经显微镜和腹腔镜手术结扎治疗精索静脉曲张疗效的meta分析

发布时间：2018-06-03 05:37

本文选题：精索静脉曲张 + 显微镜　；参考：《广西医科大学》2014年硕士论文

【摘要】：目的：目前对于手术治疗精索静脉曲张的术式比较，以传统开放手术与腹腔镜手术比较为主，显微镜手术与腹腔镜手术之间的比较少见。本研究系统评价基于经显微镜和腹腔镜手术结扎治疗精索静脉曲张的疗效，以期为临床医师选择应用安全有效的手术方法提供参考。方法：检索PubMed、EMBASE、Cochrane Library、中国循证医学/Cochrane数据库（CEMB/CCD）、中国知网、万方全文数据库,时间自1996年至2014年3月，收集符合纳入标准的文献，提取其术后精索静脉曲张复发，术后受孕，术后阴囊水肿及鞘膜积液的频数分布资料,合并效应量用比值比（OR）和95%可信区间（95%CI）表示。评价纳入研究的方法学质量，文献数据由两名研究者独立提取，用R软件metafor分析包进行处理,双侧p0.05认为差异具有统计学意义。结果：经搜索和排除后，最终有12篇文献符合纳入标准，，包含病患共1240例，经显微镜手术596例，经腹腔镜手术644例。经R软件metafor统计分析合并数据,结果显示：经显微镜下结扎治疗精索静脉曲张术后精索静脉曲张复发率低于腹腔镜手术(OR=0.28,95%CI=0.16-0.49, P0.00)；经显微镜下结扎治疗精索静脉曲张术后阴囊水肿率低于腹腔镜手术（OR=0.31,95%CI=0.13-0.73, P=0.007）；经显微镜下结扎治疗精索静脉曲张术后鞘膜积液发生率低于腹腔镜手术（OR=0.23,95%CI=0.08-0.70,P=0.009）；经显微镜下结扎治疗精索静脉曲张术后受孕率与腹腔镜手术无统计学差别（P=0.224）。结论：通过meta分析显示，经显微镜手术结扎治疗精索静脉曲张在其术后复发率、阴囊水肿及鞘膜积液发生率上低于腹腔镜手术，在术后受孕率上与腹腔镜手术相当。我们认为经显微镜手术结扎治疗精索静脉曲张的总体疗效优于腹腔镜手术，在有条件的地方可以优先采用经显微镜手术治疗精索静脉曲张。
[Abstract]:Objective: to compare the operative methods of varicocele with traditional open surgery and laparoscopic surgery. The purpose of this study was to evaluate the efficacy of varicocele ligation based on microscopical and laparoscopic surgery in order to provide a reference for clinicians to select safe and effective surgical methods for the treatment of varicocele. Methods: we searched PubMedus EMBASE Cochrane Library, China Evidence-based Medicine / Cochrane database CEMBP / CCDN, China knowledge Network, Wanfang Full-text Database, from 1996 to March 2014, collected the literature that met the inclusion criteria, extracted the recurrent varicocele and conceive after operation. The data of frequency distribution of scrotal edema and hydrocele after operation were expressed by ratio of OR and 95% CI. To evaluate the methodological quality of the study, the literature data were extracted by two researchers independently and processed with R software metafor analysis package. The difference was statistically significant in both sides (p0.05). Results: after searching and removing, 12 articles met the inclusion criteria, including 1240 cases, 596 cases by microscope and 644 cases by laparoscopy. The combined data are analyzed by R software metafor. The results showed that the recurrence rate of varicocele after spermatic varicocele ligation under microscope was lower than that of ORO 0.28 ~ 95CII 0.16-0.49, P 0.000.The scrotal edema rate after microscopical ligation of varicocele was lower than that after laparoscope operation (0.31 / 95 CI 0.13-0.73). The incidence of hydrocele in the treatment of varicocele by microscopical ligation was lower than that in the laparoscopic operation. The pregnancy rate of varicocele under microscope was not significantly different from that of laparoscopic surgery (P 0.22424). Conclusion: meta analysis showed that the recurrence rate, scrotal edema and hydrocele rate of varicocele treated by microscopical ligation were lower than those of laparoscopic surgery, and the pregnancy rate was similar to that of laparoscopic surgery. We consider that the overall curative effect of microsurgical ligation for varicocele is better than that for laparoscopic surgery, and it is preferable to treat varicocele with microscopical surgery where conditions exist.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R699.8

【参考文献】