获得性梗阻性无精症患者预处理改善经皮附睾穿刺-卵胞浆单精子注射治疗结局的临床研究  

Clinical research of pretreatment for the patients with acquired obstructive azoospermia in the improvement of percutaneous epididymal sperm aspiration-intracytoplasmic sperm injection

作　　者：黄吴键[1] 张燕[1] 黄群花[1] 陈国勇[1] 林春丽[1] 刘芸[1] 

机构地区：[1]南京军区福州总医院生殖中心,福建福州350025

出　　处：《中国医药导报》2013年第31期60-63,共4页China Medical Herald

摘　　要：目的分析获得性梗阻性无精症患者预处理对经皮附睾穿刺-卵胞浆单精子注射（PESA-ICSI）治疗结局的影响。方法选择2009年1月～2011年6月南京军区福州总医院生殖中心诊断为获得性梗阻性无精症（OA）的患者109例，随机分为两组。预处理组55例，临床检查有附属腺炎症或微生物感染患者先给予抗生素和抗炎治疗，接着给予抗氧化和促进附睾精子成熟治疗2个月（十一酸睾丸酮40mg，p0，qd，维生素C200mg，po，bid，维生素E100mg，po，bid，左卡尼汀1．0g，po，bid），无附属腺炎症或微生物感染患者，直接抗氧化和促进附睾精子成熟治疗；对照组54例，有附属腺炎症指征患者给予抗炎、抗感染治疗，余未作任何处理。比较两组诊断日与ICSI日精子活动力和ICSI后胚胎发育和临床结局。结果①两组诊断日经附睾穿刺液精子的总活动率和前向运动精子率差异均无统计学意义（P〉0．05）。ICSI日预处理组精子总活动率和前向运动精子率均有提高（P〈0．01），而对照组无明显变化（P〉0．05）；两组ICSI日精子总活动率和前向运动精子率比较，差异有统计学意义（P〈0．05）。②两组受精率、卵裂率差异无统计学意义（P〉0．05）；预处理组优质胚胎率为67．26％，高于对照组的60．49％，差异有统计学意义（P〈0．05）；预处理组临床妊娠率和植入率分别为47．16％和29．72％，高于对照组的37．25％和23．36％，但差异无统计学意义（P〉0．05）。结论对获得性OA患者进行抗氧化、促进精子成熟的预处理治疗，可以提高精子活动力，能够改善胚胎质量，但是对于ICSI治疗后临床妊娠率和植入率的影响还需要更大样本的观察。Objective To analyze the pretreatment for the patients with acquired obstructive azoospermia in the improvement of percutaneous epididymal sperm aspiration-intracytoplasmic sperm injection （PESA-ICSI）. Methods 109 patients diagnose as acquired obstructive azoospermia （OA） in Department of Assisted Reproduction Center, Fuzhou General Hospital of Nanjing Military Command from January 2009 to June 2011 were selected and divided into pretreatment group （n = 55） and control group （n = 54） randomly. Patients in pretreatment group with identified infection/inflammation of the accessory glands were treated with sensitive antibiotics or anti-inflammatory drugs; then pretreatment group was give antioxidant and sperm matura- tion promotion treatment （testosterone Undecanoate 40 mg, po, qd, Vitamin C 200 rag, po, bid, Vitamin E 100 rag, po, bid, le- vocarnitine 1.0 g, po, bid） for 2 months. Patients in pretreatment group without identified infection/inflammation were treated with antioxidant and sperm maturation promotion treatment directly. Patients in control group with identified infection/inflammation were treated with nothing except antibiotics and anti-infection treatment. Sperm motility on diagnosis day and ICSI day in the two groups were compared; embryonic development and clinical outcome after ICSI were compared. Results （1）The differences of total epididymal sperm motility and forward epididymal sperm motility in the two groups on diagnosis day were not statistically significant （P 〉 0.05）. The total epididymal sperm motility and forward epididymal sperm motility in pretreatment group on ICSI day were enhanced （P 〈 0.01）, no change was found in control group （P 〉 0.05）. The differences of total epididymal sperm motility and forward epididymal sperm motility in the two groups on ICSI day were statistically significant （P 〈 0.05）. （2）The differences of fertilization rate, cleavage rate in the two groups were not statistically significant （P 〉 0.05）; high qual

关 键 词：梗阻性无精症 精子活动力 预处理 经皮附睾穿刺-卵胞浆单精子注射 

分 类 号：R697.22[医药卫生—泌尿科学]