显微切开睾丸取精术联合ICSI治疗非梗阻性无精子症患者的疗效  

Curative effect of microdissection testicular sperm extraction combined with ICSI in treatment of non-obstructive azoospermia

作　　者：刘广兴 马超[1,2] 李吉炎 李宏图 赵菲[1,2] 刘巍 冯文华[1,2] LIU Guang-Xing;MA Chao;LI Ji-Yan(China Medical University,Shenyang,Liaoning 110031,China)

机构地区：[1]中国医科大学,辽宁沈阳110031 [2]辽宁省计划生育科学研究院附属医院,辽宁沈阳110031

出　　处：《中国妇幼保健》2020年第23期4540-4543,共4页Maternal and Child Health Care of China

基　　金：辽宁省卫生计生委省直医院临床能力建设项目(LNCCC-D50-2015)。

摘　　要：目的分析显微切开睾丸取精术(MD-TESE)联合卵胞浆内单精子显微注射(ICSI)治疗非梗阻性无精子症(NOA)患者的疗效。方法选取2016年3月-2018年3月接受MD-TESE治疗的63例NOA患者,比较不同病因NOA患者的睾丸体积、血清卵泡刺激素(FSH)水平、精子获得率(SRR),睾丸穿刺组与非睾丸穿刺组NOA患者睾丸体积、血清FSH水平和SRR,不同睾丸病理学类型的NOA患者SRR,MD-TESE获得精子患者配偶ICSI治疗结果。结果 63例NOA患者血清FSH水平为(16.20±3.50) IU/L,术前B超测量睾丸体积为(8.60±4.80) ml,SRR为49.21%(31例)。不同病因NOA患者的睾丸体积、血清FSH水平比较差异均有统计学意义(均P<0.05),SRR比较差异无统计学意义(P>0.05)。睾丸穿刺组与非睾丸穿刺组NOA患者的睾丸体积、血清FSH水平比较差异均有统计学意义(均P<0.05),SRR比较差异无统计学意义(P>0.05)。63例NOA患者中,35例患者行睾丸穿刺,20例获取精子,SRR为57.14%,生精功能低下(H-S)组SRR显著高于唯支持细胞综合征(SCOS)组,差异有统计学意义(P<0.05)。ICSI治疗后的总体受精率为70.63%(303/429),卵裂率为93.07%(282/303),可利用胚胎率为44.33%(125/282),优胚率为34.75%(98/282)。共完成移植周期20次,其中临床妊娠8例,临床妊娠率为40.00%(8/20),流产2例,流产率为25.00%(2/8)。结论 MD-TESE实用性好,易开展,技术风险小,较传统的TESE更适用于NOA患者,SRR更高。对于TESE未能成功者,MD-TESE联合ICSI可以为患者生育自己遗传背景的后代带来希望,值得进一步研究和推广。Objective To analyze the curative effect of microdissection testicular sperm extraction (MD-TESE) combined with intracytoplasmic sperm microinjection (ICSI) in treatment of non-obstructive azoospermia (NOA). Methods From March 2016 to March 2018,63 patients with NOA treated by MD-TESE were selected. Testicular volumes,serum follicle-stimulating hormone (FSH) levels,and sperm retrieval rates (SRRs) were compared among NOA patients with different causes;testicular volumes,serum FSH levels,and SRRs were compared between testicular sperm aspiration group and non-testicular sperm aspiration group;SRRs of NOA patients with different testicular pathological types were compared;ICSI outcomes of couples of NOA patients obtaining spermatozoa by MD-TESE method were compared.Results The level of serum FSH in 63 patients with NOA was (16. 20±3. 50) IU/L,testicular volume measured by preoperative ultrasonography was (8. 60±4. 80) ml,SRR was 49. 21% (31 patients). There were statistically significant differences in testicular volume and serum FSH level among NOA patients with different causes (P< 0. 05),there was no statistically significant difference in SRR (P> 0. 05).There were statistically significant differences in testicular volume and serum FSH level between testicular sperm aspiration group and nontesticular sperm aspiration group (P<0. 05),there was no statistically significant difference in SRR (P> 0. 05). Among 63 patients with NOA,35 patients underwent testicular sperm aspiration,and 20 patients obtained spermatozoa,SRR was 57. 14%. SRR in hypo-spermatogenesis (H-S) group was statistically significantly higher than that in Sertoli cell only syndrome (SCOS) group (P < 0. 05). After ICSI treatment,the total fertilization rate was 70. 63% (303/429),cleavage rate was 93. 07% (282/303),available embryo rate was 44. 33% (125/282),high quality embryo rate was 34. 75% (98/282);embryo transfer cycle was completed for 20 times,8 patients got clinical pregnancy,the clinical pregnancy rate was 40. 00% (8/20),the abortion rat

关 键 词：非梗阻性无精子症 显微切开睾丸取精术 卵胞浆内单精子显微注射 疗效 

分 类 号：R698.2[医药卫生—泌尿科学]