梗阻性无精子症患者ICSI助孕失败后精道显微重建术可行性与安全性分析——附20例报道  

Feasibility and safety of microsurgical anastomosis for obstructive azoospermia patients with prior ICSI failure(20 cases)

作　　者：董建军 赵晶鹏 杨超[4] 姚晨成 田汝辉 智二磊 张建雄 李铮[1] 李朋 Jianjun Dong;Jingpeng Zhao;Chao Yang;Chencheng Yao;Ruhui Tian;Erlei Zhi;Jianxiong Zhang;Zheng Li;Peng Li(Department of Andrology,Urologic Medical Center,Shanghai General Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200080,China;Department of Andrology,Jiaozuo Maternity and Infant Health Hospital,Jiaozuo 454000,China;State Key Laboratory of Reproductive Medicine,Nanjing Medical University,Nanjing 211166,China;Department of Urology,Jiangsu Province Hospital,Nanjing 210029,China)

机构地区：[1]上海交通大学医学院附属第一人民医院泌尿外科临床医学中心男科,男性健康评估中心,上海200080 [2]焦作市妇女儿童医院男科,焦作454000 [3]南京医科大学生殖医学国家重点实验室,南京211166 [4]江苏省人民医院泌尿外科,南京210029

出　　处：《中华生殖与避孕杂志》2022年第10期1003-1007,共5页Chinese Journal of Reproduction and Contraception

基　　金：上海市科委医学创新研究专项项目(20Y11907600);上海市第一人民医院特色研究项目(CTCCR-2021C17);上海申康医院发展中心临床三年行动计划(SHDC2020CR3077B);江苏省研究生科研与实践创新计划项目(SJCX22_0676)。

摘　　要：目的旨在探讨梗阻性无精子症(obstructive azoospermia,OA)患者卵胞质内单精子注射(intracytoplasmic sperm injection,ICSI)助孕失败后精道显微重建可行性和安全性。方法回顾性分析2015年9月至2020年5月期间于上海交通大学医学院附属第一人民医院泌尿外科临床医学中心男科收治的20例既往ICSI助孕失败的OA患者资料,总结精道显微重建术特点,并计算其术后复通率与临床妊娠率。结果显微镜下精道重建术中,8例患者存在输精管梗阻,12例患者存在附睾梗阻。输精管梗阻患者中,1例为外伤性OA,行腹腔镜辅助的右侧输精管吻合术(vasovasostomy,VV);7例为幼年斜疝术后OA,其中6例进一步行腹腔镜辅助的VV,1例行输精管附睾交叉吻合术;8例患者中6例术后复通,2例术后女方自然妊娠。附睾梗阻患者均行显微镜下输精管附睾吻合术(vasoepididymostomy,VE),12例患者中6例术后复通,3例术后女方自然妊娠。所有患者术中、术后均未出现明显并发症。结论输精管道显微重建手术是OA患者ICSI助孕失败后的一种有效的补救措施,可帮助患者实现自然妊娠。Objective To analyze the feasibility and safety of microsurgical anastomosis for obstructive azoospermia(OA)patients with prior intracytoplasmic sperm injection(ICSI)failure.Methods From September 2015 to May 2020,the data of 20 OA patients with previous ICSI-assisted pregnancy failure admitted to the Department of Andrology,Urologic Medical Center,Shanghai General Hospital,Shanghai Jiao Tong University School of Medicine were retrospectively analyzed.The characteristics of seminal tract microsurgical reconstruction were summarized,and the postoperative recurrence rate and clinical pregnancy rate were calculated.Results Vasal obstruction was found in 8 patients and epididymal obstruction in 12 patients during microscopically reconstructed seminal tract.Among the patients with vasal obstruction,1 patient developed OA after trauma and underwent laparoscopic-assisted right vasovasostomy(VV).Totally 7 patients developed OA after juvenile bilateral hernia,among whom 6 patients underwent further laparoscopic-assisted VV and 1 patient underwent vasovasostomy and epididymal cross anastomosis.Of the 8 patients who underwent VV,6 achieved postoperative patency,and 2 couples achieved natural pregnancy.Patients with epididymal obstruction underwent microscopic vasoepididymostomy(VE),and 6 out of 12 patients achieved postoperative pregnancy,while 3 couples achieved natural pregnancy.No significant complications occurred in all patients during and after operation.Conclusion Microsurgical anastomosis is an effective remedy for patients with OA after ICSI pregnancy failure,which can help patients achieve natural pregnancy.

关 键 词：不育 男性 精子注射 细胞质内 梗阻性无精子症 显微精道重建术 

分 类 号：R698.2[医药卫生—泌尿科学] R714.8[医药卫生—外科学]