本文選題：精索靜脈曲張 + 顯微鏡��； 參考：《廣西醫(yī)科大學》2014年碩士論文

【摘要】：目的：目前對于手術治療精索靜脈曲張的術式比較，以傳統(tǒng)開放手術與腹腔鏡手術比較為主，顯微鏡手術與腹腔鏡手術之間的比較少見。本研究系統(tǒng)評價基于經(jīng)顯微鏡和腹腔鏡手術結扎治療精索靜脈曲張的療效，以期為臨床醫(yī)師選擇應用安全有效的手術方法提供參考。 方法：檢索PubMed、EMBASE、Cochrane Library、中國循證醫(yī)學/Cochrane數(shù)據(jù)庫（CEMB/CCD）、中國知網(wǎng)、萬方全文數(shù)據(jù)庫,時間自1996年至2014年3月，收集符合納入標準的文獻，提取其術后精索靜脈曲張復發(fā)，術后受孕，術后陰囊水腫及鞘膜積液的頻數(shù)分布資料,合并效應量用比值比（OR）和95%可信區(qū)間（95%CI）表示。評價納入研究的方法學質量，文獻數(shù)據(jù)由兩名研究者獨立提取，用R軟件metafor分析包進行處理,雙側p0.05認為差異具有統(tǒng)計學意義。 結果：經(jīng)搜索和排除后，最終有12篇文獻符合納入標準，，包含病患共1240例，經(jīng)顯微鏡手術596例，經(jīng)腹腔鏡手術644例。經(jīng)R軟件metafor統(tǒng)計分析合并數(shù)據(jù),結果顯示：經(jīng)顯微鏡下結扎治療精索靜脈曲張術后精索靜脈曲張復發(fā)率低于腹腔鏡手術(OR=0.28,95%CI=0.16-0.49, P0.00)；經(jīng)顯微鏡下結扎治療精索靜脈曲張術后陰囊水腫率低于腹腔鏡手術（OR=0.31,95%CI=0.13-0.73, P=0.007）；經(jīng)顯微鏡下結扎治療精索靜脈曲張術后鞘膜積液發(fā)生率低于腹腔鏡手術（OR=0.23,95%CI=0.08-0.70,P=0.009）；經(jīng)顯微鏡下結扎治療精索靜脈曲張術后受孕率與腹腔鏡手術無統(tǒng)計學差別（P=0.224）。 結論：通過meta分析顯示，經(jīng)顯微鏡手術結扎治療精索靜脈曲張在其術后復發(fā)率、陰囊水腫及鞘膜積液發(fā)生率上低于腹腔鏡手術，在術后受孕率上與腹腔鏡手術相當。我們認為經(jīng)顯微鏡手術結扎治療精索靜脈曲張的總體療效優(yōu)于腹腔鏡手術，在有條件的地方可以優(yōu)先采用經(jīng)顯微鏡手術治療精索靜脈曲張。
[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.
【學位授予單位】：廣西醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R699.8

【參考文獻】

相關期刊論文 前10條

1 方平;李炳坤;鄭少波;徐亞文;陳玢\~;李傳印;劉春曉;;不同手術方式對精索靜脈曲張的療效及總費用比較[J];廣東醫(yī)學;2013年15期

2 岳煥勛;蔣敏;李福平;林麗;張思孝;;精索靜脈曲張不育患者的精液質量和精子形態(tài)學觀察[J];中華男科學雜志;2005年12期

3 呂逸清;陳斌;;精索靜脈曲張致不育機制研究進展[J];中華男科學雜志;2008年05期

4 陳向鋒;周立新;劉毅東;平萍;陳勇輝;曹明;孫杰;;3種精索靜脈曲張手術方式的療效分析(附88例報告)[J];中華男科學雜志;2009年05期

5 齊濤;張濱;周祥富;陳俊;金明昱;班德文;臧志軍;;低位顯微外科與腹腔鏡兩種精索靜脈結扎術治療精索靜脈曲張性不育療效比較[J];中國男科學雜志;2009年05期

6 蓋龍;劉智勇;孫穎浩;侯建國;許傳亮;高旭;葉華茂;盛夏;肖亮;;不同術式精索靜脈高位結扎術后睪丸鞘膜積液發(fā)病率的比較[J];中國男科學雜志;2010年02期

7 史慶;祝海;王新生;王沛濤;侯四川;;顯微鏡下精索靜脈曲張3種手術效果的對比研究(附120例報告)[J];中華男科學雜志;2013年10期

8 李陽波;羅順文;許亞宏;顧新偉;張波;;腹腔鏡與顯微外科治療精索靜脈曲張術后復發(fā)的療效比較[J];四川醫(yī)學;2011年10期

9 杜寶俊;閆朋宣;鄭nrt

本文編號：1971667