Wang Jun, Xia Shu-Jie, Liu Zhi-Hong, Tao Le, Ge Ji-Fu, Xu Chen-Min, Qiu Jian-Xin
Department of Urology, Shanghai First People's Hospital, Medical College of Shanghai Jiao Tong University, Shanghai, China.
Asian J Androl. 2015 Jan-Feb;17(1):74-80. doi: 10.4103/1008-682X.136443.
Conventional meta-analyses have shown inconsistent results for the efficacy of various treatments of varicoceles. Therefore, we performed a multiple-treatment meta-analysis to assess the effectiveness and safety of 10 methods of varicocelectomy and embolization/sclerotherapy. We systematically reviewed 35 randomized controlled trials and observational studies, from 1966 to August 5, 2013, which compared any of the following treatments for varococeles: laparoscopic, retroperitoneal, open inguinal and subinguinal varicocelectomy, microsurgical subinguinal and inguinal varicocelectomy, percutaneous venous embolization, Tauber antegrade sclerotherapy, retrograde sclerotherapy and expectant therapy (no treatment). Inguinal and subinguinal microsurgery, open inguinal, laparoscopic varicocelectomy showed a significant advantage over expectant therapy in terms of pregnancy rates (odds ratio (OR): 3.48, 2.68, 2.92 and 2.90, respectively). Compared with retroperitoneal open surgery, inguinal microsurgery showed an improvement of sperm density (mean difference (MD): 10.60, 95% confidence interval (CI): 1.92-19.60) and sperm motility (MD: 9.09, 95% CI: 4.88-13.30). Subinguinal and inguinal microsurgery outperformed retroperitoneal open surgery in terms of recurrence (OR: 0.05, 0.06 respectively). Tauber antegrade sclerotherapy and subinguinal microsurgery were associated with the lowest risk of hydrocele formation. The odds of overall complication, compared with retroperitoneal open varicocelectomy, were lowest for inguinal microsurgery (OR = 0.07, 95% CI: 0.02-0.19), followed by subinguinal microsurgery (OR = 0.09, 95% CI: 0.02-0.19). Inguinal and subinguinal micro-varicocelectomy had the highest pregnancy rates, significant increases in sperm parameters, with low odds of complication. These results warrant additional properly conducted randomized controlled clinical studies with larger sample sizes.
传统的荟萃分析显示，各种精索静脉曲张治疗方法的疗效结果并不一致。因此，我们进行了一项多治疗方法的荟萃分析，以评估10种精索静脉结扎术及栓塞/硬化疗法的有效性和安全性。我们系统回顾了1966年至2013年8月5日期间的35项随机对照试验和观察性研究，这些研究比较了以下任何一种精索静脉曲张治疗方法：腹腔镜、腹膜后、开放腹股沟和腹股沟下精索静脉结扎术、显微外科腹股沟下和腹股沟精索静脉结扎术、经皮静脉栓塞术、陶伯顺行硬化疗法、逆行硬化疗法和期待疗法（不治疗）。腹股沟和腹股沟下显微手术、开放腹股沟、腹腔镜精索静脉结扎术在妊娠率方面比期待疗法显示出显著优势（优势比（OR）分别为：3.48、2.68、2.92和2.90）。与腹膜后开放手术相比，腹股沟显微手术在精子密度（平均差（MD）：10.60，95%置信区间（CI）：1.92 - 19.60）和精子活力（MD：9.09，95%CI：4.88 - 13.30）方面有所改善。腹股沟下和腹股沟显微手术在复发率方面优于腹膜后开放手术（OR分别为：0.05、0.06）。陶伯顺行硬化疗法和腹股沟下显微手术与鞘膜积液形成的风险最低相关。与腹膜后开放精索静脉结扎术相比，腹股沟显微手术的总体并发症几率最低（OR = 0.07，95%CI：0.02 - 0.19），其次是腹股沟下显微手术（OR = 0.09，95%CI：0.02 - 0.19）。腹股沟和腹股沟下显微精索静脉结扎术妊娠率最高，精子参数显著增加，并发症几率低。这些结果需要更多样本量更大、实施得当的随机对照临床研究。
