Division of Gynecology, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd, Weston, FL, USA.
Obstetrics, Gynecology, and Women's Health Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, USA.
Hum Reprod. 2018 Dec 1;33(12):2232-2240. doi: 10.1093/humrep/dey307.
Is there perfusion to the fallopian tubes in ex-vivo and in-vivo uteri at the time of total laparoscopic hysterectomy (TLH), as observed using laser angiography with indocyanine green (ICG)?
The fallopian tubes may have perfusion from the utero-ovarian vasculature alone.
The fallopian tubes are perfused by the uterine and utero-ovarian vessels. Perfusion can be measured using laser angiography with ICG.
STUDY DESIGN, SIZE, DURATION: This prospective pilot cohort study included 15 women, ages 32-59 years old, who underwent TLH with bilateral salpingectomy for benign indications.
PARTICIPANTS/MATERIALS, SETTING, METHODS: In five participants, TLH was performed and the utero-ovarian artery was cannulated ex vivo and injected with ICG. The other 10 participants underwent the in-vivo protocol. The mesosalpinx and uterine vessels were transected in the partial protocol. Colpotomy was also performed in the complete protocol. All fallopian tubes were imaged using laser angiography with ICG. The relative fluorescence and the fluorescence intensity ratio (length of fluorescent fallopian tube/total length of fallopian tube) of the fallopian tubes were measured in the ex-vivo and in-vivo protocols, respectively.
Ex vivo, the fimbria of the ipsilateral fallopian tube had 47% median relative fluorescence as compared to the contralateral fallopian tube, which had 2.4% median relative fluorescence. In vivo, the post-ICG fluorescence intensity ratios were 0.61 ± 0.40 for the partial protocol, and 0.78 ± 0.30 for the complete protocol, with mean differences of 0.37 (95% CI: 0.23-0.50, P < .0001) and 0.22 (95% CI: 0.12-0.31, P < 0.0001), respectively, between the pre-procedure and the post-ICG fluorescence intensity ratios. Greater than 0.75 fluorescence intensity ratios (i.e. >75% tubal length fluorescence) was seen in 60% of fallopian tubes.
LIMITATIONS, REASONS FOR CAUTION: This is a pilot study with a small sample size and pathologic uteri, which would not be appropriate for uterine transplantation. No conclusions can be made regarding the functionality of the fallopian tubes.
The fallopian tubes may have perfusion with the utero-ovarian vasculature alone, potentially allowing for future animal studies regarding tubal viability in recipients of uterine-tubal transplants. If successful, human uterine-tubal transplantation may allow for spontaneous conception rather than IVF.
STUDY FUNDING/COMPETING INTEREST(S): No external funding was used. S.F., P.F.P., K.A.S. and R.F. have no conflicts of interest to report. M.L.S. is an educational consultant for Medtronic (Dublin, Republic of Ireland) and Applied Medical (Rancho Santa Margarita, CA, USA), as well as a stockholder for SynDaver Labs (Tampa, FL, USA). S.E.Z. is an educational consultant for Applied Medical (Rancho Santa Margarita, CA, USA) and is on the advisory board for AbbVie Inc. (Chicago, IL, USA).
Not applicable.
在腹腔镜子宫切除术（TLH）过程中，使用吲哚菁绿（ICG）激光血管造影术观察到输卵管是否存在来自子宫卵巢血管的灌注？
输卵管可能仅由子宫和子宫卵巢血管供血。
输卵管由子宫和子宫卵巢血管灌注。可以使用 ICG 激光血管造影术测量灌注情况。
研究设计、大小、持续时间：这项前瞻性试点队列研究纳入了 15 名年龄在 32-59 岁之间的女性，因良性指征行 TLH 伴双侧输卵管切除术。
参与者/材料、设置、方法：在 5 名参与者中，进行 TLH 并在离体状态下对子宫卵巢动脉进行插管和 ICG 注射。其余 10 名参与者接受了体内方案。在部分方案中横断了输卵管系膜和子宫血管。在完整方案中还进行了阴道切开术。使用 ICG 激光血管造影术对所有输卵管进行成像。在离体和体内方案中分别测量输卵管的相对荧光强度和荧光强度比（荧光输卵管长度/输卵管总长度）。
离体时，与对侧输卵管的 2.4%中位相对荧光强度相比，同侧输卵管的输卵管伞部具有 47%的中位相对荧光强度。在体内，部分方案中 ICG 后荧光强度比为 0.61±0.40，完整方案中为 0.78±0.30，平均差异为 0.37（95%CI：0.23-0.50，P<0.0001）和 0.22（95%CI：0.12-0.31，P<0.0001），分别为 ICG 前后荧光强度比之间。60%的输卵管出现大于 0.75 的荧光强度比（即>75%的输卵管长度荧光）。
局限性、谨慎的原因：这是一项样本量较小且为病理性子宫的试点研究，不适合子宫移植。不能就输卵管的功能得出任何结论。
输卵管可能仅由子宫卵巢血管供血，这可能为未来关于子宫-输卵管移植受者输卵管存活能力的动物研究提供了可能性。如果成功，人类子宫-输卵管移植可能允许自然受孕，而不是体外受精。
研究资金/利益冲突：未使用外部资金。S.F.、P.F.P.、K.A.S.和 R.F.没有利益冲突需要披露。M.L.S.是 Medtronic（爱尔兰共和国都柏林）和 Applied Medical（加利福尼亚州拉古纳圣玛格丽塔）的教育顾问，也是 SynDaver Labs（佛罗里达州坦帕）的股东。S.E.Z.是 Applied Medical（加利福尼亚州拉古纳圣玛格丽塔）的教育顾问，也是 AbbVie Inc.（伊利诺伊州芝加哥）的顾问委员会成员。
不适用。
