60例男性无精子症患者睾丸活检的病理研究

目的 探讨男性无精子症患者睾丸活检的病理价值和意义.方法 回顾性分析2012年1月至2017年1月,在成都医学院第一附属医院泌尿外科诊治的60例男性无精子症患者的睾丸活检组织切片,HE染色观察病理变化;免疫组化染色观察IgA、IgG、IgM的表达情况.结果 60例男性无精子症患者睾丸活检标本可分为5种类型:活检正常型占6.67%(4/60),生精细胞剥落和排列紊乱型占13.33%(8/60),生精功能低下型占18.33%(11/60),成熟障碍型占26.67%(16/60),混合损害型占35.00%(21/60);其中,混合损害型中唯支持细胞综合征占6.67%(4/60),克氏综合征占10.00%(6/60),严重生精障碍占18.33%(11/60);睾丸活检组织免疫组化中IgG阳性率81.7%(49/60),IgA阳性率68.3%(41/60),IgM阳性率61.7%(37/60).结论 睾丸活检能直接评价睾丸生精功能和生精功能障碍程度,对不育症患者的治疗和预后判断有重要意义,且无精子症患者睾丸病变与体液自身免疫紊乱有较大关联.

The Pathological Study on the Testicular Biopsy of 60 Azoospermia Patients

Objective To investigate the pathological value and significance of testicular biopsy in azoospermia patients.Methods The histological sections of testicular biopsy of the 60 azoospermia patients treated from January of 2012 to January of 2017 in The First Affiliated Hospital of Chengdu Medical College were analyzed retrospectively.The HE staining was used to observe the pathological changes and the immunohistochemical staining was adopted to detect the expressions of IgA,IgG and IgM.Results The testicular biopsy specimens of the 60 cases could be divided into five types including the type of normal specimens (6.67%),the type of spermatogenic cell spalling and disorganizing (13.33%),the type of spermatogenic dysfunction (18.33%),the type of dysmaturity (26.67%),and the type of mixed damage (35.00%).In the type of mixed damage,the sertoli cell-only syndrome accounted for 6.67%,the klinefelter syndrome accounted for 10%,and the severe spermatogenic dysfunction accounted for 18.33%.The results of the immunohistochemical staining showed that the positive rates of IgG,IgA and IgM were 81.7%,68.3% and 61.7% respectively.Conclusion The Testicular biopsy can be used directly to evaluate the testicular spermatogenesis and the degree of spermatogenic dysfunction,which is of importance for the treatment and prognosis of infertile patients.In addition,the testicular lesions of azoospermia patients are correlated closely with their humoral autoimmune disorder.