CAJ | 학술논문

目的探讨睾丸显微取精术(MD-TESE)联合传统睾丸取精术(TESE)治疗非梗阻性无精子症(non-obstructive azoospermia,NOA)的精子获得率(sperm retrieval rate,SRR)及其影响因素.方法 2011年2月至2012年4月,NOA患者共107例,患者首先接受TESE术,未获得精子者行MD-TESE术.镜下观察获取精子情况并记录结果,分析SRR与患者睾丸体积、血清卵泡刺激素(FSH)浓度及病理结果的相关性. 结果 107例患者中,TESE术获得精子46例(43.0％),TESE联合MD-TESE术获得精子61例(57.0％).病理组织学分析结果显示,71例唯支持细胞综合征(Sertoli cell only syndrome,SCOS)患者中,TESE联合MD-TESE术的SRR显著高于单纯TESE术(45.1％比32.4％,P＜0.01).而22例成熟阻滞(maturation arrest,MA)和14例精子发生低下(hypospermatogenesis,HS)患者2种方法结果差异无统计学意义(59.1％比40.9％,P=0.25；92.9％比78.6％,P=0.50).在TESE联合MD-TESE术中,HS组SRR显著高于SCOS组和MA组.术前B超测量睾丸体积＜10 ml、＞6 ml组,TESE联合MD-TESE术的SRR显著高于单纯TESE术(54.2％比31.3％,P＜0.01).在术前血清FSH浓度＞12.6 U/L组,TESE联合MD-TESE术的SRR显著高于单纯TESE术(56.9％比41.7％,P＜0.01). 结论与单纯TESE术相比,TESE联合MD-TESE术SRR更高.与病理组织学类型相关,HS患者SRR高于SCOS及MA患者.当NOA患者睾丸体积＜10 ml或者血清FSH浓度＞正常值2倍时,TESE联合MD-TESE术更具优势.而睾丸体积、血清FSH浓度并不能预测TESE联合MD-TESE术是否成功.
목적 탐토고환현미취정술(MD-TESE)연합전통고환취정술(TESE)치료비경조성무정자증(non-obstructive azoospermia,NOA)적정자획득솔(sperm retrieval rate,SRR)급기영향인소.방법 2011년2월지2012년4월,NOA환자공107례,환자수선접수TESE술,미획득정자자행MD-TESE술.경하관찰획취정자정황병기록결과,분석SRR여환자고환체적、혈청란포자격소(FSH)농도급병리결과적상관성. 결과 107례환자중,TESE술획득정자46례(43.0％),TESE연합MD-TESE술획득정자61례(57.0％).병리조직학분석결과현시,71례유지지세포종합정(Sertoli cell only syndrome,SCOS)환자중,TESE연합MD-TESE술적SRR현저고우단순TESE술(45.1％비32.4％,P＜0.01).이22례성숙조체(maturation arrest,MA)화14례정자발생저하(hypospermatogenesis,HS)환자2충방법결과차이무통계학의의(59.1％비40.9％,P=0.25；92.9％비78.6％,P=0.50).재TESE연합MD-TESE술중,HS조SRR현저고우SCOS조화MA조.술전B초측량고환체적＜10 ml、＞6 ml조,TESE연합MD-TESE술적SRR현저고우단순TESE술(54.2％비31.3％,P＜0.01).재술전혈청FSH농도＞12.6 U/L조,TESE연합MD-TESE술적SRR현저고우단순TESE술(56.9％비41.7％,P＜0.01). 결론 여단순TESE술상비,TESE연합MD-TESE술SRR경고.여병리조직학류형상관,HS환자SRR고우SCOS급MA환자.당NOA환자고환체적＜10 ml혹자혈청FSH농도＞정상치2배시,TESE연합MD-TESE술경구우세.이고환체적、혈청FSH농도병불능예측TESE연합MD-TESE술시부성공.
Objective To evaluate the outcomes of microdissection testicular sperm extraction (MD-TESE) and conventional testicular sperm extraction (TESE) in patients with non-obstructive azoospermia (NOA).And to investigate the factors that influence the sperm retrieval rate (SRR) of the MD-TESE.Methods One hundred and seven non-obstructive azoospermia patients accepting conventional TESE and MD-TESE in our institute.Testicular tissues were minced and observed under microscope with 400 magnification.The relationships between SRR and testis volume,serum FSH and pathological category were analyzed.Results There were 46 patients retrieved testicular sperm successfully in conventional TESE,versus 61 patients in TESE combined with MD-TESE.Compared with conventional TESE about pathological types,sperm retrieval rate of TESE combined with MD-TESE was significantly higher in the group of Sertoli cell only syndrome (SCOS,45.1％:32.4％,P ＜ 0.01) than in the groups of maturation arrest (MA,59.1％:40.9％,P=0.25) andhypospermatogenesis (HS,92.9％:78.6％,P=0.5).At the meantime,sperm retrieval rate of TESE combined with MD-TESE was significantly higher in the group of HS (92.9％) than in the groups of SCOS (45.1％) and MA (59.1％).Compared with conventional TESE about testicular volume,sperm retrieval rate of TESE combined with MD-TESE was significantly higher in the group of ＜10mland ＞6 ml (54.2％:31.3％,P＜0.01 =than in the groups of ＞15 ml (55.6％:50.0％,P =1.0) and 10-15 ml (61.0％:53.7％,P =0.25).However,sperm retrieval rates of TESE combined with MD-TESE were similar in the groups of ＞ 15 ml,10-15 ml,＜ 10 ml and ＞6 ml (55.6％,61.0％,54.2％,respectively,P =0.77).Compared with conventional TESE about serum FSH concentration,sperm retrieval rate of TESE combined with MD-TESE was significantly higher in the group of ＞ 12.6IU/L (56.9％:41.7％,P＜0.01 =than in the group of ≤12.6 U/L (45.7％:57.1％,P=0.125).But,sperm retrieval rates of TESE combined with MD-TESE were similar in the groups of ＞ 12.6 U/L,≤12.6 U/L (56.9％,57.1％,respectively,P =0.98).Conclusions Sperm retrieval rate of TESE combined with MD-TESE was significantly higher than conventional TESE.And sperm retrieval rate was associated with pathological types.Testicular volume and serum FSH concentration were not indexes of the success of TESE combined with MD-TESE.