Schubert J, Held H J, Kelly L U, Tolkendorf E
Klinik für Urologie, Medizinischen Akademie Carl Gustav Carus, Dresden.
Z Urol Nephrol. 1989 Apr;82(4):209-16.
Through an optimal treatment of testicular cancer the life expectancy of patients is improved, but more early and late complications were observed after different therapeutic procedures and mainly fertility problems come to the fore. In 70% of the patients (n = 30) an abnormal spermiogram was found prior to treatment. At this time 54% of all patients with testicular cancer (n = 61) were 20 to 30 years old and 43% of these patients wish to have a child. After radical retroperitoneal lymph node dissection in 71% of cases (n = 45) a total or partial loss of ejaculation was found. The cytostatic chemotherapy and radiation treatment are the cause of reversible or irreversible reduction in spermatogenesis and possibly mutagenic alterations. There are several alternatives to treat the infertility problems of cured testicular cancer patients and autologous insemination is favoured by the half of these patients. In our experience with cryopreserved sperm (n = 22) only patients with appropriate sperm quality (greater than 10 Mill. sperms/ml, greater than 30% mobile sperms, greater than 30% thaw motility) are suited to this method. In consideration of these parameters only 25% of testicular cancer patients are suited for long-term sperm preservation. The technical problems of sperm preparation, storage and autologous insemination are described in detail.
通过对睾丸癌的优化治疗，患者的预期寿命得到了提高，但在不同治疗程序后观察到了更多的早期和晚期并发症，主要是生育问题凸显出来。在70%的患者（n = 30）中，治疗前发现精子图异常。此时，所有睾丸癌患者（n = 61）中有54%年龄在20至30岁之间，其中43%的患者希望生育。在71%的病例（n = 45）中，腹膜后淋巴结清扫术后发现射精完全或部分丧失。细胞抑制化疗和放射治疗是精子发生可逆或不可逆减少以及可能发生诱变改变的原因。有几种方法可用于治疗治愈的睾丸癌患者的不育问题，其中一半患者倾向于自体授精。根据我们对冷冻保存精子（n = 22）的经验，只有精子质量合适（精子浓度大于1000万/ml、活动精子大于30%、解冻后活力大于30%）的患者适合这种方法。考虑到这些参数，只有25%的睾丸癌患者适合长期保存精子。文中详细描述了精子制备、储存和自体授精的技术问题。
