睾丸显微取精术的临床应用效果评估  

Microdissection of testicular sperm extraction in non-obstructive azoospermia patients

作　　者：马猛[1] 平萍[1] 李朋[1] 杨施[1] 王建华[1] 田汝辉[1] 刘宇飞[1] 何祖平[2] 李铮[1] 

机构地区：[1]上海交通大学医学院附属仁济医院泌尿外科上海市人类精子库,200001 [2]上海交通大学医学院附属仁济医院临床干细胞中心,200001

出　　处：《中华泌尿外科杂志》2013年第6期426-430,共5页Chinese Journal of Urology

基　　金：国家重大科学研究计划项目（2011CB944504）;上海市教委重点课题（IOZZ70）

摘　　要：目的探讨警丸姓微取精术（MD—TESE）联合传统睾丸取精术（TESE）治疗非梗阻性几精子症（tlon—obstructive azoospermia，NOA）的精子获得率（sperm retrieval rate，SRR）及其影响冈素。方法2011年2月至2012年4月，NOA患者共107例，患者首先接受TESE术，未获得精子者行MD—TESE术。镜下观察获取精子情况并记录结果，分析SRR与患者睾丸体积、血清卵泡刺激素（FSH）浓度及病理结果的相关性。结果107例患者中，TESE术获得精子46例（43．0％），TESE联合MD—TESE术获得精予61例（57．0％）。病理组织学分析结果显示，71例唯支持细胞综合征（Sertoli cell only syndrome，SCOS）忠者111，TESE联合MD—TESE术的SRR显著高于单纯TESE术（45．1％比32．4％，P〈0．01）。而22例成熟阻滞（maturation arrest，MA）和14例精子发生低下（hypospermatogen—esls，HS）患者2种方法结果差异无统计学意义（59．1％比40．9％，P=0．25；92．9％比78．6％．P=0．50）。在TESE联合MD—TESE术巾，HS组SRR显著高于SCOS组和MA组。术前B超测量睾丸体积〈10ml、〉6ml绀，TESE联合MD—TESE术的SRR显著高于单纯TESE术（54．2％比31．3％．P〈0．01）。在术前血清FSH浓度〉12．6U／L组，TESE联合MD—TESE术的SRR显著高于单纯TESE术（56．9％比41．7％，P〈0．01）。结论与单纯TESE术相比，TESE联合MD—TESE术SRR更高。与病蝉组织学类型相关，HS患者SRR高于SCOS及MA患者。当NOA患者睾丸体积〈10ml或者血清FSH浓度〉小常值2倍时，TESE联合MD—TESE术更具优势。而睾丸体积、血清FSH浓度并不能预测TESE联合MD—TESE术是甭成功。Objective To evaluate the outcomes of microdissection testicular sperm extraction （MD-TESE） and conventional testicular sperm extraction （TESE） in patients with non-obstructive azoosper-mia （NOA）. And to investigate the factors that influence the sperm retrieval rate （SRR） of the MD-TESE. Methods One hundred and seven non-obstructive azoospermia patients accepting conventional TESE and MD-TESE in our institute. Testicular tissues were minced and observed under microscope with 400 magnifi-cation. The relationships between SRR and testis volume, serum FSH and pathological category were ana-lyzed. Results There were 46 patients retrieved testicular sperm successfully in conventional TESE, ver-sus 61 patients in TESE combined with MD-TESE. Compared with conventional TESE about pathological types, sperm retrieval rate of TESE combined with MD-TESE was significantly higher in the group of Sertoli cell only syndrome （SCOS, 45. 1% ： 32.4% , P 〈 0.01） than in the groups of maturation arrest （MA, 59.1%： 40.9%, P=0.25） and hypospermatogenesis （HS, 92.9%： 78.6%, P=0.5）. At the mean-time, sperm retrieval rate of TESE combined with MD-TESE was significantly higher in the group of HS （92.9%） than in the groups of SCOS （45.1%） and MA （59.1%）. Compared with conventional TESE a-bout testicular volume, sperm retrieval rate of TESE combined with MD-TESE was sigfiificantly higher in the group of 〈10 ml and 〉6 ml （54.2%： 31.3%,P 〈0.01 =than in the groups of 〉15 ml （55.6%： 50.0% , P=1.0） and 10-15 ml （61.0%： 53.7%, P=0.25）. However, sperm retrieval rates of TESE combined with MD-TESE were similar in the groups of 〉 15 ml, 10 - 15 ml, 〈 10 ml and 〉 6 ml （55.6% , 61.0% , 54.2% , respectively, P = 0.77）. Compared with conventional TESE about serum FSH concentra-tion, sperm retrieval rate of TESE combined with MD-TESE was significantly higher in the group of 〉 12.6 IU/L （56.9%： 41.7%, P〈0.01 =than in the group of ≤12.6 U/L （45.7%： 57.1%, P=0.125

关 键 词：睾丸显微取精术 睾丸取精术 非梗阻性无精子症 精子获得率 

分 类 号：R699[医药卫生—泌尿科学]