【摘要】 目的比较睾丸穿刺取精与经皮附睾取精2种方式行卵细胞浆内单精子注射技术(ICSI)治疗对临床结局的影响。方法通过计算机检索PubMed、EMBASE、Cochrane图书馆和中国知网(CNKI)、万方数据库、维普(VIP)等数据库从建库至2017年10月有关睾丸穿刺取精与经皮附睾取精行ICSI治疗的文献,按照纳入与排除标准对文献筛选,并进行资料提取,用Cochrane协作网非随机研究推荐的Newcastle-Ottawa Scale(NOS)行文献质量评价,运用RevMan5.3进行meta分析。结果共纳入原始文献20篇,包括1 464周期用睾丸穿刺取得的精子行ICSI,2 526周期用经皮附睾取得的精子行ICSI治疗。Meta分析结果显示,睾丸穿刺取精与经皮附睾取精2种方式行ICSI治疗在妊娠率[相对危险度(RR)=1.06,95%置信区间(95%CI)0.99～1.13,P=0.11]、流产率(RR=0.99,95%CI0.76～1.30,P=0.97)、活产率(RR=0.99,95%CI0.86～1.14,P=0.88)、异位妊娠率(RR=1.44,95%CI0.70～2.95,P=0.32)、畸形率(RR=1.71,95%CI 0.50～5.80,P=0.39)、单胎率(RR=0.95,95%CI0.85～1.06,P=0.38)、多胎率(RR=1.12,95%CI0.90～1.39,P=0.32)方面无差异。术后2组患者均无感染、阴囊血肿、性功能障碍等严重并发症。结论行睾丸穿刺取精与经皮附睾取精2种方式行ICSI治疗,在安全性及疗效方面无显著差异。更多还原

【Abstract】 Objective To compare the efficiency of testicular sperm aspiration and percutaneous epididymal sperm aspiration for receiving intracytoplasmic sperm injection(ICSI)assisted reproduction.Methods PubMed,EMBASE,Cochrane Library,CNKI,Wanfang database and VIP database were searched,and all publications before October 2017 which related to comparing testicular sperm aspiration and percutaneous epididymal sperm aspiration for ICSI were browsed.According to the inclusion and exclusion criteria,the literature was screened and the data were extracted.The Newcastle-Ottawa Scale(NOS)was recommended for quality evaluation of non-randomized studies,and RevMan 5.3 was used for meta-analysis.Results A total of 20 literatures were recruited,including 1 464 cycles and 2 526 cycles used sperm by testicular sperm aspiration and percutaneous epididymal sperm aspiration for ICSI,respectively.The results based on meta-analysis showed that no significant differences could be observed between groups using testicular sperm aspiration and percutaneous epididymal sperm aspiration in rates of pregnancy(RR=1.06,95%CI 0.99-1.13,P=0.11),abortion(RR=0.99,95%CI 0.76-1.30,P=0.97),live birth(RR=0.99,95%CI 0.86-1.14,P=0.88),ectopic pregnancy(RR=1.44,95%CI 0.70-2.95,P=0.32),deformity(RR=1.71,95%CI 0.50-5.80,P=0.39),singleton(RR=0.95,95%CI0.85-1.06,P=0.38),multiple pregnancy(RR=1.12,95%CI 0.90-1.39,P=0.32),respectively.In addition,no severe complications,such as postoperative infection,scrotal hematoma or sexual dysfunction,were reported between two groups.Conclusion Testicular sperm aspiration and percutaneous epididymal sperm aspiration would be similarly safe and efficient for patients receiving ICSI assisted reproduction.更多还原