Takada Shingo, Tsujimura Akira, Ueda Tomohiro, Matsuoka Yasuhiro, Takao Tetsuya, Miyagawa Yasushi, Koga Minoru, Takeyama Masami, Okamoto Yoshio, Matsumiya Kiyomi, Fujioka Hideki, Nonomura Norio, Okuyama Akihiko
Department of Urology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.
Urology. 2008 Jul;72(1):114-8. doi: 10.1016/j.urology.2008.02.022. Epub 2008 Apr 18.
Microdissection testicular sperm extraction (TESE) is the ideal procedure for obtaining a high sperm retrieval rate. However, few studies of the postoperative endocrinologic course have been reported. We evaluated the endocrinologic course for 1 year after microdissection TESE and compared the results with the testicular histologic findings.
A total of 69 patients with nonobstructive azoospermia who had undergone microdissection TESE were included. The overall sperm retrieval rate was 50.7%. The endocrinologic data were evaluated before and 3, 6, and 12 months after surgery.
The mean serum total testosterone level in patients with hypospermatogenesis decreased postoperatively and had recovered by 12 months (102%). The mean serum total testosterone level in patients with Klinefelter syndrome also decreased postoperatively but had recovered to only 50% of the baseline value at 12 months after microdissection TESE. At 12 months, the mean serum total testosterone level in patients with maturation arrest was 93.1% of the preoperative level and that in patients with Sertoli cell-only syndrome was 80.6% of the preoperative level. The preoperative serum luteinizing hormone and follicle-stimulating hormone in patients with Klinefelter syndrome was high and remained high after microdissection TESE. The mean serum luteinizing hormone and follicle-stimulating hormone levels in patients with hypospermatogenesis did not change, and those in patients with maturation arrest increased continuously after microdissection TESE. Finally, those in patients with Sertoli cell-only syndrome increased up to 6 months after surgery and decreased after that.
The results of our study indicate that long-term endocrinologic follow-up is necessary after microdissection TESE, particularly for patients with Klinefelter syndrome to detect hypogonadism.
显微切割睾丸取精术（TESE）是获得高精子获取率的理想手术。然而，关于术后内分泌变化过程的研究报道较少。我们评估了显微切割TESE术后1年的内分泌变化过程，并将结果与睾丸组织学结果进行比较。
共纳入69例接受显微切割TESE的非梗阻性无精子症患者。总体精子获取率为50.7%。在手术前以及术后3、6和12个月评估内分泌数据。
精子发生低下患者的血清总睾酮平均水平术后下降，12个月时恢复（恢复率为102%）。克氏综合征患者的血清总睾酮平均水平术后也下降，但在显微切割TESE术后12个月仅恢复到基线值的50%。在12个月时，成熟停滞患者的血清总睾酮平均水平为术前水平的93.1%，唯支持细胞综合征患者的血清总睾酮平均水平为术前水平的80.6%。克氏综合征患者术前血清黄体生成素和卵泡刺激素水平较高，显微切割TESE术后仍保持较高水平。精子发生低下患者的血清黄体生成素和卵泡刺激素平均水平未发生变化，成熟停滞患者的血清黄体生成素和卵泡刺激素平均水平在显微切割TESE术后持续升高。最后，唯支持细胞综合征患者的血清黄体生成素和卵泡刺激素平均水平在术后6个月升高，之后下降。
我们的研究结果表明，显微切割TESE术后需要进行长期内分泌随访，尤其是对于克氏综合征患者以检测性腺功能减退。
