Department of Plastic and Reconstructive Surgery, University of Tokyo, Tokyo, Japan.
Hum Reprod. 2012 Aug;27(8):2332-40. doi: 10.1093/humrep/des169. Epub 2012 May 30.
For women with congenital uterine infertility, or for those who have undergone hysterectomy, uterine transplantation is one of the potential treatments to regain fertility. In this study, we utilized a primate model of uterine transplantation, and evaluated the patency of our microsurgical anastomoses, and the perfusion of the transplanted uterus.
Two female cynomolgus monkeys underwent surgery. We anastomosed two arteries and one vein in Case 1 and two arteries and two veins in Case 2. The arteries used were the uterine arteries and the anastomosis was done to the external iliac artery. We used one of the ovarian veins in both animals, but resected the ovary from the Fallopian tube. Uterine arterial blood flow and uterine size were determined by intraoperative indocyanine green (ICG) angiography and ultrasonography. The biopsy of the uterine cervix was performed after surgery.
ICG angiography showed that the unilateral uterine artery perfused the bilateral uterine bodies and cervix. In Case 1, ICG angiography showed the occlusion of one of the anastomosed arteries during the operation and the uterus appeared atrophied 2 months after operation. In Case 2, the transplanted uterus survived and normal menstruation occurred. The animal achieved a natural pregnancy and was delivered by the Caeserean section due to early separation of the placenta. The newborn suffered fetal distress.
These results show the anastomosis of at least the bilateral uterine arteries and the unilateral ovarian vein is required for uterus transplantation. This is the first report of a natural pregnancy in a primate following uterine autotransplantation.
对于先天性子宫不孕的女性，或因子宫切除而不孕的女性，子宫移植是恢复生育能力的潜在治疗方法之一。在本研究中，我们利用灵长类动物子宫移植模型，评估了我们显微吻合术的通畅性和移植子宫的灌注情况。
两名雌性食蟹猴接受了手术。在病例 1 中，我们吻合了两条动脉和一条静脉，在病例 2 中，我们吻合了两条动脉和两条静脉。使用的动脉是子宫动脉，吻合到髂外动脉。我们在两只动物中都使用了一条卵巢静脉，但从输卵管中切除了卵巢。术中通过吲哚菁绿（ICG）血管造影和超声检查确定子宫动脉血流和子宫大小。手术后对子宫颈进行活检。
ICG 血管造影显示单侧子宫动脉灌注双侧子宫体和子宫颈。在病例 1 中，ICG 血管造影显示手术中一条吻合动脉闭塞，术后 2 个月子宫出现萎缩。在病例 2 中，移植的子宫存活并出现正常月经。动物自然怀孕，并因胎盘早剥而行剖宫产分娩。新生儿出现胎儿窘迫。
这些结果表明子宫移植至少需要吻合双侧子宫动脉和单侧卵巢静脉。这是首例灵长类动物自体子宫移植后自然妊娠的报道。
