348例无精子症睾丸穿刺活检的病理学分析

Clinicopathological analysis of 348 cases of azoospermia by testicular puncture biopsy

目的探讨无精子症睾丸穿刺活检的病理类型及临床意义。方法选取2017年1月—2019年12月在广东省生殖医院就诊,并进行睾丸穿刺活检的无精子症患者348例,回顾性分析其睾丸活检的病理结果,根据其主要病理形态学特征分型。结果无精子症睾丸活检根据其病理学特征,病理类型可分为梗阻型无精子症(OA)(166/348,47.7%)和非梗阻型无精子症(NOA)(182/348,52.3%)。梗阻性无精子症(OA)可以进一步分为生精功能大致正常(13/166,7.83%)、轻度精子生成低下(46/166,27.71%)、中度精子生成低下(58/166,34.94%)和重度精子生成低下(49/166,29.52%)。非梗阻型无精子症(NOA)可进一步分为精子成熟阻滞(92/182,50.55%)、唯支持细胞综合症(SCOS)(77/182,42.31%)、生精小管透明变性(13/182,7.14%)。根据生精阻滞在不同细胞阶段,可以分为精原细胞阶段(5/92,5.43%)、精母细胞阶段(38/92,41.30%),精子细胞阶段(49/92,53.26%)。结论睾丸穿刺活检病理检查是无精子症患者诊疗中非常有价值的检查。主要依据睾丸中有无成熟精子可以将无精子症分为2种临床病理类型,在每一大类中根据其曲细精管大小形态和生精细胞的数量形态比例细分,有利于无精子症睾丸活检的病理诊断规范化,为无精子症进一步临床诊疗和研究提供基础。

Objective To investigate the pathological types and clinical significance of testicular biopsy in patients with azoospermatism.Methods The testicular biopsies of 348 male azoospermia patients,who admitted to Guangdong Provincial Fertility Hospital from January 2017 to December 2019,were retrospectively analyzed.The pathological types were classified according to the pathomorphological characteristics.Results According to the histopathological characteristics,the pathological types of testicular biopsy in azoospermia could be divided into Obstructed Azoospermia(OA,166/348,47.7%)and Non-Obstructed Azoospermia(NOA,182/348,52.3%).Obstructive azoospermia(OA)can be further divided into approximately normal spermatogenesis(13/166,7.83%),mild hyposperm production(46/166,27.71%),moderate hyposperm production(58/166,34.94%),and severe hyposperm production(49/166,29.52%).Non-obstructed azoospermia(NOA)was further divided into spermatogenic stasis(92/182,50.55%),Sertoli cell only syndrome(SCOS)(77/182,42.31%),and seminiogenic tubule hyalinization(13/182,7.14%).The spermatogenic stasis can be further divided in to stasis in the spermatogonial stage(5/92,5.43%),stasis in the spermatocyte stage(38/92,41.30%),stasis in the sperm cell stage(49/92,53.26%).Conclusion The pathological examination of testicular puncture is a valuable examination in the diagnosis and treatment of azoospermia patients.According to the mature sperm in the seminiferous tubule,the azoospermia can be categorized into two types of clinical pathology.Every major categories can be divided into many types based on their seminiferous tubule size and the number of sperm cells.It is conducive to the standardization of the pathology diagnosis,and the further treatment and clinical research of azoospermatism.