Gordon Uma Deve
Centre for Reproductive Medicine, 4 Priory Road, Clifton, Bristol BS8 1TY, UK.
Hum Fertil (Camb). 2002 Feb;5(1 Suppl):S9-S14. doi: 10.1080/1464727022000199851.
The advent of intracytoplasmic sperm injection (ICSI) has offered new solutions for the management of patients with azoospermia. Surgical sperm recovery combined with ICSI has allowed many men with azoospermia to father their own biological children. Azoospermia can be classified as obstructive and non-obstructive, with investigations, management and success rates varying markedly between the two forms. In certain cases of obstructive azoospermia surgical reconstruction remains a viable option, whereas cases with congenital obstruction need to be screened for mutations of the cystic fibrosis gene. In most cases of obstruction sperm can be retrieved from the epididymis using percutaneous epididymal sperm aspiration (PESA). If PESA is unsuccessful, testicular sperm extraction (TESE) is successful in all cases. With non-obstructive azoospermia, the genetic basis has been investigated intensely. Screening for karyotypic abnormalities as well as Y microdeletions is recommended. Irrespective of the histological diagnosis, focal spermatogenesis can be observed in 40-50% of cases using multiple testicular biopsies.
卵胞浆内单精子注射（ICSI）技术的出现为无精子症患者的治疗提供了新的解决方案。手术取精联合ICSI使许多无精子症男性能够生育自己的亲生孩子。无精子症可分为梗阻性和非梗阻性，两种类型在检查、治疗及成功率方面差异显著。在某些梗阻性无精子症病例中，手术重建仍是可行的选择，而先天性梗阻病例则需要筛查囊性纤维化基因的突变情况。在大多数梗阻病例中，可通过经皮附睾精子抽吸术（PESA）从附睾中获取精子。如果PESA不成功，睾丸精子提取术（TESE）在所有情况下均能成功获取精子。对于非梗阻性无精子症，人们对其遗传基础进行了深入研究。建议筛查染色体核型异常以及Y染色体微缺失。无论组织学诊断如何，通过多次睾丸活检，40%至50%的病例中可观察到局灶性生精现象。
