人离体子宫冷灌注及冷缺血保存的安全区间  

Safety limit of cold extracorporeal perfusion and ischaemic storage of human uterus

作　　者：许鑫鑫[1] 刘雯[1] 万吉鹏 李涛[2] 王飞[2] 王霞[3] 颜磊[1] 李长忠[2] 陈子江[1] XU Xinxin LIU Wen WAN Jipeng LI Tao WANG Fei WANG Xia YAN Lei LI Changzhong CHEN Zijiang(Center for Reproductive Medicine, Shandong University, National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Key Laboratory of Reproductive Endocrinology （Shandong University）, Ministry of Education, Shandong Provincial Key Laboratory of Reproductive Medicine, Jinan 250001, Shandong, China Department of Gynecology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan 250021, Shandong, China Institute of Physiology, School of Medicine, Shandong University, Jinan 250012, Shandong, China)

机构地区：[1]山东大学附属生殖医院国家辅助生殖与优生工程技术研究中心生殖内分泌教育部重点实验室(山东大学)山东省生殖医学重点实验室,山东济南250001 [2]山东大学附属省立医院妇科,山东济南250021 [3]山东大学医学院生理学研究所,山东济南250012

出　　处：《山东大学学报（医学版）》2017年第1期85-91,共7页Journal of Shandong University:Health Sciences

基　　金：国家自然科学基金(81571414)

摘　　要：目的探讨人离体子宫组氨酸-色氨酸-酮戊二酸盐(HTK)液冷灌注及冷缺血保存的安全区间。方法取因宫颈癌行广泛子宫切除术的患者子宫7例,3例于低温条件下用HTK液经子宫动脉灌注,测定一定灌注压力所对应的灌注高度,建立灌注高度与灌注压之间关系的数学模型;4例在适当灌注高度下短时灌注后取子宫内膜及肌组织于HTK保存液和生理盐水中保存,两组又根据保存时间(0、3、6、24 h)的不同分为0 h组、HTK 3 h组、HTK 6 h组、HTK 24 h组、生理盐水3 h组、生理盐水6 h组和生理盐水24 h组,测定不同保存时限的子宫组织细胞形态及平滑肌收缩能力,分析离体子宫灌注后冷缺血最佳保存时限。结果灌注压90~140 mm Hg对应的灌注高度为62~122 cm;与0 h组比较,HTK3 h组和HTK6 h组的子宫标本在光镜及电镜下形态学结构均未见明显改变,但HTK 24 h组及所有的生理盐水保存组的样本均出现不同程度的细胞水肿、细胞间失去联系、线粒体肿胀及染色质粗染等不可逆的退化性改变;HTK 3 h、HTK 6 h和HTK 24 h组的3组标本的肌收缩力差异均无统计学意义(P=0.772);而与相同时段HTK组标本相比,生理盐水3 h、6 h和24 h组标本的肌收缩最大波幅均明显降低(P<0.05)。结论人类离体子宫组织低温HTK液安全灌注高度是62~122 cm,短时灌注后4℃HTK液保存状态下可耐受冷缺血至少6 h。Objective To investigate the safety limit of cold extracorporeal perfusion with histidine-tryptophane-ketoglutarate（ HTK） and ischaemic storage of human uterus. Methods A total of 7 uteri were obtained from patients undergoing extensive hysterectomy for cervical carcinoma. Three of them were perfused with cold HTK solution through each artery to detect the safe height of perfusion and to establish the mathematical model showing the relation between perfusion height and pressure. The other four uteri were perused at proper height,and then endometrium and myometrial tissues were collected and stored in HTK or normal saline（ NS）. The samples were then divided into 0 h group,HTK 3 hgroup,HTK 6 h group,HTK 24 h group,NS 3 h group,NS 6 h group and NS 24 h group. The cellular morphology and contractility of each group was detected,and the tolerability of human uterine tissue to cold ischaemic after shorttime perfusion was determined. Results The corresponding perfusion height of 90-140 mm Hg perfusion pressure was62-122 cm. Compared with 0 h group,the HTK 3 h and HTK 6 h groups did not exhibit any major changes,while the HTK 24 h group and NS groups displayed degenerative changes such as hydropic changes,loss of intercellular contacts,hydropic mitochondria and coarse chromatin. No apparent difference in contractility was observed in specimens in HTK3 h,HTK 6 h and HTK 24 h groups（ P = 0. 772）,but the contractility weakened significantly in the NS groups compared with the HTK groups（ P〈0. 05）. Conclusion The safe height is 62-122 cm for extracorporeal perfusion of human uterus by cold HTK solution; human uterine myometrial tissue can tolerate cold ischaemia for at least 6 h when stored in HTK solution after short-time extracorporeal perfusion.

关 键 词：子宫移植 器官保存 离体灌注 冷缺血保存 HTK保存液 

分 类 号：R617[医药卫生—外科学]