青春期启动前后行睾丸下降固定术对同周期ICSI-microTESE临床结局的比较分析  

Effects of orchidopexy operations in different pubertal status on the clinical outcomes of ICSI-micro TESE:a comparative analysis

作　　者：周梁 王盛兴[2] 周党侠[3] 季兴哲 孙建华 王磊 张洲 吕茉琦 杨杰 施文浩 Zhou Liang;Wang Shengxing;Zhou Dangxia;Ji Xingzhe;Sun Jianhua;Wang Lei;Zhang Zhou;Lyu Moqi;Yang Jie;Shi Wenhao(Assisted Reproduction Center,Northwest Women and Children's Hospital,Xi'an 710003,China;Department of Urology,Xi'an 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]西安市儿童医院泌尿外科,710003 [3]西安交通大学医学部病理系,710061

出　　处：《中华生殖与避孕杂志》2021年第9期832-838,共7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：目的探讨青春期启动前、后行睾丸下降固定术对隐睾后非梗阻性无精子症(nonobstructive azoospermia,NOA)患者行同周期显微睾丸取精(microdissection testicular sperm extraction,microTESE)结合卵胞质内单精子显微注射(intracytoplasmic sperm injection,ICSI)临床结局的影响。方法回顾性队列研究分析2013年12月至2019年8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NOA患者,比较隐睾后NOA与非隐睾后NOA的精子获得率(sperm retrieval rate,SRR),同时将隐睾后NOA患者,按既往接受睾丸下降固定术的时间,分为青春期前手术组和青春期启动后手术组,比较两组患者在实施同周期microTESE结合ICSI治疗后的SRR和妊娠结局。结果34例隐睾后NOA患者和604例非隐睾后NOA患者接受了microTESE手术,其中隐睾后NOA患者的SRR为85.3%(29/34),非隐睾后NOA患者的SRR为40.2%(243/604),两组间SRR差异有统计学意义(P<0.001)。34例隐睾后NOA患者中,青春期前组17例,有17例检见精子;青春期启动后组17例,有12例检见精子,两组间SRR差异有统计学意义(P=0.044)。隐睾后NOA患者接受ICSI治疗的总临床妊娠率为65.4%(17/26);其中青春期前组的临床妊娠率为62.5%(10/16),青春期启动后组临床妊娠率为70.0%(7/10),两组间临床妊娠率、孕早期流产率、双原核率及优质胚胎率差异均无统计学意义(P>0.05)。隐睾后NOA患者中,未检见精子者的睾丸病理类型均为唯支持细胞综合征(Sertoli cell only syndrome,SCOS),青春期启动后组的SCOS占比[76.5%(13/17)]要高于青春期前组的SCOS占比[35.3%(6/17)],差异有统计学意义(P=0.016)。此外,睾丸体积、卵泡刺激素、睾酮与SRR均无显著相关性。结论隐睾后NOA患者的SRR较高,通过同周期ICSI-microTESE治疗的临床效果满意,睾丸下降固定术的手术时间对ICSI的妊娠结局可能影响不大。尽早实施睾丸下降固定术对于microTESE的精子获取可能更有利�Objective To investigate the effect of treatment with orchiopexy at different ages on the clinical outcomes of nonobstructive azoospermia(NOA)patients with a history of cryptorchidism who underwent microdissection testicular sperm extraction(microTESE)combined with intracytoplasmic sperm injection(ICSI).Methods NOA patients undergoing microTESE combined with ICSI from December 2013 to August 2019 in the ICSI treatment cycle in Assisted Reproduction Center of Northwest Women and Children's Hospital were collected in this retrospective cohort study.According to the history of cryptorchidism,the patients were divided into cryptorchidism group and non-cryptorchidism group.The sperm retrieval rates(SRRs)were assessed between these two groups.Then,based on the timing of treatment with orchiopexy,the NOA patients with orchidopexy were subdivided into prepubertal group and pubertal-postpubertal group.The SRRs and the pregnancy outcomes were also assessed.Results There were 34 NOA patients with cryptorchidism and 604 NOA patients without cryptorchidism underwent microTESE.The SRRs in NOA patients with or without cryptorchidism were 85.3%(29/34)and 40.2%(243/604),respectively.The differences were statistically significant(P<0.001).In the prepubertal surgery group,sperm was detected in 17 cases,while in the pubertal-postpubertal surgery group,the sperm was detected in 12 cases.The differences were statistically significant(P=0.044).The total clinical pregnancy rate of cryptorchidism NOA patients treated with ICSI was 65.4%(17/26).Among these individuals,the clinical pregnancy rate of the prepubertal group was 62.5%(10/16)and the pubertal-postpubertal group was 70.0%(7/10).There were no statistical differences in clinical pregnancy rate.Some other clinical pregnancy outcomes,including miscarriage rate in early pregnancy,the rate of cycle with 2PN and the rate of cycle with top-quality embryo,also showed no differences between the two groups.In pathology analysis,all the cryptorchidism NOA patients with failure sperm retrieva

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

分 类 号：R726.9[医药卫生—儿科]