顯微手術治療精索靜脈曲張療效和安全性的系統評價_《中國循證醫學雜志》

作者：

金鵬 ,  楊羅艷 , 彭佑共

中南大學湘雅二醫院泌尿外科（長沙?410011）;

關鍵詞：

精索靜脈曲張精索靜脈曲張顯微結扎術 Palomo術隨機對照試驗 Meta分析

DOI：

10.7507/1672-2531.20090120

視頻：

導出 下載 收藏 掃碼 引用

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

目的　系統評價精索靜脈曲張顯微結扎術（MV）與Palomo術治療男性精索靜脈曲張的療效與安全性。
方法　計算機檢索MEDLINE（1985～2008.10）、EMbase（1990～2008.10）、中國生物醫學文獻光盤數據庫（1979~2008.6）、中國生物醫學期刊文獻數據庫（CMCC，1979～2008.10）、CNKI數字圖書館（1990～2008.10），手工檢索《中華男科學》等4種相關雜志。納入MV和Palomo術治療精索靜脈曲張的隨機對照試驗（RCT），并追蹤已納入文獻的參考文獻。兩位評價員獨立進行文獻篩查、質量評價和資料提取，并交叉核對，意見不一致則通過討論或向專家咨詢解決。采用RevMan 4.3.1 軟件進行Meta 分析。
結果　共初檢出22篇文獻，最后納入7個RCT（1 389 例）進行分析。Meta分析結果顯示：MV組精子活率［RR= 1.21，95%CI（1.09，1.34），P=0.000 5］和密度［RR= 1.35，95%CI（1.20，1.51），P lt;0.000 01］提高率均高于Palomo組，MV組術后自然孕率高于Palomo組［RR= 1.34，95%CI（1.08，1.66），P=0.008］，而MV組單側手術時間較Palomo組長［WMD= 23.01 min，95%CI（16.86，29.16），P lt;0.000 01］，雙側手術時間亦較Palomo組長［WMD= 34.05 min，95%CI（4.9，63.21），P=0.02］。兩組術后恢復時間差異無統計學意義。MV組術后復發率低于Palomo［RR= 0.17，95%CI（0.10，0.31），P lt;0.000 01］，且MV組術后鞘膜積液發生率低于Palomo組［RR= 0.10，95%CI（0.05，0.23），P lt;0.00001］。兩組切口感染率、陰囊血腫及疼痛發生率差異無統計學意義（P gt;0.1）。
結論　本研究結果顯示，與傳統Palomo術相比，顯微結扎術具有患者術后精液改善率高，術后自然孕率高，術后復發率和鞘膜積液發生率低的特點；但手術時間更長。遠期療效有待高質量大樣本長期隨訪的RCT進一步驗證。

引用本文： 金鵬,楊羅艷,彭佑共. 顯微手術治療精索靜脈曲張療效和安全性的系統評價. 中國循證醫學雜志, 2009, 09(6): 674-680. doi: 10.7507/1672-2531.20090120 復制

1.	World Health Organization. The influence of varicocele on parameters of fertility in a large group of men presenting to fertility clinics. Fertil Steril, 1992, 57: 1289-1293.
2.	吳階平. 吳階平泌尿外科學. 濟南: 山東科技出版社, 2004: 1953.
3.	Goldstein M, Gilbert BR, Dicker AP, et al. Microsurgical inguinal varicocelectomy with delivery of the testis: an artery and lymphatic sparing technique. J Urol, 1992, 148(6): 1808-1811.
4.	Evers JLH , Collins JA. Assessment of efficacy of varicocele repair for male subfertility: a systematic review. Lancet, 2003, 361: 1849.
5.	Ficarra V, Cerruto MA, Liguori G, et al. Treatment of Varicocele in Subfertile Men: The Cochrane Review-A Contrary Opinion. Eur Urol, 2006, 49: 258-263.
6.	Mulrow CD, Oxman AD. The Cochrane Collaboration handbook, Issue 1, 2000, Oxford, Update Software.
7.	Al-Kandari AM, Shabaan H, Ibrahim HM, et al. Comparison of outcomes of different varicocelectomy techniques: open inguinal, laparoscopic, and subinguinal microscopic varicocelectomy: a randomized clinical trial. Urology, 2007, 69(3): 417-420.
8.	Al-Said S, Al-Naimi A, Al-Ansari A, et al. Varicocelectomy for Male Infertility: A Comparative Study of Open, Laparoscopic and Microsurgical Approaches. J Urol, 2008, 180(1): 266-270.
9.	Barbalias GA, Liatsikos EN, Nikiforidis G, et al. Treatment of varicocele for male infertility: a comparative study evaluating currently used approaches. Eur Urol, 1998, 34(5): 393-398.
10.	Cayan S, Kadioglu TC, Tefekli A, et al. Comparison of results and complications of high ligation surgery and microsurgical high inguinal varicocelectomy in the treatment of varicocele. Urology, 2000, 55(5): 750-754.
11.	Ghanem H, Anis T, El-Nashar A, et al. Subinguinal microvaricocelectomy versus retroperitoneal varicocelectomy: comparative study of complications and surgical outcome. Urology, 2004, 64(5): 1005-1009.
12.	Riccabona M, Oswald J, Koen M, et al. Optimizing the operative treatment of boys with varicocele: sequential comparison of 4 techniques. J Urol, 2003, 169(2): 666-668.
13.	Cayan S, Acar D, Ulger S, et al. Adolescent varicocele repair: long-term results and comparison of surgical techniques according to optical magnification use in 100 cases at a single university hospital. J Urol, 2005, 174(5): 2003-2006.
14.	Juni P, Altman DG, Egger M. Assessing the quality of controlled clinical trials. BMJ, 2001, 323: 42-46.
15.	Pintus C, Rodriguez Matas MJ, Manzonic C, et al. Varicocele in pediatric patients: comparative assessment of different therapeutic approaches. Urology, 2001, 57: 154-157.
16.	Goldstein M, Gilbert BR, Dicker AP, et al. Microsurgical inguinal varicocelectomy with delivery of the testis: an artery and lymphatic sparing technique. J Urol, 1992, 148(6): 1808-1811.
17.	Cayan S, Akbay E, Bozlu M, et al. Diagnosis of pediatric varicoceles by physical examination and ultrasonography and measurement of the testicular volume using the prader orchidometer versus ultrasonography. Urol Int, 2002, 69: 293.
18.	Watanabe M, Nagai A, Kusumi N, et al. Minimal invasiveness and effectivity of subinguinal microscopic varicocelectomy: a comparative study with retroperitoneal high and laparoscopic approaches. Int J Urol, 2005, 12(10): 892-89.

1. World Health Organization. The influence of varicocele on parameters of fertility in a large group of men presenting to fertility clinics. Fertil Steril, 1992, 57: 1289-1293.
2. 吳階平. 吳階平泌尿外科學. 濟南: 山東科技出版社, 2004: 1953.
3. Goldstein M, Gilbert BR, Dicker AP, et al. Microsurgical inguinal varicocelectomy with delivery of the testis: an artery and lymphatic sparing technique. J Urol, 1992, 148(6): 1808-1811.
4. Evers JLH , Collins JA. Assessment of efficacy of varicocele repair for male subfertility: a systematic review. Lancet, 2003, 361: 1849.
5. Ficarra V, Cerruto MA, Liguori G, et al. Treatment of Varicocele in Subfertile Men: The Cochrane Review-A Contrary Opinion. Eur Urol, 2006, 49: 258-263.
6. Mulrow CD, Oxman AD. The Cochrane Collaboration handbook, Issue 1, 2000, Oxford, Update Software.
7. Al-Kandari AM, Shabaan H, Ibrahim HM, et al. Comparison of outcomes of different varicocelectomy techniques: open inguinal, laparoscopic, and subinguinal microscopic varicocelectomy: a randomized clinical trial. Urology, 2007, 69(3): 417-420.
8. Al-Said S, Al-Naimi A, Al-Ansari A, et al. Varicocelectomy for Male Infertility: A Comparative Study of Open, Laparoscopic and Microsurgical Approaches. J Urol, 2008, 180(1): 266-270.
9. Barbalias GA, Liatsikos EN, Nikiforidis G, et al. Treatment of varicocele for male infertility: a comparative study evaluating currently used approaches. Eur Urol, 1998, 34(5): 393-398.
10. Cayan S, Kadioglu TC, Tefekli A, et al. Comparison of results and complications of high ligation surgery and microsurgical high inguinal varicocelectomy in the treatment of varicocele. Urology, 2000, 55(5): 750-754.
11. Ghanem H, Anis T, El-Nashar A, et al. Subinguinal microvaricocelectomy versus retroperitoneal varicocelectomy: comparative study of complications and surgical outcome. Urology, 2004, 64(5): 1005-1009.
12. Riccabona M, Oswald J, Koen M, et al. Optimizing the operative treatment of boys with varicocele: sequential comparison of 4 techniques. J Urol, 2003, 169(2): 666-668.
13. Cayan S, Acar D, Ulger S, et al. Adolescent varicocele repair: long-term results and comparison of surgical techniques according to optical magnification use in 100 cases at a single university hospital. J Urol, 2005, 174(5): 2003-2006.
14. Juni P, Altman DG, Egger M. Assessing the quality of controlled clinical trials. BMJ, 2001, 323: 42-46.
15. Pintus C, Rodriguez Matas MJ, Manzonic C, et al. Varicocele in pediatric patients: comparative assessment of different therapeutic approaches. Urology, 2001, 57: 154-157.
16. Goldstein M, Gilbert BR, Dicker AP, et al. Microsurgical inguinal varicocelectomy with delivery of the testis: an artery and lymphatic sparing technique. J Urol, 1992, 148(6): 1808-1811.
17. Cayan S, Akbay E, Bozlu M, et al. Diagnosis of pediatric varicoceles by physical examination and ultrasonography and measurement of the testicular volume using the prader orchidometer versus ultrasonography. Urol Int, 2002, 69: 293.
18. Watanabe M, Nagai A, Kusumi N, et al. Minimal invasiveness and effectivity of subinguinal microscopic varicocelectomy: a comparative study with retroperitoneal high and laparoscopic approaches. Int J Urol, 2005, 12(10): 892-89.

《中國循證醫學雜志》

顯微手術治療精索靜脈曲張療效和安全性的系統評價

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

上一篇

下一篇

Format

Content

《中國循證醫學雜志》

顯微手術治療精索靜脈曲張療效和安全性的系統評價

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

上一篇

下一篇

Format

Content

摘要全文圖表視頻參考文獻施引文獻補充材料