胎儿卵巢埋植治疗卵巢功能缺如综合征的临床研究

Treatment of ovary functionless syndrome by fetal ovary transplantation

目的 探讨胎儿卵巢埋植治疗卵巢功能缺如综合征的临床应用。方法 选择 2 0～ 2 4孕周的流产胎儿作为供体 ,将胎儿卵巢及其系膜完整取下 ,若抗原配型结果有两个以上位点相同 ,将胎儿卵巢埋植于受体腹直肌内 ,术后抗排斥治疗半年 ,定期行B超、性激素、免疫球蛋白和肝肾功能监测 ,观察卵巢发育、内分泌功能及排斥反应等。结果 本组埋植 4例 ,术后最长者 5年 ,最短者 1年 4个月 ,卵巢均存活 ,术后 8个月卵巢出现分泌功能 ,血清E2 水平由术前 (35 30± 10 31)pmol/L升至 (10 9 75± 19 6 0 ) pmol/L ,埋植前后比较有非常显著性差别(P <0 0 0 1) ;FSH由术前 (98 46± 4 6 3)IU/L降至 (49 94± 19 6 0 )IU/L ,埋植前后比较有非常显著性差别 (P <0 0 1)。结论 孕 2 0～ 2 4周的胎儿卵巢埋植成活率高 ,排斥反应小 ,功能建立快 。

Objective To investigate the therapeutic role of fetal ovary transplantation in the recipients of the ovary functionless syndrome.Methods Fetuses of abortion during 20～24 gestational weeks were selected as donors.The ovaries with mesovarium were cut off from the fetuses and were implanted into the rectus muscles of recipients if at least two locuses of HLA were same.The recipients received anti-rejection treatment for 6 months after operation.The ultrasonography,reproductive hormone,immunoglobulin and the function of the liver and kidney were examined regularly, meanwhile,we monitored the ovaries for their development and secrete function and the rejective reaction of the recipients.Results The implanted ovaries all survived in our four recipients,5 years for the longest one and 16 months for the shortest one.The ovaries secreted hormones 8 months after operation.The level of E 2 in the sera elevated significantly from (35 30±10 31)pmol/L before operation to (109 75±19 60)pmol/L after operation (P<0 001).The FSH level decreaed significantly from (98 46±4 63)IU/L before operation to (49 94±19 60)IU/L after operation (P<0 01).Conclusion The survival rate of transplantation of fetal ovary from 20～24 gestational weeks is higher and the rejective reaction is lesser. The functions of transplanted ovary are established rapidly.It is a good method for treatment of ovary functionless syndrome.