Brännström Mats, Dahm-Kähler Pernilla, Ekberg Jana, Akouri Randa, Groth Klaus, Enskog Anders, Broecker Verena, Mölne Johan, Ayoubi Jean-Marc, Kvarnström Niclas
Department of Obstetrics & Gynecology, Sahlgrenska Academy, University of Gothenburg, SE-41345 Göteborg, Sweden.
Department of Transplantation, Sahlgrenska Academy, University of Gothenburg, SE-41345 Göteborg, Sweden.
J Clin Med. 2020 Jul 22;9(8):2338. doi: 10.3390/jcm9082338.
Uterus transplantation has proved to be a feasible treatment for uterine factor infertility. Herein, we report on recipient outcome in the robotic uterus transplantation trial of 2017-2019. The eight recipients had congenital uterine aplasia. The donors were six mothers, one sister, and one family friend. Donor surgery was by robotic-assisted laparoscopy. Recipient surgery was by laparotomy and vascular anastomoses to the external iliacs. The duration (median (ranges)) of recipient surgery, blood loss, measured (left/right) uterine artery blood flow after reperfusion, and length of hospital stay were 5.15 h (4.5-6.6), 300 mL (150-600), 43.5 mL/min (20-125)/37.5 mL/min (10-98), and 6 days (5-9), respectively. Postoperative uterine perfusion evaluated by color Doppler showed open anastomoses but restricted blood distribution in two cases. Repeated cervical biopsies in these two cases initially showed ischemia and, later, necrosis. Endometrial growth was not seen, and hysterectomy was later performed, with pathology showing partly viable myometrium and fibrosis but necrosis towards the cavity. The other six patients acquired regular menstrual cyclicity. Surgery was performed in two patients to correct vaginal stenosis. Reversible rejection episodes were seen in two patients. In conclusion, the rate of viable uterine grafts during the initial 6-months of the present study (75%) leaves room for improvement in the inclusion/exclusion criteria of donors and in surgical techniques. Initial low blood flow may indicate subsequent graft failure.
子宫移植已被证明是治疗子宫因素不孕症的一种可行方法。在此，我们报告2017 - 2019年机器人子宫移植试验中受者的结局。8名受者患有先天性子宫发育不全。供者为6名母亲、1名姐妹和1名家庭朋友。供者手术采用机器人辅助腹腔镜手术。受者手术采用剖腹术并与髂外血管进行血管吻合。受者手术持续时间（中位数（范围））、失血量、再灌注后测量的（左/右）子宫动脉血流量以及住院时间分别为5.15小时（4.5 - 6.6小时）、300毫升（150 - 600毫升）、43.5毫升/分钟（20 - 125毫升/分钟）/37.5毫升/分钟（10 - 98毫升/分钟）和6天（5 - 9天）。彩色多普勒评估的术后子宫灌注显示吻合口通畅，但2例患者血液分布受限。这2例患者反复进行宫颈活检，最初显示缺血，后来出现坏死。未见子宫内膜生长，随后进行了子宫切除术，病理显示部分存活的肌层和纤维化，但向宫腔方向有坏死。其他6名患者出现了规律的月经周期。2名患者进行了手术以纠正阴道狭窄。2名患者出现了可逆性排斥反应。总之，在本研究的最初6个月中，存活子宫移植物的比例（75%）表明在供者的纳入/排除标准和手术技术方面仍有改进空间。最初的低血流量可能预示着随后的移植物失败。
