Yuan Renbin, Zhuo Hui, Cao Dehong, Wei Qiang
a Department of Urology, Institute of Urology, West China Hospital , Sichuan University , Chengdu , China.
b Department of Urology , Third People's Hospital of Chengdu , Chengdu , China.
Syst Biol Reprod Med. 2017 Apr;63(2):120-129. doi: 10.1080/19396368.2016.1265161. Epub 2017 Feb 14.
This study reviewed the efficacy and safety of the three surgical approaches for varicocele (microsurgical, laparoscopic, and open varicocelectomy). A systematic review of the relevant randomized clinical trials was performed. Trials were identified from specialized trials register of the Cochrane UGDP Group, the Cochrane library, additional electronic searches (mainly MEDLINE, EMBSAE, SCI, CBM), and handsearching. Clinical trials comparing microsurgical, laparoscopic and open varicocelectomies were included. Statistical analysis was managed using Review Manager 5.3. Seven clinical trials of 1,781 patients were included. The meta-analysis indicated that compared with open varicocelectomy, microsurgery had a higher pregnancy rate (p=0.002), while there was nonsignificant difference between microsurgical and laparoscopic varicocelectomies or between laparoscopic and open varicocelectomies. Both microsurgical and laparoscopic varicocelectomies had a greater increase in postoperative sperm concentration than open varicocelectomy (p=0.008 and p=0.001, respectively). Microsurgical varicocelectomy also showed better improvement in postoperative sperm motility (p=0.02). Compared with the other two, microsurgical varicocelectomy had the longest operative time (p=0.01 and p=0.0004 respectively). A nonsignificant difference was found in the hospital stay between the three approaches, whereas microsurgical and laparoscopic varicocelectomies had a shorter time to return to work. Moreover, microsurgical varicocelectomy had a lower incidence of postoperative complications and recurrence compared with the others. Analysis of current evidence shows that microsurgical varicocelectomy has a longer operative time, lower incidence of postoperative complications, and recurrence than laparoscopic and open varicocelectomies, and shows a higher pregnancy rate, with a greater increase in postoperative sperm concentration, better improvement in postoperative sperm motility, and shorter time to return to work than open varicocelectomy.
本研究回顾了精索静脉曲张三种手术方法（显微外科手术、腹腔镜手术和开放精索静脉结扎术）的疗效和安全性。对相关随机临床试验进行了系统评价。通过Cochrane泌尿生殖系统疾病组专业试验注册库、Cochrane图书馆、其他电子检索（主要是MEDLINE、EMBASE、SCI、CBM）以及手工检索来识别试验。纳入了比较显微外科手术、腹腔镜手术和开放精索静脉结扎术的临床试验。使用Review Manager 5.3进行统计分析。纳入了涉及1781例患者的7项临床试验。荟萃分析表明，与开放精索静脉结扎术相比，显微外科手术的妊娠率更高（p = 0.002），而显微外科手术与腹腔镜精索静脉结扎术之间或腹腔镜与开放精索静脉结扎术之间无显著差异。显微外科手术和腹腔镜精索静脉结扎术术后精子浓度的增加均高于开放精索静脉结扎术（分别为p = 0.008和p = 0.001）。显微外科精索静脉结扎术在术后精子活力改善方面也表现更好（p = 0.02）。与其他两种方法相比，显微外科精索静脉结扎术的手术时间最长（分别为p = 0.01和p = 0.0004）。三种手术方法在住院时间上无显著差异，而显微外科手术和腹腔镜精索静脉结扎术恢复工作的时间较短。此外，与其他方法相比，显微外科精索静脉结扎术术后并发症和复发的发生率较低。对现有证据的分析表明，与腹腔镜和开放精索静脉结扎术相比，显微外科精索静脉结扎术的手术时间更长，术后并发症和复发的发生率更低，妊娠率更高，术后精子浓度增加更大，术后精子活力改善更好，恢复工作的时间比开放精索静脉结扎术更短。
