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目的分析梗阻性无精子症患者不同精子来源行ICSI的结局,以便更好为梗阻性无精子症患者选择精子来源行ICSI助孕。方法计算机检索Cochrane Central(2014年9月)、EMBASE(1974年至2014年10月)、MEDLINE(1946 to present)、CNKI(1992年1月1日至2014年10月29日)、VIP(1989年至2014年)、WANFANG(1992年至2014年)、并辅以其他检索,纳入梗阻性无精子症患者睾丸及附睾精子行ICSI的队列研究20篇,运用Cochrane协作网非随机研究推荐Newcastle-OttawaSeale(NOS)进行质量评价并用RevMan5.0进行Meta分析。结果纳入20篇原始文献,18篇中文,2篇英文(1685个周期用睾丸精子行ICSI,1 850个周期用附睾精子行ICSI),Meta分析结果:(1)活产率无统计学意义,OR=0.87,95%CI(0.69,1.10),P=0.26。(2)妊娠率无统计学意义,OR=0.87,95%CI(0.75,1.01),P=0.07。(3)流产率无统计学意义,OR=1.24,95%CI(0.78,1.96),P=-0.37。结论梗阻性无精子症患者睾丸及附睾精子行ICSI活产率、妊娠率、流产率无显著差异,畸形率报道较少故仍需做更多的原始研究。
Objective To analyze the outcomes of ICSI with different sources of spermatozoa in patients with obstructive azoospermia in order to better select sperm source for ICSI in patients with obstructive azoospermia. Methods Cochrane Central (September 2014), EMBASE (1974 to October 2014), MEDLINE (1946 to present), CNKI (January 1 to October 29, 2014), VIP Year to 2014), WANFANG (1992 to 2014), supplemented by other searches, included 20 cohort studies of ICSI in the testis and epididymal sperm count of patients with obstructive azoospermia and the non-randomized study using the Cochrane Collaboration recommended Newcastle- OttawaSeale (NOS) for quality evaluation and Meta-analysis with RevMan 5.0. Results There were 20 original articles, 18 Chinese articles and 2 English articles (ICSI of 1685 cycles with testicular spermatogenesis and ICSI of 1 850 cycles of epididymal spermatogenesis). Results of Meta analysis: (1) The live birth rate was not statistically significant, OR = 0.87, 95% CI (0.69, 1.10), P = 0.26. (2) The pregnancy rate was not statistically significant, OR = 0.87, 95% CI (0.75,1.01), P = 0.07. (3) Abortion rate was not statistically significant, OR = 1.24, 95% CI (0.78, 1.96), P = -0.37. Conclusion ICSI live rate, pregnancy rate and miscarriage rate of testis and epididymal sperm in patients with obstructive azoospermia have no significant difference. There are few reports of deformity rate, so more original research still needs to be done.