显微镜下睾丸切开取精术在非梗阻性无精子症助孕治疗中的应用

洪伟; 王莹; 朱琳; 刘俊璇; 曾继涛; 上官陶; 陈绪富; 何畏

doi:10.16016/j.2097-0927.202208194

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显微镜下睾丸切开取精术在非梗阻性无精子症助孕治疗中的应用

临床医学 | 更新时间：2026-01-09

- 显微镜下睾丸切开取精术在非梗阻性无精子症助孕治疗中的应用
- Application of microdissection testicular sperm extraction for patients with non-obstructive azoospermia
- 陆军军医大学学报 2023年45卷第3期页码：251-256
- 作者机构：
  
  400038 重庆，陆军军医大学(第三军医大学)第一附属医院生殖医学中心
- 作者简介：
  
  [ 何畏，E-mail: anyhewei@163.com HE Wei, E-mail: anyhewei@163.com
- 基金信息：
  
  军事医学与战创伤救治临床新技术计划(SWH2016BZGFKJ-09)
- DOI：10.16016/j.2097-0927.202208194
  中图分类号： R697.22;R698.2;R713.7
- 收稿：2022-08-27，
  
  修回：2022-10-07，
  
  纸质出版：2023-02-15
- 稿件说明：
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洪伟, 王莹, 朱琳, 等. 显微镜下睾丸切开取精术在非梗阻性无精子症助孕治疗中的应用[J]. 陆军军医大学学报, 2023,45(3):251-256.

Wei HONG, Ying WANG, Lin ZHU, et al. Application of microdissection testicular sperm extraction for patients with non-obstructive azoospermia[J]. Journal of Army Medical University, 2023, 45(3): 251-256.
洪伟, 王莹, 朱琳, 等. 显微镜下睾丸切开取精术在非梗阻性无精子症助孕治疗中的应用[J]. 陆军军医大学学报, 2023,45(3):251-256. DOI： 10.16016/j.2097-0927.202208194.

Wei HONG, Ying WANG, Lin ZHU, et al. Application of microdissection testicular sperm extraction for patients with non-obstructive azoospermia[J]. Journal of Army Medical University, 2023, 45(3): 251-256. DOI： 10.16016/j.2097-0927.202208194.

摘要

目的

评估显微镜下睾丸切开取精术(microdissection testicular sperm extraction，MD-TESE)在非梗阻性无精子症(non-obstructive azoospermia，NOA)助孕治疗中的价值及其安全性。

方法

回顾性分析2017年7月1日至2022年3月15日在我中心确诊为NOA的患者，共176例，根据选择取精方式的不同分为MD-TESE和睾丸穿刺取精术(testicular sperm aspiration，TESA)。比较两种取精方式的手术时间、术中出血量、血肿形成等并发症、精子获得率(sperm retrieval rate，SRR)以及体外受精的临床结局。

结果

两组患者的年龄、体质量指数(body mass index，BMI)、睾丸体积、睾酮(testosterone，T)、促黄体生成素(luteinizing hormone，LH)、抗苗勒管激素(anti-Müllerian hormone，AMH)、促卵泡生成素(follicle-stimulating hormone，FSH)等无明显差异(

0.05)；MD-TESE组的手术时间明显长于TESA组(

0.001)；MD-TESE组术后睾丸血肿发生率为2.4%(1/42)，略低于TESA组7.5%(10/134)；两组均无术后感染。MD-TESE组的SRR为38.1%(16/42)，显著高于TESA组的9.0%(12/134，

0.001)。两组获得的精子用于卵胞浆内单精子显微注射技术(intracytoplasmic sperm infecting，ICSI)助孕治疗，MD-TESE组受精率、卵裂率、临床妊娠率分别为65.1%、93.9%和50.0%，TESA组受精率、卵裂率、临床妊娠率分别为58.3%、71.4%和50.0%，两组平均疗效无明显差别。

结论

MD-TESE安全有效，尤其适合于隐睾、病毒性睾丸炎以及Y染色体AZFc缺失等有迫切希望生育自身遗传背景的子代的无精子症患者。

Abstract

Objective

To investigate the value and safety of microdissection testicular sperm extraction (MD-TESE) for patients with non-obstructive azoospermia (NOA).

Methods

A retrospective analysis study of 176 NOA patients diagnosed in our center from July 1

2017 to March 15

2022. According to sperm retrieval methods

they were divided into MD-TESE group and testicular sperm aspiration (TESA) group. The time of procedure

intra-operative bleeding

surgical complications (such as hematoma)

sperm retrieval rate (SRR) and clinical outcome of

in vitro

fertilization were compared between the 2 groups.

Results

There were no significant differences between the 2 groups in age

body mass index (BMI)

testicular volume

and levels of testosterone (T)

luteinizing hormon

e (LH)

anti-Müllerian hormone (AMH) and follicle-stimulating hormone (FSH) (

0.05). The MD-TESE group had obviously longer operation time (

0.001) and lower incidence of testicular hematoma rate than the TESA group. No infections were observed in either group. SRR was significantly higher in MD-TESE group than the TESA group. When the obtained sperms were used in intracytoplasmic sperm injection (ICSI)

no obvious differences were seen in the fertilization rate

cleavage rate

and clinical pregnancy rate between the MD-TESE group and TESA group (65.1%

58.3%

93.9%

71.4%

50.0%

50.0%).

Conclusion

MD-TESE is a safe and effective method for sperm retrieval in NOA patients

especially in those with cryptorchidism

viral orchitis and Y-chromosome AZFc microdeletions.

关键词

Keywords

references

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生殖激素水平和睾丸体积对非梗阻性无精症患者精子存在的预测价值