患有非阻塞性无精症的男性的睾丸实质内可能有局部性生精区域。为了取出这些组织，需要在全麻下对患者进行睾丸切开取样手术。有研究发现，对患有非阻塞性无精症的男性……
患有非阻塞性无精症的男性的睾丸实质内可能有局部性生精区域。为了取出这些组织，需要在全麻下对患者进行睾丸切开取样手术。有研究发现，对患有非阻塞性无精症的男性施用切开术比经皮取精术更有优势(1)。
Testicular sperm extraction (TESE)
睾丸切开取精术
A median raphe incision is made in the scrotum, the tunica vaginalis is opened and the testis is delivered. Multiple random, transverse, 1 cm incisions are then made in each quadrant of the testis. A relatively large piece of testicular tissue is taken from each incision and given to the embryologist. This is followed by closure in layers with 4/0 vicryl and skin closure with 4/0 vicryl rapide.
睾丸切开取精术需要在阴囊正中线处做一个切口，切开鞘膜后露出睾丸。然后将睾丸分为四个象限，在每个象限内做多个随机横向的1cm的切口，并从每个切口中取出一块相对较大的睾丸组织并交给胚胎师。最后用4/0薇乔缝合线缝合膜层，用4/0快薇乔缝线缝合皮肤。
Microdissection testicular sperm extraction (micro-TESE)
睾丸显微取精术(micro-TESE)
A median raphe incision is made in the scrotum, the tunica vaginalis is opened and the testis is delivered. An equatorial incision involving three-quarters of the circumference is made along the mid-portion using the surgical microscope to identify the subtunical vessels and avoid vascular injury, the testis is then bivalved, and this allows wide exposure of seminiferous tubules in a physiological approach that follows intratesticular blood flow.
在阴囊正中线处做一个切口，切开鞘膜后露出睾丸。使用手术显微镜沿睾丸的水平中线做一个四分之三圆周的切口，切开时看清楚膜下血管并避免损伤血管。然后通过跟随睾丸内血流的生理方式将睾丸切开成双瓣，以暴露大部分生精小管。
Microdissection is then performed under 20X magnification to expose the seminiferous tubules and multiple tiny pieces of testicular tissue are taken from areas that have opaque tubules which are more likely to contain sperm. Microdissection allows access to deeper sections of the seminiferous tubules while avoiding injury to the blood supply because the minute vessels can be accurately visualized and avoided. Furthermore, in the event of vascular injury, accurate hemostasis can be performed using micro bipolar diathermy, thus preventing postoperative hematomas and at the same time minimizing the area cauterized because the bleeding vessels can be easily seen and accurately cauterized under the surgical microscope.
接下来在20X显微镜下进行显微切割以暴露生精小管，并从不透明小管区域取出多个微小的睾丸组织，这些小管更可能含有精子。显微切割能够取到生精小管更深部分的样本，同时可以准确观察和避免切割到微细血管，避免对血液供应造成损伤。如果发生血管损伤，可以使用微双极透热法进行准确止血，防止术后血肿。此外，由于在手术显微镜下可以轻松看到并准确烧灼出血血管，可以尽可能减少烧灼面积。
Thus, with this technique the entire parenchyma may be examined, a smaller amount of tissue is taken, less vascular injury occurs, and more accurate hemostasis is done. It has been suggested that this technique reduces the amount of testicular tissue that needs to be removed by 70-fold, which is important in preventing postoperative hypogonadism (2).
因此，使用显微取精术可以检查整个睾丸实质，需要取的样本量更少，发生的血管损伤也更少，止血更准确。有研究认为使用这种技术需要切除的睾丸组织的样本数是其他手术的1/70，对于预防术后性腺功能减退有重要作用(2)。
For all these reasons, this technique offers a better sperm retrieval rate and lower incidence of complications.
由此可见，显微取精术的精子提取率更高，术后并发症发生率更低。
References
参考文献
1. Friedler S, Raziel A, Strasburger D, et al. Testicular sperm retrieval by percutaneous fine needle sperm aspiration compared with testicular sperm extraction by open biopsy in men with non-obstructive azoospermia. Hum Reprod 1997;12:1488-1493.
2. Schlegel P N. Nonobstructive azoospermia: a revolutionary surgical approach and results. Semin Reprod Med 2009;27:165-170.
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