显微外科和腹腔镜手术治疗精索静脉曲线疗效及安全性meta分析  

Efficacy and Safety comparison between microscopic varicocelectomy (MV) and laparoscopic varicocelectomy (LV) on scrotal pain varicocele: a meta-analysis

作　　者：牟倩 王思达 杨竣 李明超[1,2] 王涛 王少刚[1,2] 刘继红[1,2] 蓝儒竹[1,2] Mou Qian;Wang Sida;Yang Jun;Li Mingchao;Wang Tao;Wang Shaogang;Liu Jihong;Lan Ruzhu(Department of Urology,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430030,Hubei,China;Institute of Urology,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology)

机构地区：[1]华中科技大学同济医学院附属同济医院泌尿外科,武汉430030 [2]华中科技大学同济医学院附属同济医院泌尿外科研究所

出　　处：《中国男科学杂志》2019年第4期9-14,共6页Chinese Journal of Andrology

摘　　要：目的系统评价男性精索静脉曲张经显微镜与腹腔镜治疗后的疗效与安全性。方法以"microsurgical varicocelectomy","laparoscopic varicocelectomy",""painful varicocele","varicocelectomy","scrotal pain","testicular pain","显微镜下精索静脉结扎术"、"腹腔镜下精索静脉结扎术"、"精索静脉结扎术"、"阴囊疼痛"、"睾丸疼痛"为主题词及自由词检索 PubMed、The Cochrane Library Embase Web of science、中国知网(CNKI)、万方数据库(Wanfang)和维普数据库(VIP),检索时间为各数据库建库至2018年11月,对最终纳入的随机对照研究根据Jadad量表的质量评分标准进行质量评价,非随机对照研究根据纽卡斯尔-渥太华评分(NOS)进行质量评价,运用meta分析比较两种手术方式在治疗精索静脉曲张疗效与安全性。结果经过仔细的搜索和排除后,最后纳入7篇研究,其中3篇随机对照研究,4 篇非随机对照研究。Meta分析结果显示:MV比LV对术后阴囊疼痛缓解疗效更好[OR=5.05,95%CI=(1.98,12.84), Z=3.40,P=0.0007]。MV的手术耗时长于 LV[WMD=21.20,95%CI(10.02,32.38),Z=3.72,P=0.0002]。MV 后恢复时间短于LV [WMD=-0.20,95%CI (-0.33 ,-0.07),Z=2.95 ,P=0.003]。MV 术后阴囊水肿明显少于LV[OR=0.24,95%CI=(0.09,0.63),Z=2.91 ,P=0.004]。 MV术后精索静脉曲张复发明显少于 LV[OR =0.15,95%CI=(0.06,0.42),Z=3.64,F=0.0003]。结论MV治疗精索静脉曲张对术后阴囊疼痛的缓解比LV更佳,MV术后阴囊水肿、精索静脉曲张复发比LV明显减少,然而手术时间比LV长。我们认为经显微镜手术结扎治疗精索静脉曲张术后阴囊疼痛缓解的疗效与安全性优于腹腔镜手术。Objective To systematically evaluate the efficacy and safety of microsurgical varicocelectomy (MV) compared with laparoscopic varicocelectomy (LV) for scrotal pain varicocele. Providing evidence-based medical evidence for the choice of surgical ligation in the scrotal pain varicocele. Methods Using the keywords "varicocele " varicocelectomy microsurgical varicocelectomy","laparoscopic varicocelectomy","varicocelectomy","painful varicocele" and " scrotal pain ",we searched the PubMed, The Cochrane Library, Embase, Web of science, CNKI, Wan fang and VIP Database up to November 2018 for the studies, We assessed the quality of the randomized controlled trials included with the Jadad scale and that of non-randomized controlled trials included using the Newcastle-Ottawa Scale. Results After careful search and exclusion, the final seven studies included criteria, including three randomized controlled studies and four non-randomized controlled studies. Meta-analysis results showed: Meta-analyses showed that MV was superior to LV in decreases scrotal pain [OR=5.05,95%CI (1.98,12.84),Z=3.P=0.0007], While the MV group had a longer operation time [WMD=21.20,95%CI (10.02,32.38),Z=3.72,P=0.0002] than LV surgery. That MV on recovery time [WMD=-0.20,95%CI(-0.33,-0.07),Z=2.95s P=0.003] shorter than LV. The incidence of postoperative hydrocele was significantly lower in the MV group than in the LV group [OR=0.24,95%CI (0.09,0.63),Z=2.91,7M).OO4] and the incidence of varicocele recurrence was also significantly lower in the MV group than in the LV group [OR=0.15,95%CI (0.06,0.42),Z=3.64,P P=0.0003]. Conclusion MV is superior to LV because of the decreases scrotal pain and lower incidence of postoperative hydrocele and recurrence, but the operation time is longer. We consider that microsurgical for scrotal .pain varicocele get the advantage on the effectiveness and safety over laparoscopic surgery.

关 键 词：精索静脉曲张 阴囊疼痛 显微镜下精索静脉结扎术 腹腔镜下精索静脉结扎术 META分析 

分 类 号：R697.24[医药卫生—泌尿科学]