自体卵巢组织冷冻在女性肿瘤患者生育力保存中的应用

目的探讨适合育龄期女性肿瘤患者的生育力保存方案。方法回顾性分析2017年12月至2019年9月在安徽医科大学第一附属医院生殖中心生育力保存库进行生育力保存的14例肿瘤患者的临床治疗资料,并结合相关文献,探讨合适的生育力保存方案。结果 14例女性肿瘤患者中,已婚和未婚女性各7例,平均年龄(27.35±1.52)岁,包括8例乳腺癌患者、4例卵巢交界性肿瘤患者,以及结肠癌、子宫内膜癌患者各1例。14例患者均未进行促排卵治疗,仅经腹腔镜手术取部分卵巢皮质组织进行冷冻保存。7例患者体外获取的未成熟卵母细胞经体外成熟(IVM)技术于体外培养得到成熟卵母细胞,平均成熟率为54.05%(40/74);其中2例患者(未婚)进行了卵母细胞冻存,5例患者(已婚)进行了胚胎冻存,平均冻胚(3.2±1.92)枚。结论卵巢组织、卵母细胞及胚胎冷冻技术均可用于育龄期女性肿瘤患者的生育力保存。     

促进自体冻存卵巢组织移植存活的方法研究进展

随着癌症治疗技术的发展,癌症患者的生存率显著提高。但化学药物治疗(化疗)和放射治疗(放疗)可能导致年轻女性癌症患者发生卵巢早衰和不孕,而自体冻存卵巢组织移植是这类患者保存生育能力的有效方法。目前,该技术最大的挑战是移植后卵泡大量丢失。本文综述了自体冻存卵巢组织移植存活的影响因素及改善方法。     

女性儿童和青少年肿瘤患者生育力保存研究进展

近年来随着儿童和青少年肿瘤远期生存率的不断提高,这些肿瘤患者的生育力保存受到越来越多人关注。化疗和放疗可能会损害儿童和青少年肿瘤患者的生育力,使其在成年后发生卵巢早衰和不孕的风险增大,严重影响了成年幸存者的生活质量。卵子冷冻是青春期后患者保存生育力的标准方案,卵巢组织冷冻是青春期前儿童保存生育力的主要方法。对于移植卵巢组织有肿瘤细胞种植风险的患者,卵泡体外培养和人工卵巢可能是未来生育力保存发展的方向。本文综述女性儿童和青少年肿瘤患者生育力保存的现状和研究进展,为临床工作和进一步研究提供参考。     

探究不同治疗方式对卵巢子宫内膜异位症患者卵巢功能的影响

子宫内膜异位症的发病率较高，约10%的生育期女性患有子宫内膜异位症，其中不孕女性占20%～50%,严重影响育龄女性身心健康。子宫内膜异位症累及范围广，卵巢子宫内膜异位症(也称卵巢巧克力囊肿)是最常见的类型。卵巢子宫内膜异位症可因自身病理及医源性因素而影响卵巢储备功能，导致卵巢功能不全、患者不孕。因此，保护子宫内膜异位症患者的卵巢储备功能显得尤为重要，在治疗时，需注重个体性差异，制定合适的治疗方案，更好地保护患者生育力。本文对卵巢子宫内膜异位症治疗方案及其对患者卵巢功能的影响进行综述。     

女性癌症患者生育忧虑研究进展

介绍女性癌症患者生育忧虑的概念、评估工具,并对生育信息支持、生育力保存、正念减压疗法、支持性心理疗法和自我导向管理等干预措施进行阐述,旨在为缓解女性癌症患者生育忧虑提供参考。     

副卵巢合并子宫纵隔1例报告

<正>异位卵巢包括副卵巢和多余卵巢,是罕见的女性生殖系统发育异常,其发生率尚不明确,2000年Vendeland等报道其发生率为1:29000~700000[1]。异位卵巢患者常无明显症状,少数患者表现为慢性盆腔痛、痛经、不孕。值得重视的是约1/3的异     

女性生殖生理学基础

作为生殖医学工作者 ,无论是女性或是男性生殖研究者都必需对男女双方的生殖生理 ,生殖内分泌 ,和性激素的临床应用等充分了解。本刊将从这三方面逐步进行介绍女性生殖生理的特点。一、卵巢的解剖和生理功能卵巢是女性的主要生殖器官 ,也称女性性腺。分皮质、髓质和卵巢门。皮质是卵巢的主要结构 ,由生殖上皮即不同发育阶段的卵泡和卵子组成 ;髓质则由结缔组织和卵巢间质组成 ;卵巢门是卵巢血管进入的部位。卵巢是分泌性激素的器官 ,其主要功能包括 1)产生类固醇激素和各种细胞因子 ,通过自分泌 /旁分泌来调节卵子发育和排出 ;2 )卵巢激素通…     

AMH与卵巢储备功能及体外胚胎发育潜能的关系

抗苗勒管激素(AMH)为转化生长因子β超家族的一员,是一种二聚糖蛋白。AMH作为单一指标预测卵巢储备功能,越来越受到重视。卵巢储备功能与女性的生育力及绝经年龄密切相关,准确、客观的评估女性的卵巢储备功能,预测其生育潜能及绝经年龄,利于育龄女性做好家庭生育计划及工作规划。现对AMH在预测卵巢储备功能、胚胎发育潜能的最新研究进展进行综述。     

经皮穿刺导管引导下泡沫硬化剂疗法治疗卵巢静脉曲张

目的探讨导管引导下的泡沫硬化剂疗法治疗卵巢静脉曲张的临床效果。方法选择2008~2009年就诊于我中心诊断为卵巢静脉曲张的患者共13例,平均年龄39.4(31~52)岁,病史1~20年。经皮穿刺导管引导左侧卵巢静脉主干内注射1%聚桂醇泡沫硬化剂,观察静脉主干的闭合情况。结果患者均在导管引导下成功注射硬化剂,泡沫硬化剂平均用量6.2(4~9)ml。术后平均随访时间5.3(1~12)个月,12例患者站立时盆腔坠胀不适感消失,1例减轻;5例性交痛患者中2例症状消失,3例减轻;3例大腿内侧曲张静脉较前减轻。复查超声提示未见卵巢静脉主干闭塞不满意。结论经皮穿刺导管引导的泡沫硬化剂疗法治疗卵巢静脉曲张主干闭合率较高,是微创治疗中一种有效的新方法。     

卵巢衰老的临床干预新进展

女性生育力的降低显著早于全身机体的衰老,卵巢储备一般在35岁开始下降。目前卵巢衰老的诊断主要依据年龄、基础血FSH、抑制素B和血清抗苗勒氏管激素(AMH)水平及窦卵泡计数。卵巢衰老包括生理性卵巢衰老(NOA)、隐匿性卵巢功能不全(OPOI)和早发性卵巢功能不全(POI)。在IVF周期中补充生长激素、脱氢表雄酮以及辅酶Q10可以部分改善NOA患者的IVF结局。目前针对POI尚无有效的临床治疗手段。卵巢组织玻璃化冷冻联合体外激活的POI临床研究获得了较好的妊娠结局。干细胞移植干预POI患者的临床研究提示其良好的应用前景。逆转卵母细胞衰老的技术中,自体生殖系线粒体能量移植(AUGMENT)在小规模临床试验中能够显著改善卵母细胞的质量和临床妊娠率。本文就卵巢衰老的临床诊断、发病机制和干预方法进行综述。     

基于卵母细胞线粒体探讨早发性卵巢功能不全发生机制

早发性卵巢功能不全是造成女性卵巢功能下降的重要疾病。卵母细胞线粒体是女性生殖系统中的关键细胞器,与卵巢的代谢及其他生理活动息息相关。本文从卵母细胞线粒体功能、卵母细胞线粒体的损伤机理、卵母细胞线粒体与颗粒细胞的联系、卵母细胞线粒体DNA以及卵母细胞线粒体的分裂和融合动态等几个方面探讨了基于卵母细胞线粒体的早发性卵巢功能不全发生机制。同时总结了胞浆移植、异体体细胞线粒体移植以及自体体细胞线粒体移植等治疗早发性卵巢功能不全的方法。     

Gynecologic cancers and solid organ transplantation

Solid organ transplant (SOT) recipients have an approximately 2‐fold greater risk of developing and dying from a malignancy compared to the general population. Among the gynecologic cancers, including uterine, cervical, vaginal, vulvar, and ovarian, the HPV‐related cancers are known to increase among women posttransplant compared to women in the general population, but less is known about the risk of uterine and ovarian cancers. This review provides an overview of the epidemiology of gynecologic cancers after solid organ transplantation, as well as the pathophysiology, management, and specific risk factors associated with these cancers. Closer surveillance for cervical cancers is warranted and larger studies are needed to assess whether and how uterine and ovarian cancers are associated with excess incidence and mortality. Such studies may lead to improvements in screening, prevention, and treatment before and after transplantation.     

Donor-Derived Ovarian Cancer in a Male Recipient After Kidney Transplant: A Case Report

BackgroundPatients who receive kidney transplants and experience long-term immunosuppressive therapy are tied to higher risk of developing cancers. Reports concerning about donor-associated cancers are rarely reported, especially for male ovarian cancer.Case reportHere we report a case of donor-derived ovarian malignancy of a man after 3 years of renal transplantation. This case complied with the Helsinki Congress and the Istanbul Declaration. The donor is the recipient's mother who developed ovarian malignancy 6 months after the transplantation surgery and died 1.5 years later after diagnosis due to tumor progression. The patient devolved into abnormal renal function 3 years after the transplantation. The transplanted kidney lost its function and was subsequently surgically removed. The ovary cancer was confirmed as high-grade serous ovarian cancer by pathology and had potentially metastasized to donor kidney. Then the male patient received regular maintenance and dialysis. Four years after transplantation, he gradually developed the symptoms of coughing and sputum and computed tomography examination revealed a lung space-occupying lesion that was confirmed to be a metastatic tumor with the same pathology as before. Platinum-based combination chemotherapy can effectively control the condition; by the last follow-up evaluation, the progression-free survival of the patient was 23.5 months, and the overall survival was 36 months.ConclusionsThis case demonstrates that donor-derived ovarian tumor can be transferred into the recipient via the transplanted kidney even in the male recipient. This observation provides clinicians with effective treatment options for this rare type of patient population.     

宫颈癌患者卵巢转移与保留问题的探讨

宫颈癌的卵巢转移率与病期及组织学类型有关.易发生卵巢转移的高危因素有:子宫颈管深肌层、宫体、宫旁组织受侵犯,淋巴管或血管浸润及盆腔淋巴结转移.早期宫颈癌尤其是鳞癌的卵巢转移率较低,如不存在高危因素,对绝经前患者可考虑保留卵巢.宫颈癌根治术中保留卵巢的方法有:卵巢原位保留、卵巢移位、卵巢移植、卵巢埋藏和卵巢皮质移植.卵巢移位术是保留卵巢最常用的方法.移位术后卵巢的功能与保留的卵巢离放射野边缘的距离密切相关.     

免疫抑制剂在卵巢功能保护应用中的研究进展

近年来,在社会、环境及医源性因素影响下,女性不孕症的发病率显著上升且趋于年轻化,卵巢功能提前耗竭是主要的原因之一。针对肿瘤放化疗、自身免疫性疾病等原因所致的卵巢储备功能减退(DOR)、早发性卵巢功能不全(POI)或卵巢早衰(POF),保护卵巢功能、延缓卵巢功能的下降、保留患者的生育机会是急需解决的问题。目前,免疫抑制剂广泛应用于器官移植及自身免疫性疾病的治疗,也有部分研究将免疫抑制剂应用于POF动物模型或POF患者中进行卵巢功能保护,本文将首次就这一问题进行文献综述。     

Ovarian Auto-Transplantation of Cryopreserved Tissue on Muscle Surface Compared With Subrenal Capsular in Rats

BackgroundFertility protection and ovarian function preservation are important to those undergoing radiation therapy to fight female reproductive cancers. The aim of this study was to explore a new ovarian transplantation position, the surface of thigh muscle, which was biceps femoris muscle in rats.MethodsWe hypothesized that this procedure was comparable to traditional subrenal capsular transplantation and realized a normal ovarian function. The ovarian tissue, after cryopreservation, were transplanted to surface of biceps femoris muscle by suturing.ResultsHistologic examination indicated that the transplanted tissues would survive and support a lower level of follicle growth compared with subrenal capsular (17 ± 2.6 vs 8.9 ± 4; P = .0018). According to weight gaining record, muscle surface transplantation supported appropriate weight gain although the β-estradiol levels did not completely recover. This new procedure could support a basic normal estrous cycle.ConclusionOvarian transplantation through this procedure partly rebuilt ovarian function, which was more likely to be an alternative way for those not suitable for subrenal capsular transplantation.     

A Systematic Study on Reproductive Endocrine Function Recovery From Subcutaneous Ovarian Autotransplantation in Mice After 2 Weeks

BackgroundHeterotopic ovarian transplantation can not only restore the reproductive and endocrine function of animals but can also be studied with a specialized animal model. The aim of the study was to determine whether the reproductive endocrine function of the subcutaneously transplanted ovary was restored after 2 weeks.MethodsThe ovaries of 7-week-old mice were autologously transplanted into the back muscle. Fourteen days later, the ovarian structure was examined by hematoxylin and eosin staining. We continuously observed vaginal smears for changes in the estrous cycle. Estrogen and androgen concentrations were detected on the 14th day. The oocytes were collected and then used for in vitro maturation (IVM) and in vitro fertilization (IVF).ResultsThe cyclical estrous cycle changes were similar to those of the control group. There were no differences in the serum androgen and estrogen levels between the graft and control groups. The oocytes were able to develop into blastocysts after IVM and IVF. These results indicated that ovarian endocrine and reproductive function were restored within 2 weeks.ConclusionOur studies have shown that this ovarian heterotopic autotransplantation technique is able to restore steroidogenic and gametogenic functions at day 14 after transplantation. So far, the 14th day after transplantation is a landmark during the recovery from autologous heterotopic ovarian transplantation in the back of the mouse. This time point is the appropriate window to study heterotopic ovarian transplantation in mice.     

兔卵巢组织移植模型的建立

目的 构建母兔自体及异体卵巢组织移植模型,探索非血管吻合卵巢组织移植的可行性.方法 以母兔为实验动物.A组为阳性对照,不做任何处理;B组为阴性对照,切除母兔的双侧卵巢;C组为自体移植组,分离卵巢组织,切成1 mm3左右大小的米粒块,种植于自体颈部或腹部皮下;D组为异体移植组,异体母兔的卵巢组织处理和种植方法与C组相同.术后观察阴道涂片变化,移植后18、25、35、45以及55 d时分别检测血清雌二醇(E2)和孕酮(P)水平,60 d时处死母兔,子宫称重,对移植物及子宫内膜进行组织学检查.结果 (1)C组与D组中分别有5与3只母兔阴道呈红色或者粉红色、湿润、肿胀,进入发情期;(2)A组、C组和D组术后25 d时血清E2及P水平均高于B组,以后逐渐下降,35 d时达到最低水平,随后又呈上升趋势,至55 d时已明显高于B组(P＜0.05),而B组始终维持在较低水平,未出现升高趋势;(3)A组、C组和D组卵巢皮质内可见不同发育阶段的卵泡;(4)A组、C组和D组母兔子宫内膜表层细胞呈锯齿状,宫腔间隙较宽,被复黏膜层子宫腺发育,固有膜宽大,肌壁厚,而B组母兔宫腔呈裂隙状,黏膜层平坦,缺乏子宫腺,固有膜变窄,肌壁变薄.结论 非血管吻合卵巢组织移植是建立母兔自体及异体卵巢组织移植模型的有效方法,移植物可存活,并进一步释放内源性激素,对靶器官产生作用.     

移植冻融小鼠卵巢组织后显微及超微结构的变化

目的探讨移植过程对冻融小鼠卵巢组织光镜结构及超微结构的改变情况,研究其对小鼠卵巢组织的影响。方法采用4周龄小鼠全卵巢慢冻速融,并移植到同种异体小鼠肾脏被膜下,分别于移植后24h、48h、7d回收移植物。卵巢组织分为新鲜组、冻融组、移植后24h、48h及7d组。光镜和电镜下观察各组形态学的改变。结果光镜下各组小鼠卵巢各级卵泡数具有显著性差异（P〈0．01）,随着移植后时间的推移各级卵泡数和卵泡存活率逐渐下降;各组卵泡超微结构具有差异性,移植对小鼠卵巢卵泡和间质都有损伤,移植后48h间质稀疏,大量红细胞渗出,组织损伤最严重;移植后7d可见有微血管生成,卵泡、细胞器及细胞骨架系统修复良好。结论冻融小鼠卵巢随着移植后时间的推移各级卵泡数和卵泡存活率逐渐下降,组织损伤主要在卵泡和问质,以移植后48h损伤最严重;光镜结合电镜观察能更全面地评价移植过程对冻融小鼠卵巢组织的影响。