外科手术重建生殖管道和辅助生殖技术治疗梗阻性无精子症的疗效对比
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摘要
目的对梗阻性无精子症(OA)患者行外科手术重建生殖管道或辅助生殖技术治疗并进行疗效分析。方法选取78例OA不育患者,按随机数字表法分为A、B组:A组行外科手术治疗,术后仍不孕患者根据精液精子浓度分为体外受精组(A-IVF)和单精子显微注射组(A-ICSI);B组行经皮附睾穿刺取精(PESA)或睾丸精子抽取术卵胞浆内单精子注射(TESA-ICSI)治疗。比较2组临床妊娠结局以及实验室各项指标:获卵数、受精情况、D3胚胎情况以及D5囊胚情况,分析其原因。结果 A组39例(含A-IVF 5例,A-ICSI 19例)患者采取输精管-输精管吻合术及输精管-附睾管显微吻合术,术后1月复查精液可见精子者为31例,复通率为79.49%,复查精液发现精液浓度正常者7例(22.58%),少精患者24例(77.42%),其中包含重度少精者20例(64.52%);39例中,20例临床妊娠(51.28%)。B组39例患者直接经PESA或TESA-ICSI,其中21例临床妊娠(53.85%)。经比较,2组临床妊娠率差别无统计学意义(P<0.05)。A-IVF和A-ICSI 2组的受精率分别为80.77%及79.42%,明显高于B组受精率72.79%(P<0.05)。但A-IVF和A-ICSI 2组的平均D3优质胚胎数、囊胚形成数、移植胚胎数和临床妊娠率与B组比较无显著性差异(P>0.05)。结论外科手术重建生殖管道和附睾或睾丸取精行辅助生殖技术治疗OA患者均能取得一定的疗效;不同类型的OA患者应选择合理的治疗方式。
Objective To analyze the curative effect of surgical reconstruction of reproductive canal or assisted reproductive technology in patients with obstructive azoospermia,in order to lay the foundation for the treatment of obstructive azoospermia patients. Methods In the male reproductive center and the Department of Andrology of our hospital,78 cases of obstructive azoospermia infertility patients were selected from January 2015 to December 2016,and were randomly divided into group A and group B.Group A underwent surgical treatment. After treatment,infertility patients were divided into in vitro fertilization group(A-IVF)and single sperm microinjection group(A-ICSI)according to sperm concentration. Group B underwent PESA or TESA-ICSI treatment. The results of the two groups in clinical pregnancy outcomes and the various indicators of the laboratory tests were compared,including ovulation,fertilization,D3 embryo and D5 blastocysts. Results Among Group A(39 patients with A-IVF 5 cases,a-icsi 19 cases)who underwent vasovasostomy and epididymis tube anastomosis,semen sperm count positive 1 month postoperative was presented in 31 cases,therefore the recanalization rate was 79.49%. Upon review of the semen,we found 7 cases with normal sperm concentration(22.58%),while there were 24 cases of oligospermia patients(77.42%),of which 20 cases were severe oligospermia(64.52%). In Group A(39 patients),there were 20 cases of clinical pregnancy(51.28%). Group B who underwent PESA or TESA-ICSI,had 21 cases of clinical pregnancy(53.85%). By comparison,the difference in clinical pregnancy rate between the two groups was not statistically significant(P<0.05).In A-IVF and A-ICSI groups,the fertilization rate were 80.77%,79.42%,respectively,but were significantly higher than the fertilization in Group B,which was of 72.79%(P<0.05). However the average number of D3 high quality embryos,the number of blastocyst formation,the number of embryos,and clinical pregnancy rate in the A-IVF and AICSI groups,in comparison with Group B,had no significant difference(P>0.05). Conclusion Surgical reconstruction of genital duct and epididymal or testicular sperm for assisted reproductive technology for the treatment of obstructive azoospermia patients can produce certain curative effect,though for different types of OA patients,different treatment should be considered accordingly.
Objective To analyze the curative effect of surgical reconstruction of reproductive canal or assisted reproductive technology in patients with obstructive azoospermia,in order to lay the foundation for the treatment of obstructive azoospermia patients. Methods In the male reproductive center and the Department of Andrology of our hospital,78 cases of obstructive azoospermia infertility patients were selected from January 2015 to December 2016,and were randomly divided into group A and group B.Group A underwent surgical treatment. After treatment,infertility patients were divided into in vitro fertilization group(A-IVF)and single sperm microinjection group(A-ICSI)according to sperm concentration. Group B underwent PESA or TESA-ICSI treatment. The results of the two groups in clinical pregnancy outcomes and the various indicators of the laboratory tests were compared,including ovulation,fertilization,D3 embryo and D5 blastocysts. Results Among Group A(39 patients with A-IVF 5 cases,a-icsi 19 cases)who underwent vasovasostomy and epididymis tube anastomosis,semen sperm count positive 1 month postoperative was presented in 31 cases,therefore the recanalization rate was 79.49%. Upon review of the semen,we found 7 cases with normal sperm concentration(22.58%),while there were 24 cases of oligospermia patients(77.42%),of which 20 cases were severe oligospermia(64.52%). In Group A(39 patients),there were 20 cases of clinical pregnancy(51.28%). Group B who underwent PESA or TESA-ICSI,had 21 cases of clinical pregnancy(53.85%). By comparison,the difference in clinical pregnancy rate between the two groups was not statistically significant(P<0.05).In A-IVF and A-ICSI groups,the fertilization rate were 80.77%,79.42%,respectively,but were significantly higher than the fertilization in Group B,which was of 72.79%(P<0.05). However the average number of D3 high quality embryos,the number of blastocyst formation,the number of embryos,and clinical pregnancy rate in the A-IVF and AICSI groups,in comparison with Group B,had no significant difference(P>0.05). Conclusion Surgical reconstruction of genital duct and epididymal or testicular sperm for assisted reproductive technology for the treatment of obstructive azoospermia patients can produce certain curative effect,though for different types of OA patients,different treatment should be considered accordingly.
引文
[1]周猷,旁成,何电,等.我国不孕症研究进展[J].中国计划生育学杂志,2011,1(7):63-64.
[2]Bernie A M,Ramasamy R,Schlegel P N.Predictive factors of successful microdissection testicular sperm extraction[J].Basic Clin Androl,2013,23(5):1-7.
[3]Kamal A,Fahmy I,Mansour R,et al.Does the outcome of ICSI in cases of obstructive azoospermia depend on the origin of the retrieved spermatozoa or the cause of obstruction?A comparative analysis[J].Fertil Steril,2010,94(6):2135-2140.
[4]Miyaoka R,Esteves S C.Predictive factors for sperm retrieval and sperm injection outcomes in obstructive azoospermia:Do etiology,retrieval techniques and gamete source play a role[J].Clinics,2013,68(Suppl1):111-119.
[5]Wosnitzer M S,Goldstein M.Obstructive azoospermia[J].Urol Clin North Am,2014,41(1):83-95.
[6]谢婧.显微外科治疗梗阻性无精子症的研究进展[J].医学研究生学报,2011,24(6):634-636.
[7]Ketabchi A A.Intracytoplasmic sperm injection outcomes with freshly ejaculated sperms and testicular or epididymal sperm extraction in patients with idiopathic cryptozoospermia[J].Nephrourol Mon,2016,8(6):e41375.
[8]Silber S J,Grotjan H E.Microscopic vasectomy reversal 30years later:A summary of 4010 cases by the same surgeon[J].J Androl,2004,25(6):845-859.
[9]平萍,陈向锋,王鸿翔,等.显微外科技术在男性不育症治疗中的应用及疗效分析[J].中国计划生育和妇产科,2015,7(1):20-22.
[10]张峰彬,梁忠炎,李乐军,等.梗阻性无精子症的显微外科治疗(附76例报告)[J].中华男科学杂志,2015,21(3):239-244.
[11]詹绪新,万长春,李海波,等.附睾或睾丸精子对梗阻性无精子ICSI治疗结局影响的系统评价[J].中华男科学杂志,2016,22(12):1122-1130.
[12]Practice Committee of the American Society for Reproductive Medi-cine in collaboration with the Society for Male Reproduction and Urology.The management of infertility due to obstructive azoospermia[J].Fertil Steril,2008,90(5):121-124.
[13]江专新,黄健,覃云凌,等.交叉输精管附睾显微吻合术治疗复杂梗阻性无精子症[J].中华男科学杂志,2016,22(4):373-375.
[14]张磊,黄坪,任飞强,等.梗阻性无精子症患者术后应用麒麟丸疗效观察[J].中华男科学杂志,2016,22(9):823-826.
[15]Kathrins M,Niederberger C.Diagnosis and treatment of infertility-related male hormonal dysfunction[J].Nature Reviews Urology,2016,13(6):309.
[16]Esteves S C,Lee W,Benjamin D J,et al.Reproductive potential of men with obstructive azoospermia undergoing percutaneous sperm retrieval and intracytoplasmic sperm injection according to the cause of obstruction[J].J Urol,2013,189(1):232-237.
[17]张帆,葛红山,朱春芳,等.不同来源及不同处理方式的精子对人卵子胞浆内单精子注射结局的影响[J].实用医学杂志,2014,30(4):591-593.
[2]Bernie A M,Ramasamy R,Schlegel P N.Predictive factors of successful microdissection testicular sperm extraction[J].Basic Clin Androl,2013,23(5):1-7.
[3]Kamal A,Fahmy I,Mansour R,et al.Does the outcome of ICSI in cases of obstructive azoospermia depend on the origin of the retrieved spermatozoa or the cause of obstruction?A comparative analysis[J].Fertil Steril,2010,94(6):2135-2140.
[4]Miyaoka R,Esteves S C.Predictive factors for sperm retrieval and sperm injection outcomes in obstructive azoospermia:Do etiology,retrieval techniques and gamete source play a role[J].Clinics,2013,68(Suppl1):111-119.
[5]Wosnitzer M S,Goldstein M.Obstructive azoospermia[J].Urol Clin North Am,2014,41(1):83-95.
[6]谢婧.显微外科治疗梗阻性无精子症的研究进展[J].医学研究生学报,2011,24(6):634-636.
[7]Ketabchi A A.Intracytoplasmic sperm injection outcomes with freshly ejaculated sperms and testicular or epididymal sperm extraction in patients with idiopathic cryptozoospermia[J].Nephrourol Mon,2016,8(6):e41375.
[8]Silber S J,Grotjan H E.Microscopic vasectomy reversal 30years later:A summary of 4010 cases by the same surgeon[J].J Androl,2004,25(6):845-859.
[9]平萍,陈向锋,王鸿翔,等.显微外科技术在男性不育症治疗中的应用及疗效分析[J].中国计划生育和妇产科,2015,7(1):20-22.
[10]张峰彬,梁忠炎,李乐军,等.梗阻性无精子症的显微外科治疗(附76例报告)[J].中华男科学杂志,2015,21(3):239-244.
[11]詹绪新,万长春,李海波,等.附睾或睾丸精子对梗阻性无精子ICSI治疗结局影响的系统评价[J].中华男科学杂志,2016,22(12):1122-1130.
[12]Practice Committee of the American Society for Reproductive Medi-cine in collaboration with the Society for Male Reproduction and Urology.The management of infertility due to obstructive azoospermia[J].Fertil Steril,2008,90(5):121-124.
[13]江专新,黄健,覃云凌,等.交叉输精管附睾显微吻合术治疗复杂梗阻性无精子症[J].中华男科学杂志,2016,22(4):373-375.
[14]张磊,黄坪,任飞强,等.梗阻性无精子症患者术后应用麒麟丸疗效观察[J].中华男科学杂志,2016,22(9):823-826.
[15]Kathrins M,Niederberger C.Diagnosis and treatment of infertility-related male hormonal dysfunction[J].Nature Reviews Urology,2016,13(6):309.
[16]Esteves S C,Lee W,Benjamin D J,et al.Reproductive potential of men with obstructive azoospermia undergoing percutaneous sperm retrieval and intracytoplasmic sperm injection according to the cause of obstruction[J].J Urol,2013,189(1):232-237.
[17]张帆,葛红山,朱春芳,等.不同来源及不同处理方式的精子对人卵子胞浆内单精子注射结局的影响[J].实用医学杂志,2014,30(4):591-593.