造血干细胞移植术后的重度β地中海贫血患者自体移植冻融卵巢组织诱导青春期发育成功病例1例并文献复习

Puberty induction by autograft of cryopreserved ovarian tissue in a patient with β-thalassemia after hematopoietic stem cell transplantation: a case report and literature review

目的探索自体移植冻融卵巢组织诱导青少年女性青春期发育的可行性。方法重度β地中海贫血患儿造血干细胞移植术前于2019年在中山大学附属第六医院生殖医学中心冷冻卵巢组织11片。患儿造血干细胞移植术后复诊出现卵巢早衰,无青春期发育征象,仍无月经初潮。2022年1月20日通过腹腔镜为患者行原位卵巢组织移植术,共移植卵巢组织5片。术后随访患者性激素水平、生长发育情况及月经是否来潮。结果患者卵巢移植术后5个月现月经初潮。性激素水平表现为卵泡刺激素与黄体生成素明显下降,雌二醇水平明显升高,提示卵巢组织移植成功,卵泡已开始募集及发育。患者彩色超声提示子宫明显增大,子宫内膜增厚,盆腔左侧移植部位探及窦卵泡声像。结论青春期前儿童通过卵巢组织冷冻保存生育力的临床价值。对已经出现卵巢功能衰竭、青春期发育延迟甚至停滞的患儿通过自体冻融卵巢组织移植可诱导自然的青春期发育,恢复患者的生殖内分泌功能。

Objective To explore the feasibility of autologous transplantation of frozen-thawed ovarian tissue to induce pubertal development in adolescent females.Methods Before hematopoietic stem cell transplantation in patient with severeβ-thalassemia,11 pieces of ovarian tissue were frozen in the Center of Reproductive Medicine,the Sixth Affiliated Hospital of Sun Yat-sen University in 2019.The patient was diagnosed as premature ovarian failure after hematopoietic stem cell transplantation.There were no signs of puberty development and menarche.Orthotopic ovarian tissue transplantation was performed for the patient through laparoscopy,and a total of 5 pieces of ovarian tissue were transplanted on January 20,2022.Postoperatively,we followed up the sex hormone levels,growth and development of the patients and menarche.Results The patient developed menarche 5 months after ovarian transplantation.The levels of sex hormones showed that follicle-stimulating hormone and luteinizing hormone were significantly decreased,and estradiol levels were significantly increased,indicating that ovarian tissue transplantation was successful,and follicles had begun to recruit and develop.The patient's ultrasonography revealed a markedly enlarged uterus and a thickened endometrium.Antral follicles were detected in the left implantation site of pelvic cavity.Conclusion Cryopreservation of ovarian tissue is recommended for fertility preservation in prepubertal children.Autologous frozen-thawed ovarian tissue transplantation can induce natural puberty development and restore the reproductive endocrine function in children with ovarian failure,delayed puberty development or even stagnation.