显微取精失败患者特点分析  

Analysis the characters of patients failure with micro-TESE

作　　者：赵连明[1] 姜辉[1] 洪锴[1] 林浩成[1] 唐文豪[1] 刘德风[2] 毛加明[2] 廉颖[2] 马潞林[1] 

机构地区：[1]北京大学第三医院泌尿外科,北京100191 [2]北京大学第三医院妇产科

出　　处：《中国男科学杂志》2016年第10期34-37,共4页Chinese Journal of Andrology

摘　　要：目的本文旨在从显微取精手术(micro-TESE)失败案例中探讨一些规律,能在术前预测哪一类患者显微取精的成功率低,对于此类不必尝试micro-TESE,以减少不必要的痛苦。方法对既往2014年1月至2016年6月期间做了显微取精的非克氏征无精子症患者情况进行分析,总结显微取精不成功患者的临床特点。结果 177例非克氏征无精子症患者完成了显微取精手术。患者的平均年龄(31.6±6.74)岁,平均睾丸大小(8.93±5.22)mL,平均卵泡刺激素(follicle-stimulating hormone,FSH)(20.44±7.35)IU/L,平均睾酮(testosterone,T)(7.95±3.36)nmol/L。显微取精失败的患者共95人,平均年龄(30.3±7.12)岁,平均睾丸大小(10.04±4.32)mL,平均FSH(19.36±9.66)IU/L,平均T(8.54±4.76)nmol/L。显微取精成功的患者共82人(46.3%,82/177),平均年龄(32.2±5.32)岁,平均睾丸大小(7.21±3.28)mL,平均FSH(21.21±6.83)IU/L,平均T(7.41±4.34)nmol/L。两组对比发现仅睾丸大小有显著的统计学差异(P<0.05)。我们根据睾丸大小将患者分为两组发现,睾丸≤8mL组患者共101例,显微取精成功共58例(57.4%,58/101),睾丸≥10mL组患者共76例,24人显微取精成功(31.6%,24/76)。24例患者中4例是隐睾,11例无精子症因子(azoospermia factor AZF)c区缺失患者,3例患者睾丸穿刺活检镜下未见,病理可见少量精子,4例患者FSH极高术前未做睾丸活检。对于睾丸≥10mL组我们排除隐睾患者、AZFc区缺失患者、曾经睾丸活检或者精液中见到精子的患者后共剩余28例患者,仅2例(7.1%,2/28)患者取到精子。结论对于睾丸较大患者,睾丸活检未见精子,且排除了隐睾、AZFc区缺失、既往曾经发现精子等情况后显微取精的成功率极低,不推荐显微取精手术。Objective Microdissection testicular sperm extraction （m-TESE） overturned the traditional idea of Azoospermia, because the sperm retrieval positive rate was really high in the azoospermia patients who were worthless for the testicular sperm aspiration（TESA）. However, not all azoospermia patients were suitable for m-TESE. Thus, this study was aimed to explore the category of patients with lower sperm retrieval rate, Methods Azoospermia patients （excluding Klinefelter＇ s syndrome） who underwent a m-TESE during January 2014 and June 2016 in a single center were enrolled in this study. Data were collected and analyzed. The clinical features were summarized on the patients with failed sperm retrievals. Results Total 177 patients were enrolled in this study （age 31,6±6,74 yrs, testicular volume 8.93±5.22 mL, FSH 20.44±7.35 IU/L and T 7.95±3.36 nmol/L）. 82 patients were found sperm by m-TESE （age 32.2±5.32 yrs, testicular volume 7.21±3.28 ml, FSH 21.21±6.83 IU/L and T 7.41±4.34 nmol/L）. When compared with these factors in the abovementioned two groups, only the testicular volume had a significant difference. Then, the patients were divided into two groups according the testicular volume： testicular volume≤8ml group （101 patients）,the sperm retrieval successful rate was 57.4% （58/101）; Testicular volume ≥ 10mL group （76 patients）, the sperm retrieval successful rate was 31.6% （24/76）. The 24 patients with successful sperm retrieval included 4 cryptorchidism, 11 AZFc microdeletion, 3 patients with no sperm by previous TESA, but with few sperms by pathology, and 4 patients without TESA because of the higher FSH levels. For the testicular volume〉10mL group, 28 patients were left If excluding cryptorchidism, AZFc microdeletion and patients whose sperm were found by previous TESA or sperm test, only 2 of them （7.1%, 2/28） were found sperm. Conclusion them-TESE was not recommended for the patients with larger testicular （excluding cryptorchidism, AZFc microdeletion an

关 键 词：无精子症 取精术 显微外科手术 

分 类 号：R698.2[医药卫生—泌尿科学]