睾丸穿刺活检对特发性非梗阻性无精子症患者显微取精成功率的影响

目的：探讨特发性非梗阻性无精子症患者中，睾丸穿刺活检对显微取精成功率的预测作用。方法：回顾性分析了从2014年1月至2017年8月在北京大学第三医院生殖医学中心接受显微取精术的特发性非梗阻性无精子症患者的临床资料，并对是否行诊断性穿刺活检、以及不同穿刺活检结果患者的精子获得率进行分析，探讨睾丸穿刺活检结果对显微取精成功率的预测作用。结果：共237例接受显微取精术的特发性非梗阻性无精子症患者入选研究，总体的精子获得率为25.7%。未行诊断性睾丸穿刺活检的103例患者与行诊断性睾丸穿刺活检的134例患者精子获得率分别为26.2%和25.4%，两组间比较差异没有统计学意义（P>0.05）；两组睾丸体积和血清卵泡刺激素水平分别为（4.3±1.4） mL vs. （8.5±2.4） mL和（36.1±5.2） IU/L vs. （26.1±3.5） IU/L，组间比较差异具有统计学意义（P<0.05）。在睾丸穿刺活检的患者中，术中镜检及术后病理均偶见少量精子患者的精子获得率为100.0%（7/7）， 术中镜检或术后病理可见精子的患者，精子获得率为47.2%（17/36）， 术中镜检及术后病理均未见精子的患者，精子获得率为11.0%（10/91）， 3组间比较差异具有统计学意义（P<0.05）。结论：睾丸体积较小的特发性非梗阻性无精子症患者仍有一定机会通过显微取精术发现精子；睾丸穿刺活检结果（包括术中镜检及术后病理能否发现精子）对后期进行显微镜下睾丸切开取精有一定的预测作用，其中术中镜检及术后病理均未见精子的患者，显微取精术找到精子的概率较低。

Effect of testicular puncture biopsy on the success rate of microdissection testicular sperm extraction for idiopathic non-obstructive azoospermia

Objective： To explore the predictive effect of testicular puncture biopsy and the biopsy results on the success rate of microdissection testicular sperm extraction (micro-TESE) in patients with idiopathic non-obstructive azoospermia. Methods: We retrospectively evaluated the micro-TESE perfor-mance in patients with idiopathic non-obstructive azoospermia (NOA) referred to the Reproductive Medicine Center of Peking University Third Hospital between January 2012 and August 2017.We discussed whether to take the testicular biopsy and testicular biopsy results，including the intraoperative microscopic examination and postoperative pathology findings, could predict the success rate of the late micro-TESE. Results: There were 237 patients who were diagnosed as idiopathic NOA and received micro-TESE involved in the study and the total sperm retrieve rate was 25.7%. In 103 patients without testicular biopsy and 134 patients with preoperative testicular biopsy, the sperm retrieve rate was 26.2% and 25.4%, respectively. and there was no significant difference between the two groups. The testicular volume and serum follicle stimulating hormone levels of the two groups were (4.3±1.4) mL vs.(8.5±2.4) mL and (36.1±5.2) IU/L vs.(26.1±3.5) IU/L, respectively. Compared to the patients with preoperative testicular biopsy, the group of patients without testicular biopsy had a much smaller test volume and higher serum follicle stimulating hormone and the difference between the two groups was statistically significant. For the patients who were found with a small amount of sperm in both intraoperative microscopic examination and postoperative pathological examination, the sperm retrieve rate was 100% (7/7). And for the patients who were only found with sperm in intraoperative microscopic examination or postoperative pathology examination, the sperm retrieve rate (SRR) was 47.2%（17/36）.For the patients who could be not found with sperm in both intraoperative microscopic examination and postoperative pathological examination, the SRR was only 11% (10/91).The difference between the groups was statistically significant. Conclusion: Idiopathic non-obstructive azoospermia patients with smaller testicular volume still have a chance to be found with sperm by micro-TESE. The testicular biopsy results, including intraoperative microscopic examination and postoperative pathological findings, have predictive effect on the SRR for late micro-TESE. The patient who could not be found with sperm in both intraoperative microscopic examination and postoperative pathological examination have a small chance of success in micro TESE.