非梗阻性无精子症三步法取精术及其临床意义(附73例报告)

Three-Step Sperm Retrieval for 73 non-obstructive azoospermia patients

目的:探讨非梗阻性无精子症应用三步法取精术获取睾丸精子的方法及其临床意义。方法:73例非梗阻性无精子症患者按步骤依次行睾丸细针抽吸术、睾丸活检术、睾丸显微取精术,并将每次获取的睾丸组织在倒置显微镜(×400)下寻找精子,如该步操作查见精子则终止手术,若未查找到则依次进行。同时取睾丸组织送病理行组织学检查。结果:73例患者行睾丸细针抽吸术,28例(38.4%)获得精子;行至睾丸活检术时,38例(52.1%)获得精子;行至睾丸显微取精术时,47例(64.4%)获得精子。病理学检查结果为唯支持细胞综合征型25例,其中10例查到精子,精子成熟阻滞型21例,其中14例查找到精子,精子发生低下型27例,其中23例查到精子。结论:三步法取精术能够有效地提高患者精子获得率;其精子获得率与睾丸组织学类型相关,其中精子发生低下型精子获得率较高。

Objective： To investigate the value and clinical application of the Three-Step Sperm Retrieval method in improving the sperm retrieval rate for non-obstructive azoospermia （NOA） patients. Methods： Seventy-three NOA patients underwent Three- Step Sperm Retrieval in the following order of procedures ： testicular fine needle aspiration （ TFNA）, testicular sperm extraction （TSE）, and microdissection testicular sperm extraction （MD-TSE）. The testicular tissue obtained from each step was observed for spermatozoa under the 400-fold inverted microscope. If spermatozoa were found in one step, the operation would be stopped; other- wise, the next step would be carried out. The testicular tissue was subjected to pathological examination. Results： Spermatozoa was found in the testicular tissue in 38.4% of the cases （28/73） at TFNA as the first step, in 52.1% （38/73） at TFNA and TSE, and in 64.4% （47/73） at TFNA, TSE and MD-TSE. Pathological examination showed 25 of the cases to be Sertoli cell-only syndrome, 21 to be sperm maturation arrest and the other 27 to be hypospermatogenesis, in which spermatozoa were found in 10, 14 and 23 cases, respectively. Conclusion： The Three-Step Sperm Retrieval method can significantly improve the sperm retrieval rate for NOA patients.And the sperm retrieval rate is associated with the pathological type of the testicular tissue, a higher rate with hypospermatogenesis.