显微取精术治疗非梗阻性无精子症的疗效分析(附196例报告)

Micro-dissection testicular sperm extraction for patients with non-obstructive azoospermia:A report of 196 cases

目的:探讨显微镜下睾丸切开取精术应用于非梗阻性无精子症患者的疗效,以及显微取精术的手术适应症。方法:回顾性分析自2014年9月至2017年3月在我院接受显微镜下睾丸切开取精术的196例非梗阻性无精子症病例,统计取精成功率及其与年龄、睾丸体积、FSH、病因的相关性。结果:共87例(44.4%)患者成功手术取精;按手术成功取精与否分为阳性组与阴性组比较,患者年龄、睾丸大小及血FSH无统计学差异(P>0.05);按病因分类,取精成功率分别为睾丸炎29例(100%)、隐睾下降术后16例(66.7%)、其他各种继发损害10例(55.6%)、AZFc区缺失3例(60.0%)、严重睾丸发育不良9例(40.9%)、特发性无精子症12例(21.4%)、Klinerfelter综合征8例(20.5%)、其他Y染色体异常0例(0%)。结论:显微镜下睾丸切开取精术是非梗阻性无精子症患者获取精子助孕的有效手段,其取精成功率与睾丸大小及FSH高低无关,存在明确病因的患者获精率高。

Objective： To investigate the effect of micro-dissection testicular sperm extraction （microTESE） for patients with non-obstructive azoospermia （NOA） and the indications of the strategy. Methods： This retrospective study included 196 cases of NOA undergoing mieroTESE in our center from September 2014 to March 2017. We recorded the sperm retrieval rate （SRR） and ana- lyzed its correlation with the patients＇age, testis volume, level of blood tbllicle-stimulating holaone （FSH）, and etiological factors. Results： Testicular sperm were successfully retrieved from 87 （44.4%） of the patients. No significant correlation was found between the SRR and the patients＇age, testis volume, or blood FSH level （P 〉 0.05）. As regards etiological factors, the SRR was 100% （29/29） in the patients with orchitis, 66.7% （16/24） in those surgically treated for cTptorchidism, 55.6% （10/18） in those with other secondaly testis lesions, 60.0% （3/5） in those with AZFc deletion, 40.9% （9/22） in those with severe idiopathic testicular atrophy, 21.4% （12/56） in those with idiopathic NOA, 20.5% （8/39） in those with Klinefeher＇s syndrome, and 0% （0/3） in those with other abnormal karyotypes. Conclusion： MicroTESE is an effective strategy for sperm retrieval in NOA patients, and the SRR is correlated with etiological factors but not with the FSH level or testis volume of the patients.