非梗阻性无精子症患者睾丸活检组织细胞悬液检查与病理组织学检查精子检出率的差异性研究  

Detection of spermatozoa in the testicular tissue of non-obstructive azoospermia patients:Cell suspension examination versus histopathology

作　　者：唐文豪[1] 姜辉[1] 马潞林[1] 洪锴[1] 赵连明[1] 毛加明[1] 杨译[1] 张新[1] 黄翔[2] 乔杰[2] 

机构地区：[1]北京大学第三医院泌尿外科,北京100191 [2]北京大学第三医院生殖中心,北京100191

出　　处：《中华男科学杂志》2013年第1期68-71,共4页National Journal of Andrology

摘　　要：目的:比较非梗阻性无精子症(NOA)患者睾丸活检组织细胞悬液检查与病理组织学检查精子检出率的差异,探讨两种检查方法结果不一致时获取精子的可靠性及临床治疗方案的选择。方法:1 112例NOA患者接受睾丸精子抽吸术(testicular sperm extraction,TESE),睾丸活检组织分别进行细胞悬液检查和病理组织学检查。结果:两种检查方法结果一致率为92.63%,一致精子检出率为41.82%,一致精子未检出率为50.81%。Kappa分析表明两种检查方法的一致性强度属于最强。25例进入辅助生殖周期的细胞悬液检查发现精子而组织学检查未发现精子患者中,24例患者取卵日成功获取精子(取精成功率为96.0%)并实施卵胞质内单精子注射(ICSI),其治疗结局为8例临床妊娠(33.33%)、4例流产(16.67%)、12例未妊娠(50.0%)。结论:实施诊断性TESE时,采用睾丸活检组织的细胞悬液检查与组织病理学检查双重评估精子检出率的方法,结果一致率高并且迅捷、准确、可靠,为NOA患者进入辅助生殖周期时成功取到精子提供了保障。当两种检查方法结果不一致时,细胞悬液检查对临床治疗方案的选择指导意义更大。[ Abstract] Objective： To compare cell suspension examination with histopathology in detecting spermatozoa in the testicular tissue of non-obstructive azoospermia （NOA） patients, and to investigate the reliability of sperm retrieval and appropriate therapeutic options when the results of the two methods are inconsistent. Methods ： A total of 1 112 NOA patients underwent testicuIar sperm ex- traction （TESE）, their testicular tissues subjected to cell suspension examination and histopathology, respectively. Results： The consistency rate of the two methods was 92.63%, with the sperm detection rate of 41.82% and non-sperm detection rate of 50.81%. Sperm were retrieved from 96.0% （24/25） of the patients on the day of oval retrieval, in whom sperm were found in cell suspension examination but not in histopathology. After intracytoplasmic sperm injection （ICSI）, pregnancy was achieved in 8 cases （33.33%）, abortion occurred in 4 （ 16.67% ） , and non-pregnancy in 12 （50.0%）. Conclusion ： Cell suspension examination combined withhistopathology for detecting sperm in the testicular tissue of NOA patients gives instant, accurate, reliable and consistent results, and therefore insures successful sperm retrieval for NOA patients during the IVF cycle. In case of inconsistency between the results of the two methods, cell suspension examination is more helpful for clinical therapeutic option.

关 键 词：非梗阻性无精子症 睾丸精子抽吸术 细胞悬液检查 病理组织学检查 卵胞质内单精子注射 

分 类 号：R698.2[医药卫生—泌尿科学] R446.8[医药卫生—外科学]