输精管结扎术后附睾精子及其吻合术后再现精子超微结构的观察

目的观察输精管结扎术后附睾精子和吻合术后再现精子超微结构的演变情况及其相关关系。方法15例要求作输精管吻合术的对象,手术时取出附睾精子（A组）并追踪其吻合术后精液再现精子（B组）,同时应用光镜和电子显微镜分别观察A组、B组的精子形态和结构的改变,并进行统计学分析。结果光镜分析显示：B组与A组比较,精子密度和尾畸比例下降有显著性;而精子活动率和头畸比例升高有显著性;正常形态的比例有增高的趋势。电镜分析显示：B组与A组比较,正常形态精子显著升高,而尾部畸形精子明显降低,两者差异均有统计学的显著性;头畸形和颈畸形的比例在两组间差异没有显著性;而两组间尾部畸形比例呈正相关。透射电镜显示内部结构在头、颈、尾均有多细胞器、多种形式的改变。结论本文用电镜观察进一步证实了输精管结扎术后附睾精子形态向输精管吻合术后精液再现精子变化的规律。不论电镜还是光镜分析,精子尾部异常都是由高比例（A组）向低比例（B组）转化,正常形态的精子均由低比例（A组）向高比例（B组）转化;精子头部的异常光镜分析是一个由低比例（A组）向高比例（B组）转化的过程,而电镜分析没有改变。本文在A组和B组未有发现与输精管结扎术有关的精子形态学上特征性的改变。

An investigation of sperm ultrastructure changes from epididymis after vasectomy to semen after vasectomy reversal

Objective:To observe the sperm ultrastructure in epididymis after vasectomy and their changes in semen after vasovasostomy.Methods:During the operation of vasovasostomy,the epididymal sperm samples(group A)were collected from 15 men who underwent vasectomy.Semen samples(group B)from the same subjects after vasectomy reversal were analyzed.Both optical and electronic microscopes were employed to observe the changes in sperm morphology.Results:The data from optical microscope showed that the sperm density and the percentage of sperm with tail defects were significantly lower,while the sperm motility and the percentage of sperm head defects were significantly higher in group B than those in group A.In group B there was an increase tendency in the percentage of normal sperm morphology.The data from electronic microscope showed that the percentage of normal sperm morphology was significantly higher,while the percentage of sperm with tail defects were significantly lower in group B than those in group A.There was no changes in percentage both sperm head and sperm neck defects between two groups.There was a positive correlation in the percentages of sperm with tail defects in the two groups.There existed multi-cell organ and multi-form abnormalities in the inner structures of sperm heads,necks and tails.Conclusion:The regular pattern of sperm morphological changes from Group A to Group B had been demonstrated.Base on the results of optical and electronic microscope analysis there was a change from higher(group A)to lower(group B)in the percentage of sperm with tail defects.There was a change from lower(group A)to higher(group B)in the percentage of sperm with normal morphology.There was a change from lower(group A)to higher(group B) in the percentage of sperm with head defects using optical microscope analysis,but not using electronic microscope.In both group A and group B,There was no characteristic change in the sperm microstructure related to vasectomy.