非閉塞性無精子症に対する精巣内精子採取法(TESE)の臨床成績 ―顕微鏡下精巣内精子採取法(Microdissection TESE)の経験―

Abstract

非閉塞性無精子症と診断し, 挙児を希望して精巣内精子採取法(TESE)を行った17例を対象とし, 開放切除による組織採取(c-TESE)と手術用顕微鏡を用いて行うMicrodissection TESE(MD-TESE)の2種類の方法を用いたTESEの臨床成績を検討した.c-TESEのみで精子が回収できたのは24%であった.MD-TESEの導入により精子回収率は24%から48%に向上し, MD-TESEにより効率よく精子回収を行える可能性が示唆された.術前に正常精子回収の可否を術後に予測するのは困難であると思われた.MD-TESEの際に観察される精細管の太さは精子回収の可否を予想するのに参考となる可能性があった

Testicular sperm extraction (TESE) was performed on patients with non-obstructive azoospermia using the conventional or microdissection technique. First, conventional TESE was attempted on all patients. If the sperm was retrieved successfully, the TESE procedure was terminated. Microdissection TESE was indicated only for patients for whom the conventional sperm retrieval was unsuccessful. Sperm was successfully retrieved with conventional TESE from four (24%) of 17 patients with non-obstructive azoospermia. The remaining 13 patients underwent microdissection TESE and sperm was successfully retrieved from four of them. Application of the microdissection technique resulted in an improvement in sperm retrieval rates from 24% with conventional TESE to 48% when combined with the microdissection technique. None of the patients showed any acute or chronic complications after TESE. Intracytoplasmic sperm injection (ICSI) was performed on five of the eight patients with successful sperm retrieval and the partner of four of these patients became pregnant and progressed to delivery. These results indicate the usefulness of microdissection for improving the sperm retrieval rate in men with non-obstructive azoospermia.