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目的:探讨Y染色体无精子症因素(azoospermia factor,AZF)c区缺失患者治疗方案的选择。方法:对既往183例在北京大学第三医院诊治的Y染色体AZFc区缺失患者的资料进行回顾性分析,整理诊疗过程及结局,找出AZFc区缺失患者精液情况的特点。结果:183例AZFc区缺失的患者中105例(57.4%,105/183)能够自行射出精子,其中103例(98.1%,103/105)为重度或者严重少精子症,98例通过规律的药物治疗后有6例(6.1%,6/98)自然受孕,其余99例行胞浆内单精子显微注射(intracytoplasmic sperm injection,ICSI)患者中有68例(68.7%,68/99)成功受孕。183例AZFc区缺失患者中78例临床表现为无精子症,其中49例(62.8%,49/78)先行睾丸穿刺取精术(testicular sperm aspiration,TESA),21例(26.9%,21/78)直接行显微取精术(micro-dissection testicular sperm extraction,micro-TESE)。行TESA的患者中,17例(34.7%,17/49)找到精子,32例(65.3%,32/49)未找到精子,包括12例(37.5%,12/32)放弃治疗及20例(62.5%,20/32)选择行micro-TESE患者。截至最后随访,41位选择micro-TESE的患者中已有19例(46.3%,19/41)完成手术,其中11例(57.9%,11/19)成功找到精子,包括TESA失败后行micro-TESE的患者(6例)中的4例(66.6%,4/6)。无精子症AZFc区缺失患者中已经有7例行ICSI,4例(57.1%,4/7)成功受孕。结论:AZFc区缺失的患者中有精子者大部分为重度或严重少精子症,长期的药物治疗效果不佳,应及时行ICSI治疗;无精子的患者通过TESA取到精子的概率稍低,TESA失败后行micro-TESE取精仍有一定的成功率,因此,在某些情况下直接选择micro-TESE可以减少患者的多次受创。
Objective: To investigate the treatment options for patients with deletion of c-region of azoospermia factor (AZF). Methods: A retrospective analysis was performed on the data of 183 patients with AZFc deletion in the Y chromosome at the Third Hospital of Peking University. The diagnosis and treatment process and outcome were analyzed to find out the characteristics of the semen in patients with AZFc deletion. Results: Of the 183 patients with deletion of AZFc, 105 (57.4%, 105/183) were capable of sperm injection themselves, of which 103 (98.1%, 103/105) were severe or severe oligospermia and 98 Six cases (6.1%, 6/98) conceived spontaneously after the treatment, and 68 of the 99 cases (68.7%, 68/99) had intrauterine sperm injection intracytoplasmic sperm injection (ICSI) successfully. . Among 183 patients with AZFc deletion, 78 cases showed azoospermia. Among them, 49 (62.8%, 49/78) had testicular sperm aspiration (TESA), 21 (26.9%, 21/78) ) Micro-dissection testicular sperm extraction (micro-TESE). Spermatozoa were found in 17 cases (34.7%, 17/49) of the patients who underwent TESA. No sperm were found in 32 cases (65.3%, 32/49), including 12 cases (37.5%, 12/32) 62.5%, 20/32) selected patients with micro-TESE. As of the last follow-up, 19 (46.3%, 19/41) of the 41 patients selected for micro-TESE had completed surgery. Of the 11 patients (57.9%, 11/19) who successfully found sperm, including TESA, Four of the TESE patients (6 cases) (66.6%, 4/6). ICSI has been performed in 7 patients with AZFc deletion in azoospermia, and 4 patients (57.1%, 4/7) have successful conception. CONCLUSION: Most of the patients with AZFc deletion have severe or severe oligospermia. Long-term drug treatment is not effective and ICSI should be performed promptly. The probability of sperm acquisition by TESA in patients with no sperm is slightly lower. TESA There is still a certain chance of success with micro-TESE aspiration after failure, so direct selection of micro-TESE in some cases can reduce multiple patient episodes.