外科取精术在无精子症诊断与治疗中的应用

目的研究外科取精术在无精子症诊断与治疗中的应用价值。方法在诊断为无精子症的、患者中，经睾丸体积测定、血清性激素水平、生殖系统超声等检查后，选择符合条件者198例，在局麻下行外科取精术，对获得组织显微镜下检查，统计分析取精结果。获得的精子行卵胞浆内单精子显微注射术（ICSI）及胚胎移植术（ET），统计评估受精率、卵裂率、临床妊娠率及流产率。结果其中78例附睾中存在精子（39．4％），23例睾丸中存在精子（11．6％）。睾丸体积正常的取精成功率明显高于睾丸体积偏小者，有显著性差异（P〈0．01）。血清促卵泡刺激素（FSH）水平正常的取精成功率明显高于FSH增高者，差异有显著性意义（P〈0．01）。82例外科取精术获得精子的患者进行ICSI治疗，附睾取精组与睾丸取精组比较，受精率、卵裂率、临床妊娠率及流产率差异均无统计学意义（P均〉0．05）。结论外科取精术操作简单且创伤较小，能准确鉴别诊断梗阻性无精子症（OA）及非梗阻性无精子症（NOA），对无精子症的诊断有重要价值；为部分无精子症患者提供了生育自己生物学子代的机会，也是针对无精子症的有效治疗手段。

Application of surgical sperm retrieval to the diagnosis and treatment of azoospermia

Objective To evaluate the clinical significance of surgical sperm retrieval in the diagnosis and treatment of azoospermia. Methods Azoospermia was diagnosed in 198 patients after detection of centrifuged seminal fluid. After examinations of testis volume, serum gonadal hormone level and u!trasonography of genital system, surgical sperm retrieval was performed. Histopathologic examination sperm count was conducted for tissues available. Sperm obtained from 82 azoospermia patients by surgical sperm retrieval was treated by intracytoplasmic sperm injection （ICSI）, and embryo transplantation （ET） was performed afterwards. The rates of fertilization, cleavage, clinical pregnancy and miscarriage were evaluated. Results Of all azoospermia patients, 78 （39.4%） had sperm in the epididymis and 23 （11.6%） in the testis. The rate of successful surgical sperm retrieval was significantly higher in patients with normal testis volume or normal serum follicle-stimulating hormone （FSH） level than in those with smaller testis volume （P〈0.01） or higher serum FSH level （P〈0.01）. ICSI was applied to 82 patients with sperm in the epididymis or testis after sperm extraction. There was no statistical difference for the fertilization, cleavage, clinical pregnancy and miscarriage rates between epididymis group and testis group （P〈0.05）. Conclusion Surgical .sperm retrieval is a convenient, minimally invasive and reliable method in the differential diagnosis of obstructive azoospermia （OA） and non-obstructive azoospermia （NOA）. As an effective therapy for azoospermia, it can provide chances of procreation for partial azoospermia patients.