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)
DOI:
作者:
作者单位:

1.南京医科大学附属上海一院临床医学院;2.上海交通大学医学院附属第一人民医院泌尿外科中心男科/ 上海交通大学泌尿外科研究所男性健康评估中心,上海

作者简介:

通讯作者:

中图分类号:

基金项目:

国家自然科学基金(82171590, 82171597, 82001530),上海市第一人民医院创新研究计划(KD007-ly01, CTCCR-C04),上海申康发展中心专科疾病临床“五新”(新设备)转化项目重大临床研究项目(SHDC2020CR3077B),宁夏回族自治区重点研发计划项目(2020BFH02002)。


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

Clinical Medical School, Shanghai General Hospital of Nanjing Medical University, Shanghai

Fund Project:

National Natural Science Foundation of China (82171590, 82171597, 82001530), Clinical Research Innovation Plan of Shanghai General Hospital (KD007-ly01, CTCCR-C04), Clinical Research Plan of SHDC (SHDC2020CR3077B); The Key Project of Research and Development of Ningxia Hui Autonomous Region of China (2020BFH02002).

  • 摘要
  • |
  • 图/表
  • |
  • 访问统计
  • |
  • 参考文献
  • |
  • 相似文献
  • |
  • 引证文献
  • |
  • 资源附件
  • |
  • 文章评论
    摘要:

    【摘要】目的:研究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(Microdissection testicular sperm extraction, micro-TESE)治疗的取精结局。方法:回顾性分析上海市第一人民医院自2015年3月至2022年1月1355名接受micro-TESE的患者,NOA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、腮腺性睾丸炎、放化疗、精索静脉曲张、特发性NOA,统计各组患者临床指标和精子获取率(Sperm retrieval rate, SRR),分析影响取精结局的因素。结果: NOA患者的总体SRR为26.2%(355/1355),其中腮腺性睾丸炎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(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,高龄者拥有较好的取精结局。结论:NOA患者中,不同病因/危险因素的SRR具有显著差异,是影响取精结局的重要预后指标。特发性NOA患者中,年龄对手术结局具有一定预测价值。

    Abstract:

    [Abstract] Objective To investigate the outcomes of non-obstructive azoospermia (NOA) patients with different etiologies undergoing micro-TESE. Methods A retrospective analysis of 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 clinical characteristics, sperm retrieval rate (SRR) of patients in each group were compared, and the factors affecting the outcome of sperm retrieval were analyzed successively. Results The overall SRR is 26.2% (355/1355). The mumps orchitis group ranks 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 FSH and 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. Conclusion In NOA patients, the SRR of different etiologies/risk factors is significantly different, which is an important prognostic indicator affecting sperm retrieval outcome. In patients with idiopathic NOA, age has a certain predictive value for clinical outcome.

    参考文献
    相似文献
    引证文献
引用本文
分享
文章指标
  • 点击次数:
  • 下载次数:
  • HTML阅读次数:
  • 引用次数:
历史
  • 收稿日期:2022-10-08
  • 最后修改日期:2023-02-20
  • 录用日期:2023-04-17
  • 在线发布日期:
  • 出版日期: