Nair Anjana, Stega Jeanetta, Smith J Richard, Del Priore Giuseppe
Department of Obstetrics and Gynecology, NY Downtown Hospital, New York, NY 10038, USA.
Ann N Y Acad Sci. 2008 Apr;1127:83-91. doi: 10.1196/annals.1434.003.
Absolute uterine infertility affects millions of women in the United States and more throughout the world. For instance, each year in the United States about 5,000 hysterectomies are performed in women under the age of 24. In total, nearly 9 million women of reproductive age have had a hysterectomy. Based on fecundity rates, thousands of these women may be candidates for uterus transplantation. An ongoing study enrolling some of these potential recipients onto a uterus transplant "waiting list" has revealed that most of these women have Rokitansky syndrome, hysterectomy secondary to endometriosis, cervical cancer, or compelling personal accounts justifying their candidacy. Fertility restoration by uterus transplantation was derived from fertility preservation research, including the development of the radical trachelectomy, oxygenation and perfusion of the in situ uterus, and work with organ donor networks. A decade of modern animal research set the foundation for this human work. Ongoing experiments include stable, long-term large animal allografts for investigating immunosuppression regimens and other transplantation details. Each of the animal models has contributed to the current knowledge base. Recently, nonhuman primates have been used to further investigate the possibility of human uterus transplantation. Nonhuman primate anatomy is analogous to that of humans with notable exceptions. The first human uterus transplant surgery took place in 2000, but it did not result in a pregnancy. However, taken in total, the magnitude of the intervening work from multiple groups throughout the world has made uterus transplantation a topic for discussion. It may also soon be a reality.
绝对子宫性不孕影响着美国数百万女性，全球受影响的女性更多。例如，在美国，每年约有5000例子宫切除术在24岁以下的女性中进行。总计，近900万育龄女性接受了子宫切除术。根据生育力比率，这些女性中有数千人可能是子宫移植的候选人。一项正在进行的研究将其中一些潜在受者列入子宫移植“等待名单”，结果显示，这些女性大多数患有罗基坦斯基综合征、因子宫内膜异位症、宫颈癌而进行子宫切除，或者有令人信服的个人理由证明她们符合候选条件。子宫移植恢复生育能力源于生育力保存研究，包括根治性宫颈切除术的发展、原位子宫的氧合和灌注，以及与器官捐赠网络的合作。十年的现代动物研究为这项人体研究奠定了基础。正在进行的实验包括稳定、长期的大型动物同种异体移植，以研究免疫抑制方案和其他移植细节。每个动物模型都为当前的知识库做出了贡献。最近，非人类灵长类动物被用于进一步研究人类子宫移植的可能性。非人类灵长类动物的解剖结构与人类相似，但有明显例外。首例人类子宫移植手术于2000年进行，但未实现妊娠。然而，总体而言，世界各地多个团队所做的大量工作使子宫移植成为一个讨论话题。它可能很快也会成为现实。
