Bedaiwy Mohamed A, Falcone Tommaso
Minimally Invasive Surgery, The Cleveland Clinic Foundation, Cleveland, Ohio, USA.
Reprod Biomed Online. 2007 Mar;14(3):360-71. doi: 10.1016/s1472-6483(10)60880-2.
The objective of this study was to describe the different surgical approaches involved in harvesting and heterotopic autotransplantation of intact ovaries with microvascular anastomosis. Twenty-one synchronized Merino sheep underwent harvesting of their intact ovaries with vascular pedicles. Autotransplantation was performed with fresh (n = 6) and cryopreserved-thawed (C-T; n = 15) ovaries. The ovarian vessels were anastomosed to the deep inferior epigastric vessels using end-to-end (n = 8), end-to-side (n = 6) and fish-mouth modification (n = 7) techniques. Patency of the anastomosis, ischaemia time, hormonal functions and histology were evaluated. In addition, ovarian harvesting techniques in two human subjects were described. Possible autotransplantation sites in humans were suggested. In all, 33.3% (7/21) of all fresh and C-T transplants showed patency after 10 days of follow-up. Patency was observed in 5/8, 2/6 and 0/7 animals using end-to-end, end-to-side and fish-mouth modification for completion of the microvascular anastomosis respectively. Use of the fish mouth modification technique was associated with significantly higher ischaemia time compared with end-to-end (P < 0.01) and end-to-side (P = 0.05) anastomosis. A laparoscopic approach appears to be convenient for ovarian harvesting in humans. The inferior epigastric vessel is probably the most suitable heterotopic vascularizing vessel. End-to-end anastomosis yields the highest patency rate of vascularized grafts.
本研究的目的是描述完整卵巢采集及带微血管吻合的异位自体移植所涉及的不同手术方法。21只同步发情的美利奴绵羊接受了带血管蒂的完整卵巢采集。使用新鲜卵巢（n = 6）和冻融卵巢（C-T；n = 15）进行自体移植。采用端端吻合（n = 8）、端侧吻合（n = 6）和鱼口改良吻合（n = 7）技术将卵巢血管与腹壁下深血管进行吻合。评估吻合的通畅性、缺血时间、激素功能和组织学情况。此外，还描述了两名人类受试者的卵巢采集技术。提出了人类可能的自体移植部位。总体而言，在随访10天后，所有新鲜卵巢和冻融卵巢移植中有33.3%（7/21）显示通畅。分别采用端端吻合、端侧吻合和鱼口改良吻合完成微血管吻合的动物中，通畅率分别为5/8、2/6和0/7。与端端吻合（P < 0.01）和端侧吻合（P = 0.05）相比，使用鱼口改良技术的缺血时间显著更长。腹腔镜手术方法似乎便于人类进行卵巢采集。腹壁下血管可能是最合适的异位血管化血管。端端吻合产生的血管化移植物通畅率最高。
