隐睾后非梗阻性无精子症患者睾丸精子获得率临床分析

Testicular sperm extraction in non-obstructive azoospermia associated with cryptorchidism

目的 探讨隐睾后非梗阻性无精子症（non-obstructive azoospermia,NOA）患者睾丸精子获得率（sperm retrieval rate,SRR）及行睾丸固定术的年龄对其影响. 方法 回顾性分析2012年9月至2014年3月收治的33例隐睾后NOA患者（腹股沟型）和46例睾丸体积、卵泡刺激素（folliclestimulating hormone,FSH）和黄体生成素（luteinizing hormone,LH）与之同一水平的无隐睾NOA患者的病例资料.比较两组患者睾丸显微取精术的SRR和睾丸病理差异,同时分析隐睾后NOA患者行睾丸固定术的年龄（A组：0～ 10岁,15例;B组：＞10岁,18例）对其睾丸体积、激素水平（FSH、LH）和SRR的影响. 结果 隐睾后NOA患者SRR为70％（23/33）,无隐睾NOA患者为46％ （21/46）,两组比较差异有统计学意义（P＜0.05）,两组精子成熟阻滞（64％和39％）和唯支持细胞综合征（21％和52％）两种病理类型比例比较差异有统计学意义（P＜0.05）.A、B两组的睾丸体积[（8.51±2.73）、（8.80±5.74） ml]、FSH[（24.83±7.63）、（25.32±5.66） U/L]、LH[（9.19±3.49）、（10.64±5.67） U/L]和SRR[73％（11/15）、67％（12/18）]比较差异均无统计学意义（P＞0.05）. 结论 隐睾后NOA患者SRR明显高于无隐睾NOA患者,可能与隐睾后NOA睾丸病理改变相对轻微有关.行睾丸固定术时的年龄对隐睾后NOA患者的睾丸体积、激素水平和SRR并无明显影响.

Objective To evaluate the sperm retrieval rate （SRR） in non-obstructive azoospermia （NOA） associated with cryptorchidism and the effect of age at orchidopexy on SRR.Methods A total of 33 NOA after cryptorchidism （inguinal） and 46 NOA without cryptorchidism （as control） matched for testicular volume,follicle-stimulating hormone （FSH） and luteinizing hormone （LH） levels.The NOA after cryptorchidism underwent microdissection of testicular sperm extraction （MD-TESE） from September 2012 to March 2014.The SRR and testicular histology between the two groups were compared.The effect of age at orchidopexy （Group A：age 10 and younger; Group B：age older than 10） on testicular volume,hormone levels （FSH and LH） and SRR were analyzed.Results The SRR in NOA after cryptorchidism （70%,23/33） was significantly higher than that in control group （46%,21/46） （P〈0.05）.The histology in NOA after cryptorchidism was significantly better than that in control （maturation arrest：64% versus 39% ; Sertoli cell-only syndrome：21% versus 52%） （P〈0.05）.No significant differences were found in testicular volume [（8.51±2.73） mlversus （8.80±5.74） ml],FSH [（24.83±7.63） U/Lversus （25.32±5.66） U/L],LH [（9.19±3.49） U/L versus （10.64±5.67） U/L] and SRR [73% （11/15） versus 67% （12/18）] between Group A and Group B （P〉0.05）.Conclusions The SRR is significantly higher in NOA after cryptorchidism than that in NOA without cryptorchidism,and it might be the result of better histology in NOA associated with cryptorchidism.The age at orchidopexy shows no correlations with testicular volume,hormone levels and SRR in NOA after cryptorchidism.