The Reproductive System 生殖系统

1. The Reproductive System 生殖系统 山东大学医学院 解剖教研室 李振华

2. The Reproductive System Composition • Internal genital organ内生殖器 • Gonads生殖腺(sex glands) －manufacture the sex cells an secrete the sex hormones. • Genital ducts生殖管道 －transport the sex cells from the site of production into site fertilization • Accessory glands附属腺－secrete the fluid • External genital organ外生殖器

3. Male Reprodutive System 男性生殖系统

4. Male Reproductive System Male internal genital organs • Gonad –testis睾丸 • Genital ducts • Epididymis 附睾 • Ductus deferens 输精管 • Ejaculatory duct 射精管 • Male urethra 男尿道 • Accessory glands • Seminal vesicle 精囊 • Prostate 前列腺 • Bulbourethral gland 尿道球腺 Male external genital organs • Scrotum阴囊 • Penis 阴茎

5. Male internal genital organs

6. Gonad – testis 睾丸 General features • Paired, smooth, ovoid male reproductive organ, slightly flattened anteroposteriorly • Located in scrotum • Produces sperm and secretes androgens

7. Gonad – testis 睾丸 Structures of testis • Tunica albuginea 白膜: a tough fibrous coat • Septula testis 睾丸小隔: numerous fibrous into the gland • Lobules of testis 睾丸小叶: contain the contorted seminiferous tubules 精曲小管 • Striaght seminiferous tubules精直小管 • Rete testis 睾丸网 • Efferent ductules of testis睾丸输出小管open into the head of the epididymis

8. Testis Seminiferous tubules

9. Epididymis 附睾 • Comma-shaped, with head, body and tail of epididymis • Located on superior extremity and posterolateral aspect of testis • Contains tortuous canal that extends from testis to ductus deferens in spermatic cord • Function – the site of accumulation and storage of sperm

10. Ductus deferens 输精管 • A thick-walled muscular tube approximately 45 cm in length. • It transports sperm form epididymis to ejaculatory duct

11. Ductus deferens输精管 1. Testicular part 睾丸部－extends form the tail of epididymis to the superior extremity of testis 2. Spermatic part 精索部－extends form superior extremity of testis to the superficial inguinal ring, the place where the vasectomy is performed 3. Inguinal part 腹股沟部－extends form superficial to deep inguinal rings 4. Pelvic part 盆部－crosses the obturator neurovascular bundle and the ureter to reach the base of bladder, where it expands to form the ampulla ductus deferentis 输精管壶腹

12. Vasectomy

13. Spermatic cord 精索 • Extends from the superior extremity of testis to the deep inguinal ring • Contents of the spermatic cord • Ductus deferens • Testicular and deferential arteries • Pampiniform plexus 蔓状静脉丛 • Nerves and lymphatics • Vestige of vagina process • Covering of the spermatic • Internal spermatic fascia 精索内筋膜 • Cremaster 提睾肌 • External spermatic fascia 精索外筋膜

14. Ejaculatory duct射精管 • Formed by union of distal portion ductus deferens and duct of seminal vesicle • Passes through the upper part of prostate and opens into the prostatic part of urethra

15. Seminal vesicle 精囊 • Paired sacculated, coiled glands • Secrete part of seminal fluid • Located on posterior surface of bladder, lateral to ampulla ductus deferentis

16. Prostate 前列腺 • Lies behind pubic symphysis, between neck of bladder and urogenital diaphragm • Shape — chestnut-shaped organ • Base • Apex • Body: prostatic sulcus 前列腺沟 (posterior surfaces) • Contains of five lobes • Anterior lobe • Middle lobe • Posterior lobe • Left and right lobes • Enclosed by a thin inner fibrous capsule (true capsule) and a strong outer envelope of pelvic fascia

17. Axial oblique MRI (STIR sequence) demonstrates normal high signal within prominent seminal vesicles lying above the prostate in a young man.

18. Bulbourethral gland 尿道球腺 • Two small pea-shaped glands • Located in the deep transverse muscle of perineum • Opens into bulbar portion of urethra

19. Male External genital organs

20. Scrotum 阴囊 • Pouch of thin skin lying below the root of the penis • Divided into two haves by septum of scrotum, contains testes and their ducts • Walls • Skin • Dartos coat肉膜 • Deep to skin • A connective tissue layer that contains many smooth muscle fibers • Contracts in response to cold, pulling the testes closer to the body and wrinkling the skin

21. Parietal peritoneum Transverse fascia Trasversus abdominis Obliquus internus abdominis Aponeurosis of obliquus externus abdominis External spermatic fascia 精索外筋膜 Parietal layer Visceral layer Cremaster 提睾肌 Internal spermatic fascia 精索内筋膜 Vaginal cavity Tunica vaginalis of testis 睾丸鞘膜

22. Penis 阴茎 • Consists of the root, body and glans penis • Contains • Two cavernous body of penis 阴茎海绵体 • A cavernous body of urethra 尿道海绵体 • Skin－thin and loose • Prepuce of penis 阴茎包皮 • Frenulum of prepuce 包皮系带

23. Corona glandis 阴茎头冠 Cavernous body of penis 阴茎海绵体 Cavernous body of urethra尿道海绵体 Crus penis 阴茎脚 Bulb of urethra 尿道球

24. Male urethra 男性尿道 Three parts 1. Prostatic part 前列腺部－lies within the prostate and is the widest and most dilatable portion of urethra. 2. Membranous part膜部－ passes through the urogenital diaphragm surround by the sphincter of urethra 3. Cavernous part 海绵体部－transverse the length of cavernous body of urethra Posterior urethra 后尿道－prostatic part and membranous part Anterior urethra前尿道–-cavernous part

25. Male urethra 男性尿道 • Within prostatic part • Urethral ridge 尿道嵴 • Seminal colliculus 精阜 • Prostatic utricle前列腺小囊 • The orifices of the ejaculatory ducts

26. Male urethra 男性尿道 • Three constrictions • At the internal urethral orifice • At the membranous part • At the external orifice of urethra • Three enlarged parts • At prostatic part • At bulbar portion of urethra • At navicular fossa of urethra

27. Male urethra 男性尿道 Two curvatures • Subpubic curvature 耻骨下弯－concave upward • Prepubic curvature 耻骨前弯－concave downward By holding the penis upward, the S-shaped curve to the urethra is converted into a J-shaped curve.

28. Female Reproductive System 女性生殖系统

29. Female Genital System • Female internal genital organs • Gonad –ovary 卵巢 • Genital ducts • Uterine tube 输卵管 • Uterus 子宫 • Vagina 阴道 • Female external genital organs－female pudendum 女阴

30. Female internal genital organs

31. Ovary 卵巢 • Position－lies in the ovarian fossa in the angle between the internal and external iliac vessels on the lateral pelvic wall. • Shape－an ovoid organ • Superior pole－tubal extremity • Inferior pole－uterine extremity • Anterior border－mesovarian border (hilum of ovary) • Posterior border－free border • Two surfaces－medial and lateral • Function: Produce ova and secrete estrogens

32. Ovary 卵巢 • Supporting structures of ovary • Suspensory ligament of ovary 卵巢悬韧带 • Proper ligament of ovary 卵巢固有韧带

33. Uterine tube 输卵管 • General features • About 10cm long • Located at upper edge of broad ligament of uterus between the two layers • Four parts • Uterine part 子宫部 • Isthmus of uterine tube 输卵管峡 • Ampulla of uterine tube 输卵管壶腹 • Infundibulum of uterine tube 输卵管漏斗

34. Uterine tube 输卵管 • Uterine part子宫部－narrowest part, pierces uterine wall and opens into cavity of uterus by uterine orifice of uterine tube

35. Uterine tube 输卵管 • Isthmus of uterine tube输卵管峡－straight and narrow portion, thick walls, it is the place where the tubal ligation is performed usually

36. Uterine tube 输卵管 • Ampulla of uterine tube输卵管壶腹 relatively wide, tortuous, longest part, thin walls; fertilization of the ovum takes place in its complex lumen • Infundibulum of uterine tube输卵管漏斗 • Fimbriae of uterine tube输卵管伞 • Ovarian fimbria卵巢伞

37. Ectopic pregnancy

38. Uterus 子宫 • General features －muscular pear-shaped organ • Three parts • Fundus of uterus子宫底 • Body of uterus子宫体 • Neck of uterus子宫颈 • Vaginal part of cervix 子宫颈阴道部 • Supravaginal part of cervix 子宫颈阴道上部 • Isthmus of uterus 子宫峡 short constricted part, transition between the body and the neck of uterus, taken up by body of uterus during pregnancy, thus “lower uterine segment”

40. Uterus 子宫 Interior cavity • Cavity of uterus 子宫腔－the cavity of body of uterus, is triangular in coronal section • Canal of cervix of uterus 子宫颈管－the cavity of the neck, is spindle-shaped, opens into the vagina at the orifice of uterus子宫口

41. Uterus 子宫 Position • Lies in the center of the pelvic cavity, between bladder, anteriorly, and rectum, posteriorly, usually it is anteversion and anteflexion • Anteversion 前倾 －axis of uterus at 90o with that of vagina • Anteflexion 前屈 －axis of body of uterus is bent forward with that of the cervix forming an angle of about 170o (body of uterus is bent slightly forward at isthmus) 90o 170o

42. Transabdominal ultrasound of the female pelvis showing the uterus and both ovaries.

43. Sagittal T2-weighted scan, showing a normal cephalic presentation and the positions of the pelvic inlet and outlet at 30 weeks’ pregnancy.

44. Digitally subtracted hysterosalpingogram.

45. Sagittal MRI in a young female.

46. Supports of uterus • Pelvic diaphragm • Surrounding organs: vagina and bladder • Ligaments • Broad ligament of uterus 子宫阔韧带 • Round ligament of uterus 子宫圆韧带 • Cardinal ligament of uterus 子宫主韧带 • Uterosacral ligament of uterus 子宫骶韧带

47. Supports of uterus Broad ligament of uterus子宫阔韧带 • Mesosalpinx 输卵管系膜 • Mesovarium卵巢系膜 • Mesometrium子宫系膜

48. Supports of uterus • Round ligament of uterus 子宫圆韧带 －maintain anteverted position of fundus

49. Supports of uterus • Cardinal ligament of uterus 子宫主韧带 －confer lateral stability to cervical region • Uterosacral ligament of uterus 子宫骶韧带 －maintain body of uterus in anteflexed position.

50. Vagina 阴道 • Flattened fibromuscular tube, about 8～9cm long • Extends upward and backward from vestibule to uterus • Fornix of vagina 阴道穹 • Formed between cervix and walls of vagina • Posterior fornix deepest and larger than either anterior or lateral fornices, and related to the rectouterine pouch