显微取精时代下睾丸内情况分析
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摘要
目的:让临床医生更直观认识无精症患者睾丸内生精小管形态,提高临床医生预测无精症患者显微取精成功率的能力。方法:选择2014年1月至2018年1月在北京大学第三医院做了显微取精的非克氏(Klinefelter)征无精症患者的病例资料进行回顾性分析,总结患者睾丸内生精小管类型,对比不同类型睾丸内生精小管类型的临床特点及取精成功率。结果:共472例非梗阻性无精症患者完成了显微取精手术纳入本研究,患者的平均年龄31(23,46)岁,平均睾丸大小10(1,20) mL,平均卵泡刺激素(follicle-stimulating hormone,FSH) 15.4(1.21,68.4) IU/L,平均睾酮(testosterone,T) 8.34(0.69,30.2) nmol/L,总共202人(42.7%,202/472)取到精子。根据术中所见睾丸内生精小管类型可以分为以下6种:a类:生精小管外观发育良好,均匀一致; b类:生精小管外观发育良好,偶见稍粗; c类:生精小管普遍偏细; d类:生精小管基本萎缩,偶有发育良好的生精小管; e类:全部生精小管萎缩; f类:生精小管被黄色物质浸润。各类患者的显微取精成功率有极大差异。a类患者共78人,平均年龄29(24,40)岁,FSH 11.1(1.21,15.8) IU/L,T10.2(3.29,26.5) nmol/L,睾丸大小12(12,20) mL,显微取精成功率为6.41%; b类患者共82人,平均年龄为31(23,42)岁,FSH 13.8 (3.23,19.6) IU/L,T 9.44(3.58,30.2) nmol/L,睾丸大小12(8,15) mL,显微取精成功率为74.39%; c类患者共162人,平均年龄为31(25,40)岁,FSH19.6(9.28,26.6) IU/L,T8.75(5.66,18.6) nmol/L,睾丸大小8(5,12) mL,显微取精成功率为45.06%; d类患者共36人,平均年龄为25(23,38)岁,FSH28.5(19.3,45.6) IU/L,T6.52(2.12,9.83) nmol/L,睾丸大小5(3,8) mL,显微取精成功率为94.44%; e类患者共26人,平均年龄为28(23,46)岁,FSH 31.3(18.5,68.4) IU/L,T 6.72(0.69,18.2) nmol/L,睾丸大小5(1,8) mL,显微取精成功率为15.38%; f类患者共88人,平均年龄为29(24,38)岁,FSH 18.5(5.23,31.6)IU/L,T 8.32(3.58,16.5) nmol/L,睾丸大小12(6,20) mL,显微取精成功率为28.41%。结论:睾丸内不同生精小管类型显微取精成功率的差异能够给术者术中判断带来帮助,提高术中预测显微取精成功率的能力。
Objective:To summarizes the intratesticular condition of azoospermia patients,to understand azoospermia more intuitively,and improve the ability of clinical doctors to predict the success rate of microsperm extraction in azoospermia patients.Methods:Azoospermia patients(excluding Klinefelter's syndrome) who underwent a micro-TESE during January 2014 and January 2018 in a single center were enrolled.The types of seminiferous tubules were summarized,and the clinical characteristics of different types of seminiferous tubules compared with the success rates of sperm extraction.In this study,472 cases of non-obstructive azoospermia(excluding Klinefelter's syndrome) were analyzed by SPSS 21.0 software package.Relevant data were expressed by median(minimum,maximum).t-test was used to compare the difference of success rate of sperm extraction between each group and the group with the lowest rate(a type).Results:The 472 patients with non-obstructive azoospermia underwent microTESE.The mean age of the patients was 31(23,46) years,the mean testicular size was 10(1,20) mL,the mean FSH was 15.4(1.21,68.4) IU/L,the mean T was 8.34(0.69,30.2) nmol/L,and totally202 patients achieved success in micro-TESE(42.7%,202/472).According to the seminiferous tubules seen during the operation,they were divided into the following six types:Class a,seminiferous tubules developed well and uniformly;Class b,seminiferous tubules developed well,occasionally slightly thick;Class c,seminiferous tubules were generally thin;Class d,seminiferous tubules basically atrophied,occasionally well-developed seminiferous tubules;Class e,all seminiferous tubules atrophied;Class f,seminiferous tubules were infiltrated by yellow substances.The success rate of micro-TESE varied greatly among different types of the patients.A total of 78 patients with type a were 29(24,40) years old,FSH 11.1(1.21,15.8) IU/L,T10.2(3.29,26.5) nmol/L),and testicular size 12(12,20) mL.The successful rate of sperm extraction was 6.41%;82 patients with type b were 31(23,42) years old,FSH 13.8(3.23,19.6) IU/L,T9.44(3.58,30.2) nmol/L),and testicular size 12(8,15) mL.The successful rate of sperm extraction was 74.39%;There were 162 patients in group c,aged 31(25,40),FSH 19.6(9.28,26.6) IU/L,T 8.75(5.66,18.6) nmol/L,and testicular size 8(5,12) mL.The successful rate of sperm extraction was 45.06%.There were 36 patients in group d,aged 25(23,38)years and FSH 28.5(19.3,45.6) IU/L,T6.52(2.12,9.83) nmol/L,and testicular size 5(3,8) mL,and the success rate of sperm extraction was 94.44%.26 patients with type e were 28(23,46) years old,FSH31.3(18.5,68.4) IU/L,T6.72(0.69,18.2) nmol/L,and testicular size 5(1,8) mL.The success rate of sperm extraction was 45.38%.88 patients with type f were 29(24,38) years old,FSH18.5(5.23,31.6) IU/L,T8.32(3.58,16.5) nmol/L,and testicular size 12(6,20) mL.The success rate of sperm extraction was 28.41%.Conclusion:The success rate of micro-TESE in different types of seminiferous tubules in testis can be helpful to the judgement of the surgeon during the operation.
Objective:To summarizes the intratesticular condition of azoospermia patients,to understand azoospermia more intuitively,and improve the ability of clinical doctors to predict the success rate of microsperm extraction in azoospermia patients.Methods:Azoospermia patients(excluding Klinefelter's syndrome) who underwent a micro-TESE during January 2014 and January 2018 in a single center were enrolled.The types of seminiferous tubules were summarized,and the clinical characteristics of different types of seminiferous tubules compared with the success rates of sperm extraction.In this study,472 cases of non-obstructive azoospermia(excluding Klinefelter's syndrome) were analyzed by SPSS 21.0 software package.Relevant data were expressed by median(minimum,maximum).t-test was used to compare the difference of success rate of sperm extraction between each group and the group with the lowest rate(a type).Results:The 472 patients with non-obstructive azoospermia underwent microTESE.The mean age of the patients was 31(23,46) years,the mean testicular size was 10(1,20) mL,the mean FSH was 15.4(1.21,68.4) IU/L,the mean T was 8.34(0.69,30.2) nmol/L,and totally202 patients achieved success in micro-TESE(42.7%,202/472).According to the seminiferous tubules seen during the operation,they were divided into the following six types:Class a,seminiferous tubules developed well and uniformly;Class b,seminiferous tubules developed well,occasionally slightly thick;Class c,seminiferous tubules were generally thin;Class d,seminiferous tubules basically atrophied,occasionally well-developed seminiferous tubules;Class e,all seminiferous tubules atrophied;Class f,seminiferous tubules were infiltrated by yellow substances.The success rate of micro-TESE varied greatly among different types of the patients.A total of 78 patients with type a were 29(24,40) years old,FSH 11.1(1.21,15.8) IU/L,T10.2(3.29,26.5) nmol/L),and testicular size 12(12,20) mL.The successful rate of sperm extraction was 6.41%;82 patients with type b were 31(23,42) years old,FSH 13.8(3.23,19.6) IU/L,T9.44(3.58,30.2) nmol/L),and testicular size 12(8,15) mL.The successful rate of sperm extraction was 74.39%;There were 162 patients in group c,aged 31(25,40),FSH 19.6(9.28,26.6) IU/L,T 8.75(5.66,18.6) nmol/L,and testicular size 8(5,12) mL.The successful rate of sperm extraction was 45.06%.There were 36 patients in group d,aged 25(23,38)years and FSH 28.5(19.3,45.6) IU/L,T6.52(2.12,9.83) nmol/L,and testicular size 5(3,8) mL,and the success rate of sperm extraction was 94.44%.26 patients with type e were 28(23,46) years old,FSH31.3(18.5,68.4) IU/L,T6.72(0.69,18.2) nmol/L,and testicular size 5(1,8) mL.The success rate of sperm extraction was 45.38%.88 patients with type f were 29(24,38) years old,FSH18.5(5.23,31.6) IU/L,T8.32(3.58,16.5) nmol/L,and testicular size 12(6,20) mL.The success rate of sperm extraction was 28.41%.Conclusion:The success rate of micro-TESE in different types of seminiferous tubules in testis can be helpful to the judgement of the surgeon during the operation.
引文
[1]Schlegel PN.Testicular sperm extraction:microdissection improves sperm yield with minimal tissue excision[J].Hum Reprod,1999,14(1):131-135.
[2]AbdellRaheem A,Garaffa G,Rushwan N,et al.Testicular histopathology as a predictor of a positive sperm retrieval in men with non-obstructive azoospermia[J].BJU Int,2013,111(3):492-499.
[3]Ramasamy R,Ricci JA,Palermo GD,et al.Successful fertility treatment for Klinefelter’s syndrome[J].J Urol,2009,182(3):1108-1113.
[4]Jarow JP,Espeland MA,Lipshultz LI.Evaluation of the azoospermic patient[J].J Urol,1989,142(1):62-65.
[5]Walker WH,Cheng J.FSH and testosterone signaling in Sertoli cells[J].Reproduction,2005,130(1):15-28
[6]Valenti D,La Vignera S,Condorelli RA,et al.Follicle-stimulating hormone treatment in normogonadotropic infertile men[J].Nat Rev Urol,2013,10(1):55-62
[7]Acosta AA,Khalifa E,Oehninger S.Pure human follicle stimulating hormone has a role in the treatment of severe male infertility by assisted reproduction:Norfolk’s total experience[J].Hum Reprod,1992,7(8):1067-1072.
[8]杨俊,刘继红.睾丸活检在非梗阻性无精症中应用前景及问题[J].中国男科学杂志,2011,25(4):61-64.
[9]Bryson CF,Ramasamy R,Sheehan M,et al.Severe testicular atrophy does not affect the success of microdissection testicular sperm extraction[J].J Urol,2014,191(1):175-178.
[10]Ramasamy R,Lin K,Gosden LV,et al.High serum FSH levels in men with nonobstructive azoospermia does not affect success of microdissection testicular sperm extraction[J].Fertil Steril,2009,92(2):590-593.
[2]AbdellRaheem A,Garaffa G,Rushwan N,et al.Testicular histopathology as a predictor of a positive sperm retrieval in men with non-obstructive azoospermia[J].BJU Int,2013,111(3):492-499.
[3]Ramasamy R,Ricci JA,Palermo GD,et al.Successful fertility treatment for Klinefelter’s syndrome[J].J Urol,2009,182(3):1108-1113.
[4]Jarow JP,Espeland MA,Lipshultz LI.Evaluation of the azoospermic patient[J].J Urol,1989,142(1):62-65.
[5]Walker WH,Cheng J.FSH and testosterone signaling in Sertoli cells[J].Reproduction,2005,130(1):15-28
[6]Valenti D,La Vignera S,Condorelli RA,et al.Follicle-stimulating hormone treatment in normogonadotropic infertile men[J].Nat Rev Urol,2013,10(1):55-62
[7]Acosta AA,Khalifa E,Oehninger S.Pure human follicle stimulating hormone has a role in the treatment of severe male infertility by assisted reproduction:Norfolk’s total experience[J].Hum Reprod,1992,7(8):1067-1072.
[8]杨俊,刘继红.睾丸活检在非梗阻性无精症中应用前景及问题[J].中国男科学杂志,2011,25(4):61-64.
[9]Bryson CF,Ramasamy R,Sheehan M,et al.Severe testicular atrophy does not affect the success of microdissection testicular sperm extraction[J].J Urol,2014,191(1):175-178.
[10]Ramasamy R,Lin K,Gosden LV,et al.High serum FSH levels in men with nonobstructive azoospermia does not affect success of microdissection testicular sperm extraction[J].Fertil Steril,2009,92(2):590-593.