显微切割睾丸活检在非梗阻性无精子症中的应用

Microdissection testicular sperm extraction for non-obstructive azoospermia

一直以来,学者们认为非梗阻性无精子症因睾丸生精功能受损,导致精液中无精子,而无法生育自己的后代。但随着卵胞质内单精子注射技术的问世,近十几年来涌现出多种睾丸取精术(包括开放性睾丸活检、细针穿刺抽吸、显微切割睾丸活检等)。之后,大量研究表明非梗阻性无精子症患者睾丸中仍存有局部的生精灶,即使是Klinefelter综合征,也可成功取出精子。2010年欧洲泌尿外科学会(EAU)指南明确推荐非梗阻性无精子症采用开放性睾丸活检或显微切割睾丸活检取精。与开放性睾丸活检相比,显微切割睾丸活检的取精成功率高且并发症少,本文就其取精前预测指标、手术操作方法、取精成功率及术后并发症进行综述。

Patients with non-obstructive azoospermia was once considered to be infertile due to impaired testicular spermatogenesis and consequent absence of sperm in the ejaculate. With the advent of intracytoplasmic sperm injection （ ICSI）, various testicular sperm retrieval techniques have been introduced recently, including fine needle aspiration, testicular sperm extraction, microdissection testicular sperm extraction, and so on. A large number of studies show that sperm can be retrieved in non-obstructive azoospermia pa- tients, even in those with Klinefelter syndrome, because of the existence of isolated regions of spermatogenic tissue within the testis. 2010 EAU guidelines on male infertility recommend testicular sperm extraction or microdissection testicular sperm extraction for sperm retrieval from non-obstructive azoospermia. However, compared with testicular sperm extraction, the latter has a higher sperm retrieval rate with minimal postoperative complications. This article presents an overview on the prediction, operative procedure, sperm retrieval rate and postoperative complications of microdissection testicular sperm extraction.