摘要
目的:探讨分步法小切口改良睾丸显微取精术在隐睾下降固定术后非梗阻性无精子症的有效性。创新点:既往有隐睾下降固定术手术史的非梗阻性无精子症的患者睾丸局部粘连严重,所以睾丸显微取精术时睾丸暴露困难,因此手术难度明显增大。术者将常规睾丸显微取精术改良为分步法小切口睾丸显微取精术,术中无需完全游离暴露睾丸,仅通过小切口睾丸显微取精术就可使一半的患者成功获取精子。因此分步法小切口改良睾丸显微取精术可在不降低睾丸取精成功率的前提下缩短手术时间和减少手术创伤。方法:收集2015年5月至2017年3月于上海交通大学附属第一人民医院泌尿中心男科接受睾丸显微取精术的20例既往有隐睾下降固定术手术史的非梗阻性无精子症,采用分步法小切口改良睾丸显微取精术获取睾丸精子。分步法小切口改良睾丸显微取精术具体步骤为:第一步,小切口睾丸取精术;第二步,将小切口延长为标准切口,行标准睾丸显微取精术;第三步,对侧睾丸标准睾丸显微取精术。结论:小切口睾丸显微取精术可快速有效获取睾丸内表浅位置饱满的生精小管,标准的睾丸显微取精术可作为小切口睾丸显微取精术失败时的补救措施。分步法小切口睾丸显微取精术可降低睾丸损伤前提下,快速有效地获取睾丸精子。这种手术方式特别适用于睾丸内存在表浅饱满生精小管的非梗阻性无精子症,如隐睾下降固定术后的非梗阻性无精子症。
Non-obstructive azoospermia(NOA),which is defined as the absence of spermatozoa in the ejaculate secondary to impaired spermatogenesis within the testis,may be caused by a variety of etiologies,including varicocele-induced testicular damage,cryptorchidism,prior testicular torsion,post-pubertal mumps orchitis,gonadotoxic effects from medications,genetic abnormalities,chemotherapy/radiation,and other unknown causes currently classified as idiopathic(Cocuzza et al.,2013).The microdissection testicular sperm extraction(micro-TESE)technique involves a meticulous microsurgical exploration of the testicular parenchyma to identify and selectively extract larger seminiferous tubules that carry a higher probability of complete spermatogenesis(Schlegel,1999).
基金
Project supported by the National Natural Science Foundation of China(Nos.81701524,81671512,and 81701428)
the Frontier Technology Project of Shanghai(No.SHDC12015122),China
