开放和经腹腔镜Palomo术式治疗未成年人精索静脉曲张疗效的Meta分析

Therapeutic effects of open versus laparoscopic Palomo technique on adolescent varicocele:A Meta analysis

背景:近年来对临床上应用不同手术方式治疗精索静脉曲张的研究很多,开放、腔镜及显微外科等术式各有利弊,尤其是对未成年人精索静脉曲张治疗方式的选择尚存较大争议。目的:系统评价开放和经腹腔镜途径Palomo术式治疗未成年人精索静脉曲张相关文献的治疗效果。方法:检索Medline数据库、Cochrane图书馆和中国生物医学文献数据库(CBM)2000-01/2010-01发表的有关未成年精索静脉曲张患者接受各种Palomo术式治疗效果的临床随机对照研究文献。英文检索词为"Varicocele;Palomo",中文检索词为"精索静脉曲张;Palomo术"。对资料进行初筛,选取针对性强的文章,排除重复研究,同一领域的文献则选择近期发表或权威杂志的文章。对筛选出的文献查找全文。由两名评价者独立提取资料、选择实验,并评估相关方法学质量,对检索得到的文献数据用RevMan4.2软件进行Meta分析。结果与结论:共纳入7篇符合标准的文献,其中中文1篇,英文6篇,共计1206例患者。Meta分析结果显示:接受各种不同方式的开放手术组和经腹腔镜手术组在复发率[OR=1.22,95%CI(0.48,3.12),P=0.67]和鞘膜积液发生率[OR=0.76,95%CI(0.28,2.02),P=0.58]的比较均无显著性差异。改良Palomo手术组术后精索静脉曲张的复发率要高于传统Palomo手术组[OR=0.19,95%CI(0.05,0.65),P=0.008],而术后鞘膜积液的发生率要低于传统Palomo手术组[OR=8.36,95%CI(1.88,37.12),P=0.005]。结果表明,开放和经腹腔镜手术两种术式在主要指标差异的比较未见明显差异,传统和改良Palomo术式则各有优缺点。

BACKGROUND：Various surgery methods are utilized in the treatment of varicocele with each own advantages and disadvantages,how to select a surgery method for treating varicocele in adolescents remains in dispute.OBJECTIVE：To evaluate the therapeutic effectiveness of the open and laparoscopic Palomo techniques for treating varicocele in adolescents.METHODS：Clinical randomized controlled trials regarding therapeutic effectiveness of the open and laparoscopic Palomo techniques for treating varicocele in adolescents were searched by computer from Medline,Cochrane library and CBM database using Key words of ＂Varicocele;Palomo＂ both in English and Chinese.Study selection,data collection,analyses and assessment were undertaken by two reviewers independently.Meta-analyses were done by using RevMan 4.2 software. RESULTS AND CONCLUSION：Seven trials were chosen in this research,1 from Chinese,6 from English,involving a total of 1 206 patients included in the review.Meta-analysis showed that the differences of the postoperative hydrocele rate [OR=0.76,95%CI（0.28,2.02）,P=0.58] and the varicocele recurrence rate [OR=1.22,95%CI（0.48,3.12）,P=0.67] between the open and laparoscopic varicocelectomy were not significant.The recurrence rate of the modified Palomo surgery was higher than that of the classic Palomo surgery [OR=0.19,95%CI（0.05,0.65）,P=0.008],but the modified Palomo surgery was superior to the classic Palomo surgery in lowing the postoperative hydrocele rate [OR=8.36,95%CI（1.88,37.12）,P=0.005].The evidence currently available showed that there was no significant difference between the open and laparoscopic varicocelectomy.And the two different Palomo techiniques had their own advantages and disadvantages in treating varicocele in adolescents.