睾丸细针穿刺吸液细胞学检查诊断阻塞性无精子症

目的 :观察睾丸细针穿刺吸液 ( FNA)细胞学检查的效果 ,为诊断阻塞性无精子症提供新的诊断方法。方法 :2 86例无精子症患者采用睾丸 FNA细胞学检查结合精浆生化指标测定及输精管造影对睾丸生精功能及阻塞部位进行诊断 ;以 42例精子密度在正常范围 ( 2 5～ 86× 1 0 6 / ml)的成年男性作为对照组。 2 4例做钳穿活检进行自身对照。结果 :( 1 )双侧输精管未触及者 58例 ,睾丸 FNA细胞学检查生精功能正常 2 6例 (可见较多生精细胞、精子细胞及精子 )、生精功能低下 2 4例、无生精功能 8例 ,精浆果糖在正常值范围 ,而肉毒碱及α-糖苷酶明显低于正常值范围 ;( 2 ) 3 2例睾丸 FNA细胞学检查见较多精子 ,精液沉渣涂片未见生殖细胞 ,其中 6例精浆果糖、肉毒碱及 α-糖苷酶明显低于正常值范围 ,结合输精管造影确诊为射精管阻塞 ,其余 2 6例精浆果糖在正常值范围 ,而肉毒碱及α-糖苷酶明显低于正常值范围 ,确诊为附睾尾部阻塞性无精子症 ;( 3 )睾丸生精功能极度低下或无生精功能 1 96例 ,其中 1 60例仅见各级生精细胞、精子细胞和支持细胞 (睾丸生精功能阻滞 ) ,3 6例仅见支持细胞 (唯支持细胞综合征 ) ,精浆果糖、肉毒碱及 α-糖苷酶均在正常值范围 ,为非阻塞性无精子症。结论 :睾丸 FNA细胞学检查可作为阻塞性无?     

腮腺炎致无精症患者睾丸切开取精结果与性激素水平和睾丸大小关系的研究

目的:探讨腮腺炎致无精症患者睾丸切开取精(TESA)与性激素、睾丸大小的关系。方法:52例腮腺炎致无精症患者经TESA,显微镜下观察能否找到活动的精子,电化学方法方法测定性激素(FSH、LH、T、PRL、E2)的水平,超声测量并计算睾丸体积。结果:52例患者TESA找到活精子38例(73.1%),血清FSH和LH水平,无精子组平均数明显高于有精子组,两间差异有统计学意义(P<0.05),血清T、E2、PRL组间差异无统计学意义。睾丸体积无精子组平均数小于有精子组,但组间差异无统计学意义(P>0.05)。以FSH值为标准,38例可找到活动精子患者中,正常范围之内的有23例(44.2%),高出正常值2倍范围内的有11例(21.2%),2倍范围之外的有4例(7.7%)。以睾丸体积为标准,38例可找到活动精子患者中,睾丸体积≥6ml有35例(67.3%),睾丸体积<6ml有3例(5.8%)。结论:睾丸体积和FSH水平可以作为腮腺炎致无精症患者预判取精成功概率的指标,所有患者都应该TESA,为单精子卵胞浆内注射创造机会。     

睾丸精子辅助生育30例报告

本生殖中心自 1 997年至今 ,用睾丸精子卵浆内单精子注射 (intracytoplasmic sperm injec-tion,ICSI)为 30对无精子症不育夫妇行辅助生育治疗 32个周期 ,报道如下。一、资料与方法30例无精子症不育、染色体核型正常的患者平均年龄 35 (2 2～ 45 )岁 ,治疗前均检查血卵泡刺激素 (FSH)、黄体生成素 (L H)、睾酮 (T)、泌乳素 (PRL )水平及睾丸活检了解睾丸功能及生精状况。首先对女方促超排卵治疗 [1] ,女方平均年龄 31 (2 1～ 39)岁 ,当卵泡发育成熟时 ,以阴道B超介导下取卵 ,卵子的处理及 ICSI方法见文献 [2 ]。获得卵子后即行睾丸精…     

重视无精子症的病因诊断

无精子症指离心后精液沉淀未检出精子。通过详尽的病史收集和仔细的体格检查,临床医生可以初步判定无精子症的病因。睾丸性或睾丸前性无精子症,应进行基因和促性腺激素的检测;建议对先天性双侧输精管缺如和原发性附睾梗阻性无精子症患者,行囊性纤维化跨膜传导调节因子(CFTR)基因突变的检测,以防子代囊性纤维化的发生。卵泡刺激素和抑制素B与睾丸体积结合,有助于对睾丸的生精功能作出判断;当睾丸体积正常时,诊断性睾丸穿刺可以进一步鉴别无精子症是梗阻性还是睾丸性。输精管造影仅在精道重建手术时施行,可以确定梗阻位置,又避免损伤。     

无精子症患者睾丸组织病理分型与血清抑制素B关系的研究

目的:探讨无精子症患者睾丸组织病理分型与血清抑制素B(INH B)水平间的关系,了解血清INH B在评估无精子症患者睾丸生精功能状态的敏感性和特异性。方法:对83例无精子症患者进行睾丸活组织病理检查诊断,根据病理形态的不同分为:唯支持细胞综合征组(n=21)、生精功能低下组(n=20)、生精阻滞组(n=24)和生精功能基本正常组(n=18)。患者睾丸活检前分别测定其血清INH B、卵泡刺激素(FSH)、黄体生成素(LH)及睾酮(T)水平。结果:上述4组血清INH B水平分别为(20.85±18.78)、(67.25±40.98)、(73.63±25.54)和(149.48±27.92)ng/m l。INH B水平在生精阻滞组与生精功能低下组之间差异无显著性(P>0.05),其他各组间以及与上述两组血清INH B水平间差异均有极显著性(P<0.001);FSH水平在生精阻滞组与基本正常组间差异无显著性(P>0.05),其他各组间以及与上述两组血清FSH水平间差异均有显著性(P<0.05);4组血清LH及T水平之间无相关性。结论:血清INH B水平在生精小管生精功能受损时明显降低,唯支持细胞综合征者下降最为显著。血清INH B水平可直接反映睾丸生精功能的总体状态,是判断无精子症患者睾丸生精功能更有效的诊断指标。     

睾丸穿刺活检在卵浆内单精子注射辅助生育中的价值

目的 评价单、双侧睾丸穿刺活检在无精症的病理诊断和卵浆内单精子注射生育中的价值。方法 随机对65例无精症患者进行单侧或双侧活检；测量患者睾丸体积，计算手术时间，评估术后并发症，记录病理结果。结果 65例无精症患者睾丸穿刺病理结果显示：唯支持细胞综合征41例（63％），生精功能低下10例（15．4％），精子成熟阻滞9例（13．8％），正常生精功能5例（7．8％）。双侧睾丸活检术后出现腰腹疼痛10例、恶心8例，单侧睾丸活检仅2例出现腰腹疼痛。双侧睾丸活检中，病理显示生精状态不同者占50％（15／30）。结论 睾丸钳穿活检是一种简单、损伤少的活检方法。单点、单侧睾丸活检可以对无精症进行诊断，但不能反映双侧睾丸的不同生精状态，对欲行卵浆内单精子注射的患者应行双侧睾丸活检，切开获取精子可能是最好的办法。     

无精子症和生精功能正常者睾丸组织中血红素加氧酶的表达与差异性研究

目的:对人类睾丸组织中表达血红素加氧酶(HO)的细胞进行定位;通过测定原发性无精子症及梗阻性无精子症患者睾丸组织中血红素加氧酶1(HO-1)的表达量与正常睾丸组织中HO-1表达量的差异性,来探讨其与无精子症发病的相关性。方法:应用免疫组化方法对人类睾丸组织中表达HO的细胞进行定位;采用逆转录-荧光定量PCR(FQ-PCR)方法定量检测无精子症患者与正常人睾丸组织HO-1及HO-2基因水平的表达量;应用W est-ern印迹检测各组之间HO蛋白水平表达量。结果:在正常睾丸组织,HO-1主要表达在支持细胞上;而HO-2在支持细胞和各级生精细胞中均有表达;FQ-PCR结果显示非梗阻性无精子症患者睾丸组织HO-1、HO-2的表达量均显著低于正常组及梗阻性无精子症组(P<0.05),差异具有统计学意义。而梗阻性无精子症患者睾丸组织表达HO-1、HO-2的量与正常组相比无显著性差异。W estern印迹结果显示HO-1蛋白水平的表达量差异与基因水平一致。而HO-2的蛋白水平在各组之间表达没有显著性差异。结论:非梗阻性无精子症患者睾丸组织中HO的表达量显著性降低,且HO-1无论是蛋白水平还是基因水平的差异一致。HO-1可以通过抗炎、抗氧化、抗凋亡的机制保护睾丸组织免受各种应激的损伤,从而维护正常的生精功能。可见,HO-1的减少可能与生精功能低下相关,这可能是非梗阻性无精子症的发病机制之一。     

性激素对化疗患者睾丸生精功能的保护及机理

在恶性肿瘤和一些自身免疫性疾病的治疗中 ,化疗是必不可少的治疗措施 ,但研究发现化疗药物对男性睾丸生精功能损害极大 ,可部分或全部杀死各级生精细胞 ,使男性精子数量减少和 /或精子活力降低 ,甚至不育。研究发现在化疗的不同时期应用不同的性激素可保护睾丸生精功能。近年来对睾酮和雌激素、促性腺激素释放激素类似物或激动剂、雄激素拮抗剂、促性腺激素释放激素 拮抗剂在化疗中对睾丸生精功能的保护及机理进行了较多的研究 ,并取得一定的成绩。     

无精子症及隐匿精子症患者睾丸体积与睾丸活检组织生精细胞的关系

目的:研究无精子症及隐匿精子症患者睾丸活检组织生精细胞类型及睾丸体积之间的关系。方法:收集来我院就诊的无精子症及隐匿精子症患者的完整睾丸活检病理报告,参照WHO《男性不育标准化诊疗手册》睾丸组织学分类方法进行分类,分析精液检查结果、睾丸组织学类型及睾丸体积之间的关系。结果:在492例患者中,无精子症占90.5%(445/492),隐匿精子症占9.5%(47/492)。生精小管内见成熟精子占17.9%(88/492)、生精小管内见生精细胞未见成熟精子占42.9%(211/492)、唯支持细胞综合征39.2%(193/492)。睾丸体积10ml及以下占38.6%(190/492),其中5ml及以下占7.9%(39/492)。生精小管内见成熟精子患者隐匿精子症检出率14.8%(13/88),生精小管内见生精细胞未见成熟精子患者隐匿精子症检出率11.4%(24/211),唯支持细胞综合征患者隐匿精子症检出率5.2%(10/193),唯支持细胞综合征患者隐匿精子症检出率显著下降(P<0.05)。结论:睾丸生精功能可能为局灶性,单次睾丸活检难以全面、完整反映睾丸生精功能状态。睾丸体积显著低于正常参考值仍会存在生精功能。睾丸活检适应证的掌握过于宽松。采用WHO的睾丸组织学分类方法,能更方便、更有效指导临床进一步检查及治疗方案。     

同种异体睾丸移植远期疗效观察(附4例报告)

目的探讨同种异体睾丸移植的远期疗效。方法利用亲属睾丸作供体行同种异体睾丸移植4例,其中医源性无睾症2例,原发性性腺机能低下2例,术后观察患者血清睾酮水平、第二性征变化及性功能情况。结果术后随访2~11年,4例患者血清睾酮明显升高,性功能及第二性征长期维持,精液检查未见精子。结论同种异体睾丸移植的内分泌治疗效果较为确切,但生精功能不满意。     

NEW INDICATION OF TESTIS BIOPSY FOR AZOOSPERMIA: A CLINICAL STUDY IN JAPANESE PATIENTS

Because of the progress made with assisted reproductive techniques, we decided to clarify the indication for testis biopsy in Japanese azoospermic patients. A total of 88 azoospermic patients were recruited with testis histologies obtained by bilateral biopsy. Testicular histology was evaluated using Johnsen's score count. Patients with at least 1 testis containing sperm were assigned to the active spermatogenesis group. Patients whose testes had no sperm were assigned to the hypospermatogenesis group. Differences in terms of the clinical data between the 2 groups were analyzed. Clinical data consisted of past history, physical examination and hormone concentrations. The unpaired t test was generally used to examine the statistical significance of any differences between the 2 groups. 1) There were significant differences between the 2 groups in the levels of serum testosterone and luteinizing hormone. 2) There were markedly significant differences between the 2 groups in terms of testis volume and the concentration of serum follicle-stimulating hormone (FSH). 3) The smallest testis volume and the highest serum FSH value in the active spermatogenesis group were 7 ml and 32.7 mlU/ml (normal range 2.9-8.2), respectively. In conclusion, although the presence or absence of active spermatogenesis can be accurately predicted by measuring the testis volume and serum FSH, testis biopsy should be carried out in patients with a testis volume greater than 7 ml or a serum FSH less than 4 times normal when the use of assisted reproductive techniques are planned.     

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。     

Sertoli Cell Function in the Androgen Insensitive (TFM) Rat

The Sertoli cells of the androgen insensitive (tfm) rat are capable of producing androgen binding protein (ABP) both in vivo and in vitro. ABP levels in the tfm testis are significantly higher ( P < 0.01) than that in normal littermates (NL); 2.9 ± 0.5 (SD) pmoles/mg protein and 63.7 ± 15 (SD) pmoles/testis in the tfm compared to 0.41 ± 0.07 pmoles/mg protein and 34.3 ± 6.7 pmoles/testis in the NL. However, ABP secretion rate in vitro is significantly lower in the tfm testis than that in the NL testis; 0.12 ± 0.02 (SD) pmol/testis per h and 0.31 ± 0.06 pmol/testis per h respectively. Thus, the increased levels of ABP in the tfm testis does not reflect increased ABP secretion, but is due to the atresia of the excurrent ducts and accumulation of seminiterous tubular secretion. The tfm testes show a higher concentration of FSH receptors than that in NL (171 fmoles/mg protein and 57 fmoles/mg protein respectively). However, when FSH binding is calculated per testis, binding capacities in tfm and NL testis are very similar (632 fmoles/testis and 798 fmoles/testis respectively). The present study shows that normal induction of FSH receptors is not dependent on the presence of an androgen receptor and that production and secretion of ABP is taking place in a situation where the target cells are insensitive to physiological doses of androgen.
The reduction in ABP secretion rate in vitro in the tfm rat testis supports previous studies showing that both FSH and androgens are important for normal Sertoli cell function.     

Testicular function after torsion

A group of 20 patients with torsion was investigated. The study indicated that immediate surgical intervention with a period of torsion of the testis of less than 6 h will prevent impairment of testicle function. The histology of testicular biopsies taken from such patients revealed only interstitial oedema and, at the most, partial necrosis. If torsion time exceeded 6 h testicular histology revealed severe alterations, and surgical correction could not prevent atrophy of the testis. Patients with pathological spermiograms showed FSH values over or at the upper limit of the normal range. As far as can be concluded from one single basal hormone determination, the testosterone secretion remained unaltered. Libido, potency and virilization remained normal.     

腹腔镜经腹腹膜前修补术对睾丸血供及生精功能影响的临床研究

目的 观察腹经腹腹膜前修补术对睾丸血供及生精功能影响。方法 2017年6月~2019年1月,收集在医院行腹腔镜经腹腹膜前修补术患者,共41例,比较其术前、术后7天、术后6月精子浓度、精子活力、血清卵泡刺激素（FSH）、血清抑制素B（IHN-B）、睾丸体积、睾丸动脉收缩期峰值血液流速（PSV）的差异。结果 与术前相比,术后7天及术后6月精子浓度、精子活力、血清卵泡刺激素、血清抑制素B、睾丸体积均无明显差异,而PSV在术后6天较术前有明显降低,差异有统计学意义,而术后6个月差异无统计学意义。术后血肿、手术时间延长是术后睾丸血供异常的风险因素。结论 经腹腹膜前修补术对睾丸生精功能无显著影响。     

Paternity in a patient with testicular seminoma and contralateral testicular intraepithelial neoplasia

A 32-year-old patient with unilateral βhCG-positive seminoma and contra-lateral testicular intraepithelial neoplasia (TIN; so-called carcinoma- in-situ ) with no metastases (clinical stage I) received one course of adjuvant carboplatin therapy. He refused further treatment of TIN in his remaining testis. His wife became pregnant by him 4 months later and delivered a healthy child at term. This case shows that patients with TIN in their remaining solitary testis are not necessarily infertile, and testes afflicted with TIN must also contain tubules that retain normal spermatogenic potential. Surveillance may be an treatment option for patients with TIN in their remaining testis in cases where there is a strong desire for paternity.     

非梗阻性无精子症患者睾丸体积、生殖激素水平与睾丸穿刺取精结果的相关性研究

目的:探讨非梗阻性无精子症患者睾丸体积、生殖激素水平与睾丸穿刺取精术(TESA)结果的相关性,以及可用于预测TESA结果的睾丸体积、生殖激素水平的切点值,从而为非梗阻性无精子症患者进一步诊疗提供重要资料。方法:121例研究对象均为非梗阻性无精子症患者(NOA),测定其睾丸体积和生殖激素水平,并根据TESA结果分为无精子组和有精子组。结果:无精子组和有精子组的左侧睾丸体积(ml)、右侧睾丸体积(ml)、泌乳素(PRL,ng/ml)、卵泡刺激素(FSH,mIU/ml)、黄体生成素(LH,mIU/ml)、雌二醇(E2,pmol/L)、血清总睾酮(TT,nmol/L)水平分别为7.07±1.06和11.75±1.38、7.37±1.37和11.70±1.98、12.43±11.69和9.60±4.55、15.77±10.84和8.01±7.43、6.12±2.92和8.11±20.11、119.36±43.52和141.12±48.33、11.43±4.05和12.46±4.60。无精子组血清FSH和PRL水平平均值高于有精子组,并且有显著的统计学差异。虽然无精子组的睾丸体积平均数小于有精子组,但两组之间没有统计学差异。对于年龄、血清E2和TT水平,两组之间也没有统计学差异。利用ROC曲线优选的睾丸体积切点值为9 ml,此点其敏感性为93.8%/89.6%(左/右),特异性为100%/94.3%(左/右),睾丸体积ROC曲线的AUC为0.984/0.961(左/右),表明其诊断准确性较高;优选的血清FSH水平切点值为8.18 mIU/ml,此点其敏感性为71.2%,特异性为75.0%,FSH水平ROC曲线的AUC为0.743,表明其诊断准确性中等。结论:睾丸体积和FSH水平对于预测NOA患者TESA结果具有重要意义,并且睾丸体积诊断准确性明显优于FSH。     

Semen Quality and Hormonal Status of Patients Following Testicular Torsion

16 patients, 4 months to five years following unilateral torsion of the testis were evaluated as to semen quality and hormonal status. In patients operated within 12 hours of the onset of pain 44% had normal semen quality while in those operated following more than 12 hours only 20% had normal semen analysis. FSH, LH and testosterone levels were normal in 14 of the 16 patients. One patient had a low testosterone level and slightly elevated FSH, another patient had slightly elevated levels of both FSH and LH.     

低温联合地塞米松对大鼠睾丸扭转复位后eNOS表达及生精细胞凋亡的影响

目的:探讨低温联合地塞米松对睾丸扭转复位后的保护作用,以及对eNOS表达及生精细胞凋亡的影响。方法:将80只青春期SD大鼠随机分为4组,每组20只。4组大鼠分别扭转左侧睾丸720°2 h,建立单侧睾丸扭转模型,随后各组做如下处理,A组:常温+生理盐水、B组:低温+生理盐水、C组:低温+地塞米松、D组:常温+地塞米松;术后48 h采集睾丸,通过HE染色光镜观察睾丸组织病理学改变、免疫组化法检测eNOS表达、TUNEL法检测睾丸生精细胞凋亡。结果:HE染色光镜下见4组大鼠扭转侧睾丸组织均有不同程度损伤,其中A组睾丸损伤最明显,其余3组扭转侧睾丸得到不同程度保护;睾丸组织eNOS免疫组化检测结果:A组扭转侧(左侧)睾丸组织阳性细胞数及阳性细胞着色强度明显强于B、C、D 3组,差异具有显著性(P<0.05、P<0.01、P<0.01);凋亡细胞染色:细胞核呈深棕黄色或棕褐色,A组扭转侧(左侧)睾丸可见大量生精细胞凋亡,凋亡指数AI(31.12±4.68)明显高于B组(16.58±6.22)(P<0.05)及C(8.60±1.15)、D组(13.52±3.06)(P<0.01)。结论:睾丸扭转复位后的缺血再灌注损伤可导致生精细胞凋亡增加、睾丸生殖能力下降;应用低温联合地塞米松能显著增强睾丸组织的抗损伤能力,较好地保护了扭转复位后睾丸的生精功能。     

Infancy is not a quiescent period of testicular development

Postnatal evolution of the testis in most laboratory animals is characterized by the close continuity between neonatal activation and pubertal development. In higher primates, infancy, a long period of variable duration, separates birth from the beginning of puberty. This period has been classically considered as a quiescent phase of testicular development, but is actually characterized by intense, yet inapparent activity. Testicular volume increases vigorously shortly after birth and in early infancy due to the growth in length of seminiferous cords. This longitudinal growth results from active proliferation of infantile Sertoli cells which otherwise display a unique array of functional capabilities (oestrogen and anti-müllerian hormone secretion, increase of FSH receptors and maximal response to FSH). Leydig cells also show recrudescence after birth, possibly determined by an active gonadotrophic-testicular axis which results in increased testosterone secretion of uncertain functional role. This postnatal activation slowly subsides during late infancy when periodic phases of activation of the hypothalamo-pituitary-testicular axis are paralleled by incomplete spermatogenic spurts. The beginning of puberty is marked by the simultaneous reawakening of Leydig cell function and succeeding phases of germ cell differentiation/degeneration which ultimately lead to final spermatogenic maturation. The marked testicular growth in this stage is due to progressive increase at seminiferous tubule diameter. Sertoli cells, which have reached mitotic arrest, develop and differentiate, establishing the seminiferous tubule barrier, fluid secretion and lumen formation, and acquiring cyclic morphological and metabolic variations characteristic of the mature stage. All of these modifications indicate that, far from being quiescent, the testis in primates experiences numerous changes during infancy, and that the potential for pubertal development and normal adult fertility depends on the successful completion of these changes.