开放和腹腔镜手术治疗精索静脉曲张的Meta分析

The rapeutic effects of open versus laparoscopic technique on varicocele: a meta-analysis

目的比较开放手术与经腹腔镜手术治疗精索静脉曲张两种术式的安全性及有效性。方法计算机检索PubMed、EM-base、VIP、CNKI、CBM和WANFANG数据库,查找所有比较开放和腹腔镜手术治疗精索静脉曲张的随机对照试验,检索时间均为建库至2012年6月,同时筛检纳入文献的参考文献。对文献质量进行严格评价和资料提取,对符合质量标准的RCT,采用RevMan 5.1软件进行Meta分析。结果共纳入10个研究,865例患者。Meta分析结果显示:①在安全性方面:与开放手术相比,经腹腔镜手术住院时间较短[SMD=2.15,95%CI(1.30,3.01),P<0.000 01],单侧手术时间较短[SMD=0.59,95%CI(0.20,0.97),P=0.003],双侧手术时间较短[SMD=1.21,95%CI(0.29,2.13),P=0.01],术中出血量较少[SMD=1.58,95%CI(0.09,3.07),P=0.04];②在有效性方面:术后精子密度、精子活率、症状改善指标均无统计学意义(P>0.05)。结论开放与经腹腔镜两种术式相比,有效性相似,但经腹腔镜手术的手术时间、住院时间及术中出血量却更少,安全性更高。

Objective To evaluate the efficacy and safety of open versus laparoscopic technique for varicocele（VC）.Methods We searched data bases,including PubMed,EMBASE,VIP,CNKI,CBM and WANFANG,for randomized controlled trials（RCTs） about open vs.laparoscopic technique in the treatment of VC.After that,we critically appraised the quality of RCTs and extracted data.And then we conducted meta-analyses for the eligible RCTs using the RevMan 5.1 software.Results 10 studies involving 865 patients met the inclusion criteria.The results of meta-analyses showed that： ① safety indicator： compared with open surgery,laparoscopic technique had shorter hospital stay [SMD=2.15,95%CI（1.30,3.01）,P0.000 01],shorter unilateral operation time [SMD=0.59,95%CI（0.20,0.97）,P=0.003],shorter bilateral operation time [SMD=1.21,95%CI（0.29,2.13）,P=0.01] and less blood loss [SMD=1.58,95% CI（0.09,3.07）,P=0.04];②efficacy indicator： there were no statistical differences in postoperative sperm count,sperm motility rate and improve symptom（P0.05）.Conclusions The current evidence indicated that laparoscopic technique had similar treatment effect to open surgery.However,laparoscopic technique was safer than open surgery,with shorter operation time and hospitalization,and less blood loss.