首页|显微镜辅助睾丸肿瘤分步法切除联合取精术治疗生精障碍的临床价值

显微镜辅助睾丸肿瘤分步法切除联合取精术治疗生精障碍的临床价值

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睾丸肿瘤是育龄男性常见的实体肿瘤,常伴睾丸生精障碍,其中以非梗阻性无精子症(non-obstructive azoospermia,NOA)最为严重.本研究为单中心回顾性病例系列研究,纳入了2016年9月～2021年7月间在上海交通大学医学院附属第一人民医院泌尿外科中心男科就诊的10例睾丸肿瘤合并NOA患者,旨在明确显微镜辅助睾丸肿瘤分步法切除联合取精冻存这一治疗方案的决策路径,分析其有效性和安全性.完善相关检查后,所有患者初步接受显微镜下保留睾丸的肿瘤切除术,根据术中情况决定是否转行根治术,并联合显微取精术以保存生育力.10例患者的平均年龄为31.9岁(SD=8.24),平均肿瘤最大直径为20.70 mm(SD=9.23).其中8例患者接受了保留睾丸手术,2例患者接受了睾丸根治性切除术.最终,7例患者成功取得精子并进行稀少精子冻存.术后病理显示6例为恶性,4例为良性.相较于良性患者,恶性病理类型患者多伴有隐睾病史,具有更高的取精成功率(83.3％vs.50.0％,P=0.008).术后随访44.70个月(SD=22.72),未见明显术后并发症、局部复发和远处转移.显微镜辅助睾丸肿瘤分步法切除联合取精术有效保存了患者生育力,随访期内无肿瘤复发,具有较好的疗效和安全性.
Clinical value of stepwise microsurgical resection of testicular tumors combined with sperm extraction in the treatment of spermatogenic failure
Testicular tumors,the common solid tumors in males of reproductive age,are often associated with spermatogenic failure,among which non-obstructive azoospermia(NOA)is the most severe.This single-center retrospective case series enrolled 10 patients with testicular tumors complicated by NOA from September 2016 to July 2021.The objective is to elucidate the efficacy and safety of the stepwise microsurgical resection of testicular tumors coupled with sperm extraction and cryopreservation.Following thorough preoperative assessment,all patients underwent initial microsurgical testis-sparing surgery for testicular tumors,with the decision for radical orchiectomy based on intraoperative conditions.Simultaneously,microdissection testicular sperm extraction was performed to preserve fertility.The mean age of the 10 patients was 31.9 years(SD=8.24),and the average maximum tumor diameter was 20.70 mm(SD=9.23).Eight patients underwent testis-sparing surgery,while 2 opted for radical surgery.Ultimately,sperm retrieval and cryopreservation were successful in 7 patients.Postoperative pathology revealed 6 malignant cases and 4 benign cases.Notably,patients with malignant pathology,compared to their benign counterparts,had a higher likelihood of a history of cryptorchidism and exhibited a higher sperm retrieval rate(83.3％vs.50.0％,P=0.008).During the follow-up of44.70 months(SD=22.72),no significant postoperative complications,local recurrences,or distant metastases were observed.The stepwise microsurgical resection of testicular tumors,coupled with sperm retrieval,effectively preserved patients'fertility.Moreover,no tumor recurrence was observed during the follow-up,underscoring the procedure's efficacy and safety.

testicular tumorspermatogenic failurenon-obstructive azoospermiaonco-mTESEmTESEfertility preserva-tion

孙一帆、孟子洲、赵晶鹏、卜鑫杰、李朋、智二磊、黄煜华、姚晨成、田汝辉、李铮

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上海交通大学医学院附属第一人民医院泌尿外科临床医学中心男科,男性健康评估中心,上海市生殖医学重点实验室,上海 200080

南京医科大学,生殖医学与子代健康全国重点实验室,南京 211116

睾丸肿瘤 生精障碍 非梗阻性无精子症 显微镜下睾丸肿瘤切除术 显微镜下睾丸切开取精术 生育力保存

国家重点研发计划国家自然科学基金国家自然科学基金国家自然科学基金上海市第一人民医院临床研究创新计划上海市第一人民医院临床研究创新计划松江区科技攻关项目

2022YFC2702701821715908217159782001530KD007-ly01CTCCR-C0422SJKGGG21

2024

10.1360/SSV-2023-0215

中国科学(生命科学)
中国科学院

中国科学(生命科学)

CSTPCD北大核心
影响因子：0.725
ISSN：1674-7232
年,卷(期)：2024.54(1)
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