睾丸穿刺细胞悬液与病理组织学检查在非梗阻性无精子症诊断中的对比分析
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摘要
目的:比较睾丸穿刺取精术(TESA)睾丸标本细胞悬液检查和病理组织学检查的差异,探讨两种检查方法的临床选择及其应用。方法:选择1 006例非梗阻性无精子症(NOA)患者进行TESA,睾丸活检组织分别进行细胞悬液检查和病理组织学检查。按照细胞悬液检查结果分为两组:镜检有精子组(n=567)、镜检无精子组(n=439),分别对其病理组织学检查结果进行分类、统计。结果:镜检有精子组中,病理组织学检查有精子者508例,无精子者59例;镜检无精子组中,病理组织学检查无精子者403例,有精子者36例。两种检查方法结果一致率90.56%,一致性程度较好(Kappa=0.809),细胞悬液检查的精子检出率(56.36%)要高于病理组织学检查的精子检出率(54.08%),且统计学结果具有差异性(P=0.023)。结论:NOA患者行诊断性TESA时,同时进行睾丸活检组织细胞悬液检查和病理组织学检查的双重评估更有助于临床诊疗,其中细胞悬液检查结果对于辅助生殖治疗更具有决定性意义,而病理组织学检查结果提供了明确的病因学依据,更有利于药物治疗或进一步的手术方案选择。
Objective: To explore the clinical selection and application of cell suspension examination( CSE) or histopathological technique( HPT) in detecting sperm in the testis tissue obtained by testicular sperm aspiration( TESA) in patients with non-obstructive azoospermia( NOA). Methods: Totally,1 006 NOA patients underwent TESA and their testis tissues were subjected to CSE or HPT for sperm detection. Based on the results of CSE,the testicular tissue samples were divided into groups A( with sperm,n =567) and B( without sperm,n = 439) and the results were compared with those of HPT. Results: HPT showed 508 cases with but59 without sperm in group A,and 403 with and 36 without sperm in group B. The consistency rate of CSE with that of HPT was90. 56%( Kappa = 0. 809),and CSE exhibited a significantly higher rate of sperm detection than HPT( 56. 36% vs 54. 08%,P =0. 023). Conclusion: CSE combined with HPT for detecting sperm in the testis tissue of NOA patients undergoing diagnostic TESA helps clinical diagnosis and treatment. The results of CSE have a decisive significance for assisted reproductive therapy,while those of HPT may provide some definite etiological evidence for drug therapy or surgery.
Objective: To explore the clinical selection and application of cell suspension examination( CSE) or histopathological technique( HPT) in detecting sperm in the testis tissue obtained by testicular sperm aspiration( TESA) in patients with non-obstructive azoospermia( NOA). Methods: Totally,1 006 NOA patients underwent TESA and their testis tissues were subjected to CSE or HPT for sperm detection. Based on the results of CSE,the testicular tissue samples were divided into groups A( with sperm,n =567) and B( without sperm,n = 439) and the results were compared with those of HPT. Results: HPT showed 508 cases with but59 without sperm in group A,and 403 with and 36 without sperm in group B. The consistency rate of CSE with that of HPT was90. 56%( Kappa = 0. 809),and CSE exhibited a significantly higher rate of sperm detection than HPT( 56. 36% vs 54. 08%,P =0. 023). Conclusion: CSE combined with HPT for detecting sperm in the testis tissue of NOA patients undergoing diagnostic TESA helps clinical diagnosis and treatment. The results of CSE have a decisive significance for assisted reproductive therapy,while those of HPT may provide some definite etiological evidence for drug therapy or surgery.
引文
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[7]杨慎敏,陈冰,史轶超,等.睾丸穿刺取精术睾丸标本病理学检查的价值.中华男科学杂志,2013,19(10):899-901.
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[9]吴欢,贺小进,赵济华,等.无精子症患者睾丸细针穿刺后行倒置显微镜检查与传统病理组织切片检查精子检出率的比较.安徽医科大学学报,2010,45(1):115-117.
[10]唐文豪,姜辉,马潞林,等.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.中华男科学杂志,2013,19(1):68-71.
[11]杨竣,刘继红.显微切割睾丸活检在非梗阻性无精子症中的应用.中华男科学杂志,2012,18(6):551-555.
[12]马猛,平萍,王建华,等.非梗阻性无精子症三步法取精术及其临床意义(附73例报告).中华男科学杂志,2012,18(7):606-610.
[13]Ramasamy R,Reifsnyder JE,Bryson C,et al.Role of tissue digestion and extensive sperm search after microdissection testicular sperm extraction.Fertil Steril,2011,96(2):299-302.
[14]Smith RP,Lowe GJ,Kavoussi PK,et al.Confocal fluorescence microscopy in a murine model of microdissection testicular sperm extraction to improve sperm retrieval.J Urol,2012,187(5):1918-1923.
[15]Greenhalgh JR,Griffith TS,Wald M.The use of immunofluorescence in microdissection testicular sperm extraction.J Androl,2009,30(5):548-551.
[16]Cerilli LA,Kuang W,Rogers D.A practical approach to testicular biopsy interpretation for male infertility.Arch Pathol Lab Med,2010,134(8):1197-1204.
[2]Raman JD,Schlegel PN.Testicular sperm extraction with intracytoplasmic sperm injection is successful for the treatment of nonobstructive azoospermia associated with cryptorchidism.J Urol,2003,170(4 Pt 1):1287-1290.
[3]Schlegel PN.Nonobstructive azoospermia:A revolutionary surgical approach and results.Semin Reprod Med,2009,27(2):165-170.
[4]Abdel Raheem A,Garaffa G,Rushwan N,et al.Testicular histopathology as a predictor of a positive sperm retrieval in men with non-obstructive azoospermia.BJU Int,2013,111(3):492-499.
[5]Kalsi J,Thum MY,Muneer A,et al.In the era of micro-dissection sperm retrieval(m-tese)is an isolated testicular biopsy necessary in the management of men with non-obstructive azoospermia.BJU Int,2012,109(3):418-424.
[6]Junsheng L,Quan B,Ying L,et al.The impact of surgical sperm retrieval on the in vitro fertilization outcomes of infertile patients with temporary ejaculation failure on their oocyte retrieval day.Ferti Steril,2013,99(2):362-366.
[7]杨慎敏,陈冰,史轶超,等.睾丸穿刺取精术睾丸标本病理学检查的价值.中华男科学杂志,2013,19(10):899-901.
[8]王嵩,陈菲,郐艳荣,等.无精子症患者睾丸系统针吸检查与组织病理检查的关系.中国男科学杂志,2006,20(10):35-38.
[9]吴欢,贺小进,赵济华,等.无精子症患者睾丸细针穿刺后行倒置显微镜检查与传统病理组织切片检查精子检出率的比较.安徽医科大学学报,2010,45(1):115-117.
[10]唐文豪,姜辉,马潞林,等.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.中华男科学杂志,2013,19(1):68-71.
[11]杨竣,刘继红.显微切割睾丸活检在非梗阻性无精子症中的应用.中华男科学杂志,2012,18(6):551-555.
[12]马猛,平萍,王建华,等.非梗阻性无精子症三步法取精术及其临床意义(附73例报告).中华男科学杂志,2012,18(7):606-610.
[13]Ramasamy R,Reifsnyder JE,Bryson C,et al.Role of tissue digestion and extensive sperm search after microdissection testicular sperm extraction.Fertil Steril,2011,96(2):299-302.
[14]Smith RP,Lowe GJ,Kavoussi PK,et al.Confocal fluorescence microscopy in a murine model of microdissection testicular sperm extraction to improve sperm retrieval.J Urol,2012,187(5):1918-1923.
[15]Greenhalgh JR,Griffith TS,Wald M.The use of immunofluorescence in microdissection testicular sperm extraction.J Androl,2009,30(5):548-551.
[16]Cerilli LA,Kuang W,Rogers D.A practical approach to testicular biopsy interpretation for male infertility.Arch Pathol Lab Med,2010,134(8):1197-1204.