不同病因非梗阻性无精子症患者显微切开睾丸取精及ICSI结局比较  

Results of micro-TESE and outcomes of ICSI in patients with different etiological types of non-obstructive azoospermia

作　　者：杨竣 任新玲[3] 谷龙杰[1,2,3] 孙雪娇 宋靖宇[1,2] 余哲[1,2] 唐哲[1,2] 高鑫涛 魏玉兰 吴黎[3] 郭娜 胡娟[3] 钱坤 靳镭[3] 蓝儒竹[1,2] 王涛[1,2] 王少刚[1,2] 刘继红[1,2] YANG Jun;REN Xin-ling;GU Long-jie;SUN Xue-jiao;SONG Jmg-yu;YU Zhe;TANG Zhe;GAO Xin-tao;WEI Yu-lan;WU Li;GUO Na;HU Juan;QIAN Kun;JIN Lei;WANG Tao;WANG Shao-gang;LIU Ji-hong(Department of Urology;Research Institute of Urology;Department of Reproductive Medicine,Tongji Hospi-tal,Tongfi Medical College,Huazhong University of Science and Technology,Wuhan,Hubei 430030,China)

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,湖北武汉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,湖北武汉430030 [3]华中科技大学同济医学院附属同济医院生殖医学专科,湖北武汉430030

出　　处：《中华男科学杂志》2018年第10期887-892,共6页National Journal of Andrology

摘　　要：目的:比较不同病因非梗阻性无精子症(NOA)患者显微切开睾丸取精术(micro-TESE)的成功率及配偶卵细胞胞质内单精子注射(ICSI)结局。方法:回顾分析2016年9月至2017年12月155例行micro-TESE NOA患者的临床资料,根据不同病因将其分为先天性NOA(n=49)、获得性NOA(n=15)和特发性NOA(n=91) 3组,比较3组患者年龄、睾丸体积、生殖激素水平、超声表现、micro-TESE取精成功率。同时,根据女方情况,纳入符合要求的取精成功患者对受精率、可利用胚胎率和临床妊娠率进行分析。结果:先天性NOA患者睾丸体积[(6. 4±5. 0) ml)]显著小于获得性NOA患者[(10. 2±2. 0) ml]和特发性NOA患者[(9.9±3.2) ml](P <0.05);先天性NOA患者LH[(15. 2±10. 1) IU/L]显著高于获得性NOA患者[(9. 1±6. 5) IU/L)]和特发性NOA患者[(7. 8±3. 5) IU/L)](P <0. 05);而特发性NOA患者T[(11. 8±4. 8) nmol/L]显著高于先天性NOA患者[(8. 9±4. 5) nmol/L](P <0. 05)。先天性NOA患者micro-TESE取精成功率为73. 5%(36/49),获得性NOA患者为100%(15/15),特发性NOA患者为24. 2%(22/91),3组间差异显著(P <0. 05)。获得性NOA患者配偶ICSI后受精率为(73. 1±23. 3)%,显著高于先天性NOA患者[(48. 9±21. 7)%]和特发性NOA患者[(52. 6±22. 7)%](P <0. 05)。不同病因NOA患者配偶ICSI后可利用胚胎率和临床妊娠率间无显著差异。结论:获得性NOA患者micro-TESE取精成功率最高,且ICSI后受精率、可利用胚胎率以及临床妊娠率最高,其次是先天性NOA患者;特发性NOA患者取精成功率及ICSI结局较差。Objective ： To compare the sperm retrieval rate （SRR） of microdissection testicular sperm extraction （micro-TESE） and the outcomes of intracytoplasmic sperm injection （ICSI） among different etiological types of non-obstructive azoospermia （NOA）. Methods： We retrospectively analyzed the clinical data on 155 cases of NOA undergoing micro-TESE in our hospital from September 2016 to December 2017, which were classified into three types according to etiological factors： congenital NOA （n=49）, acquired NOA （n=15 ） and idiopathic NOA （n= 91 ）. We compared the age, testis volume, levels of reproductive hormones, uhrasono- graphic manifestations, and SRR of micro-TESE among the three groups of patients. We also recorded and analyzed the rates of fertili- zation, available embryos and clinical pregnancy in the spouses of the patients included for successful sperm retrieval in micro-TESE. Results ： The testis volume was significantly lower in the congenital than in the acquired and idiopathic NOA groups （ [ 6.4 ± 5.0 ] vs [ 10.2±2.0] and [9.9±3.2] ml, P 〈 0.05）, while the LH level was markedly higher in the former group than in the latter two （ [ 15.2 ± 10.1 ] vs C 9.1 ± 6.5 ] and [ 7.8 ± 3.5 ] mlU/ml, P 〈 0.05 ）, and so was the T level in the idiopathic than in the con- genital NOA group （ [ 11.8 ± 4.8 ] vs [ 8.9 ± 4.5 ] nmol/L, P 〈 0.05）. The SRRs of micro-TESE in the congenital, acquired and idiopathic NOA patients were 73.5% （36/49）, 100% （ 15/15 ）, and 24.2% （22/91） respectively, with statistically significant differences among the three groups （ P 〈 0.05 ）. The fertilization rate after ICSI was remarkably higher in the acquired than in the congenital and idiopathic NOA groups （ [ 73.1 ± 23.3 ] % vs [ 48.9± 21.7 ] % and [ 52.6 ± 22.7 ] %, P 〈 0. 05 ）. There were no statistically significant differences among the three groups in the rates of embryo utilization and clinical pregnancy. Conclusion ： The sperm retrieval rate of micro-

关 键 词：非梗阻性无精子症 先天性 获得性 特发性 显微切开睾丸取精术 卵细胞胞质内单精子注射 

分 类 号：R698.2[医药卫生—泌尿科学]