从靶向取精到生精功能重建：治疗性睾丸精子获取技术的演进与临床应用

doi:10.3969/j.issn.1006-5725.2026.17.019

Abstract

Abstract:

Therapeutic testicular sperm retrieval and clinical application are essential for achieving biological parenthood in patients with azoospermia and severe male infertility. In recent years， significant progress has been made in the optimization of retrieval techniques， expansion of clinical indications， and exploration of regenerative medicine strategies. Focusing on the core theme of "from targeted sperm retrieval to spermatogenic function reconstruction"， this article systematically reviews the evolution of therapeutic testicular sperm retrieval techniques from blind biopsy and targeted localization to functional spermatogenesis reconstruction， and summarizes the research progress in assisted reproduction and fertility preservation， analyzes the current challenges， and discusses future directions. This review aims to provide reference for clinical standardized diagnosis and treatment as well as translational research of basic science.

Key words: azoospermia, therapeutic testicular sperm retrieval, regenerative medicine, assisted reproduction, fertility preservation

CLC Number:

R698.2

Lulu Luo, Yuqian Tang, Chunjie Ma. From targeted sperm retrieval to spermatogenic function reconstruction： evolution and clinical application of therapeutic testicular sperm retrieval techniques[J]. The Journal of Practical Medicine, 2026, 42(17): 3197-3205.

Figures/Tables 1

References 82

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术式	适应症	SRR	主要优势	主要局限
TESA	OA（首选）	OA：初次99%	微创、出血少、恢复快、可重复操作、无需显微设备、可在门诊局麻下完成	盲目性强、组织量有限、假阴性率高、依赖操作者经验
c-TESE	OA（TESA失败后补救）、 NOA（非首选）	NOA：16.7 ~ 45.0%	操作简便、学习周期短、成本低、可多点取材、无需显微设备	创伤大、难以定位局灶生精区、血供损伤风险、并发症率高
mTESE	NOA（金标准）、克氏综合征、AZFc缺失等	NOA总体：40% ~ 60%	精准定位、组织损伤小、SRR高、保护睾丸血供	设备要求高、学习曲线长；白膜开口较大、术后性腺功能减退风险
显微绘图TESE	复杂NOA、既往取精失败者	FNAM定位者：38%FNAM引导下SRR：100%	术前定位全面、整合细胞学分析、适用于复杂病例	操作复杂、FNAM增加术前操作步骤与时间
分步mTESE	预后不良NOA	总体：28.1%	递进式决策减少不必要创伤	SRR相对较低、手术时间可能延长
小切口mTESE	NOA、隐匿精子症（微创优势显著）	NOA：48% 隐匿精子症：总体89%	创伤显著减小、58%隐匿精子症患者避免广泛解剖、可缩短手术时间	浅表探查可能遗漏深部生精灶
分步小切口mTESE	NOA（尤其隐睾术后）	总体：22% ~ 80% 隐睾术后NOA：78%	兼顾高SRR与微创、保留睾丸功能	操作步骤繁琐、需充分显微外科经验

From targeted sperm retrieval to spermatogenic function reconstruction： evolution and clinical application of therapeutic testicular sperm retrieval techniques

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