法赫德国王专科医院和研究中心在利雅得对克兰费尔特综合征患者进行显微外科睾丸取精的经验。
Micro-dissection testicular sperm extraction in Klinefelter's syndrome patients, King Faisal Specialist Hospital and Research Center, Riyadh experience.
作者信息
Almardawi Abdulmalik H, Akram Rabea, Kattan Yara, Al Suhaibani Shaheed Saleh, AlAli Hamed, Kattan Said, Al Hathal Naif
机构信息
Department of Urology, King Faisal Specialist Hospital and Research Center, Riyadh, Kingdom of Saudi Arabia.
Department of Urology, College of Medicine, King Fahad University Hospital, Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia.
出版信息
Urol Ann. 2022 Jan-Mar;14(1):43-47. doi: 10.4103/ua.ua_88_21. Epub 2022 Jan 20.
BACKGROUND
In Klinefelter's syndrome patients with azoospermia, microscopic testicular sperm extraction (m-TESE) can be proposed as a therapeutic option.
AIM OF STUDY
The aim of this study is to assess the sperm retrieval rate in patients with Klinefelter syndrome in King Faisal Specialist Hospital, Riyadh.
METHODOLOGY
Retrospective, Chart review of 32 patients with Klinefelter syndrome who underwent m-TESE were reviewed and analyzed. All patients had two sets of semen analysis after 3 - 5 days abstinence of ejaculation with further study of semen by fertilization (IVF) wash. The hormonal analysis was studied. Ultrasonography of testes was assessed preoperatively. Testicular tubules were sent to the IVF laboratory and were studied under the microscope looking for sperms. Some testicular tissues were sent for the histopathology diagnosis.
RESULTS
Patients' mean age was 34.9 ± 6.0 years. Mean hormonal levels of E2, FSH, LH, prolactin, and testosterone were 96.0 ± 22.0 pmol/L, 29.8 ± 5.4 IU/L, 19.0 ± 2.9 IU/L, 15.4 ± 3.6 ug/L, and 10.0 ± 1.9 nmol/L, respectively. There were two mosaic Klinefelter syndrome patients (6.25%), whereas 30 patients had a nonmosaic form (93.75%). The overall sperm retrieval rate was 37.5%. All patients had small bilateral testes. Sperm retrieval was successful in three patients with hypospermatogenesis, one patient with maturation arrest, and 8 patients with Sertoli-cell-only pattern. Four patients with complete hyalinization of testicular tissues had complete failure to retrieve sperms. The pregnancy rate after intra-cytoplasmic sperm injection was 50%.
CONCLUSIONS
The sperm retrieval rate in Klinefelter syndrome patients with m-TESE is in accordance with most of those reported in the literature. Regarding histopathology, hypo-spermatogenesis showed a favorable outcome. The pregnancy rate with intra-cytoplasmic sperm injection was 50%.
背景
对于患有无精子症的克兰费尔特综合征患者，显微睾丸精子提取术（m-TESE）可作为一种治疗选择。
研究目的
本研究旨在评估利雅得法赫德国王专科医院中克兰费尔特综合征患者的精子获取率。
方法
对32例行m-TESE的克兰费尔特综合征患者进行回顾性病历审查与分析。所有患者在禁欲3 - 5天后进行两组精液分析，并通过体外受精（IVF）洗涤对精液进行进一步研究。研究激素分析情况。术前对睾丸进行超声检查。将睾丸小管送至IVF实验室，在显微镜下寻找精子。部分睾丸组织送去进行组织病理学诊断。
结果
患者平均年龄为34.9±6.0岁。雌二醇（E2）、促卵泡生成素（FSH）、促黄体生成素（LH）、催乳素和睾酮的平均激素水平分别为96.0±22.0 pmol/L、29.8±5.4 IU/L、19.0±2.9 IU/L、15.4±3.6 μg/L和10.0±1.9 nmol/L。有2例嵌合型克兰费尔特综合征患者（6.25%），而30例患者为非嵌合型（93.75%）。总体精子获取率为37.5%。所有患者双侧睾丸均较小。在3例生精功能低下患者、1例成熟停滞患者和8例唯支持细胞型患者中精子获取成功。4例睾丸组织完全玻璃样变的患者精子获取完全失败。卵胞浆内单精子注射后的妊娠率为50%。
结论
克兰费尔特综合征患者行m-TESE的精子获取率与文献报道的大多数情况相符。在组织病理学方面，生精功能低下显示出较好的结果。卵胞浆内单精子注射后的妊娠率为50%。
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