超声引导下生精小管定位新方法在显微镜取精术中的应用  

Application of a New Ultrasound-Guided Seminiferous Tubule Localization in Microdissection Testieular Sperm Extraction

作　　者：卢国澄 姜珏[1] 王娟[1] 何鑫[1] 唐启胜 武涛 周琦[1] Lu Guocheng;Jiang Jue;Wang Juan;He Xin;Tang Qisheng;Wu Tao;Zhou Qi(Department of Ultrasound,the Second Affiliated Hospital of Xi'an Jiaotong University,Xi'an 710004,China;Department of Urology,the Second Affiliated Hospital of Air Force Medical University,Xi'an 710038,China)

机构地区：[1]西安交通大学第二附属医院医用超声研究室,西安市710004 [2]空军军医大学第二附属医院泌尿外科,西安市710038

出　　处：《中国超声医学杂志》2023年第10期1157-1160,共4页Chinese Journal of Ultrasound in Medicine

摘　　要：目的 描述超声引导下生精小管定位新方法在显微镜取精术中的应用,评价其效果。方法 选取非梗阻性无精子症(NOA)患者44例,平均年龄(31±3.3)岁,均经过病史采集、临床触诊、精液分析、经超声检查及显微镜取精术。超声定位生精小管方法步骤:睾丸短轴切面寻找睾丸结构,睾丸长轴切面局部放大寻找增粗、饱满的生精小管,对其进行术前定位并描绘定位示意图,取精术前在睾丸实体进行定位。计算术前超声定位的生精小管与术中观察到的生精小管的符合率,并统计术中及术后并发症的发生率。结果 44例NOA患者共84个睾丸均顺利完成手术,其中79个睾丸术前定位生精小管位置与术中所见一致,符合率达94.0%。术中平均出血量(6.6±4.1)mL,无一例输血,术后3 d内发生血肿0例,术后3 d内发生感染0例,均无严重术中、术后并发症;19例成功获得精子,精子获取率(SRR)为43.1%。结论 超声引导生精小管定位新方法在睾丸显微镜取精术中可行,使手术步骤相对简便、高效,具有术中对睾丸损伤小,出血少,术后并发症少、恢复快等优势,可作为辅助显微镜下睾丸切开取精术(Micro-TESE)的一种新方法。Objective To describe the application of a new ultrasonic guided seminiferous tubule localization method in microdissection testieular sperm extraction and evaluate its effect.Methods A total of 44 patients with non-obstructive azoospermia(NOA)aged(31±3.3)years were selected.All of them underwent medical history collection,clinical palpation,semen analysis,examination by ultrasonography and microscopic semen retrieval.Methods for locating seminiferous tubules by ultrasound:Testicular short axis cut plane to search for testicular portal structure,the long axis section of the testis was locally enlarged to look for thickened and plump seminiferous tubules,performing preoperative positioning and depicting the localization diagram,localization was performed in the testicular entity before sperm retrieval.The coincidence rate of seminiferous tubules located before the preoperative ultrasound and those observed during the operation was calculated,and the rates of intraoperative and postoperative complications were calculated.Results In 44 NOA patients,84 testes were successfully completed surgery,and 79 testes were located in the same position as found in operation,with a coincidence rate of 94.0%.The average intraoperative blood loss was(6.6±4.1)mL,no blood transfusion,0 cases of hematoma within 3 days after surgery,0 cases of infection within 3 days after surgery,no serious intraoperative or postoperative complications.The sperm retrieval rate(SRR)of 19 cases was 43.1%.Conclusions The new method of ultrasound-guided seminiferous tubule positioning is feasible in testicular microscopic sperm retrieval,making the surgical steps relatively simple and efficient,with the advantages of less intraoperative testicular damage,less bleeding,less postoperative complications,and faster recovery.It can be used as a new method to assist microscopic testicular sperm extraction(Micro-TESE).

关 键 词：超声引导定位 生精小管 非梗阻性无精子症 显微镜取精术 

分 类 号：R445.1[医药卫生—影像医学与核医学] R699.8[医药卫生—诊断学]