青春期后睾丸炎致非梗阻性无精子症睾丸显微取精结局分析  

Outcome analysis of non-obstructive azoospermia patients with a history of infectious parotitis(mumps) treated by MD-TESE

作　　者：杨竣 任新玲[3] 孙雪娇[3] 谷龙杰[1,2,3] 高鑫涛 唐哲[1,2] 余哲 宋靖宇 黄博[3] 朱丽霞 李丹[3] 谈慧平[3] 钱坤 靳镭[3] 蓝儒竹[1,2] 王涛[1,2] 王少刚 刘继红[1,2] Yang Jun;Ren Xinlin;Sun Xuejiao;Gu Longjie;Gao Xintao;Tang Zhe;Yu Zhe;Song Jingyu;Huang Bo3;Zhu Lixia;Li Dan;Tan Huiping;Qian Kun;Jin Lei;Lan Ruzhu;Wang Tao;Wang Shaogang;Liu Jihong(Department of Urology,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430030,Hubei,China;Institute of Urology,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology;Reproductive Medicine Center,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology)

机构地区：[1]华中科技大学同济医学院附属同济医院泌尿外科,武汉430030 [2]华中科技大学同济医学院附属同济医院泌尿外科研究所 [3]华中科技大学同济医学院附属同济医院生殖医学专科

出　　处：《中国男科学杂志》2018年第4期9-12,16,共5页Chinese Journal of Andrology

摘　　要：目的探讨青春期后腮腺炎引起的睾丸炎导致的无精子症患者生育遗传学后代的可行性及其结局分析。方法对13名就诊于本院的青春期后睾丸炎引发的非梗阻性无精子症患者行显微睾丸取精术,成功取到精子者行卵细胞胞浆内单精子注射(intracytoplasmic sperm injection, ICSI),术后随访6周,观察患者恢复情况及其配偶妊娠情况。结果 13例青春期后睾丸炎引发的非梗阻性无精子症患者查染色体核型及Y染色体微缺失均正常,在睾丸穿刺活检未见精子后,均通过显微睾丸取精术找到少量精子。患者的平均年龄(32.31±5.36)岁,平均睾丸体积(10.38±1.45)mL,平均血清卵泡刺激素浓度(follicle-stimulating hormone,FSH)(26.43±17.78)mIU/mL,平均血清黄体生成素浓度(luteinizing hormone,LH)(8.90±6.83)mIU/mL,术前平均睾酮(testosterone,T)(3.00±0.81)ng/mL。平均手术时间为(64.85±7.81)min。其配偶平均年龄(30.69±5.33)岁,取卵后行ICSI,受精率为(78±22.20)%,优胚率为(45±25.11)%,临床妊娠率为69.23%(9/13)。术后随访1月,所有患者未出现阴囊血肿、感染等并发症,患者术后血清总睾酮水平为(3.05±0.75)ng/mL,与术前睾酮水平进行比较,差异无统计学意义(P>0.05)。结论青春期后睾丸炎引发的无精子症患者显微取精成功率高,无明显并发症,同时配合ICSI技术,大部分可生育自己遗传学意义的后代。Objective To investigate the clinical efficacy of microdissection testicular sperm extraction combined with intracytoplasmic sperm injection in the treatment of azoospermia patients with a history of pubertal infectious parotitis (mumps). Methods Thirteen azoospermia patients with a history of infectious parotitis (mumps) who underwent MD-TESE in our hospital were enrolled in the study. After fertilization by ICSI, fertilized embryos were transferred into the uterus of patients’respective spouses. And then data were collected and summarized. Results The thirteen azoospermia patients,with a history of infectious parotitis (mumps),had normal chromosomal karyotype and no Y chromosome microdeletions. Through the MD-TESE,testieular sperms were successfully retrieved in all the patients who had no sperm found through testicular sperm aspiration before the operation.For 13patients,their average age was 32.31±5.36yrs,testicular volume was 10.38±1.45mL,serum FSH level was 26.43±17.78mlU/mL,serum LH level was 8.90±6.83mlU/mL,serum T level was 3.00±0.81ng/mL and operation time was 64.85±7.81 min.Besides,the age of their spouses was 30.69±5.33yrs. Living sperms were retrieved from semen samples of 13azoospermia patients.Using ICSI,the normal fertilization rate was (78~22.20)%and the rate of high-quality embryo was (45±25.11)%.After 6weeks,9patients'spouses got pregnant. The success rate of infertility treatment was 69.23%(9/13).All patients had no obvious complications during 1month following up.There was no significant difference between the T level (3.00±0.81)ng/mL before operation and the T level (3.05±0.75)ng/mL after operation (P>0.05).Conclusion MD-TESE combined with ICSI is effective and safe in the treatment azoospermia patients with a history of mumps.Thus,most of these patients can have their own children.It may be a promising method for infertility treatment due to highly successful rate of pregnancy.

关 键 词：睾丸炎 无精子症 取精术 显微外科手术 精子注射 细胞质内 

分 类 号：R698.2[医药卫生—泌尿科学] R321.33[医药卫生—外科学]