食蟹猴自体子宫原位再植研究

Uterine autologous transplantation in cynomolgus monkeys：a preliminary report of 6 case

目的：探讨雌性食蟹猴自体子宫原位再植的手术学方法和其可行性，并评估显微外科技术在子宫再植中的作用。方法2011年5月至2014年3月，将6只7～12岁育龄期雌性食蟹猴，行自体子宫原位再植术。具体方法：随机分为两组，每组3只，A组为非显微镜组，在肉眼直视下进行深部盆腔血管吻合操作；B组为显微镜辅助操作组，采用10倍放大镜显微外科技术辅助手术操作。比较两组食蟹猴内生殖系统解剖数据、手术时间、血管吻合成功率等指标。术后定期行腹部超声观察子宫大小、血供情况，术后3个月剖腹探查评估再植子宫组织学形态。结果 A组切取子宫及血管蒂所需时间平均123．7 min、平均血管吻合时间180．7 min、平均后台灌注时间35．0 min、平均总手术时间为393．7 min；B组切取子宫及血管蒂所需时间平均88．7 min、平均血管吻合时间147．3 min、平均后台灌注时间27．3 min、平均总手术时间320．0 min，与A组相比均显著缩短。 A组后台灌注时间平均35．0 min，B组后台灌注时间平均27．3 min，两组比较差异无统计学意义。两组术中均吻合12条血管，A组3只猴手术血管吻合成功4条，而B组3只猴手术血管吻合12条均成功，两组动脉吻合成功率差异有统计学意义（P＜0．05），静脉吻合成功率差异无统计学意义（P＞0．05）。 A组子宫再植手术成功1例，但术后4周子宫缺血坏死；B组子宫再植手术3例均成功，存活的2例食蟹猴中1例术后17 d恢复月经，另1例于术后第50天恢复月经，术后3个月剖腹探查2例再植的子宫均存活良好。结论食蟹猴自体子宫再植手术技术可行，显微外科技术辅助可显著提高动脉吻合成功率。

Objective To evaluate the surgical feasibility of uterine autologous transplantation in female cynomolgus monkeys and explore the effect of microsurgical technique.Methods From May 2011 to March 2014, 6 female cynomolgus monkeys, aged 7 to 12 years, were randomly divided into 2 surgical groups.In group A, gross surgeries were performed with naked eyes.In group B, uterine re-transplantation was performed under 10-time-magnifying microscopy.Anatomical data and operative durations were recorded and analyzed.Viable uterine tissue and vascular patency were observed on trans-abdominal ultrasonography and second-look laparotomy after 3 months.Results The average uterus retrieval time, average vascular anastomotic time, average perfusion time and average total operative time of group B were 88.7, 147.3 and 320.0 min versus 123.7, 180.7 and 393.7 min in group A.The average perfusion durations were 35.0 and 27.3 min.And there was no inter-group difference.A total of 12 successful vascular procedures （ including 6 internal iliac arteries and 6 uterine-ovary veins） of vascular anastomosis were recorded in group B versus 4 cases （including 1 artery and 3 veins） in group A （vein, P〉0.05;artery, P〈0.05）.In group A, there was only 1 successful operation but uterus turned necrotic after 4 weeks.In group B, the surgical success rate was 100%.However one animal died due to intestinal obstruction.And in another 2 animals, viable uterine tissue and vascular patency were observed on trans-abdominal ultrasonography and second-look laparotomy.Two survivors resumed cyclicity at days 17 and 50 respectively as a sign of re-established uterine function.Conclusion This study has demonstrated the feasibility of uterus transplantation by vascular anastomosis in cynomolgus monkeys.And assistance of microsurgical technique can significantly improve the success rate of arterial anastomosis during uterus transplantation.