自体子宫移植手术技术的应用研究

发布时间：2018-07-25 10:36

【摘要】：世界范围内约有20%-30%的人受不孕不育问题困扰,辅助生殖技术(ART)的发展对解决不孕不育问题发挥着重大作用。子宫性不育(UFI)患者约占女性人口的3%-5%,但是现有临床应用技术人无法使那些先天性无子宫、子宫畸形等子宫性不育(UFI)患者成功孕育后代。已有研究表明,子宫移植能够使子宫性不育患者成功孕育后代。子宫移植通过将捐赠者子宫取出植入受赠者体内,使子宫性不育患者获得能够孕育后代的正常子宫。确保植入子宫各项功能正常后,子宫移植患者经过体外受精的一系列过程孕育后代,等到胎儿发育成熟时,采用剖腹产使其降生。目前,全世界范围内共有15例人体子宫移植的案例,其中11例子宫成活,只有4例分娩成功。子宫移植手术可能造成子宫血管可塑性降低,胎盘形成缺陷,神经支配功能不足等问题,易导致移植子宫坏死及流产等情况,人子宫移植手术成功率低与缺乏足够动物实验基础密切相关,子宫移植技术仍需足够动物实验基础。在过去的15多年中,世界各地的研究者经过不断探索,已在许多不同种类的动物模型中进行了子宫移植手术,如兔子、羊、猪及非灵长类动物。随着免疫抑制剂的使用,同种异体之间的子宫移植已在部分动物模型中获得成功。猪及灵长类动物的子宫血管大小和骨盆与人类的相似,但由于体积大、血管吻合困难等原因,猪的子宫移植动物模型研究很少。本课题主要通过猪自体子宫移植模型,对猪子宫移植手术技术及子宫移植术后猪的生存情况进行详尽研究,以期为未来开展人类子宫移植提供必要实验基础及临床指导支撑,对治疗女性子宫性不育具有重要意义。
[Abstract]:About 20% to 30% of the people in the world are troubled by infertility. The development of assisted reproductive technology (ART) plays an important role in solving the problem of infertility. Uterine infertility (UFI) patients account for about 3% -5% of the female population, but the existing clinical application technology can not make those congenital uterus, uterine malformation and other uterine infertility (UFI) patients to successfully conceive offspring. Studies have shown that uterine transplants can successfully conceive offspring in infertile women. By removing the donor's uterus and implanting it into the recipient, uterine transplants give infertile patients a normal uterus that can produce offspring. After ensuring the normal function of the implanted uterus, the uterine transplant patient after a series of in vitro fertilization process to conceive the offspring, when the fetus is mature, use caesarean section to make the birth. At present, there are 15 cases of human uterine transplantation worldwide, of which 11 cases survived and only 4 cases were successfully delivered. Uterine transplantation may lead to reduced uterine vascular plasticity, defects in placental formation, insufficient innervation and other problems, which can easily lead to uterine necrosis and miscarriage. The low success rate of human uterus transplantation is closely related to the lack of sufficient animal experimental basis, and the technique of uterine transplantation still needs sufficient animal experimental basis. Over the past 15 years, researchers from all over the world have carried out uterine transplantation in many different animal models, such as rabbits, sheep, pigs and non-primates. With the use of immunosuppressants, allogeneic uterine transplantation has been successful in some animal models. The size of uterine vessels and pelvis of pigs and primates are similar to those of humans, but due to the large size and difficult anastomosis of blood vessels, there is little research on the animal models of pig uterus transplantation. Based on the model of pig autologous uterus transplantation, this paper makes a detailed study on the surgical techniques of pig uterus transplantation and the survival of pigs after uterine transplantation, in order to provide the necessary experimental basis and clinical guidance support for the future development of human uterine transplantation. It is of great significance for the treatment of female infertility.
【学位授予单位】：中国人民解放军医学院
【学位级别】：博士
【学位授予年份】：2016
【分类号】：R713.4

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