operation, the uterus should certainly be removed, because. at primary cancer F. of t. it is surprised in 12% (Ruge). Cases of metastases in neck-icy, resp. portio vaginalis (Kundrat, Hofbauer, Schafer). The results of subsequent X-ray irradiation cannot be taken into account due to the small number and brevity of observations (Amreich, Thaler, H. Kustner). To improve the results of surgical treatment of primary tube cancer, it is necessary to operate more widely in case of any suspicious neoplasm in the tubes. Secondary Iraq F. t. arr. papillary blastomas. A wedge, such secondary carcinomas in view of their exceptional rarity do not have a value. Metastatic cancer of the tubes occurs either by direct transition of the neoplasm from the ovaries (more often) and the uterus, resp. cervix (rarely), or it is brought here along limf, ways, like a real metastasis, from some other source in the body. From the side of neighboring organs (from the side of the uterine cavity or through the fimbrial end of the tube in case of ovarian cancer), the spread of the cancerous process can proceed through the canalicular route. Cancer can be introduced into the tubes and through the blood vessels (extremely rare). Cancer metastases into the chimney, an extremely rare phenomenon in general. By the way, true Krukenberg tumors are also described in the tubes. There are only 11 such tumors in the entire world literature. One must think that they are not so rare, as can be judged from the literature data. It is necessary in all cases of an ovarian tumor of Krukenberg to carefully examine the pipes. Chorioepithelialoma. Actinomycosis of the tubes. Extremely rare cases of tube damage by a radiant fungus, according to the clinical and pathoanatomical picture, do not represent anything special in comparison with actinomycosis in other organs. Infection apparently occurs through the intestines (a moot point). More often, pipes are involved in the process along with other organs. Recognition is possible only with a hist. and bacteriological research.M. Malinovsky. Tuberculosis of the Fallopian tubes (salpingitis tuberculosa), an inflammatory disease of the tubes caused by infection of the tubes. bacila-mi and characterized by the development of specific tubercles. Thc of the tubes and uterus was first described by Morgagni in 1744. Since that time, the study of tuberculosis of both the tubes and other parts of the female genital area began. Only since the research of Virchow and R. Koch (Virchow, R. Koch), who found out the stalemate. anatomy and etiology of tbc in general (1882), the study of tbc Fallopian tubes became a solid scientific path. Steven (Steven) in 1883 first discovered Koch's bacid in tubercular tubes. The frequency of tbc female genital organs among gynecological diseases in the clinic is according to Williams, Polano (Williams, Polano), Schroeder, Kiparsky, Melnikov and Morozova and others from 1% to 7.7%. All departments of the female genital apparatus can get sick with tbc, but the tubes are most often affected, mainly their ampullary segment. Tube frequency. salpingitis according to Kronig, P. Schroeder, Horizontov and others reaches up to 85-90% of all tubes. female genital diseases. The reason for this frequency and predisposition of the tubes to tbc has not yet been fully elucidated, but apparently it comes down, on the one hand, to an abundant blood supply to these organs, and on the other hand, to a slow blood flow in them, which contributes to the settling of tuberculous bacilli circulating in the blood. After pipes, the uterus is more often (47 - 70%) affected by tbc. Then follow the frequency of tbc of the ovary (Fig. 5) (15-44%), the vagina-(6.7-9%) and finally the external genitalia (1%). Tuberculous salpingitis is usually observed in both tubes at the same time (Fig. 6).

Figure 5. View of a dissected ovary affected by a caseous form of tuberculosis. Several tuberculous cavities are visible (1); 2-wall of the cavity.

In addition, it is often combined with tbc of other departments of the female genital area; especially common is its combination with tbc of the uterus (according to Horizontov, Krenig, Schroeder, Simmonds "y) - in 32.9-60-70%, with tbc of the ovaries and peritoneum - 52-68.5% or more. Conglomerate inflammation -

Drawing c. Tuberculosis of the endometrium, Fallopian tubes and perimetrium.

Body tumors of the appendages of the tubes. character, basically consisting of b. h. from a dramatically changed tbc tube, are far from common among inflammatory tumors of the appendages; according to R. Schroeder, they occur in 10%, and according to Pankow, even in 22%. Age and favorable moments. Tube. salpingitis, as well as tbc of other parts of the female genital area, is b. including a disease of young age-20-30 children. Favorable moments for the development of tbc tubes, as well as other parts of the female genital area, are the puerperal state, insufficient development of the genital organs and the previous defeat of their inflammatory processes, especially gonorrhea. However, there is no unanimity among the authors regarding the favorable influence of this latter; Sellheim and Pankov, for example, completely deny it. Method of infection and ways of spread. A number of pathologists (Bollinger, Schmorl, Albrecht, Aschoff, etc.) have recently established that tube. salpingitis, like tbc of other parts of the female genital area, is almost exclusively secondary. It arises most often from explicit or latent tubes. foci in the lungs (89.5%), in the lymph, glands, intestines, peritoneum, and other organs. Concerning the importance of peritoneal tbc in the occurrence of tubas. salpingitis, the views of researchers differ sharply. According to some (Albrecht, Baumgarten, and others), tbc of the peritoneum very rarely serves as a source of tube disease. Baumgarten failed to establish the transition of the process from the peritoneum to the mucous membrane of the tube experimentally (on rabbits). According to others (Kre-nig, Ghon, Kafka, Zelgeim, Horizons), on the contrary, such a transition plays a large role in the emergence of sexual tbc and often takes place. Of the tubes mentioned above. the centers process extends to pipes hl. arr. on circulatory and limf, vessels and then per continuitatem. The last way distribution of tbc is important in the transition process from the intestines, peritoneum and other neighboring organs. From distant foci, the infection is brought into the tubes of Ch. arr. through the blood vessels. Here tuba. bacilli due to slow blood flow (Amann) settle in the tissues and cause tubes. process.-Tbc tubes are very often a source of development of tbc in other genital organs. Ascending spread of tbc from bottom to top along the mucous membranes from the sleeve to. uterus, etc. theoretically quite acceptable, but in reality it occurs in women with sexual tbc very rarely and only with special favorable conditions as stagnation of the secret, anti-peristalsis, etc. (Jung, Baumgarten). Primary tube. salpingitis in the true sense of the word has never yet been established pat.-anat. way, so the question of it is only of purely theoretical interest. The primary tbc of the tubes is theoretically just as acceptable as the primary tbc of the bones. The rarity of the primary tbc of the lower genital canal indicates that the infection of the female genital organs through the seed of the tubes. to detect only a small number of tube bacilli, if it can occur, it is very rare and does not have that practical value, which was attributed to her earlier. Pathological anatomy. A diseased tbc tube has, macroscopically, in general, the same changes as in septic and gonorrheal inflammation, i.e. it is thickened, compacted and twisted. The thickening is more strongly developed in the ampullar and often in the isthmus and interstitial parts. Here we often meet the so-called. knotty salpingitis (salpingitis isthmica nodosa), erroneously considered by Hegar (Hegar) and his students to be exclusively characteristic of tubes. salpingitis. In addition to tubercles, sometimes noticeable to the naked eye, characteristic of tubes. salpingitis is an accumulation in the tubal canal of cheesy masses, to-rye in the form of plugs protrude in some cases from the abdominal openings. With tube. salping the abdominal ends of the tube remain open in about half of the cases (Neupe-mann). In the case of fusion, the pipes often turn into the so-called. tub. pyosalpinx (pyosalpinx tuberculosa) - containing a lot of cheesy pus in its enlarged canal and sometimes reaching significant sizes (up to a fist and more). The described changes in the tubes are based on the development of round-cell infiltration in them, tubes. tubercles and their further changes. Depending on the development of these changes, either in the mucous membrane, or in the muscle, or in the serous cover, there are 1) tubes. endosalpingitis (endosal-pingitis tuberculosa); 2) tube. mesosalpingitis (mesosalpingitis tuberculosa) and 3) tube. peri-salpingitis (perisalpingitis tuberculosa). Sometimes the disease of the tubes can be limited only to the serous cover (perisalpingitis tuberculosa), which occurs during the transition of the tubes. peritonitis on the peritoneum of the tubes. The most commonly affected tbc is one mucosa or the mucosa together with the muscular one. In the mucous membrane under the epithelium, a small or significant number of miliary tubercles are usually found, and in some places there is desquamation and death of the epithelium and the fusion of folds of the mucous membrane, in places, on the contrary, its proliferation and the formation of glandular passages (Kundrat, Polano, Franke). These proliferative processes in the epithelium are in some cases very pronounced, giving some resemblance to incipient cancer. With the further development and fusion of tubercles, as well as with the appearance of curds in them, 51" after a severe degeneration, the mucous membrane of the tube gradually becomes necrotic and turns into caseous masses. The same thing happens in the muscle membrane. The main component of the above-mentioned conglomerate tubes. adnexal tumors are altered tubes. In addition to them, these tumors include the intestines, most often flexura sigmoi-dea or rectum, closely fused with the tube and sometimes communicating with its canal, and finally the ovary, which is often affected by tbc. All described changes in pipes take place at chronic course process. In its acute course, which happens with general acute miliary tbc, there is a strong round cell infiltration in the tubes, a small number of giant cells, and many tubes. bacyl and abundant caseous necrosis of the mucous membrane. Special changes in the appearance of the pipe when acute form does not happen (Ortman). With self-healing tuba. salpingitis, which can sometimes take place, in addition to the tubes, also in other parts of the genital area (uterus, ovaries), there is a fibrous change, agglomeration and calcification of tubercles and other tubes. products, as well as the infection of the tubal openings with abundant peritoneal adhesions. Course and symptoms. The acute course of tbc F. t. is less common, is observed in acute general miliary tbc and does not cause noticeable gynecological symptoms. symptoms that occur in chronic gonorrheal or septic inflammation of the female genital area.These symptoms consist mainly of leucorrhea, menstrual disorders, pain and infertility.They depend partly on salpingitis itself, partly on concomitant diseases of other genital organs and the pelvic peritoneum Leucorrhoea with tubal salpingitis is rarely of tubal origin due to emptying of the contents into the uterine cavity (sactosalpinx tuber-culosa profluens), but most often depends on concomitant tubal endometritis.Menstrual disorders, according to Schroeder and Martin, occur only in 50% and appear in the form of dysmenorrhea, amenorrhea, and least of all in the form of metrorhagia and menorrhagia (nypermenorrhoea).These disorders depend both on the overall effect on the body of tubes. infections, and from the often concomitant damage to the ovaries and uterus by the same process. - Infertility, being a very frequent companion of tubes. salpingitis, depends on changes in the mucous membrane of the tubes (endo-salpingitis tuberculosa), on the infection of their abdominal openings, as well as on concomitant endometritis, but sometimes with tuba. salpingitis may occur or uterine or ectopic pregnancy. The first is often interrupted prematurely, the second b. h is localized in the funnel of pipes (graviditas infun-dibularis) and has the usual outcomes. According to Gepner (Nbrrpeg), only 8 cases of tubal pregnancy are known with tbc tubes. localized in the lower abdomen and back with irradiation to the legs and are not particularly intense. They are caused by contraction of the tube, stretching of the serous cover and the development of an inflammatory process around the appendages in the peritoneum with the formation of adhesions or liquid exudate. Temp. is within the normal range or subfebrile. From the side of the walls of the abdomen, persistent tension is often observed, as well as retraction, and sometimes, on the contrary, protrusion and enlargement of the abdomen due to an exudative process in the peritoneum. With the development of a significant conglomerate tumor of the appendages, it is possible to palpate through the abdominal integument a diffuse or clearly delimited seal in one or another hypogastrium. In a gynecological examination, they are found on the sides of the uterus. b. or m. significantly thickened and changed pipes, to-rye are either mobile or soldered to the ovaries, forming a picture of the usual hron. salpingo-oophoritis with periadnexitis; sometimes in the region of the appendages, significant sizes of sactosadpinx or conglomerate tumors are noted, characterized by an abundance of dense, painless adhesions. In the presence of the listed symptoms and objective data, the process in the pipes has a slow, increasing course. In most cases, patients with tuba. salpingitis die from tbc, which exacerbated either in the primary foci (lungs or other organs) or, which happens much less frequently, in the genitals, sometimes tubes. salpingitis completely subsides, and the previously enlarged appendages are significantly reduced and hardened, which indicates the onset of self-healing (Hegar, A. Martin). Forecast. Tube forecast. salpingitis, as well as tbc of other genital organs is generally serious. Although there are not so rare cases of a benign course, and sometimes self-healing, but still b-nye suffering from this disease are constantly under the threat of exacerbation and secondary septic infection. With the introduction of genital tbc therapy, x-rays, rays and other physical. methods of treatment, as well as with the limitation of the scope of major operations, mortality has decreased, and the chances of a cure have increased. Diagnostics. Diagnosis of sexual tbc and in particular tbc of the uterine appendages is made on the basis of anamnesis, general objective and gynecological examination , as well as on the basis of auxiliary methods, such as examination with mirrors, abrasion of the uterus and trial excision of ulcerations of the genital canal, followed by a microscope, examination of the obtained tissues, examinations on tubes. bacilli of sexual secretion and fluids obtained by test puncture. Past and present tbc of the lungs, habitus phthisicus and sexual infantilism are points in favor of tubas. diseases of the appendages, but of course only with the exclusion of diseases of a septic and gonorrheal nature. Existence hron. sactosalpinx in virgins and children also indicates with a greater degree of probability their tuba. character.- Detection of tubes. ulceration in the lower parts of the genital canal or tubes. endometritis, as well as finding tubes. bacyl in the secretions and fluids of the genital canal makes the diagnosis of tbc appendages, in particular the tubes, almost reliable. In general, we still do not have a single wedge at our disposal. a sign that could be reliably guided in recognizing tbc appendages. - Development of nodular thickenings in the tubes, nodules in the posterior Douglas and along the sacro-uterine ligaments, ascertaining to-rykh Hegar and his students (Selheim, Bulius et al. .) fill was given pathognomonic significance for tbc tubes and pelvic peritoneum, can occur not only on the basis of tbc, but also on the basis of septic, gonorrheal inflammation, and can also be with papillary ovarian cysts, peritoneal carcinomatosis and endometriosis. For the diagnosis of tbc appendages (in particular tubes), a blood test for leukocytosis and erythrocyte sedimentation rate is of known auxiliary importance. According to Krenig, the absence of leukocytosis, and, according to Gragert (Gra-gert), pronounced erythrocyte sedimentation and slight leukocytosis most often accompany hron. tbc appendages. Due to the fact that in the vast majority of cases tbc of the appendages is secondary, diagnostic methods with tuberculin (ophthalmoreaction, Pirquet's reaction and its modifications on G. Freund's portio vagi-nalis, subcutaneous injections of tuberculin according to Birnbaum) turned out to have no diagnostic value for tbc of the genital organs in general and pipes in particular. Having received a general reaction to tuberculin, one cannot be sure that the body reacts specifically to the process in the genital area. As for the local reaction in the genital organs, this is not very reliable in view of the possibility of the appearance of local reactive phenomena on tuberculin and, in inflammatory diseases, is clearly not a tuber. character. These latter give, according to Borrell (Borge1), a local reaction to tuberculin in 37-65%. In this state of affairs, the most reliable way to recognize tbc appendages is a trial laparotomy, which has to be resorted to in some cases. The diagnosis of tbc of the uterine appendages (tubes) is definitely found out in most cases either during surgery or only with a microscope, examination of the removed tubes and ovaries. - Recently, in order to clarify and make more reliable the presumptive diagnosis of tbc tubes (uterine appendages) Yagunov, Mandelstam and Teverovsky began to resort to the method of vaccine diagnostics according to Burlakov, consisting in injections in a known sequence separately intradermally and into the thickness of the mucous membrane of the sleeve, cervix and rectal wall of four different vaccines (gono-, staphylo-, strepto- and colivation vaccines) and allowing to determine exclude septic, gonorrheal and colibacillary diseases of the genital canal. These authors obtained, however, so far on a small material, good diagnostic results. Treatment. Radical treatment of genital tbc in general and uterine appendages in particular is possible only in cases where these organs are affected in the form b. or m. an isolated focus with a latent or slightly active state of other tubes. foci of the body. In present there are two main methods radical treatment adnexal and uterine tbc - surgical and non-surgical, conservative. The last method includes treatment with a quartz lamp (Yagunov) and Ch. arr. x-ray, rays. One hir. treatment carried out in former time quite widely and radically, in the form of, for example, complete removal of the uterus with appendages, gave a high primary mortality of 10-25% (Kroenig, Bumm, Thaler). X-ray therapy of genital tbc, being a young method, leading from 1909 (Spaeth, Wetterer), does not have immediate primary mortality and gives favorable results, but differs in duration (up to a year or more) and requires an absolutely accurate diagnosis, to-ry. can only be delivered through surgery. Therefore, most modern gynecologists adhere to combined treatment, consisting of a combination of surgery and X-ray therapy, and surgery b. h. are conservative or diagnostic in nature and consist of an abdominal abdominal cut. With easily mobile or weakly fused appendages with or without ascites, a laparotomy is performed, the fluid is released, the obviously sick is removed without touching the uterus, if there are no sharp changes in it, and then after a certain time X-ray therapy or treatment with a Bach quartz lamp follows. In the case of detection during laparotomy of abundant adhesions in the area of ​​altered appendages or the detection of a dry form of tubes. peritonitis, one should refrain from removing the appendages and separating the adhesions (due to the danger of a large injury and fecal fistulas), and, limiting themselves to a trial excision, close abdominal cavity and further apply X-rays. - In the presence of abundant adhesions and tubes. pyosalpinx or ovarian abscess, it is best to do x-ray therapy first. If the latter does not help, then a radical operation is performed (removal of the appendages, and, if necessary, of the uterus, by means of abdominal abdominal ablation). Incision of purulent tubes. appendages is made in the presence of vital indications. The incision is most often made in the posterior fornix (posterior colpotomy). The need for such incisions is rare. Their unfavorable consequence is the possibility of formation hron. purulent fistula. In cases of adnexal tbc accompanied by acute events, the usual anti-inflammatory treatment is used, i.e. rest, ice, drugs. Often associated tube. endometritis is best treated, according to some of the latest authors (Weibel), conservatively - X-ray, quartz lamp, etc., and not actively, through abrasion. In clinically isolated disease of the endometrium, abrasion gives quite satisfactory results (Veit, P. Schroeder). Small doses of beams (from J/4 to 1/48 HED) are applied to a roentgenotherapy, concerning size to-rykh for the present among authors unanimity is not reached. Weibel recommends doses */s- l U HED with two large fields in front and behind, with a filter of 3 mm aluminum, with intervals between exposures of 4-8 weeks. Stefan, Keller, Uther, Pankov and others (Stephan, Keller, Uter) recommend doses in Vs- 1 la HED. For the treatment of such doses, small and inexpensive x-rays can be used. devices. Along with the described treatment, it is necessary to prescribe the usual measures aimed at raising the general condition of the body, i.e. enhanced nutrition, climate, treatment, sunbathing, rest, arsenic, iron and at the same time the treatment of existing tubes. foci of other organs. All this treatment is most conveniently carried out in special sanatoriums. According to P. Schumacher (P. Schumacher), by the described radical and ancillary therapy, you can get up to 70-80% wedge, cure and up to 20-30% improvement. ■513 Prevention. General prevention - see Tuberculosis. In relation to the genitals, preventive measures are the observance of cleanliness and the rules of sexual hygiene, as well as abstinence from coitus "a with a tube husband, especially suffering from tbc genitourinary system. If this is not possible, then precautions should be taken, such as coitus condomatosus or disinfectant douching (mercuric chloride) AND Dr.N. Goriontov. Blowing out the Fallopian tubes. Blowing F. t. (pertubatio, insufflatio) is used for infertility in a woman for diagnostic purposes, to determine the patency of the tubes. Diagnosis of tubal infertility can be carried out by a number of other methods. The most objective of them - metiosalpingography(see), at a cut on roentgenograms it is possible not only to see, pipes are passable or not, but also to establish, what part of a pipe is impassable. According to various statistics, tubal infertility is observed from 21% to 90% of all cases of female infertility. It is associated most often with obstruction of the pipes on the basis of the transferred infection, both gonorrhea and septic. Other causes of tubal obstruction are less common, including intrauterine iodine injections, tubal surgery, congenital anomalies, etc. Tube blowing was first proposed by Rubin in 1919; he introduced oxygen through the uterus and tubes into the abdominal cavity and determined the presence of gas in the abdominal cavity by radiography. His original technique was very complex; the amount of injected gas reached 1 liter (average was 300 see 3). The equipment was not very portable and expensive; it consisted of a metal oxygen bomb, a two-necked bottle of antiseptic liquid to filter the oxygen; on the way to the uterus were a manometer and a gas watch to determine the pressure and amount of gas injected. Over time, this equipment has become much simpler. More simplified apparatuses were described and proposed by Selgeim, Engelman in 1922, and here in the USSR by Mandelstam. The Selheim apparatus consists of a syringe with a capacity of 150 cm 3, the syringe is connected to a manometer showing the pressure in the uterus and in the tubes (Fig. 7). The diagnosis of patency of Selheim is if^h vit on the base - "" ™ nii listening to the sounds of passing air, pressure drop in the pressure gauge and the absence of obstacles from \ 1 \tf$l ST0 R 0NY WHO ~ ) \y I) \ //viv" spirit in syringe tse when pressing on the piston. Fig.7. Selgeim's equipment for Vpribor Man-blowing the Fallopian tubes. ^Щ?£Жъ AIR is pumped into the uterus with a rubber balloon, the injected air is passed through hydrogen peroxide in a two-necked bottle, and the pressure in the system is controlled by a manometer (Fig. 8). With passable pipes, the pressure drops in the pressure gauge during blowing, and air bubbles pass through the liquid in the Wolff bottle.

Figure 8. Device for blowing the Fallopian tubes according to Mandelstam.

Spirit. Mandelstam's apparatus was widely used here in the USSR, both in its original form and in various modifications. Subsequently, it was proposed to blow the tubes with a 10-gram Luer syringe, the pressure was not measured. Such a simplified apparatus was described by Legenchenko-ko (1925). In connection with the simplification of the equipment, various modifications of the tips introduced into the uterine cavity appeared. The simplest model is the tip from a Brown syringe with a rubber cone from a Tarnovsky syringe put on it. Instead of a Brown tip, you can also take a metal female catheter. Mandelstam proposed a metal conical cannula hermetically closing the external opening of the uterine os. Instead, Selheim and Stiasny propose a different method: with one hand, the tip is fixed to the outer uterine os and, at the same time, bullet forceps, applied to the anterior lip of the vaginal part, pull it forward on the surgeon. In addition, a range of self-adhering tips are offered for fixing the cannula and neck. Of the Soviet self-holding tips, Zhivatov's cannula should be pointed out. Pipes are blown in the intermenstrual interval, best of all in the second week after the end of menstruation. Pipe blowing is contraindicated in the presence of acute and subacute inflammatory processes of the pelvic organs, with erosions, endocervicitis, with bloody, purulent and serous-purulent leucorrhoea; during pregnancy, with malignant neoplasms and in the presence of large anats. changes in the uterine appendages. General diseases of the body, high t °, diseases of the kidneys, heart, endocrine system, etc. are also contraindications to pipe blowing. Where there are doubts about the correctness of the diagnosis, it is necessary to subject b-nyh blood tests, erythrocyte sedimentation reactions and determine the degree of purity of the vaginal secretion in order to exclude the presence of infection and avoid complications associated with an exacerbation of the inflammatory process, or infection by air flow from the lower sections of the genital tract into the uterus, tubes or peritoneum. Blowing pipes is a serious undertaking. Therefore, some clinics do it only in a stationary setting. B-naya is placed on a gynecological chair, and the vagina is opened with mirrors. The vagina and vaginal part are wiped with alcohol or iodine tincture. The anterior lip of the cervix is ​​grasped with bullet forceps or Musét forceps. A tip is inserted into the uterus, connected by a rubber tube to an air blowing device. The tip should tightly close the opening of the cervical canal, so that air does not escape from the uterus. went into the vagina. With a rubber balloon, air is slowly introduced into the uterus, while the pressure in the system is measured by a manometer. Air pressure over 150-180 mm Hg should not be used when blowing pipes, because at higher pressure there is a danger of pipe rupture. Based on the pressure drop, one can judge how much air has passed into the abdominal cavity; so, if the pressure is from 150 mm dropped to 50 mm, then we must assume that 30 eat 9 air, if the pressure drops from 100 to 50, then the amount of air introduced is 15 cm 3. Based on the pressure, Mandelstam judges the degree of patency of the pipes. So, if the symptoms of patency appear at a pressure below 75 mm Hg, the pipes are easily passable; at pressure from 75 to 125 mm-satisfactorily passable and over 125 mm tubes are stenotic. During the blowing of air, the surgeon or assistant listens with a stethoscope from the abdominal wall for sounds indicating the patency of the tubes. At the end of blowing, the second one must be laid down. Symptoms indicating the patency of the pipes are as follows: 1. A clear trumpet sound is heard on auscultation, resembling the whistle of wind in a chimney. These sounds can be heard from one or both sides. On the basis of a one-sided trumpet sound, with a very small probability, one can speak of a unilateral patency of the pipe. During auscultation, sometimes you can hear other sounds that are not related to the patency of the tubes - intestinal motility, the release of air from the cervix into the vagina when the external opening of the cervical canal is not tightly closed. When the tube is obstructed in the ampullar part, sometimes sounds are also heard associated with the penetration of air into the expanded end of the tube. 2. With passable pipes, the pressure in the pressure gauge drops at the moment of blowing, because the air from closed system enters the abdominal cavity. 3. With passable pipes, air bubbles pass through the antiseptic liquid in a two-necked bottle. 4. Air introduced in large quantities into the abdominal cavity, pressing on the diaphragm, raises hepatic dullness above the costal margin. 5. With passable pipes, pains in the shoulder and shoulder blade (Phre-nicus symptom) are observed due to air pressure on the diaphragm. This symptom is markedly marked by the introduction of large quantities of air. When penetrating a large number air into the abdominal cavity, this symptom may be absent. 6. With passable pipes, air can be determined by radiography in the peritoneal cavity. The most certain symptoms indicating the patency of the pipes are as follows: listening to pipe sounds, pressure drop in the pressure gauge at the time of blowing and Phrenicussymptom; the latter may be absent with the introduction of a small amount of air into the abdominal cavity. Where there is any doubt about the correctness of the diagnosis, it is necessary to repeat the blowing of the pipes after a certain amount of time, preferably in the next intermenstrual interval. To clarify the diagnosis of patency, metrosalpingography is also shown. Misdiagnosis may depend on tubal spasm; to avoid this, belladonna or morphine preparations can be administered. Complications observed during blowing are most often associated either with technical errors (too much pressure and forced air injection) or with insufficiently careful selection of b-nyh for blowing pipes (the possibility of exacerbating the former inflammatory process or infection in the overlying genitals). Cases of death after blowing pipes are described, and the mortality rate was 1: 1,000 and was associated with improper selection of b-nyh for blowing. In addition to valuable diagnostic data, blowing pipes, according to some authors, sometimes gives a therapist. Effect. These authors claim that as a result of blowing in 8-12% of cases, pregnancy occurs. The onset of pregnancy can be explained both by straightening the folds of the tube, and by stretching light adhesions and adhesions (pipe gymnastics according to Selheim). In addition to uterine pregnancy after blowing, isolated cases of ectopic pregnancy are also described. Blowing of the tubes is also performed with an open abdominal cavity during an operation on the tubes; while air can be introduced both from the side of the vagina and uterus, and from the abdominal end of the tube. For blowing from the abdominal end, a syringe is most often used. After salpingostomy, it is also recommended to blow out the tubes in order to avoid the formation of adhesions and to check the results of the operation. It is noteworthy that even in the hands of very experienced doctors(eg Kustner from the Selheim Clinic) blowing the tubes sometimes leads to wrong conclusions, and therefore the results obtained by blowing should be subjected to more critical evaluation than is usually the case. It is very possible that the method of blowing pipes will gain in the future great value, if we can use the new apparatus proposed by Rubin (Rubin), which makes it possible to graphically register pressure fluctuations in the uterus, depending on the contractility of the tubes. With the introduction of tubal blowing, no operation undertaken for infertility can be performed without first checking the patency of the tubes.M. Pobedinsky.. Transplantation of Fallopian tubes into the uterus. With infertility, depending on the obstruction of F. t "in the interstitial or isthmic part, it is sometimes necessary to resort to the operation of removing the altered part of the tube and transplanting the rest of it into the uterus in order to restore patency pipe channel. For the first time such operation was published in 1899 by Ries and Witkins (Ries, Weit-kins); they applied it at the woman, at a cut removal of the right appendages was made earlier; The result was a pregnancy that ended in miscarriage. However, at that time, the operation was not yet recognized by gynecologists and began to be used only after the case published in 1921 by Cullen and Shaw (Cullen, Shaw), where, after a tube transplant, b-naya became pregnant, and the first pregnancy ended in a miscarriage, and the second - in normal childbirth. . Strassmann in 1924 already had the opportunity to publish several cases and proposed his own method. operating. Since that time, a large number of authors have published their cases and developed the operating technique. If at first F. t.'s transplantation was carried out along the way in those cases when the modified tube of one side was removed, while the second tube was changed in the isthmic part, then at present, the time of transplantation is used both incidentally and as an independent operation in the presence of infertility. Applying operation of change F. t., a number of authors (Mandelshtam, Unterberger, Mi-chaelis, vgёkeguidr.) specifies that as a result of operation passability and normal fiziol is restored. pipe function; so, Reiprich, on the basis of world literature, cases where pregnancy subsequently occurred, calculates in 10-15%; according to Serdyukov, out of 72 published cases of tubal transplantation, 23% were pregnant; according to the material of Mandelstam and Kiparsky, 21 cases were pregnant twice. Of the indications available in the literature, pregnancy occurs within 3 months to 3 years after surgery. Of the proposed methods, it is necessary to dwell on the operations of Strassmann (Strassmann), Unterberger, Mandelstam, Kiparsky and Serdyukov. Strassmann's operation is performed in the following way: the uterine cavity at the top of the angle is opened with a transverse incision so that a tube can be passed through the hole into the uterine cavity; then, with two catgut sutures, the serous cover of the inner end of the tube is captured and carried through the entire thickness of the uterine wall, making an injection on the mucous membrane and a prick on its serous cover, with one end of each thread being brought out on the back, and the other on the front surface of the uterus; when starting to immerse the end of the tube into the uterine cavity, a thin probe is first inserted through the ampullar end; sipping on the ligatures and directing the probe, the tube is immersed in the uterine cavity, after which the catgut sutures are tied up; in the interval between two fixing sutures, several interrupted catgut sutures are applied. It is necessary here to adhere to the rule not to tighten the seams strongly and thereby not squeeze the tube. - Unterberger proposes to make a sagittal incision in the area of ​​\u200b\u200bthe angle of the uterus, and the inner end of the tube, after resection of the altered part, is cut into two lips and then fixed to the mucous membrane of the uterus with two catgut sutures , according to the type of suturing of the ureters into the bladder, brought out through the entire thickness of the uterine wall; submersible muscular and superficial gray-serous catgut sutures are superimposed on the incision of the uterine wall. Mandelstam, in order to eliminate compression of the tube by the uterine wall, suggests cutting out a cone-shaped canal from the uterine wall in the uterine angle, at the location of the interetial part, opening its cavity, where the tube is immersed. After the channel is ready, a long ligature is drawn on the needle through the entire uterus from front to back; from the formed channel, the thread is captured with tweezers and removed in the form of a loop, the thread is cut, needles are put on its ends, which capture both lips of the inner section of the pipe cut along the length of 2-3 mm from the edge; these threads are tied into knots, then a probe is inserted through the ampullar end of the tube, and with the help of it and pulling on the outer threads, the tube is immersed. By tying the ends of these threads, the tube is fixed to the wall of the uterus and the mucosa of the tube to the uterine mucosa; With interrupted sutures, the serous membrane of the “ruby” is sutured to the uterus. Kiparsky, instead of excising the angle of the uterus with a scalpel, uses a special tool in the form of a cylinder with a cutting edge - a uterine trephine, which, passing through the wall of the uterus, removes the corresponding piece of tissue. The disadvantages of this method, according to Serdyukov, Unterberger and others, are that

Rie. 13.

It is necessary to pierce in the dark, as a result of which it is not visible how the sewn-in tube is attached to the uterine cavity; this can also explain the absence in the literature of an indication where, after transplantation according to the Kiparsky method, pregnancy would subsequently be observed. - In 1932 G. Serdyukov published 10 articles. transplants F. T.; he finds that if both tubes are obstructed, a bilateral transplant is necessary. He performs the operation as follows: the uterine cavity is opened with a transverse incision along the bottom of the uterus (Fig. 9); the changed part of the tube in the isthmic or interstitial section of the tube is resected (Fig. 10); to stop bleeding, one catgut suture is applied along the edge of the uterus behind and slightly below the attachment of the round uterine ligament to it, the second suture is placed on the tubal artery at the site of the pipe incision, on its mesentery (Fig. 11); then needles are put on the ends of this suture and one thread is passed through the entire thickness of the uterine wall, bringing it to the front surface (Fig. 12), and the second to the back, after which the ends of the thread are tied up; That. the pipe is fixed, and the edges of its cut are connected. The operation ends with first fixing the tube with several thin sutures in the region of its mesentery along the anterior and posterior surfaces of the uterus, and then closing it with thicker interrupted sutures. 17 the opening of the uterus (Fig. 13), on top of which Minin considers it necessary to apply a continuous seromuscular suture. -Okinchits believes that there is no need to dissect the entire fundus of the uterus, but it is enough to confine oneself to one of its corners, making an incision in such a size that it would be possible to transplant the tube under visual control. During the transplant operation, it is necessary that the isthmic part is not completely removed, and the longer the ampullar end of the tube is left, the more data on the possibility of obtaining stable patency in the postoperative period. According to the studies of Miku-lich-Radetsky, the entire pipe, both its ampullar and its isthmic part, represents one fiziol. the whole, the unity of which is of great importance for the successful operation of the pipe. The loss of the ampullary part in relation to the violation of muscle activity (peristalsis) is less important than the loss of the isthmic part. Therefore, when transplanting a tube into the uterus, it is desirable to preserve a part of the istmus, which, having a more powerful musculature, will better resist the uterine wall than the weaker muscles of the ampullar end of the tube. as Serdyukov proposes, or can we confine ourselves to a transplant on one side? Minin agrees with Douay's bluing, to-ry advises to produce a unilateral transplant in order to limit the injury, and in his two cases applied the Strassman operation with a unilateral transplant. Horizons believes that for the onset of pregnancy there is no need to necessarily transplant both tubes; so, he brings 10 ate. urgent delivery after the transplant operation, and in 5 cases there was a bilateral and in 5 cases a unilateral transplant. It is necessary to approach operation of transplantation F. of t. especially seriously, it is necessary to consider that quite often obstruction, for the sake of a swarm the operation was made, comes again, and sometimes at the presence of the latent infection in the postoperative period it is possible to expect serious complications. Before the operation, it is necessary to observe t° for a long time (3-4 weeks); an increase in t ° should serve as a contraindication; before the operation, it is necessary to examine the blood picture, the rate of erythrocyte sedimentation reaction, and also, using metrosalpingography, to accurately determine the site of infection. Therefore, the operation of transplantation of the Fallopian tubes can be performed only in cases where there is a completely calm process that has not given exacerbations for a long period; special care is needed if there is a history of gonorrhea. N. Minin. Lit .: Berejazon L., Air test of patency of the fallopian tubes, Zhurn. obstetrics and Shensk. diseases, vol. XXXIX, book. 1, 19"."8; Bykov S., On the diagnostic and therapeutic significance of blowing the fallopian tubes in infertility, ibid., vol. XLII, book. 2, 19;H; Horizons N., Implantation of fallopian tubes in the uterus, ibid., 1934, No. 5; ZaretskyS, Papillary tumors of the fallopian tubes, ibid., 1907, No. 9; Levitsky M., On the issue of primary cancer of the fallopian tubes, Journal of Obstetrics and Women's Diseases, 1913, No. 12; Mikhnov S., To the question of the disease of the fallopian tubes and ovaries in Pat.-Anat. and clinical attitude ii, diss, St. Petersburg, 1889; Popov D., On the issue of changes in the fallopian tubes in uterine fibroids, Vrach, 1890, No. 51; Serdyukov M., Critical Assessment modern methods diagnosis of tubal infertility, Zhurn. obstetrics and Shensk. diseases, vol. XXXVІII, kp. 1, 1927; Cahen, Less modifications de la trom; e uterine chez la femme, Arch, internat. de msd. exp., v. IV, 1928; Condam in F., Du traitement chirurgical de la tuberculose annexielle, Gyn. et obstetr., v. XIX, 1929; Dietrion H., Pie Neubildungen der Eileiter (Biologie u. Patnologie des Weibes, hrsg. v. J. Halban u. L. Seitz, B.V, T. 1, B.-Wien, 192fi, lit.); Grusdew F., Zur Hlstologie der Fallopischen Tuben, Zentralbl. f. Gyn., 1897, M 10; To a both G., Eileiterdurchblasung, Ber. iiber die ges. Gynakologie und Geburtshille, B. XII, H. 3, p. 129, 1927 (lit.); Pop off D., Zur Morphologie u. Histologie der Tuben und des Parovasiums beim Menschen wahrend des intra- und extrauterinen Lebens bis zur Puberiat, Arch. f. Gyn., B. LXIV, Y. 2, 1893; Serdyukov M., La chirurgie restauratrice des trompes, ses methodes et sea results, Gynecologie, v. XXXI, 1932; Wei be 1 W., Tuberkulose des weiblichen Genitalapparates (Biologie und Pathologie des Weibes, hrsg. v. J. Halban u. L. Seitz, B. V, T. 1, B.-Wien, 1928, lit.). See also resp. chapters of the main guidelines referred to in lit. to Art. Gynecology,

The fallopian tubes (synonym: oviducts, fallopian tubes) are a paired tubular organ through which the egg enters the uterus from the ovary. The fallopian tubes start from the upper corners of the uterus (see) in the bottom area, pass along the upper edge of the wide fallopian tubes towards the side walls of the pelvis and open into the abdominal cavity near the ovaries. In the fallopian tubes, there are: 1) the uterine part, located in the thickness of the muscles of the uterus; 2) the isthmus - the middle section of the tube and 3) the ampulla, which is instilled by a funnel with fimbriae. The length of the fallopian tubes is 11 cm, the width of the uterine part of the tube is 0.5–1 mm, the isthmus is 3 mm, and the ampullary part is 6–10 mm. The wall of the fallopian tube consists of a mucous membrane, a muscular layer and a serous membrane. The mucous membrane forms longitudinal folds, covered with ciliated epithelium. Flickering movements are made towards the uterus, contributing to the advancement of a fertilized egg.

With underdevelopment of the genital organs (infantilism), the fallopian tubes are usually elongated, tortuous and narrowed.

The muscular layer of the fallopian tube has the ability to make peristaltic movements from the ampullary end to the fallopian. Peristalsis is most pronounced at the time of ovulation and at the beginning of the luteal phase (see). As a result of the peristaltic movements of the fallopian tubes, the fertilized egg is promoted. The fallopian tubes have a richly developed vascular network formed by branches of the uterine and ovarian arteries. This explains the occurrence of severe bleeding during an interrupted tubal (ectopic) pregnancy.

Violations of the patency of the fallopian tubes occur most often as a result of previous diseases of gonorrhea, septic and tuberculous etiology and are one of the most common causes of a woman. For functional diagnostics of the fallopian tubes, various methods studies: hysterosalpingography (see), pertubation, hydrotubation.

Pertubation(blowing) of the fallopian tubes is performed by a gynecologist using a special apparatus consisting of a tip, a pressure gauge and an oxygen tank. Pertubation is usually performed from the 8th to the 20th day of the menstrual cycle (with a 28-day cycle) in the presence of a normal blood picture (not higher than 15 mm per hour) and I-II Degree of purity of the vaginal flora.

hydrotubation- the introduction of fluid under pressure into the uterine cavity and fallopian tubes. Usually, a warm 0.25% solution of novocaine with antibiotics is used. Hydrotubation is used not only for diagnostic, but also for therapeutic purposes - with obstruction of the pipes, infertility; for this, lidase (, solvent) and are additionally introduced into the specified solution. With obstruction of the tubes and infertility as a result of a chronic inflammatory adhesions around the fallopian tubes (perisalpingitis), an operation can be performed to cut the adhesions (salpingolysis).

As a result of all the proposed operations, pregnancy occurred only in 4-21%, which can be explained by the functional inferiority of the transplanted sections of the fallopian tubes or their re-infection.

II. Salpingectomy (tubectomia) - removal of the tube. Indications: tubal pregnancy, chronic diseases of the fallopian tubes and the presence of a paraovarian cyst. Operation technique: the tube is isolated from the adhesions, a Kocher clamp is applied to the tubal-ovarian ligament (the outer end of the mesosalpinx), the second clamp is applied to the uterine end of the tube. Cross the tubal-ovarian ligament and mesosalpinx along the tube; areas of the mesosalpinx containing vascular branches are ligated with catgut. Cut off the uterine end of the tube above the clamp. More often, a wedge-shaped excision of the tube is made from the angle of the uterus. Bleeding branches of the uterine artery and the genital branch are tied up and then the wound of the uterus is sutured. Peritonization with a purse-string or twisting suture. With a large wound surface (abundant adhesions), a round uterine ligament is used to cover the stump, sewing a loop of it to the corner of the uterus over the sutures at the site of the excision of the tube. Peritonization is continued towards the tubal-ovarian ligament, where a purse-string suture is applied to immerse it.

Rice. 11. Transplantation of the fallopian tubes into the uterus:
1 - the direction of the incision along the bottom of the uterus; 2 - cutting off the uterine ends of the tubes; 3 - operation completed. The tubes are fixed in the incision of the uterus and sutures are placed on the incision of the fundus of the uterus (according to Petchenko).