睾丸固定钳固定法在经皮附睾穿刺取精术中的应用价值

Application value of testis fixing forceps in percutaneous epididymal sperm aspiration

目的评价睾丸固定钳固定法在经皮附睾穿刺取精术(PESA)中的应用价值。方法选取初步诊断为梗阻性无精子症患者532例,将其随机分为三指固定法组(249例)和睾丸固定钳组(283例),比较两组PESA穿刺精子获取率差异。另根据经阴囊超声附睾头有无扩张以及扩张特征将病例分为附睾头细网状扩张亚组、附睾头管状/多囊管状扩张亚组和附睾头无扩张亚组,比较两种PESA方法对不同附睾头病变穿刺精子获取率的差异。结果三指固定法组穿刺精子获取率为60.64%(151/249),睾丸固定钳组为74.56%(211/283),显著高于三指固定法组(P<0.05)。睾丸固定钳组穿刺精子获取率的优势主要由细网状扩张组贡献,该组三指固定法穿刺精子获取率为72.67%(125/172),而睾丸固定钳法为89.90%(178/198),显著高于三指固定法组(P<0.05)。管状/多囊管状扩张亚组以及附睾头无扩张亚组2种PESA法穿刺精子获取率都偏低,差异无统计学意义(P>0.05)。结论使用睾丸固定钳固定法对附睾头细网状扩张的患者进行PESA穿刺能提高精子获取率。

Objective To evaluate the application value of testis fixing forceps in percutaneous epididymal sperm aspiration （PESA）. Methods Totally 532 cases with the initial diagnosis of obstructive azoospermia （OA） were selected and randomly divided into three fingers fixed method PESA group （249 cases） and testicular fixation forceps PESA group （283 cases）, the difference of the sperm retrieval rate was calculated between the two groups. In addition, according to the different epididymis head ultrasonic manifestations through scrotal ultrasonography, the cases were divided into the epididymis head of fine mesh expansion group, the epididymis head tubular / polycystic tubular expansion group and the epididymis head without expansion group, the difference of the sperm retrieval rate in different epididymis lesions groups by the two PESA methods was compared. Results The sperm retrieval rate in the testicular fixation forceps PESA group [74.56% （211/283] was significantly higher than that in the three fingers fixation PESA group [60.64% （151/249）] （P〈0.05）. The advantages of the successful sperm retrieval rate in the PESA group with testicular fixation forceps were mainly contributed by the fine mesh expansion group, the sperm retrieval rate in the three fingers fixed PESA group [72.67% （125/172）] was significantly lower than that in the testicular fixation forceps PESA group [89.90% （178/198）] （P〈0.05）. The sperm retrieval rate of the two PESA methods in the tubular/polycystic tubular expansion group and the non dilated group was low, the difference was not statistically significant （P〉0.05）. Conclusion The use of testis fixing forceps for PESA can improve sperm retrieval rate.