睾丸癌治疗与生育能力：成都男性患者应如何保护？精子保存与癌症治疗：杭州患者如何应对潜在生育风险？

　　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).

　　霍齐金病，睾丸疾病，白血病和非霍齐金淋巴瘤是育龄男性中较常见的恶性肿瘤(1)。睾丸肿瘤患者的精子质量并不理想，即使在开始化疗/放射治疗之前也不乐观，导致这种情况的部分原因是肿瘤产生的局部负面影响。一项研究发现，恶性睾丸肿瘤患者的精子浓度明显低于系统性恶性肿瘤患者和已经有过生育史的健康者。此外，睾丸肿瘤患者和全身恶性肿瘤患者的精子活动率明显低于已经有过生育史的健康者(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.

　　抗肿瘤治疗与严重的并发症有关，其中睾丸功能障碍是男性接受细胞毒性化疗较常见的长期副作用之一。接受放疗的疾病症患者发生不孕症的危险很高。疾病症手术会降低精子浓度，导致勃起功能障碍(3)。接受性腺毒性治疗的患者中有15%至30%的人无法恢复生育功能(4)。大多数接受化疗的患者在治疗12周时会出现无精症。

　　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.

　　睾丸功能的受损程度取决于使用的药剂和剂量(5)。烷化剂(例如环磷酰胺和白消安)和电离辐射经常容易引起无精症，导致患者不育。在治疗前的一个主要原因是担心暴露于化学治疗的精子有潜在的染色体畸变(6)。尽管没有研究发现接受化疗或放疗的患者所生儿童在畸形率上有增加，但是可用的数据和随访仍然有限。

　　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).

　　化疗针对G0期以外的细胞，会破坏增殖期的精原细胞(7)。大多数化疗患者在治疗期间会出现无精症，很难预测是否以及何时会恢复精子生成，这跟治疗剂量有关。接受低剂量治疗的患者可能会在完成化疗12周后恢复精子生成。但是超过50%的患者需要接受高剂量化疗，可能导致15-30%的患者长期处于不育状态。据估计，高达15%的男性患者在接受任何类型的化疗之前已经有无精症。精液应在疾病症治疗开始前进行保存保存，且保存保存多个样本是选择(8)。接受诸如连续或多重毒性治疗如骨髓移植的患者面临无精症的危险较高。

　　Refences

　　参考文献

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　　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.

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　　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.