介入栓塞对比腹腔镜治疗精索静脉曲张的系统评价

A Systematic Review of Interventional Embolization versus Laparoscopic Surgery for the Treatment of Varicocele

目的系统评价介入栓塞与腹腔镜手术治疗精索静脉曲张的有效性及安全性。方法以"介入"、"栓塞"、"腹腔镜"、"精索静脉曲张"为主题词或关键词检索中国期刊全文数据库、万方医药期刊数据库、维普中文科技期刊全文数据库,以"interventional embolization"、"inerventional therapy"、"embolization"、"laparoscope"、"laparoscopic surgery"、"varicocele"为主题词或自由词检索Pub Med、Cochrane图书馆,检索时间为各数据库建库至2015年3月。按照制定的纳入标准筛选比较介入栓塞与腹腔镜手术治疗精索静脉曲张的对照研究。对最终纳入的研究进行采用Newcastle-Ottawa Scale评价其研究质量,并用Rev Man 5.2软件对结果进行Meta分析,结局指标包括精液改善率、复发率、并发症发生率、怀孕率等。结果共纳入7个比较介入栓塞与腹腔镜手术治疗精索静脉曲张的研究,其中前瞻性研究1个,回顾性研究6个,介入栓塞组349例,腹腔镜手术组400例。介入栓塞组与腹腔镜手术组在精液分析改善率[OR=1.17,95%CI(0.70,1.96),P=0.54]、怀孕率[OR=0.58,95%CI(0.29,1.13),P=0.11]、复发率[OR=0.84,95%CI(0.40,1.78),P=0.66]和并发症发生率[OR=0.68,95%CI(0.34,1.32),P=0.25]方面差异均无统计学意义。结论根据目前证据尚不能认为介入栓塞与腹腔镜手术治疗精索静脉曲张有明显差异。

Objective To systematically evaluate the efficiency and safety of interventional embolization versus laparoscopic surgery in the treatment of varicocele.Methods We searched the Chinese Journal Full-text Database,Wanfang Medical Journal Database,and VIP Chinese Science and Technology Journal Full-text Database with such keywords as interventional therapy,embolization,laparoscope,and varicocele.For PubMed and Cochrane Library,MESH terms or keywords were interventional embolization,interventional therapy,embolization,laparoscope,laparoscopic surgery,and varicocele.All database were searched up to March 2015.Then we selected trials comparing interventional embolization versus laparoscopic surgery in the treatment of varicocele according to the including criteria.We assessed the quality of the included studies with the Newcastle-Ottawa Scale and conducted meta-analysis with revman 5.2 for the primary outcomes sperm improvement rate,recurrence rate,complication rate,pregnant rate,etc.Results We included 7 trials comparing interventional embolization with laparoscopic surgery,including 1 prospective study and 6 retrospective studies,with a total of 349 patients receiving interventional therapy and 400 patients receiving laparoscopic surgery.Meta analysis of the included studies showed that there were no significant differences for sperm improvement rate[OR=1.17,95%CI（0.70,1.96）,P=0.54],pregnant rate[OR=0.58,95%CI（0.29,1.13）,P=0.11],recurrence rate[OR=0.84,95CI%（0.40,1.78）,P=0.66]or complication rate[OR=0.68,95%CI（0.34,1.32）,P=0.25]between the two groups.Conclusion Present evidence shows that there is no significant difference between interventional embolization and laparoscopic surgery for varicocele.