谢强　谢小菲　刘淑慎

【摘要】 目的：探究兩种取精术式对卵胞浆内单精子注射（ICSI）结局的影响。方法：选取2016年6月-2017年12月本院收治的梗阻性无精子症（OA）患者89例。按取精方式及患病性质不同分成A组（n=10）、B组（n=11）、C组（n=33）、D组（n=35）。患者均采用ICSI，其中先天性OA中的A组行附睾取精（PESA），B组行睾丸取精（TESA）；后天性OA中C组行PESA，D组行TESA。比较患者受精率、正常受精率、优质胚胎率、种植率、妊娠率、临床妊娠率。结果：先天性OA中的A、B组受精率、正常受精率、临床妊娠率比较，差异均无统计学意义（P>0.05）；但A组种植率、妊娠率均高于B组，优胚率低于B组，比较差异均有统计学意义（P<0.05）；后天性OA中的C、D组受精率、正常受精率、优胚率、种植率、临床妊娠率比较，差异均无统计学意义（P>0.05）；但D组妊娠率高于C组（P<0.05）。结论：临床在进行ICSI时，对先天性OA患者应选用PESA，对后天性OA患者应选用TESA。

【关键词】 卵胞浆内单精子注射术； 梗阻性无精子症； 经皮附睾穿刺取精术； 经皮睾丸穿刺取精术

Comparative Study of Two Kinds of Sperm Extraction Operation on the Outcome of Intracytoplasmic Sperm Injection/XIE Qiang，XIE Xiaofei，LIU Shushen，et al.//Medical Innovation of China，2018，15（14）：141-144

【Abstract】 Objective：To explore the two kinds of sperm extraction operation on the outcome of intracytoplasmic sperm injection（ICSI）.Method：A total of 89 patients with obstructive azoospermia（OA） from June 2016 to December 2017 in our hospital were selected.According to the way of extraction and the nature of the disease，they were divided into group A（n=10），group B（n=11），group C（n=33），group D

（n=35）.They were treated with ICSI，group A of congenital OA underwent percutaneous epididymal sperm aspiration（PESA） and group B of congenital OA received testicular epididymal sperm aspiration（TESA），group C

of acquired OA received PESA，and group D of acquired OA received TESA.The fertilization rate，normal fertilization rate，quality embryo rate，implantation rate，pregnancy rate and clinical pregnancy rate in patients were compared.Result：The fertilization rate，normal fertilization rate and clinical pregnancy rate in group A and B

of congenital OA were compared，the differences were not statistically significant（P>0.05）.The implantation rate and pregnancy rate in group A were higher than those of group B，and quality embryo rate was lower than that of group B，the differences were statistically significant（P<0.05）.The fertilization rate，normal fertilization rate，quality embryo rate，implantation rate and clinical pregnancy rate in group C and D were compared，the differences were not statistically significant（P>0.05），but the pregnancy rate in group D was higher than that of group C（P<0.05）.Conclusion：When ICSI is performed in clinic，PESA should be selected for congenital OA patients，and TESA should be selected for acquired OA patients.

【Key words】 Intracytoplasmic sperm injection； Obstructive azoospermia； Percutaneous epididymal sperm aspiration； Testicular epididymal sperm aspiration

First-authors address：Dongguan Peoples Hospital，Dongguan 523059，China

doi：10.3969/j.issn.1674-4985.2018.14.035

据世界卫生组织调查，大约有15%的育龄夫妇存在不孕不育问题，而梗阻性无精子症（OA）是此问题中一个重要因素[1-2]。临床上通常将3次离心镜检精液仍未见到精子者确诊为无精子症[3-4]，可分为OA和非梗阻性无精子症。OA是指睾丸有正常生精功能，从睾丸网到射精管口之间某一部位的缺失或机械性阻塞，使睾丸生成的精子不能排出体外。OA按照病因可分先天性因素和后天性因素。先天性因素：附睾、输精管、精囊、前列腺的发育不全或囊肿阻塞[5-6]。后天性因素：生殖道的感染、创伤、肿瘤、医源性损伤（输精管结扎）等。以往临床对该病多根据致病因素的不同而采用中西医药物或手术治疗，但效果不确切。近年来，随着卵胞浆内单精子注射（ICSI）技术的日益成熟，已使大量OA患者成功受孕，但取精方式对于ICSI结局的影响仍然众说纷纭[7-8]。因……