在多器官捐献的脑死亡病例中提取子宫的技术及改良方法  

Surgical technique and outcomes of uteri retrieval from brain-dead multi-organ donors：a preclinical research of human uterine transplantation

作　　者：陈高文[1] 刘翔宇 崔曾营[1] 郑友红[1] 江海炜 杨海艳 林燕真 祝颖[1] 王颖[1] 王袁 李肖璇[1] 唐莺 贾琳琳 梁晓媚 杨雨露 龙雨生 朱琳[2] 王沂峰[2] Chen Gaowen;Liu Xiangyu;Cui Zengying;Zheng Youhong;Jiang Haiwei;Yang Haiyan;Lin Yanzhen;Zhu Ying;Wang Ying;Wang Yuan;Li Xiaoxuan;Tang Ying;Jia Linlin;Liang Xiaomei;Yang Yulu;Long Yusheng;Zhu Lin;Wang Yifeng(Department of Obstetrics and Gynecology,Zhujiang Hospital,Southern Medical University,253 Gongye Middle Avenue,Guangzhou 510282,China)

机构地区：[1]南方医科大学珠江医院妇产科,广州510282 [2]南方医科大学第二临床学院

出　　处：《中华医学杂志》2018年第39期3178-3182,共5页National Medical Journal of China

基　　金：广东省自然科学基金资助项目（S2011010004055）;南方医科大学2016年省级大学生创新训练计划项目（201612121055）

摘　　要：目的探讨在多器官捐献的脑死亡病例中提取子宫的技术及改良方法。方法2015年5月至2017年5月对南方医科大学珠江医院4例多器官捐献的脑死亡女性病例进行子宫提取手术（广泛子宫切除术＋宫旁血管游离术）。前2例子宫提取手术在多器官提取手术中为第3顺位，后2例均为第1顺位，前2例子宫提取手术位列肝脏和肾脏提取手术之后。子宫动脉系统采用顺行分离，而子宫静脉系统采用逆行分离的原则。子宫提取后即采用4 ℃的生理盐水和低分子肝素钠的混合液经动脉端进行灌注冲洗，以评估离体子宫的可用性。子宫提取术中，每间隔30 min取子宫肌层组织送病理检查，以评估子宫缺血损伤情况。结果第1例脑死亡多器官捐献患者提取子宫静脉血管失败，第2例右侧子宫静脉撕裂；其余2例均成功提取了包括双侧子宫动静脉、髂内动静脉和卵巢动静脉在内的血管蒂。手术时间152.5±39.0（115～215） min。第3、4枚离体子宫能进行有效体外灌注。结论从脑死亡的多器官捐献病例中提取子宫是可行的，所提取的子宫理论上可用于进行活体的子宫移植。但是子宫静脉回流系统分离是手术最困难的一个环节，而卵巢静脉取代子宫静脉作为移植子宫的静脉主要回流途径有待更多的临床活体子宫移植试验进一步验证。ObjectiveTo evaluate the surgical technique and outcomes of uteri retrieval from brain-dead multi-organ donors.This study is a preclinical research of human living uterine transplantation.MethodsFrom May, 2015 to May, 2017, four uteri retrieval procedures, characterized with radical hysterectomy and uterine vascular pedicles dissection, were performed in multi-organ brain-dead donors.The uterus was the third authorized organ after the kidney and liver retrieval procedures in the first two cases.The uterine pedicles included the uterus, ovaries, fallopian tubes, the upper one-third of the vagina and internal iliac vessels or external iliac vessels.The perfusion of the uterus was conducted after the retrieval for evaluating the availability, followed by histopathological examination of the uterine issues per 30 minutes.ResultsSince the uterine vein was quite difficult to identify and dissect in the first two case, which result in the rupture of triple uterine veins.Therefore, the uterine venous vessels including uterine vein connected with internal iliac vein and internal iliac arteries were selected as vascular grafts and dissected successfully in the last two cases, which could be perfused with the mixture of 4 ℃ heparinized physiological saline through each artery because of shortening the surgical time and arranging the uterine procurement as the first authorized organ procedure.Mean （SD） operative time was 152.5±39.0 min （115-215 min, n=4）.ConclusionOur preliminary experience indicated that the uterus could be retrieved from the brain-dead multi-organ donors and transplanted to the recipient.The attempt of skeletonizing the uterine veins should be replaced by dissection of internal iliac vein.

关 键 词：子宫移植 多器官捐献 脑死亡 子宫静脉 卵巢静脉 

分 类 号：R713.4[医药卫生—妇产科学]