显微镜与腹腔镜手术治疗精索静脉曲张疗效与安全性的试验序贯Meta分析

Efficacy and safety of microsurgery and laparoscopic surgery for varicocele:a meta-analysis with trial sequential analysis

目的对显微镜与腹腔镜下精索静脉结扎术治疗男性精索静脉曲张的疗效与安全性进行系统累积分析,为精索静脉曲张的手术治疗决策提供循证参考依据。方法计算机检索Pub Med、The Cochrane Library、EMbase、维普数据库（VIP）、中国知网（CNKI）、中国生物医学文献数据库（CBM）、万方数据库（Wangfang Date）1990年~2015年7月外科治疗精索静脉曲张相关的随机对照试验（RCT）,检索纳入文献的参考文献进行扩大检索,两名评价员分别依据已制定的检索策略进行文献的筛查、评价和提取,选出符合纳入标准的文献进行Meta分析。结果初步共检出488篇文献,最后纳入9篇随机对照实验共857例患者资料进行序贯性分析,Meta分析结果显示：显微镜组手术时间较腹腔镜组长,显微镜组术后复发率、鞘膜积液发生率低于腹腔镜组,而两组术后睾丸萎缩发生率、配偶自然妊娠率、住院时间差异无统计学意义;序贯性分析提示术后复发率、鞘膜积液发生率及手术时间提前得到证实,而住院时间及配偶自然妊娠率尚需进一步证实。结论显微镜与腹腔镜术式相比,在术后配偶自然妊娠率、住院时间方面相似,但需进一步证实;显微镜手术的复发率、鞘膜积液发生率较低,但手术时间较腹腔镜长。

Objective To systematically evaluate the curative effect and safety of microsurgery versus laparoscopic surgery for varicocele. Methods Databases such as PubMed, the Cochrane Library, EMbase,VIP,CNKI,CBM and Wanfang Data were searched from 1990 to Jul 2015 for collecting the randomized controlled trials（RCT） about microscopic varicocelectomy and laparoscopic surgery for the treatment of varicocele,and the references of those RCTs were also searched by hand. According to the inclusion and exclusion criteria, literature was screened, data were extracted, and the level of evidence was also assessed. Then,meta-analysis was performed by RevMan 5.2 and TSA 0.9 software. Results 9 RCTs were included,contained 857 patients. The meta-analysis results showed that compared with the laparoscopic surgery,the microsurgery had longer duration of operation,lower incidence of postoperative secondary hydrocele,lower recurrence rate,which was confirmed by TSA for benifit establishing sufficient and conclusive evidence. But there was no significant difference between microsurgery and laparoscopic surgery for varicocele on duration of hospital stay,spontaneous pregnancy rate and postoperative testicular atrophy rate. Results of TSA for outcomes of duration of hospital stay and spontaneous pregnancy rate demonstrated that evidence from RCTs was insufficient to draw a conclusion. Conclusion The duration of hospital stay and spontaneous pregnancy rate of both methods for varicocele are similar,however both of them need to be further confirmed. Compared with laparoscopic surgery,the microsurgery has lower incidence of postoperative secondary hydrocele and lower recurrence rate,but has longer duration of operation.