腮腺炎性睾丸炎非梗阻性无精子症患者行同周期显微睾丸取精结合卵胞质内单精子显微注射技术的临床结局分析  

Clinical outcomes analysis of nonobstructive azoospermia patients associated with mumps orchitis undergoing microdissection testicular sperm extraction and intracytoplasmic sperm injection

作　　者：周梁 孙建华 季兴哲 周党侠[2] 高明 刘项 王磊 张洲 吕茉琦 李意新 杨杰 施文浩 Zhou Liang;Sun Jianhua;Ji Xingzhe;Zhou Dangxia;Gao Ming;Liu Xiang;Wang Lei;Zhang Zhou;Lyu Moqi;Li Yixin;Yang Jie;Shi Wenhao(Assisted Reproduction Center,Northwest Women and Children's Hospital,Xi'an 710003,China;Department of Pathology,Medical School,Xi'an Jiaotong University,Xi'an 710061,China)

机构地区：[1]西北妇女儿童医院生殖中心,西安710003 [2]西安交通大学医学部病理系,710061

出　　处：《中华生殖与避孕杂志》2020年第11期927-931,共5页Chinese Journal of Reproduction and Contraception

基　　金：国家自然科学基金(81673224);陕西省自然科学基金(2019JM-029)。

摘　　要：目的探讨由腮腺炎性睾丸炎所导致的非梗阻性无精子症(NOA)患者行同周期显微睾丸取精(microTESE)结合卵胞质内单精子显微注射(ICSI)治疗的临床结局。方法回顾性分析2013年12月至2019年10月期间在西北妇女儿童医院生殖中心接受同周期microTESE结合ICSI治疗的有腮腺炎病史的NOA患者,根据是否合并睾丸炎分为合并睾丸炎NOA患者(合并睾丸炎组)和未合并睾丸炎NOA患者(未合并睾丸炎组)2组,观察这2组在实施同周期microTESE结合ICSI治疗后的临床结果。结果52例既往有腮腺炎病史的NOA患者实施了microTESE手术,其中检见精子26例,总精子获得率(SRR)为50.0%。合并睾丸炎组SRR为94.4%(17/18),未合并睾丸炎组SRR为26.5%(9/34),组间比较差异有统计学意义(P<0.001)。检见精子患者尝试ICSI治疗,每取卵周期首次移植即临床妊娠16例,临床妊娠率为61.5%(16/26)。合并睾丸炎组和未合并睾丸炎组的临床妊娠率和早期流产率差异均无统计学意义[58.5%(10/17)比66.7%(6/9),P=0.696;20.0%(2/10)比16.7%(1/6),P=0.868]。实验室数据中,合并睾丸炎组和未合并睾丸炎组的双原核率差异有统计学意义(73.9%比57.0%,P=0.006),而优质胚胎率组间比较差异无统计学意义(44.2%比56.8%,P=0.144)。结论腮腺炎性睾丸炎NOA患者的SRR较高,通过同周期ICSI-microTESE治疗的临床效果良好。Objective To investigate the clinical outcome of microdissection testicular sperm extraction(microTESE)combined with intracytoplasmic sperm injection(ICSI)in patients with nonobstructive azoospermia(NOA)associated with mumps orchitis.Methods The clinical data of NOA patients who underwent microTESE from December 2013 to October 2019 in the ICSI treatment cycle in Assisted Reproduction Center,Northwest Women and Children's Hospital were collected.All the patients who had a history of mumps were divided into two groups according to whether they had mumps orchitis or not.The clinical outcomes after the implementation of microTESE combined with ICSI were compared.Results A total of 52 NOA patients were finally collected in the present study and 26 patients successfully processed sperm retrieval,the total sperm retrieval rate(SRR)was 50.0%(26/52).The SRR was 94.4%(17/18)in ornitis group,and 26.5%(9/34)in non-ornitis group.The difference between the two groups was statistically significant(P<0.001).ICSI treatment was tried in sperm patients,and the clinical pregnancy rate was 61.5%(16/26).There was no statistically significant difference in the clinical pregnancy rate and the early pregnancy abortion rate between ornitis group and non-ornitis group[58.5%(10/17)vs.66.7%(6/9),P=0.696;20.0%(2/10)vs.16.7%(1/6),P=0.868].In the laboratory data,the difference of two pronucleus rate between orchitis group and non-orchitis group was statistically significant(73.9%vs.57.0%,P=0.006),while the difference of high-quality embryo rate between the two groups was not statistically significant(44.2%vs.56.8%,P=0.144).Conclusion The SRR of NOA patients with mumps orchitis was higher that of out ornitis.And good results can be expected when microTESE and ICSI treatment are performed at the same period.

关 键 词：非梗阻性无精子症 腮腺炎性睾丸炎 睾丸显微取精术 卵胞质内单精子显微注射 

分 类 号：R714.8[医药卫生—妇产科学]