不同病因的非梗阻性无精子症显微镜下睾丸取精术结局研究(附1355例报道)

Outcomes of azoospermic patients with different etiologies undergoing microdissection testicular sperm extraction(1355 cases)

目的:分析不同病因的非梗阻性无精子症(non⁃obstructive azoospermia,NOA)患者经显微镜下睾丸取精术(microdis⁃section testicular sperm extraction,micro⁃TESE)的治疗结局。方法:回顾性分析上海市第一人民医院2015年3月—2022年1月1355例接受micro⁃TESE的患者,病因/危险因素包括克氏综合征(Klinefelter syndrome,KS)、Y染色体AZFc缺失、隐睾、腮腺炎性睾丸炎、放化疗、精索静脉曲张以及特发性NOA,研究分析各组患者精子获取率(sperm retrieval rate,SRR),并比较各组取精成功的妊娠结局。结果:NOA患者的总体SRR为26.2%(355/1355),其中腮腺炎性睾丸炎SRR最高(75.9%,22/29),其次分别为隐睾(70.5%,43/61)、Y染色体AZFc缺失(55.6%,30/54)、KS(47.6%,71/149)、特发性NOA(18.6%,167/897)、放化疗(15.4%,2/13),精索静脉曲张SRR最低(13.2%,20/152)。根据手术结局,将NOA患者分为取精成功组及取精失败组。特发性NOA及放化疗类型中,取精成功组卵泡刺激素(follicle⁃stimulating hormone,FSH)和黄体生成素(luteinizing hormone,LH)水平显著高于取精失败组;Y染色体AZFc缺失类型中,取精成功组FSH、LH水平显著低于取精失败组;腮腺炎性睾丸炎类型中,取精成功组睾丸体积高于取精失败组。回归分析发现年龄可作为预测特发性NOA患者取精结局的因素,年龄较高者拥有较好的取精结局。卵胞浆内单精子注射治疗的妊娠率为51.4%(200/389),活产率为73.5%(147/200)。结论:不同病因/危险因素NOA患者的SRR具有显著差异,是影响micro⁃TESE取精结局的重要指标。

Objective:To investigate the outcomes of non⁃obstructive azoospermia(NOA)patients with different etiologies undergoing microdissection testicular sperm extraction(micro⁃TESE).Methods:A retrospective analysis was carried out in 1355 patients who accepted micro⁃TESE in Shanghai General Hospital from March 2015 to January 2022.The etiology/risk factors of NOA patients included Klinefelter syndrome(KS),Y⁃chromosome AZFc deletion,cryptorchidism,mumps orchitis,chemoradiotherapy,varicocele,idiopathic etiology.The sperm retrieval rate(SRR)of patients in each group were analyzed,and the pregnancy outcomes of successful sperm retrieval in each group were compared.Results:The overall SRR was 26.2%(355/1355).The mumps orchitis group ranked the highest SRR of 75.9%(22/29),followed by cryptorchidism(70.5%,43/61),Y⁃chromosome AZFc deletion(55.6%,30/54),KS(47.6%,71/149),idiopathic etiology(18.6%,167/897),radiotherapy and chemotherapy(15.4%,2/13),and varicocele was the lowest(13.2%,20/152).According to the clinical outcome,NOA patients were divided into a success group and a failure group.In idiopathic and chemoradiotherapy group,the levels of follicle⁃stimulating hormone(FSH)and luteinizing hormone(LH)in successful cases were significantly higher than those failed;In Y⁃chromosome AZFc deletion group,the levels of FSH was significantly lower than those failed;In mumps orchitis group,the volume of the testis in the success group was higher than those failed.In addition,we found that age can serve as an independent factor to predict sperm retrieval outcome in patients with idiopathic NOA,and the older had better sperm retrieval outcomes.After ICSI treatment,the pregnancy rate was 51.4%(200/389),and the live birth rate was 73.5%(147/200).Conclusion:The SRR of NOA patients with different causes/risk factors are significantly different,which are important indicators affecting the outcome of micro⁃TESE.