Amer Medhat, Zohdy Wael, Abd El Naser Taha, Hosny Hossam, Arafa Mohammed, Fakhry Emad
Department of Andrology, Faculty of Medicine, Kaser El Aini, Cairo University Hospital, Cairo, Egypt.
Fertil Steril. 2008 Mar;89(3):592-6. doi: 10.1016/j.fertnstert.2007.03.043. Epub 2007 May 22.
The aim of this study was to measure the diameter of seminiferous tubules (ST) during microdissection testicular sperm extraction (TESE) using a micrometer fixed to one of the eyepieces of the operating microscope to find a correlation between the extracted ST diameter and TESE outcome.
A prospective comparative study.
Adam International Andrology and Infertility Clinic, Giza, Egypt.
PATIENT(S): Two hundred sixty-four patients with nonobstructive azoospermia (NOA) were included.
INTERVENTION(S): Patients underwent TESE using the open surgical technique. The STs were measured using the micrometer, and the tubule with the largest diameter was excised and freshly examined under an inverted microscope. If no spermatozoa were found, another sample was taken from the second most dilated tubule area and then at random until sperm were found or a maximum six samples were harvested. If no spermatozoa were detected, the contralateral testis was operated upon.
MAIN OUTCOME MEASURE(S): The TESE outcome in relation to ST diameter.
RESULT(S): The total sperm recovery rate was 105 out of 264 (39.8%). When ST measured >or=300 microm the sperm retrieval rate was 16 out of 19 (84.2%). When ST diameter was <300 microm, the sperm retrieval rate was 36.3% (89 out of 245).
CONCLUSION(S): During microdissection TESE, the best cutoff level of the ST diameter for harvesting testicular spermatoza is 110 microm with sensitivity 86.0% and specificity 74.4% (AUC 0.653, 95% confidence interval 0.608-0.663). When ST diameter is 300 microm or more a single tubule biopsy is usually sufficient to harvest enough testicular spermatozoa for intracytoplasmic sperm injection or sperm freezing with minimal tissue excision.
本研究旨在通过使用固定在手术显微镜目镜之一上的测微计测量显微切割睾丸取精术（TESE）期间的生精小管（ST）直径，以找出所提取的ST直径与TESE结果之间的相关性。
前瞻性对照研究。
埃及吉萨的亚当国际男科学与不孕不育诊所。
纳入264例非梗阻性无精子症（NOA）患者。
患者采用开放手术技术接受TESE。使用测微计测量ST，切除直径最大的小管，并在倒置显微镜下进行新鲜检查。如果未发现精子，则从第二大扩张小管区域再取一个样本，然后随机取样，直到发现精子或最多采集六个样本。如果未检测到精子，则对侧睾丸进行手术。
与ST直径相关的TESE结果。
264例患者中，精子总回收率为105例（39.8%）。当ST测量值≥300微米时，精子提取率为19例中的16例（84.2%）。当ST直径<300微米时，精子提取率为36.3%（245例中的89例）。
在显微切割TESE期间，获取睾丸精子的ST直径最佳临界值为110微米，敏感性为86.0%，特异性为74.4%（曲线下面积0.653，95%置信区间0.608 - 0.663）。当ST直径为300微米或更大时，单次小管活检通常足以获取足够的睾丸精子用于卵胞浆内单精子注射或精子冷冻，且组织切除最少。
