评估对比增强超声在非梗阻性无精子症中引导微切割睾丸精子提取中的应用。
Assessment of the use of contrast enhanced ultrasound in guiding microdissection testicular sperm extraction in nonobstructive azoospermia.
机构信息
Department of ultrasound, Renji Hospital, School of Medicine, Shanghai Jiaotong University, 160 Pujian RD, Shanghai, 200127, China.
Department of Andrology, Shanghai General Hospital, Shanghai Jiaotong University, 100 Haining RD, Shanghai, 200080, China.
出版信息
BMC Urol. 2018 May 23;18(1):48. doi: 10.1186/s12894-018-0367-y.
BACKGROUND
The aim of this study is to assess the value of contrast-enhanced ultrasound (CEUS) as a new non-invasive approach to locate the testicular area in which spermatogenesis is most likely to be found in non-obstructive azoospermic testes and to evaluate the accuracy of CEUS as a predictor of successful sperm retrieval.
METHODS
CEUS was performed in 120 nonobstructive azoospermia (NOA) patients. Microdissection testicular sperm extraction (M-TESE) was performed on the best and poorest perfusion areas selected by CEUS and on conventional areas.
RESULTS
In the 187 testicles that underwent M-TESE, the sperm retrieval rates (SRRs) in the best perfusion area and poorest perfusion area over the maximal longitudinal section and conventional area were 63.1, 34.7 and 47.1%. According to receiver operating characteristic (ROC) analysis, the arrival times (AT) ≤27 s, time-to-peak intensity (TTP) ≤45 s, and peak intensity (PI) ≥11 dB were the best predictors of positive sperm retrieval. The location of the best perfusion area was able to guide M-TESE to improve the success rates.
CONCLUSIONS
Testicle CEUS is suggested to be performed in all patients with NOA. If AT≤27 s, TTP ≤ 45 s or PI≥11 dB are found in the best perfusion area, M-TESE is strongly recommended.
背景
本研究旨在评估对比增强超声（CEUS）作为一种新的非侵入性方法在非梗阻性无精子症睾丸中寻找最有可能发生生精的睾丸区域的价值，并评估 CEUS 作为预测精子成功获取的准确性。
方法
对 120 例非梗阻性无精子症（NOA）患者进行 CEUS 检查。在 CEUS 选择的最佳和最差灌注区域以及常规区域上进行显微睾丸精子提取（M-TESE）。
结果
在 187 例接受 M-TESE 的睾丸中，最佳灌注区和最差灌注区的精子获取率（SRR）在最大长轴上和常规区分别为 63.1%、34.7%和 47.1%。根据受试者工作特征（ROC）分析，到达时间（AT）≤27s、达峰时间（TTP）≤45s 和峰值强度（PI）≥11dB 是预测精子获取阳性的最佳指标。最佳灌注区的位置能够指导 M-TESE 以提高成功率。
结论
建议所有非梗阻性无精子症患者进行睾丸 CEUS。如果在最佳灌注区发现 AT≤27s、TTP≤45s 或 PI≥11dB，则强烈建议进行 M-TESE。
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