机器人手术联合新生血管化人细胞外基质支架的卵巢移植：与荟萃分析数据比较的病例系列研究。
Ovarian transplantation with robotic surgery and a neovascularizing human extracellular matrix scaffold: a case series in comparison to meta-analytic data.
机构信息
Department of Obstetrics, Gynecology and Reproductive Sciences, Laboratory of Molecular Reproduction and Fertility Preservation, Yale University School of Medicine, New Haven, Connecticut; Innovation Fertility Preservation and IVF, New York, New York.
Department of Obstetrics, Gynecology and Reproductive Sciences, Laboratory of Molecular Reproduction and Fertility Preservation, Yale University School of Medicine, New Haven, Connecticut; Department of Women's and Children's Health, University of Padua, Padua, Italy.
出版信息
Fertil Steril. 2022 Jan;117(1):181-192. doi: 10.1016/j.fertnstert.2021.08.034. Epub 2021 Nov 17.
OBJECTIVE
To report our experience with robot-assisted (RA) autologous cryopreserved ovarian tissue transplantation (ACOTT) with the use of a neovascularizing extracellular matrix scaffold.
DESIGN
Case series with meta-analytic update.
SETTING
Academic.
PATIENT(S): Seven recipients of RA-ACOTT.
INTERVENTION(S): Before or shortly after initiating chemotherapy, ovarian tissue was cryopreserved from 7 women, who then underwent RA-ACOTT 9.9 ± 1.8 years (range, 7-12 years) later. Perioperatively, they received transdermal estrogen and low-dose aspirin to enhance graft vascularization. Ovarian cortical pieces were thawed and sutured on an extracellular matrix scaffold, which was then robotically anastomosed to the bivalved remaining ovary in 6 cases and retroperitoneally (heterotopic) to the lower abdomen in 1 case.
MAIN OUTCOME MEASURE(S): Ovarian function return, the number of oocytes/embryos, aneuploidy %, live births, and neonatal outcomes were recorded. Graft longevity was compared with the mean from the meta-analytic data.
RESULT(S): Ovarian function returned 13.9 ± 2.7 weeks (11-16.2 weeks) after ACOTT, and oocytes were retrieved in all cases with 12.3 ± 6.9 embryos generated. In contrast to orthotopic, the heterotopic ACOTT demonstrated low embryo quality and an 80% aneuploidy rate. A recipient did not attempt to conceive and 2 needed a surrogate, whereas 4 of 4 delivered 6 healthy children, compared with 115 of 460 (25% pregnancy rate) from the meta-analytic data (n = 79). The mean graft longevity (43.2 ± 23.6/47.4 ± 22.8 months with/without sensitivity analysis) trended longer than the meta-analytic mean (29.4 ± 22.7), even after matching age at cryopreservation.
CONCLUSION(S): In this series, RA-ACOTT resulted in extended graft longevity, with ovarian functions restored in all cases, even when the tissues were cryopreserved after chemotherapy exposure.
目的
报告我们使用新生血管化细胞外基质支架进行机器人辅助（RA）自体冷冻卵巢组织移植（ACOTT）的经验。
设计
病例系列并进行荟萃分析更新。
设置
学术环境。
患者
7 名接受 RA-ACOTT 的患者。
干预措施
在开始化疗之前或不久后，从 7 名女性中冷冻保存卵巢组织，然后在 9.9 ± 1.8 年后（7-12 年）进行 RA-ACOTT。围手术期，她们接受透皮雌激素和低剂量阿司匹林以增强移植物血管化。将卵巢皮质片解冻并缝合在细胞外基质支架上，然后在 6 例中将支架机器人吻合到两半剩余的卵巢上，在 1 例中将支架异位于下腹部的后腹膜。
主要观察指标
记录卵巢功能恢复、卵母细胞/胚胎数量、非整倍体率、活产和新生儿结局。比较移植物的寿命与荟萃分析数据的平均值。
结果
ACOTT 后 13.9 ± 2.7 周（11-16.2 周）恢复卵巢功能，所有病例均获得卵母细胞，并产生 12.3 ± 6.9 个胚胎。与原位相比，异位 ACOTT 表现出低胚胎质量和 80%的非整倍体率。1 名患者未尝试受孕，2 名需要代孕，而 4 名患者中的 4 名成功分娩了 6 名健康儿童，而荟萃分析数据中 79 例（n = 460）的妊娠率为 25%（115 例妊娠）。（无敏感性分析），即使在匹配冷冻保存时的年龄后，移植物的平均寿命（43.2 ± 23.6/47.4 ± 22.8 个月）也呈现出更长的趋势。
结论
在本系列中，RA-ACOTT 导致移植物的寿命延长，所有病例均恢复卵巢功能，即使组织在化疗暴露后冷冻保存。
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