Highlights of human uterus transplantation / 器官移植

As a novel solid organ transplantation, uterus transplantation has become an important approach for women with uterine infertility to obtain biological offspring. Multiple technological challenges exist in uterus transplantation, such as acquisition of vascular pedicle, organ perfusion and vascular suture, etc. However, with the development and application of uterus transplantation in animal model and transplantation in human cadavers, a lot of problems have become new hot topics of discussion, such as the selection of uterus transplantation donors and recipients, selection of uterine vessels, prevention and treatment of complications after uterus transplantation, evaluation of graft vitality, timing of pregnancy and delivery, timing of hysterectomy, mental health of donors and recipients and offspring health, etc. According to current data and outcomes of human uterus transplantation worldwide, these hot topics were reviewed in this article, aiming to provide reference for promoting the development and progress of human uterus transplantation research in China.

A case of spontaneous hemoperitoneum by uterine vessel rupture in pregnancy

A 27-year-old pregnant woman, para 1, was transferred to our hospital at 29+3 weeks of gestation complaining of abdominal pain. She was diagnosed with hemoperitoneum based on ultrasonography. An emergency laparotomy was performed, and the bleeding was confirmed to be caused by ruptured surface blood vessels on the uterine fundus. Hemostasis with compression was successfully performed to sustain the pregnancy, and the patient delivered a full-term baby. Spontaneous hemoperitoneum during pregnancy caused by rupture of uterine blood vessels is very rare. It requires rapid diagnosis and surgical treatment because it increases the morbidity of the fetus and mother. In most incidences of spontaneous hemoperitoneum during pregnancy, a cesarean delivery is performed along with a simultaneous emergency laparotomy. However, in this case, the pregnancy was maintained to full term after surgical hemostasis, which prevented neonatal complications due to premature birth.

Laparoscopic Hysterectomy for Large Uterus：Experience of 200 Cases / 中国微创外科杂志

Objective To explore the feasibility and safety of laparoscopic resection of large uterus . Methods We performed laparoscopic hysterectomy in patients who had more than 3 months pregnant huge uterus in our hospital from January 2010 to December 2013.The mirror trocar was introduced at 5 cm above fundus .Surgical key steps were appropriate management of uterine blood vessels, electrical coagulation of the ascending uterine artery , and dissection of uterine vessels from front , rear, and lateral sides. Results The laparoscopic surgery was completed in all the 200 cases, without conversion to laparotomy .The operation time was 80-170 min,with a mean of 120 min;the blood loss was 20-250 ml,with a mean of 60 ml.No blood transfusion was required due to hemorrhage during operation .Two cases developed deep vein thrombosis at the third day after surgery , and were cured by anticoagulant therapy .Two patients with vaginal stump inflammation at 15 postoperative day were cured by applying the metronidazole powder at vaginal .One patient were sutured by 2 stitches for vaginal stump bleeding at the first month after the operation .The remaining patients had no serious complications .Postoperative hospital stay was (5 ±2) days.Follow-up reviews in 144 patients for 6 months found satisfactory heal of the vaginal stump , normal ultrasonographic results of bilateral ureters , and no abnormity in the pelvic cavity. Conclusion Laparoscopic hysterectomy of large uterus with bipolar coagulation is safe and feasible .