Microdissection testicular sperm extraction for non-obstructive azoospermia: the assessment of serum hormone levels before and after procedure
Microdissection testicular sperm extraction for non-obstructive azoospermia: the assessment of serum hormone levels before and after procedure
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显微解剖睾丸取精治疗非梗阻性无精子症：手术前后血清激素水平的评估
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发表时间：
2009
期刊：
影响因子：
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通讯作者：
M. Fujisawa
中科院分区：
文献类型：
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作者：
T. Ishikawa;M. Fujisawa
显微解剖睾丸精子提取（microTESE）已成为男性非阻塞性无精子症（NOA）的公认程序。试管受精和卵胞浆内单精子注射（ICSI）周期会使夫妇承受情感和经济负担，因此在尝试手术前使用无创参数预测精子提取的成功将是有益的。已经注意到，与随机活检相比，在手术显微镜下观察输精管时进行的微tese可以最大限度地减少对睾丸组织的损伤，同时最大限度地恢复精子。Micro-TESE也被证明比单次活检或多次随机活检更能成功地获取精子[2,3]。此外，micro-TESE提高了每次活检的精子产量，减少了组织切除（和睾丸丢失），并且可以识别睾丸内的血管，最大限度地降低了血管损伤和睾丸其他区域丢失的风险。因此，微型tese是基于识别睾丸中精子发生的最先进模式的原则，而不一定是主要模式。虽然FSH反映了精子发生的主要模式，但它可能不能反映睾丸内孤立的精子发生区域。Klinefelter综合征（KS）是最常见的性染色体疾病，每660名男性中有1人患病，是性腺功能减退和不育症的常见原因。在所有microTESE成功的患者中，我们可以在被缩小的小管或纤维组织包围的扩张和不透明的精管中发现局灶性精子发生。Micro-TESE对KS病例的成功精子恢复特别有帮助。虽然有大量的研究比较了常规和微tese[2,3,5]，但分析微tese后激素变化的大型综合研究很少。此外，特别是KS患者，对microTESE后激素变化的研究缺乏。性腺功能减退症在KS中是相对的而不是绝对的，并且已被发现是腹部肥胖bbb发展的独立危险因素。性腺功能减退也与代谢综合征和2型糖尿病有关。我们回顾了显微tese的结果，主要是血清FSH升高患者的精子恢复。我们还分析了促性腺激素和活检组织学对NOA患者通过显微tese提取睾丸精子的预测价值。此外，我们回顾了46XY男性NOA和KS患者在随访期间的并发症。
Microdissection testicular sperm extraction(microTESE)has become a recognized procedure for men with nonobstructive azoospermia(NOA). Micro-TESE and intracytoplasmic sperm injection(ICSI)cycles expose the couple to an emotional and financial burden, so it would be beneficial to predict the success of sperm retrieval using noninvasive parameters before attempted procedure. It has been noted that micro-TESE done while observing the seminiferous tubules under an operating microscope could minimize the damage to testicular tissue, while maximizing sperm recovery, compared to random biopsies[1]. Micro-TESE has also been shown to be more successful in sperm retrieval than a single biopsy or multiple random biopsies[2,3]. In addition, micro-TESE improves the yield of spermatozoa per biopsy, results in less tissue removal(and loss of testicle), and allows identification of blood vessels within the testicle, minimizing the risk of vascular injury and loss of other areas of the testis[1]. Thus, micro-TESE is based on the principle of identifying the most advanced pattern, not necessarily the predominant pattern, of spermatogenesis in the testis. Although FSH reflects the predominant pattern of spermatogenesis, it may not reflect isolated areas of spermatogenesis within the testis. Klinefelter syndrome (KS) is the most common sex-chromosome disorder, with a prevalence of 1 in 660 men[4], and is a frequent cause of hypogonadism and infertility. In all patients in whom microTESE was successful we could identify focal spermatogenesis in dilated and opaque seminiferous tubules surrounded by shrunken tubules or fibrous tissue. Micro-TESE is particularly helpful for successful sperm retrieval in KS cases. Although numerous studies have compared conventional versus micro-TESE[2, 3, 5], there are a few large comprehensive study analyzing the hormonal changes after micro-TESE. In addition, especially KS patients, the study of hormonal change after microTESE is lacking. Hypogonadism in KS is relative rather than absolute and has been found to be an independent risk factor for development of abdominal adiposity[6]. Hypogonadism is also associated with metabolic syndrome and type2 diabetes[7]. We reviewed the outcomes of micro-TESE, primarily the sperm retrieval in patients with elevated serum FSH. We also analyzed the predictive value of gonadotropin and biopsy histology for retrieving testicular sperm by micro-TESE in NOA patients. In addition, we reviewed complications in this procedure for the patients between 46XY males with NOA and KS during follow-up.