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目的系统评价男性不育伴精索静脉曲张行腹股沟下、腹股沟内、腹膜后手术路径显微外科治疗临床疗效及安全性。方法以精索静脉曲张(varicocele)、精索静脉结扎术(varicocelectomy)和显微精索静脉结扎术(microsurgical varicocelectomy)等检索词分别检索Cochrane图书馆、Pub Med及EMBASE、中国生物医学文献数据库(CBM),对符合纳入标准的文献进行Meta分析。结果共检索相关文献916篇,经筛查及阅读全文后,最终纳入15篇文献,其中英文文献13篇,中文文献2篇。Meta分析显示3种手术路径精索静脉结扎术复发率及相关并发症发生率低,但各组比较无统计学差异(P>0.05);3种手术路径精索静脉结扎术均明显提高临床妊娠率、精液参数,但各组比较无统计学差异(P>0.05);腹股沟内、腹膜后路径较腹股沟下路径所需结扎静脉数量少、手术时间降低。结论 3种手术路径精索静脉结扎术均可有效保护睾丸动脉及淋巴管,减少术后复发、并发症发生,并提高妊娠率、精液参数,但腹股沟内、腹膜后路径较腹股沟下路径所需结扎静脉数量少、手术时间降低。
Objective To evaluate the clinical efficacy and safety of microsurgical treatment of male infertility with varicocele under inguinal, intra-groin, and retroperitoneal surgical approaches. Methods The search terms of varicocele, varicocelectomy and microsurgical varicocelectomy were searched for the Cochrane Library, Pub Med and EMBASE, China Biomedical Literature Database CBM), met the inclusion criteria of the literature Meta-analysis. Results A total of 916 related literatures were retrieved. After screening and reading the full text, 15 literatures were finally included, of which 13 were English and 2 were Chinese. Meta-analysis showed that the recurrence rate of the varicocele ligation and the incidence of related complications were low in all the three surgical paths, but there was no significant difference among the three groups (P> 0.05). All the three surgical routes of varicocele ligation significantly improved clinical pregnancy Rate and semen parameters, but there was no significant difference between the groups (P> 0.05). The number of ligation veins needed for inguinal and retroperitoneal pathways was lower than that for the groin pathways, and the operation time was reduced. CONCLUSION: All the three surgical routes of varicocele can effectively protect the testicular artery and lymphatic vessels, reduce postoperative recurrence, complications and pregnancy rate and semen parameters, but the intra-inguinal and retroperitoneal pathways are more desirable than the inguinal pathway Ligation of the small number of veins, surgery time decreased.