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目的研究经皮附睾穿刺取精(PESA)和短时受精治疗梗阻性无精子症的效果。方法选择2012年3月-2013年5月接受治疗的20对夫妇(282个卵母细胞)。20例梗阻性无精子症患者采用PESA治疗,女方一半卵子行卵泡浆内单精子显微注射(ICSI组);另一半卵子和PESA精子行短时受精,4~5 h后,机械性去除颗粒细胞,观察第二极体,再决定是否行补救ICSI(RE-ICSI组)。结果短时受精组PESA精子消化了颗粒细胞,但没有第二极体,因此行RE-ICSI。RE-ICSI和ICSI两组的受精率、2PN卵裂率和优胚率比较差异均无统计学意义(P>0.05)。结论未经离心的PESA精子能消化颗粒细胞,但没有受精能力,因此可以替代合成的透明质酸酶使用。两种方法结果相似。使用PESA得到的精子和短时受精加上RE-ICSI是治疗男性梗阻性无精子症的可行性方法。
Objective To study the effect of percutaneous epididymal puncture (PESA) and short-term fertilization on obstructive azoospermia. Methods 20 couples (282 oocytes) treated from March 2012 to May 2013 were selected. Twenty patients with obstructive azoospermia were treated with PESA. One half of the female ovules were injected intracytoplasmic sperm injection (ICSI group); the other half of oocytes and PESA spermatozoa were short-term fertilized. After 4 ~ 5 h, mechanical removal of particles Cells, observe the second polar body, and then decide whether to rehabilitate ICSI (RE-ICSI group). Results PESA sperm digested granulosa cells but no second polar body in short-term fertilization group, so RE-ICSI was performed. There was no significant difference in fertilization rate, 2PN cleavage rate and excellent embryo rate between RE-ICSI and ICSI (P> 0.05). Conclusions Undigested PESA sperm can digest granulosa cells but have no ability to fertilize and therefore can be used in place of the synthetic hyaluronidase. The results of the two methods are similar. Sperm and short-term fertilization with PESA plus RE-ICSI is a viable method of treating obstructive azoospermia in men.