结扎引带静脉在显微精索静脉曲张手术中安全性及有效性的Meta分析

A Meta-Analysis of the Safety and Effectiveness of Testicular Ligation of the Gubernacular Veins in Microsurgical Varicocelectomy

目的利用Meta分析评价结扎引带静脉在显微精索静脉曲张手术中的安全性及有效性。方法检索PubMed、Cochrane图书馆、EMbase、中国知网、中国生物医学文献数据库等数据库有关显微精索静脉曲张手术中结扎引带静脉的相关研究,按文献纳入与排除标准筛选出文献,提取相关数据进行Meta分析。结果共纳入9篇文献,1226例行显微精索静脉曲张手术患者,其中结扎组542例,未结扎组684例。Meta分析结果显示,与未结扎组相比,结扎组手术时间更长(WMD=11.06,95%CI 8.21~13.92,P<0.05),术后总体并发症发生率更高(OR=6.95,95%CI 3.33~14.51,P<0.05),术后阴囊水肿发生率更高(OR=5.85,95%CI 3.07~11.18,P<0.05),差异均有统计学意义。两组在术后静脉曲张复发率、手术前后精子密度,手术前后精子活动度,术后受孕率,住院时间等方面差异无统计学意义。结论显微精索静脉曲张手术中结扎引带静脉疗效上与未结扎相当,但安全性上未结扎优于结扎,因此本研究认为显微精索静脉曲张手术中不应结扎引带静脉。

Objective To evaluate the safety and effectiveness of testicular ligation of gubernacular veins in microsurgical varicocelectomy by Meta-analysis.Methods Search PubMed,Cochrane Library,EMbase,China Knowledge Network,China Biomedical Literature Database and other databases related to microsurgical varicocelectomy for ligation of gubernacular veins,perform Meta-analysis using relevant data selected according to the standard inclusion and exclusion criteria.Results A total of 9 articles were included 1226 patients underwent microsurgical varicocelectomy,including 542 in the ligated group and 684 in the unligated group.Meta-analysis results showed that compared with the unligated group,the ligated group had a longer operation time(WMD=11.06,95%CI 8.21~13.92,P<0.05),and the overall postoperative complication rate was higher(OR=6.95,95%CI 3.33~14.51,P<0.05),the incidence of postoperative scrotal edema(OR=5.85,95%CI 3.07,11.18,P<0.05)was higher,and the differences were statistically significant.There was no significant difference between the two groups in terms of recurrence rate of postoperative varicose veins,sperm density before and after operation,sperm activity before and after operation,pregnancy rate after operation,and length of hospital stay.Conclusion The effectiveness of ligation of gubernacular veins in microsurgical varicocelectomy is equivalent to that of unligated group,the safety of the unligated group is better than ligated group.Therefore,we believe that the gubernacular veins should not be ligated in microsurgical varicocelectomy.