CAJ | 학술논문

目的对显微镜与腹腔镜下精索静脉结扎术治疗男性精索静脉曲张的疗效与安全性进行系统累积分析,为精索静脉曲张的手术治疗决策提供循证参考依据. 方法计算机检索PubMed、The Cochrane Library、EMbase、维普数据库(VIP)、中国知网(CNKI)、中国生物医学文献数据库(CBM)、万方数据库(Wangfang Date)1990年~2015年7月外科治疗精索静脉曲张相关的随机对照试验(RCT),检索纳入文献的参考文献进行扩大检索,两名评价员分别依据已制定的检索策略进行文献的筛查、评价和提取,选出符合纳入标准的文献进行Meta 分析. 结果初步共检出488篇文献,最后纳入9篇随机对照实验共857例患者资料进行序贯性分析,Meta分析结果显示:显微镜组手术时间较腹腔镜组长,显微镜组术后复发率、鞘膜积液发生率低于腹腔镜组,而两组术后睾丸萎缩发生率、配偶自然妊娠率、住院时间差异无统计学意义;序贯性分析提示术后复发率、鞘膜积液发生率及手术时间提前得到证实, 而住院时间及配偶自然妊娠率尚需进一步证实. 结论显微镜与腹腔镜术式相比,在术后配偶自然妊娠率、住院时间方面相似,但需进一步证实;显微镜手术的复发率、鞘膜积液发生率较低,但手术时间较腹腔镜长.
목적 대현미경여복강경하정색정맥결찰술치료남성정색정맥곡장적료효여안전성진행계통루적분석,위정색정맥곡장적수술치료결책제공순증삼고의거. 방법 계산궤검색PubMed、The Cochrane Library、EMbase、 유보수거고(VIP)、중국지망(CNKI)、중국생물의학문헌수거고(CBM)、만방수거고(Wangfang Date)1990년~2015년7월외과치료정색정맥곡장상관적수궤대조시험(RCT),검색납입문헌적삼고문헌진행확대검색,량명평개원분별의거이제정적검색책략진행문헌적사사、평개화제취,선출부합납입표준적문헌진행Meta 분석. 결과 초보공검출488편문헌,최후납입9편수궤대조실험공857례환자자료진행서관성분석,Meta분석결과현시:현미경조수술시간교복강경조장,현미경조술후복발솔、초막적액발생솔저우복강경조,이량조술후고환위축발생솔、배우자연임신솔、주원시간차이무통계학의의;서관성분석제시술후복발솔、 초막적액발생솔급수술시간제전득도증실, 이주원시간급배우자연임신솔상수진일보증실. 결론현미경여복강경술식상비,재술후배우자연임신솔、주원시간방면상사,단수진일보증실;현미경수술적복발솔、초막적액발생솔교저,단수술시간교복강경장.
Objective To systematically evaluate the curative effect and safety of microsurgery versus laparoscopic surgery for varicocele. Methods Databases such as PubMed, the Cochrane Library, EMbase,VIP,CNKI,CBM and Wanfang Data were searched from 1990 to Jul 2015 for collecting the randomized controlled trials (RCT) about microscopic varicocelecto-my and laparoscopic surgery for the treatment of varicocele,and the references of those RCTs were also searched by hand. Ac-cording to the inclusion and exclusion criteria, literature was screened, data were extracted, and the level of evidence was also assessed. Then,meta-analysis was performed by RevMan 5.2 and TSA 0.9 software. Results 9 RCTs were included,contained 857 patients. The meta-analysis results showed that compared with the laparoscopic surgery ,the microsurgery had longer duration of operation,lower incidence of postoperative secondary hydrocele,lower recurrence rate,which was confirmed by TSA for benifit establishing sufficient and conclusive evidence. But there was no significant difference between microsurgery and laparoscopic surgery for varicocele on duration of hospital stay,spontaneous pregnancy rate and postoperative testicular atrophy rate. Results of TSA for outcomes of duration of hospital stay and spontaneous pregnancy rate demonstrated that evidence from RCTs was insuffi-cient to draw a conclusion. Conclusion The duration of hospital stay and spontaneous pregnancy rate of both methods for varicocele are similar,however both of them need to be further confirmed. Compared with laparoscopic surgery,the microsurgery has lower incidence of postoperative secondary hydrocele and lower recurrence rate ,but has longer duration of operation.