显微切开睾丸取精术在继发性睾丸损伤所致非梗阻性无精子症患者中的应用

Micro-dissection testicular sperm extraction for non-obstructive azoospermia patients with the history of secondary testicular injury

目的:探讨显微切开睾丸取精术(micro-TESE)应用于因继发性睾丸损伤导致非梗阻性无精子症(NOA)患者的疗效。方法:回顾性分析2014年9月至2017年12月接受micro-TESE并具继发性睾丸损伤病史的121例NOA患者,分析不同睾丸损伤病因患者micro-TESE取精成功率的差异。并进一步比较micro-TESE获得精子与重度少精子症患者(精子浓度<1×106/ml)射出精子的卵细胞胞质内单精子注射(ICSI)助孕结局,比较两组间女方年龄、受精(2PN)率、第3天(D3)可移植胚胎率、D3优质胚胎率、D14血h CG阳性率、胚胎种植率、临床妊娠率。结果:104例患者(86.0%,104/121)成功通过micro-TESE获得精子。按其继发性睾丸损伤的病史,microTESE取精成功率分别为:睾丸炎98.4%、隐睾下降固定术后75.5%、化疗/放疗损害63.6%。micro-TESE所获得精子和重度少精子症患者射出精子ICSI助孕周期的2PN受精率(59.4%vs 69.3%)、D14血h CG阳性率(44.6%vs 57.9%)、胚胎种植率(31.8%vs 32.6%)、临床妊娠率(41.5%vs 48.7%)均无统计学差异(P>0.05),但两者D3可移植胚胎率(40.5%vs 52.2%)、D3优质胚胎率(32.5%vs 42.1%)均有显著差异(P<0.05)。结论:micro-TESE应用于继发性睾丸损伤所致的NOA患者时取精成功率较高,可作为首选治疗方法,但需要进一步探索改善micro-TESE获得精子后行ICSI助孕结局的有效手段。

Objective： To investigate the value of micro-dissection testicular sperm extraction （micro-TESE） in the treatment of non-obstructive azoospermia （NOA） in patients with the history of secondary testicular injury. Methods： Totally, 121 NOA pa-tients with the history of secondary testicular injury underwent micro-TESE in our hospital from September 2014 to December 2017. We analyzed the correlation of the sperm retrieval rate with the causes of testicular injury and compared the outcomes of the ICSI cycles with the sperm retrieved from the NOA males by micro-TESE （the micro-TESE group） and those with the sperm ejaculated from severe oli- gospermia patients （sperm concentration 〈 1×10^6/ml, the ejaculate group）. Comparisons were also made between the two groups in the female age, two-pronucleus （2PN） fertilization rate, transferrable embryos on day 3 （D3） , D3 high-quality embryos, D14 blood HCG positive rate, embryo implantation rate, and clinical pregnancy rate. Results： Testicular sperm were successfully retrieved by micro-TESE in 86.0% of the patients （ 104/121 ）, of whom 98.4% had the history of orchitis, 75.5% had been treated surgically for cryptorchidism, and 63.6% had received chemo- or radiotherapy. No statistically significant differences were observed between the mi- cro-TESE and ejaculate groups in the 2PN fertilization rate （59.4% 57.9% , P〉0.05）, embryo implantation rate （31.8 % % vs 32 vs 69.3%, P 〉 0.05）, D14 blood HCG positive rate （44.6% vs 6% , P〉0.05） and clinical pregnancy rate （41.5% vs 48.7% , P 〉 0.05）. However, the rate D3 transferrable embryos was significantly lower in the micro-TESE than in the ejaculate group （40.5% vs52.2%,P 〈 0.05）, and so was that of D3 high-quality embryos （32.5% vs42.1%, P 〈 0.05）. Conclusion： Mi- cro-TESE can be applied as the first choice for NOA patients with the history of secondary testieular injury, but more effective strategies are to be explored for the improvement of ICSI outcomes with the sperm retrieved by micro-TESE.