关键词: 无精症, 显微取精, 睾丸内生精小管类型

Abstract:

Objective: To summarizes the intratesticular condition of azoospermia patients, to understand azoospermia more intuitively, and improve the ability of clinical doctors to predict the success rate of microsperm extraction in azoospermia patients.Methods: Azoospermia patients (excluding Klinefelter’s syndrome) who underwent a micro-TESE during January 2014 and January 2018 in a single center were enrolled. The types of seminiferous tubules were summarized, and the clinical characteristics of different types of seminiferous tubules compared with the success rates of sperm extraction. In this study, 472 cases of non-obstructive azoospermia (excluding Klinefelter’s syndrome) were analyzed by SPSS 21.0 software package. Relevant data were expressed by median(minimum,maximum).t-test was used to compare the difference of success rate of sperm extraction between each group and the group with the lowest rate (a type).Results: The 472 patients with non-obstructive azoospermia underwent micro-TESE. The mean age of the patients was 31(23,46) years, the mean testicular size was 10(1,20) mL, the mean FSH was 15.4(1.21,68.4) IU/L, the mean T was 8.34(0.69,30.2) nmol/L, and totally 202 patients achieved success in micro-TESE (42.7%, 202/472). According to the seminiferous tubules seen during the operation, they were divided into the following six types: Class a, seminiferous tubules developed well and uniformly; Class b, seminiferous tubules developed well, occasionally slightly thick; Class c, seminiferous tubules were generally thin; Class d, seminiferous tubules basically atrophied, occasionally well-developed seminiferous tubules; Class e, all seminiferous tubules atrophied; Class f, seminiferous tubules were infiltrated by yellow substances. The success rate of micro-TESE varied greatly among different types of the patients. A total of 78 patients with type a were 29(24,40) years old, FSH 11.1(1.21,15.8) IU/L, T10.2(3.29,26.5) nmol/L), and testicular size 12(12,20) mL. The successful rate of sperm extraction was 6.41%; 82 patients with type b were 31(23,42)years old, FSH 13.8(3.23,19.6) IU/L, T9.44(3.58,30.2) nmol/L), and testicular size 12(8,15) mL. The successful rate of sperm extraction was 74.39%; There were 162 patients in group c, aged 31(25,40), FSH 19.6(9.28,26.6) IU / L, T 8.75(5.66,18.6) nmol/L, and testicular size 8(5,12) mL. The successful rate of sperm extraction was 45.06%. There were 36 patients in group d, aged 25(23,38) years and FSH 28.5(19.3,45.6) IU/L, T6.52(2.12,9.83) nmol/L, and testicular size 5(3,8) mL, and the success rate of sperm extraction was 94.44%. 26 patients with type e were 28(23,46) years old, FSH31.3(18.5,68.4) IU/L, T6.72(0.69,18.2) nmol/L, and testicular size 5(1,8) mL. The success rate of sperm extraction was 45.38%. 88 patients with type f were 29(24,38) years old, FSH18.5(5.23,31.6) IU / L, T8.32(3.58,16.5) nmol/L, and testicular size 12(6,20) mL. The success rate of sperm extraction was 28.41%.Conclusion: The success rate of micro-TESE in different types of seminiferous tubules in testis can be helpful to the judgement of the surgeon during the operation.

Key words: Azoospermia, Micro-TESE, Types of intratesticular seminiferous tubules