腹腔镜下有选择性的精索静脉高位结扎术治疗精索静脉曲张疗效的Meta分析  

The efficacy of laparoscopic selective ligation of spermatic vein for the treatment of varicocele ： a meta - analysis

作　　者：段启新[1] 吴天鹏[1] 易小春[1] 许明伟[1] 

机构地区：[1]武汉大学人民医院泌尿二科,湖北430060

出　　处：《国际泌尿系统杂志》2013年第3期299-307,共9页International Journal of Urology and Nephrology

摘　　要：目的系统评价腹腔镜下有选择性的精索静脉高位结扎术（包括腹腔镜单纯精索内静脉高位结扎术、腹腔镜单纯保留精索动脉的精索静脉结扎术、腹腔镜单纯保留淋巴管的精索静脉结扎术）与腹腔镜精索血管集束状结扎术治疗精索静脉曲张的疗效。方法计算机检索Cochrane Central Register of Con-trolled Trials（CENTRAL）、PubMed、EMbase、中国知网（CNKI）、维普数据库（VIP）、万方数据库（WangfangDate），查找所有纳入腹腔镜下有选择性的精索静脉高位结扎术治疗精索静脉曲张的随机对照试验（RCT），文献检索起始时间均为建库到2012年12月。同时手检纳入文献的参考文献。按纳入排除标准由两人独立进行RCT的筛选、资料提取和质量评价后，采用RevMan5．1软件进行Meta分析，并采用GRADE系统进行证据质量评价。结果共纳入13个随机对照试验，包括1061例精索静脉曲张患者。Meta分析结果显示：①腹腔镜下有选择性的精索静脉高位结扎术与腹腔镜精索血管集束状高位结扎术相比，术后继发鞘膜积液的发生率低[RR=0．07，95％CI（0．03，0．19）]、术后睾丸萎缩率低[RR=0．09，95％CI（0．03，0．27）]、精液质量改善率高[RR=1．29，95％CI（1．08，1．55）]、术后自然孕率高[RR=1．53，95％CI（1．03，2．29）]，而手术时间长[SMD=1．83，95％CI（0．37，3．28）]、复发率较高[RR=3．73，95％CI（1．92，7．23）]。②腹腔镜单纯精索内静脉结扎术（保留精索动脉和淋巴管的精索静脉结扎术）与腹腔镜精索血管集束状结扎术相比，术后继发鞘膜积液的发生率低[RR=0．04，95％CI（0．01，0，21）]、术后睾丸萎缩率低[RR=0．08，95％CI（0．02，0．30）]、精液质量改善率高[RR=1．37，95％CI（1．12，1．68）]、术后自然孕率高[RR=1．76，95％CI（1．00，3．07）]，而手术时间长[SMD=3．16，95％CI（2．15，4．16Objectives To evaluate clinical efficacy of laparoscopic selective ligation of spermatic vein,including laparoscopic high ligation of internal spermatic vein, laparoscopic varix ligation with internal spermatic artery preservation and laparoscopic varix ligation with lymphatic vessels, and laparoscopic cluster ligation of spermatic vessels for the treatment of varicocele. Methods Such database as cochrane central register of controlled trials （ CEN- TRAL） ,PubMed, EMbase, CNK1, V1Pand Wangfang were searched from their establishment to December 2012 for collecting the randomized controlled trials （RCT） about laparoscopic selective ligation of spermatic vein and laparoscopic cluster ligation of spermatic vessels for the treatment of varicocele, and the references of those RCTs were also searched by hand. After study selection, assessment and data extraction conducted by two reviewers independently, meta - analyses were performed by using the RevMan 5.1 soft ware. The level of evidence was assessed by using the GRADE system. Results 13 studies involving 1061 patients were included. The results of meta - analyses showed that ： ①compared with the control group, laparoscopic selective ligation of spermatic vein had lower incidence of postoperative secondary hydrocele[ RR = 0.07,95% CI （ 0.03,0.19 ） ], postoperative testicular atrophy [ RR = 0.09, 95% CI （0.03,0.27） ], and higher rate of semen quality improvement [ RR = 1.29, 95% CI （ 1.08,1.55 ） ] and spontaneous pregnancy[ RR = 1.53,95 % CI （ 1.03,2.29 ） ], but longer operation time [ SMD = 1.83,95 % CI （0. 37,3.28） ] ,higher recurrence rate[ RR =3.73, 95% CI（1.92,7.23） ]. ②compared with the control group,laparescopic high ligation of internal spermatic vein had lower incidence of postoperative secondary hydrocele [ RR = 0. 04,95% CI （0.01,0.21） ], postoperative testicular atrophy[ RR = 0.08,95% CI （0.02,0.3） ], and higher rate of semen quality improvement[ RR = 1.37,95% CI （1.12,1.68） ] and spontaneous pregnancy[ （

关 键 词：精索静脉曲张 腹腔镜检查 结扎术 META分析 

分 类 号：R699.8[医药卫生—泌尿科学]