概要
目 的
探讨分步法小切口改良睾丸显微取精术在隐睾下降固定术后非梗阻性无精子症的有效性.
创新点
既往有隐睾下降固定术手术史的非梗阻性无精子症的患者睾丸局部粘连严重, 所以睾丸显微取精术时睾丸暴露困难, 因此手术难度明显增大. 术者将常规睾丸显微取精术改良为分步法小切口睾丸显微取精术, 术中无需完全游离暴露睾丸, 仅通过小切口睾丸显微取精术就可使一半的患者成功获取精子. 因此分步法小切口改良睾丸显微取精术可在不降低睾丸取精成功率的前提下缩短手术时间和减少手术创伤.
方 法
收集 2015 年 5 月至 2017 年 3 月于上海交通大学附属第一人民医院泌尿中心男科接受睾丸显微取精术的 20 例既往有隐睾下降固定术手术史的非梗阻性无精子症, 采用分步法小切口改良睾丸显微取精术获取睾丸精子. 分步法小切口改良睾丸显微取精术具体步骤为: 第一步, 小切口睾丸取精术; 第二步, 将小切口延长为标准切口, 行标准睾丸显微取精术; 第三步, 对侧睾丸标准睾丸显微取精术.
结 论
小切口睾丸显微取精术可快速有效获取睾丸内表浅位置饱满的生精小管, 标准的睾丸显微取精术可作为小切口睾丸显微取精术失败时的补救措施. 分步法小切口睾丸显微取精术可降低睾丸损伤前提下, 快速有效地获取睾丸精子. 这种手术方式特别适用于睾丸内存在表浅饱满生精小管的非梗阻性无精子症, 如隐睾下降固定术后的非梗阻性无精子症.
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Peng LI and Chen-cheng YAO performed the research and data analysis, wrote and edited the manuscript. Peng LI guided the surgery. Zheng LI, Peng LI, Hui-xing CHEN, Ru-hui TIAN, Zhong WAN, Ying-chuan JIANG, and Yu-hua HUANG performed the surgery. Er-lei ZHI collected the data. Chao YANG and Liang-yu ZHAO performed the sperm harvest. Yuan XU and Yue-hua GONG performed the sperm cryopreservation. Zheng LI contributed to the study design, data analysis, writing and editing of the manuscript. All authors read and approved the final manuscript and, therefore, had full access to all the data in the study and take responsibility for the integrity and security of the data.
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Peng LI, Chen-cheng YAO, Er-lei ZHI, Yuan XU, Zhong WAN, Ying-chuan JIANG, Yu-hua HUANG, Yue-hua GONG, Hui-xing CHEN, Ru-hui TIAN, Chao YANG, Liang-yu ZHAO, and Zheng LI declare that they have no conflict of interest.
All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008 (5). Informed consent was obtained from all patients included in the study.
Additional information
Project supported by the National Natural Science Foundation of China (Nos. 81701524, 81671512, and 81701428), and the Frontier Technology Project of Shanghai (No. SHDC12015122), China
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Li, P., Yao, Cc., Zhi, El. et al. Modified stepwise mini-incision microdissection testicular sperm extraction: a useful technique for patients with a history of orchidopexy affected by non-obstructive azoospermia. J. Zhejiang Univ. Sci. B 21, 87–92 (2020). https://doi.org/10.1631/jzus.B1900232
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DOI: https://doi.org/10.1631/jzus.B1900232