睾丸穿刺取精与经皮附睾取精行卵细胞浆内单精子注射技术的meta分析
|
摘要
目的比较睾丸穿刺取精与经皮附睾取精2种方式行卵细胞浆内单精子注射技术(ICSI)治疗对临床结局的影响。方法通过计算机检索PubMed、EMBASE、Cochrane图书馆和中国知网(CNKI)、万方数据库、维普(VIP)等数据库从建库至2017年10月有关睾丸穿刺取精与经皮附睾取精行ICSI治疗的文献,按照纳入与排除标准对文献筛选,并进行资料提取,用Cochrane协作网非随机研究推荐的Newcastle-Ottawa Scale(NOS)行文献质量评价,运用RevMan5.3进行meta分析。结果共纳入原始文献20篇,包括1 464周期用睾丸穿刺取得的精子行ICSI,2 526周期用经皮附睾取得的精子行ICSI治疗。Meta分析结果显示,睾丸穿刺取精与经皮附睾取精2种方式行ICSI治疗在妊娠率[相对危险度(RR)=1.06,95%置信区间(95%CI)0.99～1.13,P=0.11]、流产率(RR=0.99,95%CI0.76～1.30,P=0.97)、活产率(RR=0.99,95%CI0.86～1.14,P=0.88)、异位妊娠率(RR=1.44,95%CI0.70～2.95,P=0.32)、畸形率(RR=1.71,95%CI 0.50～5.80,P=0.39)、单胎率(RR=0.95,95%CI0.85～1.06,P=0.38)、多胎率(RR=1.12,95%CI0.90～1.39,P=0.32)方面无差异。术后2组患者均无感染、阴囊血肿、性功能障碍等严重并发症。结论行睾丸穿刺取精与经皮附睾取精2种方式行ICSI治疗,在安全性及疗效方面无显著差异。
Objective To compare the efficiency of testicular sperm aspiration and percutaneous epididymal sperm aspiration for receiving intracytoplasmic sperm injection(ICSI)assisted reproduction.Methods PubMed,EMBASE,Cochrane Library,CNKI,Wanfang database and VIP database were searched,and all publications before October 2017 which related to comparing testicular sperm aspiration and percutaneous epididymal sperm aspiration for ICSI were browsed.According to the inclusion and exclusion criteria,the literature was screened and the data were extracted.The Newcastle-Ottawa Scale(NOS)was recommended for quality evaluation of non-randomized studies,and RevMan 5.3 was used for meta-analysis.Results A total of 20 literatures were recruited,including 1 464 cycles and 2 526 cycles used sperm by testicular sperm aspiration and percutaneous epididymal sperm aspiration for ICSI,respectively.The results based on meta-analysis showed that no significant differences could be observed between groups using testicular sperm aspiration and percutaneous epididymal sperm aspiration in rates of pregnancy(RR=1.06,95%CI 0.99-1.13,P=0.11),abortion(RR=0.99,95%CI 0.76-1.30,P=0.97),live birth(RR=0.99,95%CI 0.86-1.14,P=0.88),ectopic pregnancy(RR=1.44,95%CI 0.70-2.95,P=0.32),deformity(RR=1.71,95%CI 0.50-5.80,P=0.39),singleton(RR=0.95,95%CI0.85-1.06,P=0.38),multiple pregnancy(RR=1.12,95%CI 0.90-1.39,P=0.32),respectively.In addition,no severe complications,such as postoperative infection,scrotal hematoma or sexual dysfunction,were reported between two groups.Conclusion Testicular sperm aspiration and percutaneous epididymal sperm aspiration would be similarly safe and efficient for patients receiving ICSI assisted reproduction.
Objective To compare the efficiency of testicular sperm aspiration and percutaneous epididymal sperm aspiration for receiving intracytoplasmic sperm injection(ICSI)assisted reproduction.Methods PubMed,EMBASE,Cochrane Library,CNKI,Wanfang database and VIP database were searched,and all publications before October 2017 which related to comparing testicular sperm aspiration and percutaneous epididymal sperm aspiration for ICSI were browsed.According to the inclusion and exclusion criteria,the literature was screened and the data were extracted.The Newcastle-Ottawa Scale(NOS)was recommended for quality evaluation of non-randomized studies,and RevMan 5.3 was used for meta-analysis.Results A total of 20 literatures were recruited,including 1 464 cycles and 2 526 cycles used sperm by testicular sperm aspiration and percutaneous epididymal sperm aspiration for ICSI,respectively.The results based on meta-analysis showed that no significant differences could be observed between groups using testicular sperm aspiration and percutaneous epididymal sperm aspiration in rates of pregnancy(RR=1.06,95%CI 0.99-1.13,P=0.11),abortion(RR=0.99,95%CI 0.76-1.30,P=0.97),live birth(RR=0.99,95%CI 0.86-1.14,P=0.88),ectopic pregnancy(RR=1.44,95%CI 0.70-2.95,P=0.32),deformity(RR=1.71,95%CI 0.50-5.80,P=0.39),singleton(RR=0.95,95%CI0.85-1.06,P=0.38),multiple pregnancy(RR=1.12,95%CI 0.90-1.39,P=0.32),respectively.In addition,no severe complications,such as postoperative infection,scrotal hematoma or sexual dysfunction,were reported between two groups.Conclusion Testicular sperm aspiration and percutaneous epididymal sperm aspiration would be similarly safe and efficient for patients receiving ICSI assisted reproduction.
引文
[1]PALERMO G,JORIS H,DEVROEY P,et al.Pregnancies after intracytoplasmic injection of single spermatozoon into anoocyte[J].Lancet,1992,340(8810):17-18.
[2]房磊臣,付劲草,吴小候,等.经皮附睾和睾丸精子获取术的方法改进及在无精子症诊断和治疗的应用[J].重庆医科大学学报,2009,34(9):1209-1210.
[3]蒲军,丘彦.3种取精方式获得的精子进行ICSI治疗效果的比较[J].重庆医学,2010,39(3):302-303.
[4]孙捷,陈厚仰,黄志辉,等.126例梗阻性无精子症借助ICSI治疗的临床结局分析[J].中国医学创新,2011,8(23):7-9.
[5]蔡敏生,邓茹.不同来源精子对体外受精患者胚胎和妊娠结局的影响[J].临床医学工程,2017,24(2):211-212.
[6]罗莉,赵静,李东红,等.不同来源精子行卵胞浆内单精子显微注射结局分析[J].中国妇幼健康研究,2012,23(3):297-299.
[7]曹金凤,杜元杰,赵志明,等.不同来源精子行卵胞浆内单精子注射临床妊娠结局分析[J].生殖医学杂志,2015,24(2):129-133.
[8]董悦芝,宋亚男,张轶乐,等.梗阻性无精症附睾或睾丸取精行卵胞质内单精子注射研究[J].中华实验外科杂志,2013,30(4):852-854.
[9]林小民.梗阻性无精子症附睾精子与睾丸精子行ICSI治疗结局比较[J].国际医药卫生导报,2014,20(15):2298-2300.
[10]董瑞娜,郭艺红,孙莹璞,等.3 106个不同来源精子ICSI周期临床妊娠结局分析[J].生殖与避孕,2013,33(4):233-238.
[11]张志宏,朱海波,张馨月,等.不同来源精子对卵胞浆内单精子注射治疗结局的影响[J].生殖医学杂志,2014,23(3):252-255.
[12]霍雷,金海霞,孙莹璞,等.不同来源精子行ICSI助孕1662个周期治疗结局分析[J].现代妇产科进展,2011,20(4):272-274.
[13]欧蕾,郭艺红,孙莹璞,等.不同来源精子行卵细胞胞质内单精子注射临床妊娠结局分析[J].中华男科学杂志,2010,16(7):656-659.
[14]金华,丁家怡,邵骏.不同来源精子在ICSI中对受精,胚胎发育的影响[J].医学综述,2015,21(23):4392-4393.
[15]孙文枫,黄元华,谢宝国,等.睾丸与附睾精子对梗阻性无精子症ICSI助孕结局的影响[J].中国优生与遗传杂志,2017,25(7):114-116.
[16]孙赟,滕晓明,李卫平,等.不同源性及不同参数精子对ICSI结局的影响[J].生殖与避孕,2006,26(5):294-298.
[17]欧蕾,郭艺红,孙莹璞,等.冻融复苏微量精子行卵细胞胞质内单精子注射术的疗效及临床妊娠结局分析[J].中华男科学杂志,2010,16(4):328-332.
[18]贺小进,赵济华,章志国,等.不同外科手术取精方法与精子发生对无精子症患者卵泡浆内单精子显微注射临床结局的影响[J].安徽医科大学学报,2010,45(3):371-373.
[19]王巍,梁国耀,李美玲,等.192例男性因素不孕患者不同来源精子ICSI后临床结局分析[J].中国男科学杂志,2016,30(12):40-46.
[20]DOZORTSEZ ZD,NEME R,DIAMOND MP,et al.Embryos generated using testicular spermatozoa have higher developmental potential than those obtained using epididymal spermatozoa in men with obstructive azoospermia[J].Fertil Steril,2006,86(3):606-611.
[21]BORGES E,ROSSI-FERRAGUT LM,PASQUALOTTO FF,et al.Testicular sperm results in elevated miscarriage rates compared to epididymal sperm in azoospermic patients[J].Sao Paulo Med J,2002,120(4):122-126.
[22]冯翠娥,丛林,章志国,等.不同来源精子对卵胞浆内单精子注射助孕结局的影响[J].安徽医科大学学报,2010,45(1):112-114.
[23]SHAH R.Surgical sperm retrieval:techniques and their indications[J].Indian J Urol,2011,27(1):102-109.
[24]VAN PEPERSTRATEN A,PROCTOR ML,JOHNSON NP,et al.Techniques for surgical retrieval of sperm prior to intra-cytoplasmic sperm injection(ICSI)for azoospermia[J].Cochrane Database Syst Rev,2008,2(2):CD002807.
[25]VAN PERPERSTRATEN AM,PROCTOR ML,PHILLIPSONG,et al.Techniques for surgical retrieval of sperm prior to ICSIfor azoospermia[J].Cochrane Database Syst Rev,2001,2(4):CD002807.
[26]郑爱燕,顾斌,丁洁,等.精子来源和质量对卵胞浆内单精子注射治疗结局的影响[J].中国妇幼保健,2014,29(2):257-258.
[27]刘雅峰,欧建平,王琼,等.附睾精子和睾丸精子妊娠结局比较[J].中国优生与遗传杂志,2006,14(11):100-101.
[28]苗聪秀,朱文兵,李娜.不同来源精子及其活力与无精子症患者ICSI受精结局的关系[J].中国现代医学杂志,2013,23(1):78-82.
[2]房磊臣,付劲草,吴小候,等.经皮附睾和睾丸精子获取术的方法改进及在无精子症诊断和治疗的应用[J].重庆医科大学学报,2009,34(9):1209-1210.
[3]蒲军,丘彦.3种取精方式获得的精子进行ICSI治疗效果的比较[J].重庆医学,2010,39(3):302-303.
[4]孙捷,陈厚仰,黄志辉,等.126例梗阻性无精子症借助ICSI治疗的临床结局分析[J].中国医学创新,2011,8(23):7-9.
[5]蔡敏生,邓茹.不同来源精子对体外受精患者胚胎和妊娠结局的影响[J].临床医学工程,2017,24(2):211-212.
[6]罗莉,赵静,李东红,等.不同来源精子行卵胞浆内单精子显微注射结局分析[J].中国妇幼健康研究,2012,23(3):297-299.
[7]曹金凤,杜元杰,赵志明,等.不同来源精子行卵胞浆内单精子注射临床妊娠结局分析[J].生殖医学杂志,2015,24(2):129-133.
[8]董悦芝,宋亚男,张轶乐,等.梗阻性无精症附睾或睾丸取精行卵胞质内单精子注射研究[J].中华实验外科杂志,2013,30(4):852-854.
[9]林小民.梗阻性无精子症附睾精子与睾丸精子行ICSI治疗结局比较[J].国际医药卫生导报,2014,20(15):2298-2300.
[10]董瑞娜,郭艺红,孙莹璞,等.3 106个不同来源精子ICSI周期临床妊娠结局分析[J].生殖与避孕,2013,33(4):233-238.
[11]张志宏,朱海波,张馨月,等.不同来源精子对卵胞浆内单精子注射治疗结局的影响[J].生殖医学杂志,2014,23(3):252-255.
[12]霍雷,金海霞,孙莹璞,等.不同来源精子行ICSI助孕1662个周期治疗结局分析[J].现代妇产科进展,2011,20(4):272-274.
[13]欧蕾,郭艺红,孙莹璞,等.不同来源精子行卵细胞胞质内单精子注射临床妊娠结局分析[J].中华男科学杂志,2010,16(7):656-659.
[14]金华,丁家怡,邵骏.不同来源精子在ICSI中对受精,胚胎发育的影响[J].医学综述,2015,21(23):4392-4393.
[15]孙文枫,黄元华,谢宝国,等.睾丸与附睾精子对梗阻性无精子症ICSI助孕结局的影响[J].中国优生与遗传杂志,2017,25(7):114-116.
[16]孙赟,滕晓明,李卫平,等.不同源性及不同参数精子对ICSI结局的影响[J].生殖与避孕,2006,26(5):294-298.
[17]欧蕾,郭艺红,孙莹璞,等.冻融复苏微量精子行卵细胞胞质内单精子注射术的疗效及临床妊娠结局分析[J].中华男科学杂志,2010,16(4):328-332.
[18]贺小进,赵济华,章志国,等.不同外科手术取精方法与精子发生对无精子症患者卵泡浆内单精子显微注射临床结局的影响[J].安徽医科大学学报,2010,45(3):371-373.
[19]王巍,梁国耀,李美玲,等.192例男性因素不孕患者不同来源精子ICSI后临床结局分析[J].中国男科学杂志,2016,30(12):40-46.
[20]DOZORTSEZ ZD,NEME R,DIAMOND MP,et al.Embryos generated using testicular spermatozoa have higher developmental potential than those obtained using epididymal spermatozoa in men with obstructive azoospermia[J].Fertil Steril,2006,86(3):606-611.
[21]BORGES E,ROSSI-FERRAGUT LM,PASQUALOTTO FF,et al.Testicular sperm results in elevated miscarriage rates compared to epididymal sperm in azoospermic patients[J].Sao Paulo Med J,2002,120(4):122-126.
[22]冯翠娥,丛林,章志国,等.不同来源精子对卵胞浆内单精子注射助孕结局的影响[J].安徽医科大学学报,2010,45(1):112-114.
[23]SHAH R.Surgical sperm retrieval:techniques and their indications[J].Indian J Urol,2011,27(1):102-109.
[24]VAN PEPERSTRATEN A,PROCTOR ML,JOHNSON NP,et al.Techniques for surgical retrieval of sperm prior to intra-cytoplasmic sperm injection(ICSI)for azoospermia[J].Cochrane Database Syst Rev,2008,2(2):CD002807.
[25]VAN PERPERSTRATEN AM,PROCTOR ML,PHILLIPSONG,et al.Techniques for surgical retrieval of sperm prior to ICSIfor azoospermia[J].Cochrane Database Syst Rev,2001,2(4):CD002807.
[26]郑爱燕,顾斌,丁洁,等.精子来源和质量对卵胞浆内单精子注射治疗结局的影响[J].中国妇幼保健,2014,29(2):257-258.
[27]刘雅峰,欧建平,王琼,等.附睾精子和睾丸精子妊娠结局比较[J].中国优生与遗传杂志,2006,14(11):100-101.
[28]苗聪秀,朱文兵,李娜.不同来源精子及其活力与无精子症患者ICSI受精结局的关系[J].中国现代医学杂志,2013,23(1):78-82.