上海交通大学学报（医学版）

上海交通大学学报（医学版） ›› 2017, Vol. 37 ›› Issue (10): 1368-.doi: 10.3969/j.issn.1674-8115.2017.10.011

• 论著（临床研究） • 上一篇    下一篇

非梗阻性无精子症患者睾丸局部生精功能的超声造影评估

张时君，杜晶，吕仁华，田汝辉，李凤华   

  1. 上海交通大学 医学院附属仁济医院超声医学科，上海 200127
  • 出版日期:2017-10-28 发布日期:2017-11-01
  • 通讯作者: ?李凤华，电子信箱：fenghua-li@163.com
  • 作者简介:张时君（1980—），男，主治医师，硕士；电子信箱：zsj8666@163.com
  • 基金资助:
    上海市科学技术委员会研究项目（15411966300）；上海申康医院发展中心辅助科室能力建设项目（SHDC22015003）；上海交通大学医学院附属仁 济医院科研种子基金培养计划（RJZZ14-012）

Application of contrast enhanced ultrasound in assessing the testicular spermatogenesis of nonobstructive azoospermia patients#br#

ZHANG Shi-jun, DU Jing, LÜ Ren-hua, TIAN Ru-hui, LI Feng-hua   

  1. Department of Ultrasound, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
  • Online:2017-10-28 Published:2017-11-01
  • Supported by:
     Research Project of Science and Technology Commission of Shanghai Municipality, 15411966300; Assistant Department Capacity Building Project of Shanghai Hospital Development Center, SHDC22015003; Research Seed Training Plan of Renji Hospital affiliated to Shanghai Jiao Tong University School of Medicine, RJZZ14-012

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摘要： 目的 · 探讨超声造影定位对引导非梗阻性无精子症（NOA）患者睾丸显微取精术的应用价值。方法 · 95 例 NOA 患者行睾 丸超声造影，分别选取造影浓聚区和稀疏区进行定位并量化分析。显微取精术分别在造影浓聚区、稀疏区以及常规区取精。比较各 个区域的取精成功率。结果 · 95 例患者共147 个睾丸行显微取精术，浓聚区、稀疏区和常规区的取精成功率分别为66.3%（63/95）、 32.6%（31/95）和 47.3%（45/95），两两比较差异具有统计学意义（均 P<0.05）。在取精阳性位点组（94 个位点）和取精阴性位点组 （200 个位点）对比中，造影起始增强时间、达峰时间、峰值强度和曲线下面积间差异均具有统计学意义（均 P<0.05）。 3 个病理组间 取精成功率具有差异，成熟障碍组和唯支持细胞综合征组中浓聚区取精成功率高于常规区（均P<0.05）。 结论 · 不同的病理类型具有 不同的取精成功率，通过术前睾丸造影定位浓聚区引导显微取精术可提高成熟障碍和唯支持细胞综合征患者的取精成功率。

关键词: 超声造影, 显微取精术, 取精成功率, 非梗阻性无精子症

Abstract:

Objective · To assess the usefulness of contrast enhanced ultrasound (CEUS) in locating the testicular area to guide microdissection testicular sperm extraction (M-TESE) for patients with nonobstructive azoospermia (NOA).  Methods · CEUS was performed in 95 NOA patients. M-TESE was performed in the best and poorest perfusion areas on CEUS and in the conventional area. Sperm retrieval rates (SRR) of the three areas were compared.  Results · M-TESE was performed in 147 testicles (95 patients). SRRs in best perfusion area, poorest perfusion area and conventional area were 66.3%, 32.6% and 47.3% respectively, and the differences between groups were statistically significant (all P<0.05). The arriving time (AT), time to peak intensity (TTP), peak intensity (PI) and area under the curve (AUC) showed statistical significance (all P<0.05) between the successful retrieval group (94 points) and unsuccessful retrieval group (200 points). And the SRR showed statistical difference among the three pathological groups. In maturation arrest group and Sertoli cell only group, the SRR in the best perfusion area was higher than that in the conventional area (both P<0.05).  Conclusion · SRR was different in different pathological groups. The locating of the best perfusion area could guide M-TESE so as to improve the SRRs of maturation arrest group and Sertoli cell only group.

Key words:  contrast enhanced ultrasound, microdissection testicular sperm extraction, sperm retrieval rate, nonobstructive azoospermia