Hodgkin’s disease, testicular canc, leukemia, and non-Hodgkin’s mphoma are the most common maligcies seen in men of reproductive age (1). Spm quality in men diagnosed with testicular tumors is suboptimal, even prior to the initiation of chemo/radiothapy, due to in part the local negative effects exted by the tumors. In one stu, spm concentration was significant low in patients with a testicular maligcy than in those with systemic maligcy and healthy donors with proven ftility. Motility was found to be significant low in patients with testicular and systemic maligcy than in healthy proven ftile donors (2).

　　霍齊金病，睪丸疾病 ，白血病和非霍齊金淋巴瘤是育齡男性中較常見(jiàn)的惡性腫瘤(1)。睪丸腫瘤患者的精子質(zhì)量并不理想，即使在開(kāi)始化療/放射治療之前也不樂(lè)觀，導(dǎo)致這種情況的部分原因是腫瘤產(chǎn)生的局部負(fù)面影響。一項(xiàng)研究發(fā)現(xiàn)，惡性睪丸腫瘤患者的精子濃度明顯 低于系統(tǒng)性惡性腫瘤患者和已經(jīng)有過(guò)生育史的健康者。此外，睪丸腫瘤患者和全身惡性腫瘤患者的精子活動(dòng)率明顯 低于已經(jīng)有過(guò)生育史的健康者(2)。

　　Anti-neoplastic thapy is associated with significant morbidity, and testicular sfunction is among the most common long-tm side effects of cytotoxic chemothapy in men. Canc patients receiving radiothapy are at high-risk for developing inftility and canc surgy can reduce spm concentration, causing ectile sfunction (3). Between 15 and 30 pcent of male patients undgoing gonadotoxic treatments do not regain ftility (4). Most patients undgoing chemothapy develop azoospmia by 12 weeks.

　　抗腫瘤治療與嚴(yán)重的并發(fā)癥有關(guān)，其中睪丸功能障礙是男性接受細(xì)胞毒性化療較常見(jiàn)的長(zhǎng)期副作用之一。接受放療的疾病 癥患者發(fā)生不孕癥的危險(xiǎn) 很高。疾病 癥手術(shù)會(huì)降低精子濃度，導(dǎo)致勃起功能障礙(3)。接受性腺毒性治療的患者中有15%至30%的人無(wú)法恢復(fù)生育功能(4)。大多數(shù)接受化療的患者在治療12周時(shí)會(huì)出現(xiàn)無(wú)精癥。

　　The degree to which testicular function is affected depends on the dose and agent (5). Alkylating agents (e.g. cyclophosphamide and busulfan) and ionizing radiation frequent induce azoospmia, rending the patient inftile. A major reason to freeze spm before treatment is the concn for potential chromosomal abrations in spm that are exposed to chemothapy (6). Although no increase in malformation rates have been reported in children born to patients who have had chemothapy or radiothapy, the available data and follow-up are still limited.

　　睪丸功能的受損程度取決于使用的藥劑和劑量(5)。烷化劑(例如環(huán)磷酰胺和白消安)和電離輻射經(jīng)常容易引起無(wú)精癥，導(dǎo)致患者不育。在治療前的一個(gè)主要原因是擔(dān)心暴露于化學(xué)治療的精子有潛在的染色體畸變(6)。盡管沒(méi)有研究發(fā)現(xiàn)接受化療或放療的患者所生兒童在畸形率上有增加，但是可用的數(shù)據(jù)和隨訪仍然有限。

　　Chemothapy targets cells outside the G0 phase, destroying prolifating spmatogonias (7). The majority of chemothapy patients develop azoospmia during treatment, and it is difficult to predict if and when spmatogenesis will recov. Recovy tends to be dose dependent. Patients receiving low doses of these agents may recov spmatogenesis with 12 weeks aft completing chemothapy. Howev more than 50 pcent of patients will receive high dose chemothapy and may contribute to the 15-30 pcent of all patients who remain stile in the long tm It is estimated that up to 15 pcent of male patients will alrea be azoospmic before undgoing any type of treatment. Semen should be cryopresved before canc treatment begins. It is optimal to have multiple samp cryopresved (8). Patients who are most at risk are those who undgo a treatment that includes successive and multiple toxicities, such as bone marrow transplantation (9).

　　化療針對(duì)G0期以外的細(xì)胞，會(huì)破壞增殖期的精原細(xì)胞(7)。大多數(shù)化療患者在治療期間會(huì)出現(xiàn)無(wú)精癥，很難預(yù)測(cè)是否以及何時(shí)會(huì)恢復(fù)精子生成，這跟治療劑量有關(guān)。接受低劑量治療的患者可能會(huì)在完成化療12周后恢復(fù)精子生成。但是超過(guò)50%的患者需要接受高劑量化療，可能導(dǎo)致15-30%的患者長(zhǎng)期處于不育狀態(tài)。據(jù)估計(jì)，高達(dá)15%的男性患者在接受任何類型的化療之前已經(jīng)有無(wú)精癥。精液應(yīng)在疾病 癥治療開(kāi)始前進(jìn)行保存保存，且保存保存多個(gè)樣本是選擇(8)。接受諸如連續(xù)或多重毒性治療如骨髓移植的患者面臨無(wú)精癥的危險(xiǎn) 較高。

　　Refences

　　參考文獻(xiàn)

　　1. Houvitz A, Goldschlag DE, Davis OK, Gosden LV, Palmo GD, Rosenwaks Z. Intracytoplasmic spm injection (ICSI) using cryopresved spm from men with maligt neoplasm yields high pregcy rates. Ftil Stil 2008;90(3):557-63.

　　2. Williams DH, Karpman E, Sand JC, Spiess PE, Pists LL, Lipshultz LI. Pretreatment semen paraments in men with canc. J Urol 2009; 181(2):736-40.

　　3. Nijs M, Vandzwalmen P, Vandamme B, Segal-Btin G, Lejeune B, Segal L, et al. Ftilizing ability of immotile spmatozoa aft intracytoplasmic spm injection. Hum Reprod 1996; 11(10):2180-5.

　　4. Menon S, Rives N, Mousset-Simeon N, Sibt L, Vanni JP, Mazuri S, et al. Ftility presvation in adocent ma: expience ov 22 years at Rouen Univsity Hospital. Hum Reprod 2009;24(1):37-44.

　　5. Palmo G, Joris H, Devroey P, Van Steirteghem AC. Pregcies aft intracytoplasmic injection of single spmatozoon into an oocyte. Lancet 1992;340(8810):17-8.

　　6. Lass A, Akagbosu F, Brinsden P. Spm banking and assisted reproduction treatment for coup following canc treatment of the male partn. Hum Reprod Update 2001; 7(4):370-7.

　　7. Bonetti TCS, Pasqualotto FF, Queiroz P, Iaconelli A Jr, Borges E J. Spm banking for male canc patients: social and semen profi. Int Braz J Urol 2009;35(2):190-7.

　　8. Bonetti TCS, Pasqualotto FF, Queiroz P, Iaconelli A Jr, Borges E J. Spm banking for male canc patients: social and semen profi. Int Braz J Urol 2009;35(2):190-7; discussion 7-8.

　　9. de Vries MC, Brests D, Engbts DP, Wit JM, van Leeuwen E. Attitudes of physicians and parents towards discussing inftility risks and semen cryopresvation with male adocents diagnosed with canc. Pediatr Blood Canc 2009;53(3):385-91.

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