非梗阻性无精子症患者显微切开睾丸取精及ICSI结局分析
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摘要
目的:分析显微切开睾丸取精术(micro-TESE)治疗非梗阻性无精子症(NOA)的疗效及联合卵细胞胞质内单精子注射(ICSI)的临床应用价值。方法:回顾性分析2015年12月至2017年12月130例NOA患者接受micro-TESE治疗及其中29例接受ICSI治疗的临床资料。130例患者中特发性NOA 36例,特发性NOA+小睾丸22例,Klinefelter综合征18例,隐睾术后46例,AZFc微缺失8例。患者均行micro-TESE,对其中29例获得精子患者行ICSI。观察术后血清T变化,分析不同类型NOA、睾丸病理学改变对精子获得率(SRR)的影响及ICSI结果。结果:所有micro-TESE手术均顺利完成。隐睾术后组SRR(60. 9%)明显高于与其他NOA组(P <0. 05),其他NOA组间SRR的差异均无统计学意义(P> 0. 05)。不同睾丸病理组间SRR的差异均具有统计学意义(P <0. 05),其中生精低下组SRR最高(100%),单纯唯支持细胞综合征组SRR较低(11. 8%),生精停滞组SRR为0。术后1、6个月血清T水平均较术前明显下降(P <0. 01),术后6个月较术后1个月明显升高(P <0. 01)。52例接受microTESE获取精子的患者中,29例配偶接受ICSI治疗,妊娠17例,生育6例,自然流产6例。结论:micro-TESE是治疗NOA的有效方法,联合运用ICSI可使NOA患者获得具有自己遗传学的后代。
Objective: To investigate the clinicaleffects of micro-dissection of testicular sperm extraction( micro-TESE) and its combination with intracytoplasmic sperm injection( ICSI) in the treatment of non-obstructive azoospermia( NOA). Methods: We retrospectively analyzed the clinical data on 130 NOA patients treated between December 2015 and December 2017,including36 cases of idiopathic NOA,22 cases of idiopathic NOA with small testis,18 cases of Klinefelter syndrome,46 cases of surgically treated cryptorchidism and 8 cases of AZFc microdeletion. All the patients underwent micro-TESE and 29 of them with sperm received micro-TESE+ ICSI. We observed the changes in the postoperative serum T level,analyzed the influences of different types of NOA and testicular pathology on the sperm retrieval rate( SRR) and the outcomes of ICSI. Results: All the micro-TESE operations were successfully completed. The SRR was significantly higher in those surgically treated for cryptorchidism( 60. 9%) than in the other NOA groups( P < 0. 05),withstatistically significant differencesnot among the latter groups( P > 0. 05) but among differenttypes of testicular pathology( P < 0. 05),the highest in the hypospermatogenesis group( 100%),very low in those with Sertoli-cell-only syndrome( 11. 8%),and the lowest in the cases of spermatogenesis arrest( 0). The serum T level was remarkably decreased at 1 and 6 months after operation( P < 0. 01),but markedly higher at 6 than at 1 month( P < 0. 01). Of the 52 patients with sperm retrieved at microTESE,29 of their spouses received ICSI,resulting in 17 pregnancies,6 live births,and 6 spontaneous abortions. Conclusion: Micro-TESE is an effective method for the treatment of NOA,and its combination with ICSI can help the NOA patients obtain their genetic offspring.
Objective: To investigate the clinicaleffects of micro-dissection of testicular sperm extraction( micro-TESE) and its combination with intracytoplasmic sperm injection( ICSI) in the treatment of non-obstructive azoospermia( NOA). Methods: We retrospectively analyzed the clinical data on 130 NOA patients treated between December 2015 and December 2017,including36 cases of idiopathic NOA,22 cases of idiopathic NOA with small testis,18 cases of Klinefelter syndrome,46 cases of surgically treated cryptorchidism and 8 cases of AZFc microdeletion. All the patients underwent micro-TESE and 29 of them with sperm received micro-TESE+ ICSI. We observed the changes in the postoperative serum T level,analyzed the influences of different types of NOA and testicular pathology on the sperm retrieval rate( SRR) and the outcomes of ICSI. Results: All the micro-TESE operations were successfully completed. The SRR was significantly higher in those surgically treated for cryptorchidism( 60. 9%) than in the other NOA groups( P < 0. 05),withstatistically significant differencesnot among the latter groups( P > 0. 05) but among differenttypes of testicular pathology( P < 0. 05),the highest in the hypospermatogenesis group( 100%),very low in those with Sertoli-cell-only syndrome( 11. 8%),and the lowest in the cases of spermatogenesis arrest( 0). The serum T level was remarkably decreased at 1 and 6 months after operation( P < 0. 01),but markedly higher at 6 than at 1 month( P < 0. 01). Of the 52 patients with sperm retrieved at microTESE,29 of their spouses received ICSI,resulting in 17 pregnancies,6 live births,and 6 spontaneous abortions. Conclusion: Micro-TESE is an effective method for the treatment of NOA,and its combination with ICSI can help the NOA patients obtain their genetic offspring.
引文
[1] Verheyen G,Popovic-Todorovic B,Tournaye H. Processing and selection of surgically-retrieved sperm for ICSI:A review. Basic Clin Androl,2017,27:6.
[2] Schlegel PN. Testicular sperm extraction:Microdissection improves sperm yield with minimal tissue excision. Hum Reprod,1999,14(1):131-135.
[3]张靖,刘贵华,赵鲁刚,等.显微取精术治疗非梗阻性无精子症的疗效分析(附196例报告).中华男科学杂志,2017,23(9):804-807.
[4]苏煌,刘边疆,杨晓玉,等.男性不育症伴成人型多囊肾患者ICSI治疗结局分析.中华男科学杂志,2015,21(1):38-43.
[5] Okuyama N,Obata R,Oka N,et al. Long-term clinical outcomes of testicular sperm extraction and intracytoplasmic sperm injectionfor infertile men. Reprod Med Biol,2017,17(1):82-88.
[6] Flannigan R,Bach PV,Schlegel PN. Microdissection testicular sperm extraction. Transl Androl Urol,2017,6(4):745-752.
[7]秦超,宋宁宏,杨晓玉,等.睾丸显微取精技术治疗非梗阻性无精子症1例.南京医科大学学报(自然科学版),2016,36(1):127-128.
[8]季兴哲,刘项,周梁,等. ICSI周期显微取精术治疗13例AZF微缺失致无精症的临床研究.生殖医学杂志,2017,8(26):737-742.
[9] Alrabeeah K,Witmer J,Ruiz S,et al. Mini-incision microdissection testicular sperm extraction:A useful technique for men with cryptozoospermia. Andrology,2016,4(2):284-289.
[10] Ghalayini IF,Al-Ghazo MA,Hani OB,et al. Clinical comparison of conventional testicular sperm extraction and microdissection techniques for non-obstructive azoospermia. J Clin Med Res,2011,3(3):124-131.
[11] Bernie AM,Ramasamy R,Schlegel PN. Predictive factors of successful microdissection testicular sperm extraction. Basic Clin Androl,2013,23:5.
[12] Ramasamy R,Yagan N,Schlegel PN. Structural and functional changes to the testis after conventional versus microdissection testicular sperm extraction. Urology,2005,65(6):1190-1194.
[13] Tsujimura A,Matsumiya K,Miyagawa Y,et al. Conventional multiple or microdissection testicular sperm extraction:A comparative study. Hum Reprod,2002,17(11):2924-2929.
[14] Okada H,Dobashi M,Yamazaki T,et al. Conventional versus microdissection testicular sperm extraction for nonobstructive azoospermia. J Urol,2002,168(3):1063-1067.
[15] Amer M,Ateyah A,Hany R,et al. Prospective comparative study between microsurgical and conventional testicular sperm extraction in non-obstructive azoospermia:Follow-up by serial ultrasound examinations. Hum Reprod,2000,15(3):653-656.
[16] Ishikawa T. Surgical recovery of sperm in non-obstrucive azoospermia. Asian J Androl,2012,14(1):109-115.
[17] Aksglaede L,Juul A. Testicular function and fertility in men with Klinefelter syndrome:A review. Eur J Endocrinol,2013,168(4):R67-R76.
[18] Yalcin I,Berker B,Sukur YE,et al. Comparison of intracytoplasmic sperm injection with testicular spermatozoa success in infertile men with obstructive and non-obstructive azoospermia:A retrospective analysis. Hum Fertil(Camb),2017,20(3):186-191.
[2] Schlegel PN. Testicular sperm extraction:Microdissection improves sperm yield with minimal tissue excision. Hum Reprod,1999,14(1):131-135.
[3]张靖,刘贵华,赵鲁刚,等.显微取精术治疗非梗阻性无精子症的疗效分析(附196例报告).中华男科学杂志,2017,23(9):804-807.
[4]苏煌,刘边疆,杨晓玉,等.男性不育症伴成人型多囊肾患者ICSI治疗结局分析.中华男科学杂志,2015,21(1):38-43.
[5] Okuyama N,Obata R,Oka N,et al. Long-term clinical outcomes of testicular sperm extraction and intracytoplasmic sperm injectionfor infertile men. Reprod Med Biol,2017,17(1):82-88.
[6] Flannigan R,Bach PV,Schlegel PN. Microdissection testicular sperm extraction. Transl Androl Urol,2017,6(4):745-752.
[7]秦超,宋宁宏,杨晓玉,等.睾丸显微取精技术治疗非梗阻性无精子症1例.南京医科大学学报(自然科学版),2016,36(1):127-128.
[8]季兴哲,刘项,周梁,等. ICSI周期显微取精术治疗13例AZF微缺失致无精症的临床研究.生殖医学杂志,2017,8(26):737-742.
[9] Alrabeeah K,Witmer J,Ruiz S,et al. Mini-incision microdissection testicular sperm extraction:A useful technique for men with cryptozoospermia. Andrology,2016,4(2):284-289.
[10] Ghalayini IF,Al-Ghazo MA,Hani OB,et al. Clinical comparison of conventional testicular sperm extraction and microdissection techniques for non-obstructive azoospermia. J Clin Med Res,2011,3(3):124-131.
[11] Bernie AM,Ramasamy R,Schlegel PN. Predictive factors of successful microdissection testicular sperm extraction. Basic Clin Androl,2013,23:5.
[12] Ramasamy R,Yagan N,Schlegel PN. Structural and functional changes to the testis after conventional versus microdissection testicular sperm extraction. Urology,2005,65(6):1190-1194.
[13] Tsujimura A,Matsumiya K,Miyagawa Y,et al. Conventional multiple or microdissection testicular sperm extraction:A comparative study. Hum Reprod,2002,17(11):2924-2929.
[14] Okada H,Dobashi M,Yamazaki T,et al. Conventional versus microdissection testicular sperm extraction for nonobstructive azoospermia. J Urol,2002,168(3):1063-1067.
[15] Amer M,Ateyah A,Hany R,et al. Prospective comparative study between microsurgical and conventional testicular sperm extraction in non-obstructive azoospermia:Follow-up by serial ultrasound examinations. Hum Reprod,2000,15(3):653-656.
[16] Ishikawa T. Surgical recovery of sperm in non-obstrucive azoospermia. Asian J Androl,2012,14(1):109-115.
[17] Aksglaede L,Juul A. Testicular function and fertility in men with Klinefelter syndrome:A review. Eur J Endocrinol,2013,168(4):R67-R76.
[18] Yalcin I,Berker B,Sukur YE,et al. Comparison of intracytoplasmic sperm injection with testicular spermatozoa success in infertile men with obstructive and non-obstructive azoospermia:A retrospective analysis. Hum Fertil(Camb),2017,20(3):186-191.