单孔与传统腹腔镜治疗精索静脉曲张随机对照研究的Meta分析

Effects of single-incision laparoscope and conventional laparoscope in the treatment of varicocele:a meta-analysis of randomized contolled trials

目的:基于随机对照试验,评价单孔腹腔镜和传统腹腔镜治疗精索静脉曲张的疗效。方法:通过电子检索PubMed、Embase、Cochrone图书馆、中国生物医学文献数据库(CBM)、中国知网数据库(CNKI),并根据制定的纳入和排除标准对文章进行筛选,采用Cochrone系统评价手册推荐的随机对照试验的评估方法对文章的偏倚风险进行评估,通过RevMan 5.2软件对各项观察指标(手术时间、术中出血量、24h疼痛评分、住院时间、住院费用、精子数量、精子活力、精子形态)进行统计学分析。结果:共12项研究纳入到本次的Meta分析中(单孔组325例,传统组326例)。单孔腹腔镜组的手术时间长于传统腹腔镜组(SMD:0.70[0.05,1.34];P=0.03);而单孔腹腔镜组的术中出血量(SMD:-0.26[-0.49,-0.03];P=0.0.02)及24h疼痛评分(SMD:-1.15[-2.10,-0.20];P=0.02)则低于传统腹腔镜组;两组间的住院时间(SMD:-0.37[-0.76,0.03];P=0.07)、住院费用(SMD:0.02[-0.64,0.68];P=0.94)、精子数量(SMD:-0.24[-0.49,0.01];P=0.06)、精子活力(SMD:0.06[-0.94,1.05];P=0.91)、精子形态(SMD:0.48[-0.08,1.03];P=0.10)没有明显差异。结论:和传统腹腔镜治疗精索静脉曲张相比较,单孔腹腔镜是一种安全、有效、创伤更小、美观效果更佳的手术方式。

Objective:To compare the effects of single-incision laparoscope and conventional laparoscope in the treatment of varicocele based on randomized controlled trials.Methods:By searching PubMed,Embase,Cochrone liberary,the Chinese biomedical literature database(CBM)and China National Knowledge Infrastructure(CNKI),all of the eligible articles which conformed to the inclusion and exclusion criteria were harvested,and the risk of bias was evaluated according the Cochrone's methods.The observation indexes(operating time,bleeding,pain scores,length of hospital stay,hospital costs,sperm counts,sperm motility,sperm morphology)were analyzed using the software of RevMan 5.2.Results:A total of 12articles(325cases of single-incision group and 326 cases of conventional group)were analyzed in our study.The operating time(SMD:0.70[0.05,1.34])in singleincision group was significantly longer than in conventional group.The bleeding(SMD:-0.26 [-0.49,-0.03])and the pain scores(SMD:-1.15 [-2.10,-0.20])in single-incision group were significantly lower than in conventional group.However,there were no significant differences in the length of hospital stay(SMD:-0.37 [-0.76,0.03]),the hospital costs(SMD:0.02[-0.64,0.68]),the sperm counts(SMD:-0.24 [-0.49,0.01]),the sperm motility(SMD:0.06 [-0.94,1.05]),and the sperm morphology(SMD:0.48 [-0.08,1.03])between single-incision group and conventional group.Conclusions:As compared with conventional laparoscope,single-incision laparoscope is a safe and effective minimally invasive surgical alternative for varicocele.