Liu Xing-Zhang, Tang Yun-Ge, Liu Huang, Tang Li-Xin, Wen Ren-Qian
Male Outpatient Clinic, Family Planning Hospital of Guangdong Province, Guangzhou, Guangdong 510600, China.
Zhonghua Nan Ke Xue. 2010 Jan;16(1):52-4.
To study the relationship between the testis volume and types of spermatogenic cells derived from testicular biopsy in patients with azoospermia or cryptozoospermia.
We collected testicular pathological biopsies from 492 infertile patients with azoospermia or cryptozoospermia reported in our hospital, classified them according to the testicular histological classification methods in WHO Manual for Standardized Investigation, Diagnosis and Management of the Infertile Male, and analyzed the relationship of the testis volume with the results of semen analyses and testicular histology.
Of the 492 cases, 90.5% (445/492) were azoospermia and 9.5% (47/492) cryptozoospermia; mature spermatozoa were present in the seminiferous tubules in 17.9% (88/492) but absent in 42.9% (211/492), and Sertoli cell-only syndrome indicated in 39.2% (193/492); the testis volume was < or = 10 ml in 38.6% (190/492) and < or = 5 ml in 7.9% (39/492). Cryptozoospermia was detected in 14.8% (13/88) of those with mature spermatozoa in the seminiferous tubules, in 11.4% (24/211) of those without, and in 5.2% (10/193) of those with Sertoli cell-only syndrome, with a significantly lower rate in the latter group than in the former two (P < 0.05).
Spermatogenesis of the testis may be focal and difficult to be completely reflected by a single testicular biopsy, and it may exist even if the testis volume is significantly below the reference value. The indications for testicular biopsy should not be improperly expanded. The WHO testicular histological classification methods have provided a convenient and effective guidance for further clinical examinations and establishment of a protocol.
研究无精子症或隐匿性无精子症患者睾丸活检所得睾丸体积与生精细胞类型之间的关系。
收集我院报道的492例无精子症或隐匿性无精子症不育患者的睾丸病理活检标本，按照世界卫生组织《男性不育标准化检查、诊断与治疗手册》中的睾丸组织学分类方法进行分类，分析睾丸体积与精液分析结果及睾丸组织学之间的关系。
492例患者中，无精子症占90.5%（445/492），隐匿性无精子症占9.5%（47/492）；生精小管中存在成熟精子的占17.9%（88/492），不存在成熟精子的占42.9%（211/492），支持细胞综合征占39.2%（193/492）；睾丸体积≤10 ml的占38.6%（190/492），≤5 ml的占7.9%（39/492）。生精小管中有成熟精子的患者中隐匿性无精子症检出率为14.8%（13/88），无成熟精子的患者中为11.4%（24/211），支持细胞综合征患者中为5.2%（10/193），后一组的检出率显著低于前两组（P<0.05）。
睾丸生精可能呈局灶性，单次睾丸活检难以完全反映，即使睾丸体积明显低于参考值，生精也可能存在。不应不当扩大睾丸活检的适应证。世界卫生组织睾丸组织学分类方法为进一步的临床检查及方案制定提供了便捷有效的指导。
