人离体子宫冷灌注及冷缺血保存的安全区间

发布时间：2018-04-01 18:13

  本文选题：子宫移植　切入点：器官保存　出处：《山东大学学报(医学版)》2017年01期

【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(P0.05)。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。
[Abstract]:Objective to investigate the safe interval of cold perfusion and cold ischemia preservation of human uterine histidine-tryptophan-ketoglutarate (HTK) solution.Methods 7 patients with cervical cancer underwent extensive hysterectomy and 3 patients were perfused with HTK solution through uterine artery under hypothermia. The perfusion height corresponding to a certain perfusion pressure was measured.A mathematical model of the relationship between perfusion height and perfusion pressure was established in 4 cases. The endometrium and muscle tissue were taken for preservation in HTK preservation solution and normal saline after infusing for a short time at the appropriate perfusion height.According to the different preservation time, the two groups were divided into 0 h group and HTK 3 h group, HTK 6 h group, normal saline 3 h group, normal saline 6 h group and normal saline 24 h group.The morphology of uterine tissue cells and the contractility of smooth muscle were measured with different preservation time, and the optimal preservation time of cold ischemia after uterine perfusion in vitro was analyzed.Results the perfusion height corresponding to the perfusion pressure of 90g 140mm Hg was 62 ~ 122cm. Compared with the 0 h group, there was no obvious change in the morphological structure of the uterine specimens in the HTK3 h and HTK6 h groups under light and electron microscope.However, the samples of HTK 24 h group and all the saline preservation groups showed various degrees of cell edema, and the cells lost contact with each other.There was no significant difference in muscle contractility between HTK3h- HTK6 h and HTK 24h groups, but there was no significant difference in muscle contractility between HTK3h- HTK6 and HTK 24h groups, but there was no significant difference in muscle contractility between HTK group and HTK group at the same time.The maximal amplitude of muscle contraction was significantly decreased in 6 h and 24 h groups of normal saline group (P 0. 05%, P 0. 05%, P 0. 05%, P 0. 05%).Conclusion the safe perfusion height of cryogenic HTK solution in human isolated uterus is 62 ~ 122cm, and the cryogenic ischemia can be tolerated at least 6 h after short-term perfusion with HTK solution at 4 鈩，

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