摘要
目的探讨显微镜下睾丸取精术联合辅助生殖技术治疗克氏综合征的疗效及结局。方法95例克氏综合征患者分为显微手术组65例和对照组30例,显微手术组行显微镜下睾丸取精术,对照组行睾丸穿刺活检术,比较2组患者临床资料、获精率,并随访治疗结局。比较显微手术组取精成功者中同周期治疗者与非同周期治疗者双原核率、双原核卵裂率、D3可利用胚胎率、种植率和妊娠率。结果显微手术组获精率(46.15%)高于对照组(6.67%)(P<0.05),手术时间[(76.8±19.8)min]长于对照组[(13.8±5.0)min](P<0.05);显微手术组年龄[(29.0±3.8)岁]、睾丸体积[(1.3±0.6)mL]、促卵泡生成素[(33.1±8.8)u/L]、促黄体生成素[(20.1±6.9)u/L]、总睾酮[(1.9±1.3)μg/L]、雌二醇[(21.7±12.0)ng/L]与对照组[(28.6±2.9)岁、(1.3±0.5)mL、(33.3±11.4)u/L、(20.2±7.0)u/L、(2.4±1.2)μg/L、(22.6±13.8)ng/L]比较差异无统计学意义(P>0.05);显微手术组获取精子者30例均进入试管周期,其中同周期治疗者14例,非同周期治疗者16例,同周期治疗者双原核率(68.05%)、双原核卵裂率(96.52%)、D3胚胎可利用率(73.87%)高于非同周期治疗者(52.53%、83.13%、59.42%)(P<0.05),种植率(61.11%)和妊娠率(69.23%)与非同周期治疗者(38.09%、38.46%)比较差异无统计学意义(P>0.05);显微手术组已生育3个遗传学子代,12例获临床妊娠。结论显微镜下睾丸取精术是帮助克氏综合征患者获取精子的一种有效方法,克氏综合征患者采用同周期显微手术联合辅助生殖技术更易获得遗传学子代。
Objective To investigate the effect and outcome of microdissection testicular sperm extraction(micro-TESE)combined with assisted reproductive technology in the treatment of Klinefelter syndrome.Methods Ninety-five patients with Klinefelter syndrome were divided into microsurgery group(n=65)receiving micro-TESE and control group(n=30)receiving testicular biopsy.The clinical data and precision rate were compared between two groups,and the treatment outcome was followed up.The double pronucleus rate,double prokaryotic cleavage rate,D3available embryo rate,implantation rate and pregnancy rate were compared between the patients with successful sperm retrieval in same cycle and patients in different cycle in microsurgery group.Results The precision rate was higher and the operation lasting time was longer in microsurgery group(46.15%,(76.8±19.8)min)than that in control group(6.67%,(13.8±5.0)min)(P<0.05).There were no significant differences in the age((29.0±3.8)years vs(28.6±2.9)years),testicular volume((1.3±0.6)mL vs(1.3±0.5)mL),follicle-stimulating hormone level((33.1±8.8)u/L vs 33.3±11.4)u/L),luteinizing hormone level((20.1±6.9)u/L vs(20.2±7.0)u/L),total testosterone level((1.9±1.3)u/L vs(2.4±1.2)u/L)and estradiol level((21.7±12.0)ng/L vs(22.6±13.8)ng/L)between microsurgery group and control group(P>0.05).The retrieved sperm in 30patients in microsurgery group got into ICSI cycle,including 14patients treated with the same cycle and 16patients treated with different cycle.Double prokaryotic rate(68.05%),double prokaryotic cleavage rate(96.52%),and D3available embryo rate(73.87%)in patients treated with the same cycle were higher than those in patients treated with different cycle(52.53%,83.13%,59.42%)(P<0.05),and implantation rate(61.11%)and pregnancy rate(69.23%)were not significantly different from those in patients treated with different cycle(38.09%,38.46%)(P>0.05).Three genetic offspings were born in microsurgery group,and 12patients were clinical pregnant.Conclusion Micro-TESE is an effective method for obtaining sperm in patients with Klinefelter syndrome.Co-cycle microsurgery combined with assisted reproductive technology makes it easier to obtain genetic offsprings in patients with Klinefelter syndrome.
作者
冯科
郭海彬
曲晓伟
宋小兵
万锋
张翠莲
夏彦清
FENG Ke;GUO Haibin;QU Xiaowei;SONG Xiaobing;WAN Feng;ZHANG Cuilian;XIA Yanqing(Center for Reproductive Medicine,Henan Provincial People's Hospital,People's Hospital of Zhengzhou University,People's Hospital of Henan University,Zhengzhou 450003,China)
出处
《中华实用诊断与治疗杂志》
2019年第12期1208-1211,共4页
Journal of Chinese Practical Diagnosis and Therapy
基金
河南省科技厅科技攻关计划项目(142102310393)
关键词
克氏综合征
显微镜下睾丸取精术
辅助生殖技术
获精率
妊娠
Klinefelter syndrome
microdissection testicular sperm extraction
assisted reproductive technology
sperm retrieval rate
pregnancy
作者简介
通信作者:夏彦清,E-mail:15093105609@163.com。
