11例附睾梗阻性无精子症患者附睾病理特征

Pathologic features of the epididymis in patients with epididymal obstructive azoospermia:Observation of 11 cases

目的：观察继发于感染的双侧附睾梗阻性无精子症患者的附睾病理特征,分析可能的病理生理机制以便寻找可能的治疗靶点。方法：2015年3-12月,收集既往有附睾感染史的不育就诊者11例,年龄28-53岁。通过精液常规、精液离心检查筛选确诊为无精子症患者,行生殖激素、精浆生化、阴囊超声检查,初步确定系附睾梗阻性无精子症者,进行手术探查,观察附睾大体病理特征并采集图像;切取病变处附睾组织,行病理切片观察。结果：病变附睾大体标本观察示,附睾管积水样改变是主要的病理特征;病理切片观察,附睾管管腔结构完整,管腔内充盈扩张,腔内未见精子。大多数病例管壁间未见炎性细胞浸润,以无纤维化为主。少数病程较长患者除附睾管扩张外,可见腔内组织细胞浸润、间质纤维组织增生或间质纤维透明变性,散在淋巴细胞、嗜酸性细胞浸润。结论：继发于感染的附睾梗阻性无精子症患者病变附睾的病理解剖学特征主要为附睾管积水,以及造成的腔内梗阻,其具体机制有待进一步研究。

Objective： To search for potential therapeutic targets for epididymal obstructive azoospermia （EOA） secondary to epididymal infection by observing the pathologic features and analyzing the possible pathophysiologic mechanisms of the disease. Methods ： Eleven 28 - 53 years old infertile men with the history of epididymal infection were enrolled in this study, all diagnosed with azoospermia by routine semen examination and centrifugation. EOA was confirmed by further examinations of reproductive hormones and seminal plasma biochemical markers and scrota1 ultrasonography, followed by surgical exploration and observation of the pathologi- cal characteristics of the epididymis. Results ： The gross epididymal specimen showed fluid accumulation in the epididymal tube to be the main pathologic feature. Under the microscope, the epididymal duct lumen was structurally intact but distended and with no sperm. Most of the cases revealed no inflammatory cell invasion in the wall of the duct. A small number of the patients with a longer course of disease exhibited cell infiltration in the lumen, hyperblastosis and glassy degeneration of the interstitial fibers, and scattered infiltration of lymphocytes and acidocytes in addition to expansion of the epididymal duct. Conclusion ： EOA secondary to epididymal infection is pathologically characterized mainly by fluid accumulation in the epididymal duct, and its pathogenesis remains to be further studied.