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子宫移植 为不孕妇女带来新希望

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  本文摘要:CLEVELAND — Six doctors swarmed around the body of the deceased organ donor and quickly started to operate.克利夫兰——六名医生环绕在器官捐献者的遗体周围,很快开始手术。

CLEVELAND — Six doctors swarmed around the body of the deceased organ donor and quickly started to operate.克利夫兰——六名医生环绕在器官捐献者的遗体周围,很快开始手术。The kidneys came out first. Then the team began another delicate dissection, to remove an organ that is rarely, if ever, taken from a donor. Ninety minutes later they had it, resting in the palm of a surgeons hand: the uterus.他们首先放入了死者的肾脏。

然后,团队开始了另一项精细的解剖学工作,目的是放入一个此前很少——是说道,如果曾多次有过的话——从捐献者体内摘的器官。90分钟之后,他们顺利了,一名外科医生用手掌捧着它:子宫。

The operation was a practice run. Within the next few months, surgeons at the Cleveland Clinic expect to become the first in the United States to transplant a uterus into a woman who lacks one, so she can become pregnant and give birth. The recipients will be women who were either born without a uterus, had it removed or have uterine damage. The transplants will be temporary: each uterus will be removed after the recipient has had one or two babies, so she can stop taking transplant anti-rejection drugs.这是一次试验性的手术。在接下来的几个月内,克利夫兰医院(Cleveland Clinic)的外科医生们未来将会已完成美国的首例子宫移植手术。

手术的受者将是天生缺陷子宫,或因故手术子宫又或者子宫损毁的女性,她将因此取得分娩和生育的能力。但这只是暂时性的重制:当受者生下一两个孩子后,子宫就不会被去除,这样受者就需要之后服用外用敌视药物了。Uterine transplantation is a new frontier, one that pairs specialists from two fields known for innovation and for pushing limits, medically and ethically: reproductive medicine and transplant surgery. If the procedure works, many women could benefit: an estimated 50,000 women in the United States do not have a uterus. But there are potential dangers.子宫重制是一个新兴的前沿领域,它进发了从医学和伦理学上均以创意和突破无限大闻名的生殖医学和移植手术这两方面的专家。

它的顺利将为众多妇女带给福音:在美国,估算有5万名女性没子宫。只不过,这个程序并非仅有无潜在危险性。The recipients, healthy women, will face the risks of surgery and anti-rejection drugs for a transplant that they, unlike someone with heart or liver failure, do not need to save their lives. Their pregnancies will be considered high-risk, with fetuses exposed to anti-rejection drugs and developing inside a womb taken from a dead woman.首先,不同于那些因为心脏或肝脏中风而被迫必须依赖移植手术来救命的患者,子宫重制的受者在其他方面都十分身体健康,该程序却令其她们面对动手术和拒绝接受外用敌视药物所带给的风险。

其次,由于胎儿在从已故的供者体内摘的子宫内发育,且将不可避免地认识到外用敌视药物,胎儿风险十分低。Eight women from around the country have begun the screening process at the Cleveland Clinic, hoping to be selected for transplants. One, a 26-year-old with two adopted children, said she still wanted a chance to become pregnant and give birth.目前,有数八名来自全美各地的妇女前往克利夫兰医院拒绝接受检验,期望能被选为重制受者。其中一名早已领养了两个孩子的26岁女性称之为,她依然期望自己有机会可以分娩和生育。

“I crave that experience,” she said. “I want the morning sickness, the backaches, the feet swelling. I want to feel the baby move. That is something Ive wanted for as long as I can remember.”“我渴求能享有那样的体验,”她说道。“我想体会孕吐、腰酸背痛和双脚出血的感觉。我想感觉宝宝在我体内活动。这是我自记事以来仍然的希望。

”She traveled more than 1,000 miles to the clinic, paying her own way. She asked that her name and hometown be withheld to protect her familys privacy.她自费长途跋涉1000多英里(约合1609千米)回到了克利夫兰医院。为了维护她家人的隐私,本文按她的拒绝略去了她的名字和家乡。She was 16 when medical tests, performed because she had not begun menstruating, found that she had ovaries but no uterus — a syndrome that affects about 1 in 4,500 newborn girls. She comes from a large family, she said, and always assumed that she would have children. The test results were devastating.由于仍然没月经来潮,她在16岁时拒绝接受了内科检查,这才找到她虽然有卵巢却没子宫——这是一种在4500名新生女婴中才有1例的综合征。她来自一个大家庭,她说道,她仍然以为自己不会生很多孩子。

这个检查结果对她来说真是是一场灾难。Dr. Andreas G. Tzakis, the driving force behind the project, said, “There are women who wont adopt or have surrogates, for reasons that are personal, cultural or religious.” Tzakis is the director of solid organ transplant surgery at a Cleveland Clinic hospital in Weston, Florida. “These women know exactly what this is about,” he said. “Theyre informed of the risks and benefits. They have a lot of time to think about it, and think about it again. Our job is to make it as safe and successful as possible.”该项目的发起人,克利夫兰医院医院(Cleveland Clinic hospital,坐落于佛罗里达州韦斯顿市)的实体器官移植外科主任安德烈亚斯·G·察基斯(Andreas G. Tzakis)博士说道:“出于个人、文化或宗教原因,有些妇女无法领养孩子或去找人领养。

”他还说道:“这些妇女很确切这项程序究竟是怎么一其实,她们理解它有可能的风险和收益,也有很多时间去重复思维。而我们的工作是使其尽量地安全性和顺利。”Laying the Groundwork打下基础The hospital plans to perform the procedure 10 times, as an experiment, and then decide whether to continue. Tzakis said he hoped to eventually make the operation readily available in the United States.医院计划再行实验性地展开10次这样的程序,然后再行要求否继续下去。

察基斯博士说道,他期望惜有一天美国可以实行这样的手术。Sweden is the only country where uterine transplants have been completed successfully — all at the University of Gothenburg with a uterus from a live donor. Nine women have had them, and four have given birth, the first in September 2014. Another is due in January. Their babies were born healthy, though premature. Two transplants failed and had to be removed, one because of a blood clot and the other because of infection.瑞典是全世界唯一顺利已完成过子宫移植手术的国家。所有这些手术皆在哥德堡大学展开,而且子宫皆源于活体供者。

共计九名女性拒绝接受过重制,其中四人早已生育,第一名婴儿在2014年9月出生于。还有一名妇女的预产期在明年1月。这些婴儿虽然早产,但都身体健康地降临了。有两例重制遭告终(一例是经常出现了血凝块,另一例是因为病毒感染),被迫切除了移植物。

Two earlier attempts — one in Saudi Arabia, and one in Turkey — failed. Other hospitals in the United States, and in Britain, are also preparing to try the surgery, but are not as close as the team in Cleveland is.此前,沙特阿拉伯和土耳其也各自展开过一次类似于的尝试,但皆以告终收场。美国其他医院以及英国也争相打算试验这样的手术,但他们的进展都近不及克利夫兰医院的团队。Tzakis said the anti-rejection drugs were safe, noting that thousands of women with donor kidneys or livers, who must continue taking anti-rejection drugs during pregnancy, had given birth to healthy babies. Those women are more likely than others to have pre-eclampsia, a complication of pregnancy involving high blood pressure, and their babies tend to be smaller. But it is not known whether those problems are caused by the drugs, or by the underlying illnesses that led to the transplants. Because the women receiving uterine transplants would be healthy, Tzakis said, he was optimistic that complication rates would be very low.察基斯博士指出外用敌视药物是安全性的,并认为,成千上万拒绝接受了肾脏或肝脏重制,被迫在分娩期间之后服用外用敌视药物的孕妇都产下了身体健康的宝宝。

这些孕妇比其他人更容易患上先兆子痫(一种与高血压有关的胎儿并发症),且她们的孩子往往个体较小,不过目前尚能不确切这些问题是药物引发的,还是因最初造成受体女性丧失子宫的那些疾病导致。察基斯博士说道,由于拒绝接受子宫重制的都是身体健康的妇女,他悲观地指出,并发症的发生率应当很低。

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A medical ethicist not connected with the research, Jeffrey Kahn, of Johns Hopkins University, said the procedure did not set off any alarms with him.与该研究牵涉到的一名医疗伦理学家,约翰斯·霍普金斯大学(Johns Hopkins University)的杰弗里·卡恩称之为(Jeffrey Kahn)回应,该手术并没令其他实在不悦。“Were doing lots of things to help people have babies in ways that were never done before,” Kahn said. “It falls into that spectrum.”“我们正在以前所未有的方式,大力协助人们享有自己的孩子,”卡恩说道。

“子宫移植手术正是其中之一”。A Complicated Process 简单的程序The Swedish team used live donors, and showed that a uterus from a woman past menopause, transplanted into a young recipient, can still carry a pregnancy. In five cases, the donor was the recipients mother, which raised the dizzying possibility of a woman giving birth from the same womb that produced her.瑞典的团队用于的是活体供者,并证明,来自绝经期女性的子宫在重制到年长受者体内后,仍然不具备胎儿功能。其中五例手术的供者是受者的母亲,这也就造成了一个能把人绕晕了的可能性——受者将从曾多次孕育出她自己的那同一个子宫中怀孕出有自己的孩子。

The Cleveland doctors will use deceased donors, to avoid putting healthy women at risk. For a live donor, the operation is far more complicated than a standard hysterectomy and takes much longer, seven to 11 hours, Tzakis said, adding, “You have to work near vital organs.”克利夫兰医院的医生们将用于胞弟捐赠者的子宫,以防止将身体健康女性置放危险性之中。察基斯博士说道,对活体供者展开手术,远比标准的子宫切除术更加简单,也必须更长的时间(7至11小时),他还补足道:“(而且)你将被迫在她的最重要器官附近已完成简单操作者。

”The surgeons have to remove part of the donors vagina and other tissue needed to attach the uterus to the recipient. And they must tease away tiny blood vessels without harming the donor.外科医生必须手术供者的部分阴道以及将子宫相连到受者体内所需的其他的组织,还必需在不伤害供者的前提下挤压小血管。The uterine vessels are wound around the ureters, which carry urine from the kidneys to the bladder. “Theyre like worms wrapped around a tube,” Tzakis said. “Its very tedious to separate them.”子宫血管卷曲在负责管理将尿液从肾脏输送到膀胱的器官——输尿管的周围。

“它们像蠕虫一样缠绕在输尿管上,”察基斯博士说道。“挤压它们可是十分困难的苦差事。”With deceased donors, there is no need to worry about injuries. The organ can be removed faster, and can survive outside the body for at least six to eight hours if kept cold.在胞弟的捐赠者身上做手术,就不必须这么多的疑虑了。

器官可以更加慢地被切除,如果维持低温,它可以在体外存活最少六至八小时。Because the fallopian tubes will not be connected to the transplanted uterus, a natural pregnancy will be impossible.因为重制子宫上未相连输卵管,所以受者不有可能大自然分娩。Instead the recipients will go through in vitro fertilization. Before the transplant, the woman will be given hormones to stimulate her ovaries to produce multiple eggs. Ten will be needed, so she may have to go through more than one cycle of hormone treatment. Doctors will collect the eggs, fertilize them with her partners sperm and freeze them. Once there are 10 embryos in the freezer, the woman will be put on the waiting list for a transplant.她们将拒绝接受体外受精。

在重制前,这些妇女不会拒绝接受激素化疗,性刺激她的卵巢排泄多个卵细胞。体外受精大约必须十个卵细胞,因此激素化疗有可能好比一轮。然后,医生将搜集这些卵细胞,用于这些女性各自伴侣的精子分别对它们生殖,待受精卵发育到一定阶段后再行将其冻存一起。待到攒够10个冻存胚胎,这名妇女就不会被排出重制等候名单。

When a donor with matching blood and tissue type becomes available, the transplant will take place.此时,只要有血液和的组织型都给定的供者,就可以展开移植手术了。The transplant surgery is expected to take about five hours. It requires connecting an artery and a vein on either side of the uterus to the recipients blood vessels. The organ will have part of the donors vagina attached, and that will be stitched to the recipients vagina. Supporting tissue attached to the uterus will be sewn into the recipients pelvis to stabilize the transplant. No nerves have to be connected.移植手术预计必须五个小时左右。在这个过程中,医生们不会将子宫两侧的动脉和静脉与受者的血管连接。

该子宫不会具有供者的部分阴道,它也将穿孔在受者的阴道上。吸附于子宫的反对的组织亦将被缝入受者的骨盆,以平稳移植物。但须相连神经。The woman will wait one year to heal from the surgery and adjust the doses of anti-rejection medicine before trying to become pregnant.受者将必须一年的时间从手术中康复并调整外用敌视药物的剂量,其后才能开始尝试分娩。

Then doctors will implant one embryo at a time in the uterus, until the recipient becomes pregnant. The baby will be delivered by cesarean section before the due date, to protect the transplanted uterus from the strain of labor.然后,医生将不会向子宫内植入胚胎,每次一个,直到受者顺利胎儿。为防止重制子宫遭到怀孕的压力,婴儿将在预产期前以剖宫产的方式降临。After giving birth, the mother can either keep the uterus so she can try to have one more baby (two is the limit, for safety reasons), or have it removed so she can stop taking the anti-rejection drugs. If she does not want to have surgery to have it removed, doctors said it may be possible to quit the drugs and let the immune system reject the uterus, which should then gradually wither away.生完孩子后,母亲可以自由选择保有子宫,试着再造一个孩子(出于安全性原因,两个孩子是无限大),或者将其去除,以便停止使用外用敌视药物。如果受者不不愿做手术,医生回应也可以自由选择戒断,让免疫系统来敌视子宫,令其它渐渐衰退。

Initial Skepticism 最初的顾虑One of the surgeons working with Tzakis will be Dr. Tommaso Falcone, the Cleveland Clinics chairman of obstetrics and gynecology. Falcone said he first heard of uterus transplants about 10 years ago, in early research described at medical conferences. Initially, he was skeptical.克利夫兰医院的妇产科主任托马索·法尔科内(Tommaso Falcone)是察基斯博士的合作伙伴之一。他回忆起自己第一次听闻子宫重制是在约10年前,医学会议上讲解了一些早期研究。最初,他是持猜测态度的。

A trip to Sweden changed his mind. He went there in 2013 — like a doubting Thomas, he said — to see what the team was doing. He watched the surgery and spoke to several couples who wanted it.直到一次瑞典之行转变了他的观点。那是在2013年——他说道,当时他是本着眼见为实的原则,想去目睹想到那个团队的工作。他观赏了手术,并专访了几对想拒绝接受手术的夫妇。

“I almost cross-examined them,” Falcone said. “I was thinking, `Theres got to be something wrong with these people.”“我完全是在问话他们,”法尔科内博士说道。“我当时实在:‘这些人认同有毛病。’ ”But, he said, he came to understand how much pregnancy meant to them.不过,他之后说,后来他渐渐明白了分娩对那些人的意义有多么根本性。

“Its a legitimate request,” he said. “I got on the plane and knew I would be at the forefront of trying to make this program work at the Cleveland Clinic.”“这拒绝合情合理,”他说道。“当我攀上回程的飞机时,我就告诉我将不会坚决致力于在克利夫兰医院尝试某种程度的工作。”The 26-year-old candidate said that finding out she had no uterus had made her wonder if anyone would ever want to marry her. She did marry, and in addition to adopting children, she and her husband considered surrogacy, but could not afford it. Much of the transplant and pregnancy costs will be paid for by research money from the clinic and health insurance.上文提及的那位26岁的重制候选人说道,获知自己没子宫后,她一度猜测否有人不愿嫁给她。

在她结婚后,除了领养了几个孩子外,她和丈夫还考虑过领养,但他们无法开销费用。而这次子宫重制和胎儿的大部分费用将不会由医院的研究经费和医疗保险缴纳。“I know the risks,” she said. “Its a high-risk pregnancy. But I think were in the best of hands. I think we can handle anything that comes our way.”“我很确切个中风险,”她说道。

“这是一次高危胎儿。不过,我坚信我们不会获得最篮的医护。我想要我们应当可以应付将不会再次发生的任何事情。”She recently began the hormone treatments to stimulate egg production.最近,她开始拒绝接受激素化疗,以性刺激受精。

She belongs to a nondenominational Christian church, and members are praying she will have the transplant, she said.她说道,她所属的无宗派基督教教堂的成员们都在为她祷告,希望她能取得重制的机会。“I know there will be people who dont understand or agree,” she added. “But this is not a whim.”“我告诉一定会有很多人不解读或者不赞成我的自由选择,”她补足道。“但我决不是一时冲动。


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