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人体子宫移植相关要点讨论

刘宇, 丁岩, 张旭垠, 等. 人体子宫移植相关要点讨论[J]. 器官移植, 2023, 14(2): 305-312. doi: 10.3969/j.issn.1674-7445.2023.02.019
引用本文: 刘宇, 丁岩, 张旭垠, 等. 人体子宫移植相关要点讨论[J]. 器官移植, 2023, 14(2): 305-312. doi: 10.3969/j.issn.1674-7445.2023.02.019
Liu Yu, Ding Yan, Zhang Xuyin, et al. Highlights of human uterus transplantation[J]. ORGAN TRANSPLANTATION, 2023, 14(2): 305-312. doi: 10.3969/j.issn.1674-7445.2023.02.019
Citation: Liu Yu, Ding Yan, Zhang Xuyin, et al. Highlights of human uterus transplantation[J]. ORGAN TRANSPLANTATION, 2023, 14(2): 305-312. doi: 10.3969/j.issn.1674-7445.2023.02.019

人体子宫移植相关要点讨论

doi: 10.3969/j.issn.1674-7445.2023.02.019
基金项目: 

国家重点研发计划 VEG157011

国家自然科学基金青年科学基金 8190061150

详细信息
    作者简介:
    通讯作者:

    华克勤,博士,教授,主任医师,研究方向为生殖内分泌、妇科肿瘤及妇科微创医学,E-mail: huakeqin@126.com

  • 中图分类号: R617, R711.74

Highlights of human uterus transplantation

More Information
  • 摘要: 子宫移植作为一种新兴的实体器官移植,已成为子宫性不孕女性获取生物学后代的重要方式。子宫移植手术本身存在血管蒂提取、器官灌注及血管缝合等方面的技术挑战,但随着子宫移植动物造模及尸体移植手术的开展及应用,子宫移植供受者的选择、子宫血管的选择、子宫移植的并发症及其防治、移植物活力评估、妊娠及分娩时机的选择、子宫切除时机的选择及供受者心理健康及后代健康等问题越发成为讨论的新热点。本文根据全球现有人体子宫移植数据及结局,就以上热点问题进行综述,以期为促进国内人体子宫移植研究的开展和取得更长远的进步提供参考。

     

  • 表  1  目前子宫移植的免疫抑制方案

    Table  1.   Current immunosuppressive regimen for uterine transplantation

    药物 时间(d)
    0 1 2 3 4 5 6 7 ≥8
    甲泼尼龙(静脉滴注,500 mg)  
    抗胸腺细胞球蛋白(静脉滴注,5 mg/kg,每日2次)          
    他克莫司[口服,0.1 mg/(kg·d),每日2次]            
    吗替麦考酚酯(口服,1 g,每日2次)
    泼尼松(口服,5 mg,每日1次)  
    下载: 导出CSV
  • [1] 西京医院成功实施全国第二例子宫移植术[EB/OL]. [2022-09-01]. https://www.fmmu.edu.cn/news/info/1004/160726.htm.
    [2] 张红菊, 张敏, 李丹, 等. 国内首例人亲体子宫移植受体围手术期的护理[J]. 中国实用护理杂志, 2017, 33(22): 1723-1725. DOI: 10.3760/cma.j.issn.1672-7088.2017.22.012.

    ZHANG HJ, ZHANG M, LI D, et al. Perioperative nursing care of the first recipient of human related uterine transplantation in China[J]. Chin J Pract Nurs, 2017, 33(22): 1723-1725. DOI: 10.3760/cma.j.issn.1672-7088.2017.22.012.
    [3] 王晓阳, 杨丽霞, 周瑾, 等. 子宫移植治疗1例先天性子宫阴道缺如综合征病人的围术期护理[J]. 护理研究, 2018, 32(20): 3294-3295. DOI: 10.12102/j.issn.1009-6493.2018.20.036.

    WANG XY, YANG LX, ZHOU J, et al. Perioperative nursing of a patient with congenital uterine vaginal deficiency syndrome treated with uterus transplantation[J]. Chin Nurs Res, 2018, 32(20): 3294-3295. DOI: 10.12102/j.issn.1009-6493.2018.20.036.
    [4] FAVRE-INHOFER A, CARBONNEL M, DOMERT J, et al. Involving animal models in uterine transplantation[J]. Front Surg, 2022, 9: 830826. DOI: 10.3389/fsurg.2022.830826.
    [5] 刘宇, 张英, 华克勤. 子宫移植动物模型的手术研究进展[J]. 器官移植, 2018, 9(6): 463-468. DOI: 10.3969/j.issn.1674-7445.2018.06.013.

    LIU Y, ZHANG Y, HUA KQ. Progress in research on operation of animal model of uterine transplantation[J]. Organ Transplant, 2018, 9(6): 463-468. DOI: 10.3969/j.issn.1674-7445.2018.06.013.
    [6] DION L, SANTIN G, NYANGOH TIMOH K, et al. Procurement of uterus in a deceased donor multi-organ donation national program in france: a scarce resource for uterus transplantation?[J]. J Clin Med, 2022, 11(3): 730. DOI: 10.3390/jcm11030730.
    [7] CASTRO F, EJZENBERG D, PINHEIRO RS, et al. Uterus procurement from deceased donor for transplantation[J]. Transpl Int, 2021, 34(12): 2570-2577. DOI: 10.1111/tri.14143.
    [8] KISU I, BANNO K. Uterus transplantation: from a deceased donor or living donor?[J]. J Clin Med, 2022, 11(16): 4840. DOI: 10.3390/jcm11164840.
    [9] LENTINE KL, SMITH JM, HART A, et al. OPTN/SRTR 2020 annual data report: kidney[J]. Am J Transplant, 2022, 22(Suppl 2): 21-136. DOI: 10.1111/ajt.16982.
    [10] TRAN L, HUMAR A. Current status of adult liver transplantation: utilization of living donor versus deceased donor graft[J]. Curr Opin Organ Transplant, 2021, 26(2): 133-138. DOI: 10.1097/MOT.0000000000000849.
    [11] CHMEL R, PASTOR Z, NOVACKOVA M, et al. Clinical pregnancy after deceased donor uterus transplantation: lessons learned and future perspectives[J]. J Obstet Gynaecol Res, 2019, 5(8): 1458-1465. DOI: 10.1111/jog.13992.
    [12] JOHANNESSON L, RICHARDS E, REDDY V, et al. The first 5 years of uterus transplant in the US: a report from the United States Uterus Transplant Consortium[J]. JAMA Surg, 2022, 157(9): 790-797. DOI: 10.1001/jamasurg.2022.2612.
    [13] GULLO G, ETRUSCO A, FABIO M, et al. The reproductive potential of uterus transplantation: future prospects[J]. Acta Biomed, 2022, 93(2): e2022138. DOI: 10.23750/abm.v93i2.12868.
    [14] KISU I, KATO Y, OBARA H, et al. Emerging problems in uterus transplantation[J]. BJOG, 2018, 125(11): 1352-1356. DOI: 10.1111/1471-0528.15230.
    [15] 陈高文, 刘翔宇, 崔曾营, 等. 在多器官捐献的脑死亡病例中提取子宫的技术及改良方法[J]. 中华医学杂志, 2018, 98(39): 3178-3182. DOI: 10.3760/cma.j.issn.0376-2491.2018.39.010.

    CHEN GW, LIU XY, CUI ZY, et al. Surgical technique and outcomes of uteri retrieval from brain-dead multi-organ donors: a preclinical research of human uterine transplantation[J]. Natl Med J China, 2018, 98(39): 3178-3182. DOI: 10.3760/cma.j.issn.0376-2491.2018.39.010.
    [16] KISU I, BANNO K, AOKI D. Living donor surgery in uterus transplantation: a delicate hysterectomy technique in gynecological surgery[J]. J Obstet Gynaecol Res, 2022, 48(10): 2652-2653. DOI: 10.1111/jog.15355.
    [17] KISU I, BANNO K, MATOBA Y, et al. Current status of uterus transplantation and approaches for future clinical application in Japan[J]. Transplant Proc, 2018, 50(9): 2783-2788. DOI: 10.1016/j.transproceed.2018.02.198.
    [18] LIU Y, ZHANG Y, DING Y, et al. Clinical applications of uterus transplantation in China: issues to take into consideration[J]. J Obstet Gynaecol Res, 2020, 46(3): 357-368. DOI: 10.1111/jog.14199.
    [19] AYOUBI JM, CARBONNEL M, RACOWSKY C, et al. Evolving clinical challenges in uterus transplantation[J]. Reprod Biomed Online, 2022, 45(5): 947-960. DOI: 10.1016/j.rbmo.2022.06.020.
    [20] CARBONNEL M, KARPEL L, CORRUBLE N, et al. Transgender males as potential donors for uterus transplantation: a survey[J]. J Clin Med, 2022, 11(20): 6081. DOI: 10.3390/jcm11206081.
    [21] 陈高文, 李湘元, 郑友红, 等. 临床子宫移植相关问题的探讨[J]. 中华器官移植杂志, 2018, 39(11): 684-688. DOI: 10.3760/cma.j.issn.0254-1785.2018.11.011.

    CHEN GW, LI XY, ZHENG YH, et al. Discussion on the problems related to clinical uterine transplantation[J]. Chin J Organ Transplant, 2018, 39(11): 684-688. DOI: 10.3760/cma.j.issn.0254-1785.2018.11.011.
    [22] JOHANNESSON L, WALLIS K, KOON EC, et al. Living uterus donation and transplantation: experience of interest and screening in a single center in the United States[J]. Am J Obstet Gynecol, 2018, 218(3): 331.e1-331.e7. DOI: 10.1016/j.ajog.2017.11.594.
    [23] ONG JQL, LIM LJH, HO RCM, et al Depression, anxiety, and associated psychological outcomes in living organ transplant donors: a systematic review[J]. Gen Hosp Psychiatry, 2021, 70: 51-75. DOI: 10.1016/j.genhosppsych.2021.03.002.
    [24] BRÄNNSTRÖM M, JOHANNESSON L, DAHM-KÄHLER P, et al. First clinical uterus transplantation trial: a six-month report[J]. Fertil Steril, 2014, 101(5): 1228-1236. DOI: 10.1016/j.fertnstert.2014.02.024.
    [25] EJZENBERG D, ANDRAUS W, BARATELLI CARELLI MENDES LR, et al. Livebirth after uterus transplantation from a deceased donor in a recipient with uterine infertility[J]. Lancet, 2019, 392(10165): 2697-2704. DOI: 10.1016/S0140-6736(18)31766-5.
    [26] WEI L, XUE T, TAO KS, et al. Modified human uterus transplantation using ovarian veins for venous drainage: the first report of surgically successful robotic-assisted uterus procurement and follow-up for 12 months[J]. Fertil Steril, 2017, 108(2): 346-356. DOI: 10.1016/j.fertnstert.2017.05.039.
    [27] TESTA G, MCKENNA GJ, GUNBY RT JR, et al. First live birth after uterus transplantation in the United States[J]. Am J Transplant, 2018, 18(5): 1270-1274. DOI: 10.1111/ajt.14737.
    [28] BALKO J, ZÁMEČNÍK J, CHMEL R. Uterus transplantation in the treatment of female infertility: the pathologists perspective[J]. Cesk Patol, 2022, 58(1): 57-60.
    [29] BALKO J, NOVACKOVA M, SKAPA P, et al. Histopathological examination of the ectocervical biopsy in non-transplanted uteri: a study contributing to the provisional scoring system of subclinical graft rejection after uterus transplantation[J]. Acta Obstet Gynecol Scand, 2022, 101(1): 37-45. DOI: 10.1111/aogs.14280.
    [30] MÖLNE J, BROECKER V, EKBERG J, et al. Monitoring of human uterus transplantation with cervical biopsies: a provisional scoring system for rejection[J]. Am J Transplant, 2017, 17(6): 1628-1636. DOI: 10.1111/ajt.14135.
    [31] D'AMICO G, DEL PRETE L, EGHTESAD B, et al. Immunosuppression in uterus transplantation: from transplant to delivery[J]. Expert Opin Pharmacother, 2023, 24(1): 29-35. DOI: 10.1080/14656566.2022.2090243.
    [32] SCHULZ P, TESTA G, YORK JR, et al. Children after uterus transplantation: 2-year outcomes from the Dallas UtErus Transplant Study (DUETS)[J]. BJOG, 2022, 129(13): 2117-2124. DOI: 10.1111/1471-0528.17270.
    [33] BRÄNNSTRÖM M, DAHM-KÄHLER P, KVARNSTRÖM N, et al. Reproductive, obstetric, and long-term health outcome after uterus transplantation: results of the first clinical trial[J]. Fertil Steril, 2022, 118(3): 576-585. DOI: 10.1016/j.fertnstert.2022.05.017.
    [34] REHMER JM, FERRANDO CA, FLYCKT R, et al. Techniques for successful vaginal anastomosis in the uterine transplantation patient[J]. Fertil Steril, 2021, 115(3): 802-803. DOI: 10.1016/j.fertnstert.2020.05.017.
    [35] JOHANNESSON L, KVARNSTRÖM N, MÖLNE J, et al. Uterus transplantation trial: 1-year outcome[J]. Fertil Steril, 2015, 103(1): 199-204. DOI: 10.1016/j.fertnstert.2014.09.024.
    [36] BHASIN S, KERR C, OKTAY K, et al. The implications of reproductive aging for the health, vitality and economic welfare of human societies[J]. J Clin Endocrinol Metab, 2019, 104(9): 3821-3825. DOI: 10.1210/jc.2019-00315.
    [37] KISU I, BANNO K, AOKI D. Considerations in performing hysterectomy secondary to uterus transplantation[J]. Acta Obstet Gynecol Scand, 2022, 101(8): 933-934. DOI: 10.1111/aogs.14368.
    [38] JÄRVHOLM S, KVARNSTRÖM N, DAHM-KÄHLER P, et al. Donors' health-related quality-of-life and psychosocial outcomes 3 years after uterus donation for transplantation[J]. Hum Reprod, 2019, 34(7): 1270-1277. DOI: 10.1093/humrep/dez087.
    [39] LOTZ M. Public funding of uterus transplantation: deepening the socio-moral critique[J]. Bioethics, 2021, 35(7): 664-671. DOI: 10.1111/bioe.12914.
    [40] FARRELL RM, JOHANNESSON L, FLYCKT R, et al. Evolving ethical issues with advances in uterus transplantation[J]. Am J Obstet Gynecol, 2020, 222(6): 584.e1-584.e5. DOI: 10.1016/j.ajog.2020.01.032.
    [41] JÄRVHOLM S, BOKSTRÖM H, ENSKOG A, et al. Striving for motherhood after uterus transplantation: a qualitative study concerning pregnancy attempts, and the first years of parenthood after transplantation[J]. Hum Reprod, 2022, 37(2): 274-283. DOI: 10.1093/humrep/deab260.
    [42] AGYEMANG-DUAH W, PEPRAH C, PEPRAH P. "Let's talk about money": how do poor older people finance their healthcare in rural Ghana? a qualitative study[J]. Int J Equity Health, 2019, 18(1): 47. DOI: 10.1186/s12939-019-0927-0.
    [43] 2020年全国医疗保障事业发展统计公报[EB/OL]. [2022-09-01]. http://www.nhsa.gov.cn/art/2021/6/8/art_7_5232.html.
    [44] 广东省医疗保障局关于公布心脏移植等修订医疗服务价格项目的通知[A/OL]. [2022-09-01]. http://hsa.gd.gov.cn/zwgk/content/post_3670670.html.
    [45] 河南省人力资源和社会保障厅关于印发《河南省基本医疗保险和生育保险诊疗项目暨医疗服务设施目录(试行)》的通知[A/OL]. [2022-09-01]. https://www.pds.gov.cn/contents/4652/64916.html.
    [46] 倪沪平. 肝移植术"价值医保支付"探索[J]. 中国社会保障, 2020(12): 84. DOI: 10.3969/j.issn.1008-4304.2020.12.042.

    NI HP. Liver transplantation "value medical insurance payment" exploration[J]. China Soc Secur, 2020(12): 84. DOI: 10.3969/j.issn.1008-4304.2020.12.042.
    [47] 浙江试点肝移植术基本医保按绩效支付[EB/OL]. [2022-09-01]. http://www.gov.cn/xinwen/2017-12/09/content_5245565.htm.
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出版历程
  • 收稿日期:  2022-10-19
  • 网络出版日期:  2023-03-15
  • 刊出日期:  2023-03-15

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