testicular biopsy

Testicular biopsy (referred to as testicular biopsy) is a clinical technique with dual functions of diagnosis and treatment. It is a simple surgical method to take out a small piece of living testicular tissue for histological observation of pathological sections to understand testicular spermatogenesis. The condition used to diagnose testicular disease and assess prognosis. At present, there are hormonal examination methods and biochemical tests to understand the testicular spermatogenesis function. These methods cannot accurately reflect the testicular spermatogenic function compared with testicular biopsy. Because the testicular biopsy is a direct examination of the seminiferous tubules of the testes, and endocrine and biochemical tests are indirect to understand the spermatogenic function. At present, testicular biopsy is the gold standard for the diagnosis of testicular spermatogenesis, so this test should be done for patients with azoospermia. Basic Information Specialist classification: male examination check classification: semen and prostatic fluid examination Applicable gender: whether the male is fasting: not fasting Analysis results: Below normal: Normal value: no Above normal: negative: A negative test result indicates that the subject should be in a normal condition. Positive: A positive test indicates that the subject may have testicular disease. Tips: It is best to abstain from sex for 3-7 days before surgery. Normal value Normal adult male testicular tissue It consists of fine tubules and interstitial. (1) The spermatic tubule contains spermatogenic cells (spermatogonial cells, spermatocytes, sperm cells, sperm, etc.) and supporting cells (Sertoli cells), which are present in the spermatogenesis process. Short, often difficult to see. The support cell is large in volume, and its cell body extends from the basement membrane to the small lumen surface, and has the functions of secretion, nutrition, phagocytosis, support of spermatogenic cells and release of sperm, which constitute a blood testis barrier. (2) The outer membrane of the conjunctiva is a thin and neat boundary membrane, also known as the lamina propria, which is divided into three layers. From the inside to the outside, there are no cell layer (basement membrane), myoblast layer, lymphatic endothelial cells and The fibroblast layer is a component of the blood testis barrier and has functions such as contraction, substance exchange, and phagocytosis. (3) The interstitial interstitial is loose connective tissue, which contains L~eydig cells, macrophages, blood vessels, lymphatic vessels, and fibrous tissues. The normal test value is negative. Clinical significance Abnormal result (1) The seminiferous epithelial-shedting type of fine-tuned tubules expand, and most or all of the lumens are filled with exfoliated spermatogenic cells, and the lumen disappears, often accompanied by changes in the membrane and small blood vessels of different degrees. (2) spermatogenesis block or maturation disorder The spermatogenic process is often blocked in the spermatocyte or sperm cell stage, often accompanied by spermatogenic cells, membrane and blood vessel changes, which is a differentiation abnormality of the spermatogenic process. (3) The spermatogenic cells and spermatozoa of all levels of spermatogenic function are uniformly reduced, and a large number of vacuoles are formed in the supporting cells, and the lumen is dilated. It can be seen that the immature spermatogenic cells, the membrane and the blood vessels that have shed early are not significantly changed. (4) The transparent degenerative fine tubules are widely hyaline degeneration, atrophy, and stenosis of the lumen. In severe cases, "phantom tubules" are often accompanied by extensive fibrosis and vascular transparency. This is a manifestation of autoimmune response, which may be caused by non-specific inflammation, viral mumps with orchitis, drug effects, or may be the cause of unknown causes or other pathological damage. (5) Only support the cell syndrome, spermatogenic cells lack or disappear, only support cells, the small tubule diameter is small, the boundary membrane and interstitial lesions are serious, can be divided into 1 primary (innate Sexuality is caused by the undeveloped or unreduced germ cells in the yolk sac of the embryonic stage, and the testicular size and sexual characteristics are abnormal. 2 acquired (secondary) is the late result of various testicular lesions. (6) There are two or more types of mixed tissue changes, which are often difficult to distinguish between primary and secondary, which are characterized by epithelial shedding of spermatogenic cells, maturation disorders, and hyaline degeneration. In addition, there are testicular hypoplasia or developmental obstruction, such as the immature testis of Klinefelter syndrome, often manifested as small testicular, secondary sexual dysplasia, testicular lesions are consistent, may have chromosomal abnormalities, easy to diagnose. (7) The relationship between histological classification and prognosis of testicular biopsy. The spermatogenic epithelial shedding, the best prognosis, the lowering of spermatogenic function, the basis of treatment, transparency, only support cell syndrome, spermatogenic disorder, Klinefelter's sign, etc. The basis of treatment, poor prognosis. People who need to be checked (1) azoospermia with normal testicular size; (2) oligozoospermia with moderately reduced testicular volume; (3) small or asymmetrical testicular oligozoospermia or azoospermia such as testicular size, one side of the vas deferens can not be or the epididymis induration. It should be demonstrated that there is spermatogenesis in both testes because it may be blocked on one side and testicular dysfunction on the other side; (4) If the bilateral testicular lesions are basically the same, in order to determine the extent or type of testicular injury, the testicles on the healthy side are often selected for biopsy; (5) Obstructive azoospermia should be performed on both sides of the testicular biopsy to determine which side is suitable for microsurgical anastomosis; (6) Biopsy in patients with cryptorchidism can detect the presence or absence of carcinoma in situ. Unexplained testicular mass testicular biopsy can confirm the diagnosis; (7) If the long-term effects or environmental factors of male birth control are evaluated, the effects of cytotoxic drugs and radiation on testicular spermatogenesis can also be used for testicular biopsy. Positive results may be disease: testicular cancer, vas deferens cloaca, testicular hydrocele, pediatric familial olfactory-sexual hypoplasia syndrome, scrotal cancer, seminoma, obesity reproductive incompetence syndrome, congenital testicular hypoplasia in children , male sex, gender deformity, azoospermia Taboo before inspection: 1. Precautions should be taken to disinfect and clean the testicles before surgery to prevent infection. 2, the best abstinence before surgery 3-7 days. Note after inspection: 1, as long as you pay attention to maintenance after the inspection, can not do vigorous exercise, can not catch cold, especially the testicular part, can not wear too tight clothes, when you have to pay attention to sexual intercourse, can not force too much, can go to the hospital after a period of time Review it to make sure there are no bad things. 2, testicular biopsy (will not damage the original fertility of the testicles, therefore, patients do not have to worry too much and nervous during surgery. 3. Anesthesia will be performed during testicular biopsy, and patients do not have to worry about being too painful. Inspection process Testicular biopsy Incision biopsy After disinfection of the scrotal skin, local anesthesia, fixed testicles by hand, tighten the surface of the scrotum skin, select the site with less blood vessels, make an incision of about 1 ~ 2cm, the incision vertically through the skin, the intima and the sheath. The testicular white film is made into a "∧"-shaped incision, about 0.5cm long, gently squeeze the testicles to expose the testicular parenchyma, take a little testicular tissue as a specimen, and send the pathology for pathological examination. Strict disinfection during surgery, careful operation, generally does not cause infection, hematoma or pain. In a small number of patients, the sperm count decreases in the short term after taking testicular tissue, and it takes about 4 months to gradually recover. Cut the skin and testicles, take out the seminiferous tubules in the testicles, so that the extraction is very complete, can accurately reflect the spermatogenic function of the testis, without the error of inspection, the result is reliable. However, this method of examination is traumatic, and it is necessary to make the skin, the incision of the testicular tunica, and suture removal after surgery, which brings more pain and inconvenience to the patient. Although this method of examination is accurate, it is difficult to carry out clinically because of the pain and the patient's fear of surgery. Puncture method Using a needle and needle for puncture, after routine disinfection of the skin and anesthesia, puncture the needle through the scrotal skin puncture into the testicle, withdraw the needle core, aspirate the needle tube to obtain a little testicular tissue, and then pull out the puncture needle, if the tissue is extracted once If it is too small, it can be pumped several times in different parts. After the end, the puncture site is wrapped, the testicular tissue is sent for examination, the puncture site is wrapped, and the testicular tissue is sent for examination. Compared with the incision method, this method has less damage and less pain, and does not require suturing. Its deficiency is that needle aspiration cytology can only obtain a small number of tissue cells, and can not see the overall structure of the tissue, so it can not accurately reflect the testicular spermatogenesis. There are errors of false positives and false negatives. The results of the tests are not reliable and are easily misdiagnosed. Testicular biopsy puncture After disinfecting the skin with 1 ‰ 新洁尔, the spermatic nerve block anesthesia was performed with 2% or 1% procaine, 10 ml per side to reduce the discomfort during testicular fixation and extrusion. After fixing the testicles, disinfect the puncture site with iodine, infiltrate the anesthesia and deep anesthesia with avascular zone, and then use the vas deferens to remove the avascular zone into the skin and intima, and enlarge the piercing hole to about 0.7cm, deep into the testicular sheath. On the surface of the membrane, the tip of the peeling forceps is used to puncture the wall layer of the testis and the visceral layer (testis white membrane) to a depth of 0.5 cm, and then separated into 0.5-0.7 cm small mouth with a spreader, and the finger of the testicle is slightly squeezed. Testicles, so that the testicular tissue protrudes from the small mouth, quickly remove the stripping forceps in the testicles, use the ophthalmic surgery to cut the small test pieces of the testicles, and leave a biopsy. Rapid testicular biopsy This method is a new method after Director Yuan Yuqing further improved on the above traditional methods. Its operation has no trauma to the incision method, but the testicular tissue taken out is complete and can accurately reflect the spermatogenic function of the testicle. The specific operation is to use a special instrument to remove the intact testicular tissue without cutting the testicles. This has the advantages of small damage to the puncture method and the accuracy of the incision method. And to avoid the shortcomings of the above methods, this operation is fast (complete surgery within a few seconds, is one-hundredth of the time of routine testicular biopsy operation), less pain, no bleeding during surgery, no suture and suture removal, postoperative recovery Fast, get the completeness of the organization and fully comply with the medical examination requirements. Surgical procedure for rapid biopsy: 1. Prepare the skin in a regular operating area and disinfect it. 2, fixed testicles The doctor should select one side of the testicle as needed, apply the left middle finger and the ring finger, and fix the testicle firmly with the thumb. The epididymis end of the testicle should be under the hand, exposing the testicle to the thumb and index finger. The testicles examined are fixed by hand to tighten the surface of the scrotum skin. 3, local anesthesia Choose a relatively avascular zone, local anesthesia. 4, surgery After successful anesthesia, the special testicular biopsy inserting step is used to quickly remove the seminiferous tubules in the testis, and then the specimen is placed in the fixative solution, and the site of the operation is pressed to stop bleeding, and the amount of bleeding is very small, or even no bleeding. No suture, postoperative dressing. 5, postoperative treatment The oral anti-inflammatory drug was applied for 3 days, the tape was removed on the 3rd, and no incision was left after the operation. No obvious sequelae were found. 6, specimen observation Analyze in combination with the patient's condition. Not suitable for the crowd There are no specific taboos for this check. Adverse reactions and risks 1. Risk of infection: If you use an unclean instrument to take pathological sections, there is a risk of infection. 2. Risk of injury: Testicular damage may occur when taking pathological sections.