无精子症病人精液中非精子细胞的检测

无精子症病人的病因分为梗阻性和睾丸源性 ,在临床上 ,对无精子症病人重在判断病因并估计预后。精液脱落细胞学检查对病因及预后的判断既经济实用又快速简单 ,现报告如下。1　资料与方法无精子症病人 5 1例 ,年龄 2 3～ 35岁 ,婚龄 1～ 8年 ,性生活均正常。多次检查精液示离心沉渣无精子 ,无明确的睾丸附睾炎、睾丸损伤或其他相关生殖系统病史。体格检查 :睾丸 12～ 2 5ml(睾丸模型比拟法 ) ,附睾及输精管未见异常 ,无其他明显异常体征。所有病例均行精液脱落细胞学检查及睾丸活检 ,其中 3例行输精管造影。精液细胞学检查方法为 :病人禁欲 2…     

无精子症病因分析:实验诊断流程图的应用

目的 应用无精子症实验诊断流程图,探讨实验诊断在无精子症病因分析中的意义.方法 对672例无精子患者按无精子症实验诊断流程图进行精液常规检查和精浆生化检测,精液脱落细胞计数,血清性激素或抑制素B测定,染色体核型分析或基因检测(AZF),必要时细针经皮睾丸穿刺活检等检查,同时结合病史及体格检查判断无精子症的病因.结果 睾丸前病因37例(5.5%),睾丸病因284例(42.3%),睾丸后病因262例(39.0%),特发性无精子症89例(13.2%).结论 无精子症实验诊断流程图在病因诊断中起到规范作用,有利于指导治疗.     

126例无精子症病因分析和诊治体会

本文对在１９９３年９月￣１９９５年１２月，门诊诊治的１３４２例男性不育症中的１２６例无精子症病人进行病因诊断分析，提出无精子症的病因诊断应根据病史，体检，第二性片，睾丸体积、精液分析、生殖激素等检查方法。按传统的病因分类方法可分为睾丸原发性生精障碍４１例，睾丸后病变５４例，睾丸前病变１０例，其它（包括精索静脉曲张和特发性无精子症）２１例，并对睾丸活检、睾丸性激素测定和精索静脉曲张在无精子症病因诊断     

126例无精子症病因分析和诊治体会

本文对在1993年9月～1995年12月，门诊诊治的1342例男性不育症中的126例无精子症病人进行病因诊断分析，提出无精子症的病因诊断应根据病史、体检、第二性征、睾丸体积、精液分析、生殖激素等检查方法。按传统的病因分类方法可分为睾丸原发性生精障碍41例，睾丸后病变54例，睾丸前病变10例，其它（包括精索静脉曲张和特发性无精子症）21例，并对睾丸活检、睾丸性激素测定和精索静脉曲张在无精子症病因诊断中的作用作了讨论。对126例无精子症中的64例，采用中西医结合方法进行治疗，有效率达26．56％。     

58例无精子症的睾丸活检与染色体检查结果分析

分析５８例无精子症的染色体检查和睾丸活检结果，染色体异常检出率为３７．９３％，其中４７ＸＸＹ（克氏征）占１７．２４％，绝大部分染色体畸变的无精子症患者，其睾丸组织均有不同程度的损害，无生精功能，对于常染色体的结构畸变是否影响睾丸组织功能尚不能肯定，睾丸组织结构异常检出率为７９．３１％，是无精子症的主要原因，而９例输精管缺如患者未发现与染色体变异之间有何联系，由此认为染色体畸变在地精子症的病因中占重     

男性无精子症患者血清生殖激素水平与睾丸生精功能的相关分析

目的观察男性无精子症患者血清生殖激素水平情况,探讨生殖激素水平异常能否预测临床穿刺取精结果。方法选择2011年1月至2013年10月在我院生殖中心就诊的878例男性无精子症患者作为研究组,同期在本院体检的40例正常男性作为对照组。采用免疫分析法检测外周血生殖激素水平,根据体格检查情况,对520例无精子症患者行睾丸/附睾穿刺取精,比较各组生殖激素水平及穿刺取得精子情况。结果研究组卵泡刺激素(FSH)、黄体生成素(LH)水平较对照组显著增高(P0.01),泌乳素(PRL)和睾酮(T)水平两组间比较无显著性差异(P0.05);穿刺无精子组与穿刺有精子组及对照组比较,FSH、LH水平升高,有显著性差异(P0.01),T水平显著下降(P0.05),PRL水平无显著性差异(P0.05)。结论血清生殖激素FSH、LH升高与男性无精子症有关,FSH的升高程度可初步预测睾丸/附睾的穿刺结果,对临床上睾丸穿刺处理具有一定的指导意义。     

Y染色体上热休克转录因子在无、少精子症患者精液、睾丸中的缺失研究

目的 通过检测无、少精子症不育患者睾丸、精液基因组HSFY基因缺失情况,探讨其病因的基因诊断方法.方法 选择35例特发性无、少精子症患者作为研究对象,其中少精子症18例、严重少精子症12例、无精子症5例;10例正常已生育健康男性作为正常对照.应用PCR技术,检测每例患者睾丸、精液中精子基因组中的Y染色体上特异性序列标签位点(STS)的引物扩增了解基因缺失情况.结果 35例患者中5例表现睾丸、精液中精子基因组微缺失,其中少精子症2例,严重少精子症3例;其余30例患者和10例正常对照睾丸、精液中精子基因组未见基因微缺失.结论 AZFb区热休克转录因子基因的部分缺失将会使精子数量明显减少.     

睾丸精子抽吸术加单精子卵细胞胞浆内注射术成功受孕1例报道

男,２８岁,结婚２年不育,１９９８年９月因无精子症前来就诊。无腮腺炎史,无睾丸炎、附睾炎、睾丸下降异常史,无尿道下裂史,无尿路感染史,性交频率为每周２～３次,能阴道内射精。体检提示睾丸容积左侧为１２ｍｌ,右侧为１０ｍｌ,质地中等;左侧输精管难以扪及。...     

睾丸穿刺活检

我院自1986年10月至1992年4月对100例血FSH、LH正常的减少精子症和无精子症患者,进行无选择性径皮穿刺睾丸活检及传统睾丸切开活检,经比较我们发现,睾丸穿刺活检有快速、简便、易行、痛苦少等优点,对诊断是准确的。现报道如下: 临床资料:100例门诊不育症患者、血FSH,LH测定正常;精液分析:精子数减少或无精子。年龄20～42岁,平均30岁。睾丸大小 4ml至24ml,平均18ml。     

无精子症263例病因诊断分析

本文对１９８６～１９９２年门诊收治的２６０３例男子不育症中的２６３例无精子症患者进行病因诊断分析。提出无精子症病因诊断应根据病史、体检、第二性征、睾丸体积、精液分析、生殖激素等检查方法，首先区别是梗阻性的还是非梗阻性的。按ＷＨＯ男性不育诊断流程图的诊断标准对无精子症２６３例进行病因分类，提出其常见病因依次为先天异常不育８９例，特发性无精子症５５例和附属性腺感染不育４５例。对睾丸功能、阴囊探查和睾丸活检在无精子症病因诊断中的作用作了介绍。     

外科取精术在无精子症诊断与治疗中的应用

目的研究外科取精术在无精子症诊断与治疗中的应用价值。方法在诊断为无精子症的、患者中,经睾丸体积测定、血清性激素水平、生殖系统超声等检查后,选择符合条件者198例,在局麻下行外科取精术,对获得组织显微镜下检查,统计分析取精结果。获得的精子行卵胞浆内单精子显微注射术（ICSI）及胚胎移植术（ET）,统计评估受精率、卵裂率、临床妊娠率及流产率。结果其中78例附睾中存在精子（39．4％）,23例睾丸中存在精子（11．6％）。睾丸体积正常的取精成功率明显高于睾丸体积偏小者,有显著性差异（P〈0．01）。血清促卵泡刺激素（FSH）水平正常的取精成功率明显高于FSH增高者,差异有显著性意义（P〈0．01）。82例外科取精术获得精子的患者进行ICSI治疗,附睾取精组与睾丸取精组比较,受精率、卵裂率、临床妊娠率及流产率差异均无统计学意义（P均〉0．05）。结论外科取精术操作简单且创伤较小,能准确鉴别诊断梗阻性无精子症（OA）及非梗阻性无精子症（NOA）,对无精子症的诊断有重要价值;为部分无精子症患者提供了生育自己生物学子代的机会,也是针对无精子症的有效治疗手段。     

经皮附睾穿刺取精术在无精子症诊断中的应用

目的:介绍经皮附睾穿刺取精术(PESA)在梗阻性和非梗阻性无精子症诊断中的应用,并探讨睾丸体积和血清卵泡刺激素(FSH)水平对其结果的影响。方法:对118例临床诊断为无精子症的患者,用模型法测量睾丸体积,化学发光法测定血清性激素水平,用7号蝶形针头穿刺附睾头,同时抽吸附睾液。结果:118例无精子症患者中,60例附睾液中可见精子,其中睾丸体积正常者为56例,睾丸体积偏小者为4例;血清FSH水平正常者为55例,血清FSH水平增高者为5例。58例未见精子,其中睾丸体积正常者为34例,睾丸体积偏小者为24例;血清FSH正常者为38例,血清FSH增高者为20例。结果显示睾丸体积正常的患者PESA成功率明显高于睾丸体积偏小者,差异有显著性(P<0.05);血清FSH水平正常的患者PESA成功率明显高于FSH水平增高者,差异有显著性(P<0.05)。结论:PESA简便、快速,是无精子症诊断的一种可行方法。     

Color Doppler ultrasonography in the diagnosis of the acute scrotum

PURPOSE: To determine the value of color Doppler ultrasonography (CDUS) in the diagnosis of acute scrotum. MATERIALS AND METHODS: 10 patients referred to our hospital with acute scrotal pain were included in this study. All patients were evaluated with CDUS after the initial clinical examinations. Blood flow of the involved testis was compared semiquantitatively to that of the opposite testis. Patients with a diagnosis of testicular torsion by CDUS underwent surgical exploration. Patients with CDUS diagnosis of epididymitis were treated with intravenous antibiotics. RESULTS: Of the 10 patients evaluated, CDUS diagnosed 5 patients with testicular torsion and 5 patients with epididymitis. All cases of torsion were confirmed intraoperatively. 2 cases with no intratesticular blood flow on CDUS had necrotic testes and underwent orchiectomy with orchiopexy of the contralateral testes. A case with absent flow and 2 cases with decreased flow had bilateral orchiopexy. CDUS findings of normal or increased flow were present in all patients with epididymitis. No cases of testicular atrophy were encountered on long-term follow up in patients with epididymitis. CONCLUSION: CDUS is helpful in detecting the perfusion of the testis as well as in getting anatomical information. CDUS is a very useful device which causes a minimal burden to the patient with acute scrotum. In most cases it will rapidly provides us the correct information although it may not be regarded as the definitive adjunct.     

CR16在特发性无精子症患者睾丸组织中的表达

目的:研究糖皮质激素区域表达基因16(corticosteroids and regional expression 16,CR16)在特发性无精子症患者睾丸组织中的表达,探讨CR16在精子发生中的作用。方法:采用免疫组化法和逆转录-聚合酶链反应(RT-PCR)检测CR16蛋白和CR16 mRNA在48例特发性无精子症患者(病例组)和10例正常生育男性(正常组)睾丸组织中的表达情况。结果:CR16蛋白表达于睾丸生精小管上皮,主要分布在支持细胞与生精细胞连接区,在特发性无精子症患者睾丸组织中的表达显著弱于正常生育男性睾丸组织中的表达。CR16 mRNA在病例组睾丸组织中的表达水平显著低于正常组。结论:特发性无精子症患者睾丸组织中CR16表达水平显著降低,这可能与无精子症相关。     

经皮附睾精子抽吸术和睾丸精子获取术在无精子症诊断和治疗中的应用

目的 :研究附睾和睾丸精子抽吸术对无精子症患者的诊断和治疗价值。　方法 :应用经皮附睾精子抽吸术(PESA)和睾丸精子获取术 (TESE)两种方法对 385例无精子症患者进行穿刺检查。　结果 :其中 6 4例附睾中存在精子 (1 6 .6 2 %) ;4 5例患者睾丸中存在精子 (1 1 .6 9%) ;对其中 6 4例睾丸或附睾中发现精子的患者采取PESA或TESE取精后行卵细胞胞质内单精子注射 (ICSI)治疗。胚胎移植后妊娠率为 39.0 7%。　结论 :PESA和TESE为部分无精子症患者提供了生育的机会 ,也是针对无精子症的有效的治疗手段。     

结核性附睾炎的超声诊断与鉴别诊断

目的 通过分析结核性和非结核性附睾炎的彩色多普勒声像图特征，提高对两种疾病声像图的认识和诊断准确率。方法 回顾分析经证实的90例非结核性附睾炎和15例结核性附睾炎的声像图特征。结果 附睾炎多位于附睾尾部或体尾部，以青壮年多见，两者的声像图相似，但又有区别，结核病灶旁阴囊壁层的结构破坏和睾丸受累是主要的鉴别点。结论 超声检查可作为结核性附睾炎症的重要辅助诊断和鉴别诊断方法。     

Sensitivity and specificity of serum FSH and testis size in predicting the existence of spermatogenesis in azoospermic infertile men

The objective of research was to determine the sensitivity, specificity and positive predictive value of serum follicle stimulating hormone and testis size in predicting spermatogenesis in infertile men with azoospermia. In a prospective study, azoospermic men were studied. Serum follicle stimulating hormone measurement and scrotal sac ultrasonography were performed. Bilateral testis biopsy was performed for all of these patients. The sensitivity and specificity of follicle stimulating hormone and testis size were determined to predict the existence of different cellular steps of spermatogenesis. Of eighty infertile men who recruited into the study, 53 patients did not represent any different cellular steps of spermatogenesis, while 27 of them had various steps of such differentiation. Among the 53 patients without cellular steps of spermatogenesis in the biopsy, 41 were predicted to be azoospermic based on their serum follicle stimulating hormone levels (77.3% sensitivity), and of 27 patients with various cellular steps of spermatogenesis in the biopsy, 23 were predicted to have spermatozoa according to the follicle stimulating hormone level (85.2%) specificity. It is suggested that combination of these two indicators can substitute the invasive testis biopsy for predicting the existence of spermatozoa in infertile men with azoospermia.     

The effect of long-term treatment with crude cotton seed oil on pituitary and testicular function in men

In a previous study, compensatory dysfunction of the Leydig cell was identified in men in whom spermatogenesis had failed to recover after gossypol treatment. In this study, LHRH- (100 micrograms i.v.) and hCG (3000 IU i.m.)-stimulation tests were conducted in four controls and in 45 men who had used crude cotton seed oil as their cooking oil. The patients were divided into two groups: group A--17 men with normospermia or oligospermia and group B--28 men who were azoospermic. The basal serum LH and FSH concentrations were within the normal range in group A, whereas those in group B were increased markedly. There was no significant difference in testosterone levels between the two groups, although the levels were significantly lower than in the controls. The response of LH and FSH to LHRH, and of testosterone to hCG stimulation, were within the normal range in group A, whereas in group B the response to the LHRH test was increased significantly while their response to the hCG test was reduced markedly. It was concluded that the functions of the pituitary and Leydig cells remained unchanged in group A after long-term use of crude cotton seed oil, and that once azoospermia has occurred, it is followed by total testicular failure as indicated by the responses to LHRH and hCG tests.