睾丸细针穿刺吸液细胞学检查诊断阻塞性无精子症

Diagnosis of obstructive azoospermia with testicular cytology by fine needle aspiration

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?

Objective: Using testicular cytology by fine needle aspiration (FNA) to diagnose obstructive azoospermia. Patients and Methods: A total of 286 men with azoospermia was investigated by testicular cytology by FNA, vasography and biochemical indices (fructose, carnitine and α glucosidase) in seminal fluid. At the same time, forty two men with normal sperm density(NSD,>20×10 6/ml) were served as control.Results: The results showed that in 286 azoospermic men, patients with congenital absence of the vas deferens (CAVD), with bilateral epididymal obstruction (BEO),with bilateral ejaculatory duct obstruction (BEDO), and with non obstructive azoospermia (NOAZ) were 58, 26, 6 and 196, respectively. In NSDs, the mean levels of fructose, carnitine and α glucosidase in seminal fluid were (9.59±4.94) μmol/ml, (365±112) nmol/ml and (18.7±5.3) mU/ml, repectively. Cytology analysis of smears in 58 men with CAVD revealed that spermatogenesis was normal ( n=26 ) or subnormal ( n=24 ) or arrest ( n=8 ),and the levels of fructose, carnitine and α glucosidase in seminal fluid were very low. Many spermatozoa were observed in 26 cases of BEO with normal level of fructose but very low levels of carnitine and α glucosidase in seminal fluid. In 6 petients with BEDO, spermatogenesis was normal and the levels of three biochemical indexes were low. However in 196 patients with NOAZ, the three biochemical indexes were normal. Conclusions: (1)Testicular cytology by FNA may be used for investigation of spermatogenesis in infertile male; (2)Testicular cytology by FNA combined with determination of semen biochemical indexes and vasography can be useful in differential diagnosis of azoospermia.