中国医生精索静脉曲张手术方式疗效的Meta分析

Meta-analysis of Surgical Treatment of Varicocele in Chinese Doctors

目的分析中国医生对精索静脉曲张高位结扎术的显微镜、腹腔镜及开放三者手术方式对精索静脉曲张的疗效。方法从Cochrane图书馆、Medline、Embase、CBM、CNKI、VIP收集所有与精索静脉曲张的处理有关的文献,由两位评价者按照相关限定条件进行筛选,选出符合纳入标准文献,使用RevMan5.3进行Meta分析。结果共有13项随机对照研究1159例患者纳入分析,显微镜组手术时间长于腹腔镜组及开放组,差异有统计学意义(P<0.05),但腹腔镜组与开放组之间手术时间差异无统计学意义(P>0.05)。显微镜组住院时间明显短于腹腔镜组及开放组,差异有统计学意义(P<0.05),腹腔镜组住院时间也短于开放组,差异有统计学意义(P<0.05)。显微镜组与腹腔镜组间配偶自然妊娠率的差异无统计学意义,差异有统计学意义(P>0.05)。显微镜组并发症发生率明显低于腹腔镜组及开放组,差异有统计学意义(P<0.05),腹腔镜组并发症发生率也低于开放组(P<0.05)。显微镜组、腹腔镜组及开放组术后复发率差异无统计学意义(P>0.05)。结论中国医生所采用的治疗精索静脉曲张的三种手术方式中,显微镜辅助精索静脉高位结扎术手术时间长于腹腔镜组和开放组,但住院时间和术后并发症发生率均明显低于两者,而术后配偶自然妊娠率并无明显差异,与国际相关研究结论相近。

Objective To analyzethe curativeeffect of high ligation of spermatic vein by three kinds of surgical methods, including laparoscopy, laparoscopy and open surgery,in the treatment of varicocelein Chinese doctors. Methods All literatures re- lating to treatment of varicocele were collected from the Cochrane library, Medline, Embase, CBM, CNKI and VIP, and they were se- lected by two reviewers according to the relevant restrictive conditions. Meta-analysis was performed in literatures met the inclusion criteriaby the RevManS. 3. Results A total of 13 randomized controlled trials involving 1159 patients were included in the analy- sis. The operation time in the microscope group was longer than that in the laparoscopic group and the open group （P 〈 0, 05 ）, but there was no significant difference between the laparoscopic group and the open group（ P 〉 0. 05 ）. The hospitalization time of the microscope group was significantly shorter than that of the laparoscopic group and the open group（ P 〈 0. 05 ~, and the hospitaliza- tion time of the laparoscopic group was shorter than that of the open group （ P 〈 0. 05 ）. There was no significant difference in the spouse natural pregnancy rate between the microscope group and the laparoscopic group （ P 〉 0. 05 ）. The complication rate in the microscope groupwas significantly lower than that in the laparoscopic group and the open group （ P 〈 0. 05 ）, and the complication rate in the laparoscopic group was lower than that in the open group（ P 〈 0. 05 ）. There was no significant difference in thepostoper- ative recurrence rate in microscope group,laparoscopic group and open group（ P/〉0. 05 ）. Conclusion Between the threekinds of surgical methods used by Chinese doctors for the treatment of varicocele,the operation time of microscope assisted high ligation of the internal spermatic vein is longer than that of the laparoscopic group and open group, but the hospitalization time and postopera- tive complication rate are significantly lower than those of the two. However,there is no significant difference in the spouse natural pregnancy rate between the three groups,which is similar to the conclusion of related international research.