子宫移植的免疫学研究进展

子宫性不孕(UFI)约占女性不孕原因的8%。在禁止代孕的国家和地区,子宫移植是UFI患者成为遗传学母亲的唯一希望。目前子宫移植已进入人体试验阶段,手术技术上已不存在困难,而移植术前供受者的选择、移植术后的免疫抑制治疗、排斥反应监测、免疫耐受等一系列免疫学相关的问题逐渐引起关注,本文将综述该领域的研究进展。     

子宫移植的伦理学探讨

子宫移植是目前子宫性不孕患者实现自己孕育后代的唯一可行方法。子宫移植现已在外科技术等方面获得了重大突破,并有移植后分娩的成功案例。作为一种涵盖器官移植及辅助生殖两大领域的新技术,子宫移植同样在伦理学方面也存在许多新的问题有待探讨。本文在简单介绍子宫移植研究现状及特点的基础上,重点对子宫移植所涉及的伦理学问题进行探讨分析。     

子宫移植实验研究进展

绝大部分子宫性不育的妇女没有成为遗传母亲的机会,除非采用妊娠代孕。但妊娠代孕有伦理和法律上的问题,所以子宫性不育的最根本、合理的治疗方法是子宫移植。子宫移植可以使妇女成为遗传和妊娠上的母亲。子宫移植作为未来治疗子宫性不孕的有效方法,在许多方面已经取得了研究成果,例如同种异体子宫移植的小鼠术后产下正常后代,现对该领域的研究进展做一综述。     

子宫移植供体选择中的伦理问题

子宫移植技术作为治疗子宫性不孕(UFI)的唯一外科途径,目前已在世界各地得以广泛研究,其中的伦理问题同样争议不断。器官移植供体选择的伦理问题在移植伦理中是不可回避的问题,不同类型的子宫供体也带来了独特的监管难题。无论是活体还是死亡供体,绝经期还是育龄期供体的子宫移植都需评估相关风险和预后并获得知情同意,在器官移植伦理的四个原则基础上才可进行。     

美国生殖医学会关于子宫移植立场声明的解读

子宫移植是目前子宫性不孕患者实现自己孕育后代的唯一可行方法。随着子宫移植在全球范围内的应用增多,一些相关问题也逐渐凸显。但迄今为止,国内外尚无专门针对子宫移植的专家共识或指南。现就对2018年美国生殖医学会(ASRM)关于子宫移植的立场声明进行解读,以为临床医师们在子宫移植中所面临的团队建设、伦理学及知情同意、供者及受者的选择、免疫抑制及排斥反应监测、手术一致性报告标准等问题提供参考。     

自体输卵管移植术的临床应用及方法介绍

我院采用的自体输卵管移植术,经过近10年的临床观察,证明是一种简便、有效、可靠的手术方式,值得同道们共同探讨与完善。1资料与方法1.1研究对象1985～2004年我院行自体输卵管移植术共14例,其中因输卵管间质部阻塞不孕要求手术治疗13例,异位妊娠手术中发现残角子宫而行输卵管移植术1例。14例中原发不孕3例,继发不孕6例,绝育术后要求再通4例,1例异位妊娠破裂手术中发现与子宫相通的输卵管妊娠破裂,无法修复而切除一侧输卵管,另一侧输卵管位于右侧残角子宫上,切除残角子宫同时将输卵管移植于右侧宫角。施术14例,移植26条输卵管。年龄23～42岁…     

辅助生育技术适应于哪些不孕妇女

问 :辅助生育技术适应于哪些不孕妇女 ?答 :造成妇女不孕的原因很多 ,久治无效者可以通过辅助生育技术——体外受精和胚胎移植 (IVF- ET)获得生育机会。其主要手术指征如下 :1　输卵管性不孕　 1输卵管严重粘连 ,通过手术治疗失败者。 2输卵管多处结节硬化而丧失运输能力者。 3输卵管严重阻塞 ,配子不能通过输卵管受精者。4输卵管结核 ,但宫内膜正常者。5多次异位妊娠 ,输卵管严重损害或切除者。上述患者均可作 IVF- ET。2　子宫内膜异位症所致不孕　子宫内膜异位症通过各种治疗后仍存在以下情况适合做 IVF- ET:1药物治疗 3～ 6个周期…     

子宫移植中缺血再灌注损伤的研究进展

子宫移植是治疗子宫性不孕症可行的治疗方法,目前全球共实施52例人类子宫移植,经移植子宫活产者仅14例,成功率低。子宫移植仍面临许多科学问题亟需系统研究,缺血再灌注损伤可能对移植术后子宫的存活和功能恢复具有关键影响。因此,研究子宫的缺血耐受性至关重要,尤其是来源于已故捐献者的子宫。本文总结了有关子宫移植缺血再灌注损伤的研究,对其进展做一综述。     

子宫内膜损伤致不孕症的临床处理

子宫是妊娠建立与维持的必要器官,子宫内膜损伤将导致不孕和反复流产。宫腔粘连是子宫内膜损伤的最常见形式,治疗的主要目的是恢复宫腔形态与子宫内膜的完整性和容受性,以改善妊娠结局。目前,以宫腔镜手术为核心的综合治疗是有效的治疗手段,但术后复发率特别是在重度宫腔粘连患者中仍很高。文章阐述了宫腔粘连所致不孕症的临床治疗进展。     

宫腹腔镜联合手术和子宫输卵管碘油造影在输卵管性不孕中的应用价值

育龄妇女中各种原因所致的不孕症约占10％,其中输卵管性不孕的发病率较高,占不孕症病因的30％～40％。随着宫腔镜、腹腔镜的诊断和治疗技术在妇产科领域的应用和普及,宫腹腔镜联合手术为输卵管性不孕的治疗开辟了一条新途径。子宫输卵管碘油造影（hysterosalpinggography,HSG）广泛应用于不孕症检查中。本文旨在探讨宫腹腔镜联合检查与子宫输卵管碘油造影在诊断子宫输卵管性不孕中的一致性及宫腹腔镜联合在诊治子宫输卵管性不孕的价值。     

Transplantation utérine. État des lieux

Except adoption, absolute uterine factor infertility lacks solution in case of motherhood desire. Gestational surrogacy is still not approved in France. Over the last decade, uterus transplantation experimentation made advances. Data from animal research, progress in immunosuppressive treatment and knowledge about pregnancy after transplantation provide a scenario in which a human allotransplantation project can become reality.     

Uterine Transplantation: Evolving Data,Success, and Clinical Importance

Uterine transplantation is an evolving procedure to allow for childbearing in paitents with absolute uterine factor infertility. The objective of this study was to review the existing literature using a comprehensive PubMed literature search. A systematic medical subheadings search strategy was used with the terms “uterus transplant” and “uterine transplantation”. Of the 75 full-text articles assessed for eligibility, 68 were included in the qualitative synthesis. Of these, 9 were included in the meta-analysis on living donor uterine transplant, 5 on deceased donor uterine transplant, and 6 case reports of single uterine transplants. In conclusion, uterus transplant is a nascent field undergoing a rapid rate of evolution as programs mature their data and increase the number of procedures performed. The most recent publications and advances are thus summarized in this article to capture the most up-to-date information.     

First report on fertility after allogeneic uterus transplantation

Uterus transplantation may become the first available treatment for uterine factor infertility, which is due to the absence or malfunction of the uterus. Here we describe for the first time pregnancy after allogeneic uterus transplantation, as a proof of concept of uterine function in a transplanted uterus in a standardized animal model (rat) under immunosuppression.     

Uterus transplantation: animal research and human possibilities

Uterus transplantation research has been conducted toward its introduction in the human as a treatment of absolute uterine-factor infertility, which is considered to be the last frontier to conquer for infertility research. In this review we describe the patient populations that may benefit from uterus transplantation. The animal research on uterus transplantation conducted during the past two decades is summarized, and we describe our views regarding a future research-based human attempt.     

Uterus transplantation: on the edge

Uterus transplantation for absolute uterus factor infertility is moving closer to human trials. The indication for uterus transplantation is evident as is its potential to ameliorate the social and personal burdens of these patients. The extensive collaborative research efforts between animal works, advancements in transplantation medicine, and immune suppression have culminated in demonstrating its apparent feasibility. As for the concerns regarding its risk, in perspective it is similar to other high-risk pregnancies. Moving uterus transplantation toward clinical applications obviously will require a continued commitment of research and support.     

Uterine transplantation

Uterine factor infertility is either due to congenital malformation or acquired. Most women with uterine factor infertility have no chance to become genetic mothers, except by the use of gestational surrogacy. The logical but radical approach for treatment would be replacement of the unfunctional or absent uterus. Uterine transplantation could allow these women to become both genetic and gestational mothers. The present work reviews the existing literature on the history and recent development around this topic. We also briefly describe a newly developed model for heterotopic uterine transplantation in the mouse, in which pregnancies have been accomplished. Some specific issues that are required to be solved prior any further attempts to transplant the uterus in humans are also addressed.     

Uterine Transplantation: Surgical Innovation in the Treatment of Uterine Factor Infertility

Uterine factor infertility (UFI) is a condition that affects thousands of women and is estimated to have a prevalence as high as one in five hundred reproductive-aged women. A wide range of circumstances can lead to UFI and include women with congenital absence of a uterus (Mayer Rokitansky Kuster Hauser or MRKH syndrome), women who have undergone iatrogenic removal of the uterus, or women who have uteri that are in situ but have been damaged by infection or surgical instrumentation. There have been 17 published reports of human uterine transplantation in the world. This article will summarize the history of human uterine transplantation and discuss our current understanding of the medical, surgical, and ethical considerations surrounding this innovative procedure.     

Uterus transplantation and fertility preservation

Absolute uterine factor infertility (AUFI), with uterine absence or presence of a non-functional uterus, was considered untreatable until 2014, when the first child was born after transplantation of a uterus from a postmenopausal woman to a woman of fertile age who was born with no uterus, as a part of the Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome. Concerning gynaecological cancer, AUFI may occur after hysterectomy for malignancy or after surgery/radiation that will preserve the uterus but causing non-functionality in terms of future implantation and pregnancy. This review summarises the research preparations that paved the way for the clinical introduction of uterus transplantation (UTx) as a treatment for AUFI. We also summarise the human UTx attempts that have been published as well as the live births reported thus far. The clinical use and procedures for UTx are also proposed for a number of gynaecological malignancies.     

Transplantation of the uterus in sheep: methodology and early reperfusion events

AIM: Uterine transplantation is developing into a clinical treatment for uterine factor infertility. An animal model with a similar uterus size and vessels to humans and with pregnancy extending over several months would be beneficial for research on uterine transplantation. The aim of this study was to develop and evaluate autotransplantation of the sheep uterus to an orthotopic position in the pelvis. METHODS: Female sheep (n=7) were subjected to laparotomy with the uterus and its vascular supply and drainage being surgically isolated. The excised uterus was kept ex vivo at +4 degrees C for 60 min and then autotransplanted with vascular end-to-side anastomoses to the external iliac vessels. The effects of uterine blood-reperfusion were assessed by measurements of pCO(2), pO(2), lactate and pH in uterine venous blood. Uterine contractility and histology was assessed after 3 h of reperfusion. RESULTS: Reperfusion of blood was observed in five out of seven transplanted uteri. The pCO(2)/pO(2)-ratio and the lactate level were initially elevated but decreased and became normal after 60 min. After 3 h of reperfusion there was a visible tissue blood flow and spontaneous uterine contractions were seen. Histological analysis revealed a mild inflammation, but no edema or stasis. CONCLUSIONS: This study demonstrates that the sheep uterus can successfully be autotransplanted to an orthotopic position with novel vascular connections. This model is suitable for future experiments studying long-term results concerning uterine viability and pregnancy using a transplanted uterus of similar size to the human uterus.     

Uterine transplantation: one human case followed by a decade of experimental research in animal models

Uterine transplantation (UTx) aims to treat unconditional uterine factor infertility by replacing a non-functioning or non-existing uterus. After one attempt of UTx in the human 10 years ago, intensive research has been performed. The results of these specific studies on surgical technique, ischaemia-reperfusion injury, immunosuppression and fertility are discussed.