双侧和单侧手术治疗左侧Ⅱ、Ⅲ度合并右侧亚临床或Ⅰ度精索静脉曲张不育男性疗效的Meta分析

摘要

Objectives:To evaluate whether the efficacy of bilateral varicocelectomy (BV) is superior to unilateral varicocelectomy (UV) in treating infertile patients with left grade]Ⅱ or Ⅲ varicocele and right Ⅰ or subclinical varicocele.Methods:Data bases including Elsevier,PubMed,CNKI and WANFANG were searched for all the randomized controlled trials (RCTs) about the efficiency of BV and UV in the treatment of the infertile men with varicocele.The authors independently assessed the quality of studies and then isolated data.Stata1 1 was used for Meta-analysis.Results:A total of 5 studies involving 448 patients were included.According to Meta-analysis,BV consistently improved semen quality such as sperm concentration [WMD =11.94,95％ CI (8.67,15.21);P =0.00];normal morphology [WMD =4.57,95％ CI (1.90,7.24),P =O.01] and progressive motility [WMD =18.72,95％CI=(1.61,35.83);P =0.03].Conclusion:The efficacy of BV is superior to UV in treating infertile patients with left grades lⅡ or]Ⅲ varicocele and right grade Ⅰ or subclinical varicocele.Therefore,BV should be recommended to treat infertile patients with bilateral varicocele.%目的:评价左侧Ⅱ、Ⅲ度合并右侧亚临床或Ⅰ度精索曲张静脉曲张不育患者双侧手术(Bi-lateral Varicocelectomy,BV)效果是否优于单纯左侧手术(Unilateral Varicocelectomy,UV).方法:计算机检索以下数据库Elsevier,Pubmed,中国知网(CNKI)和万方数据,搜索所有比较BV和UV治疗精索静脉曲张不育患者的随机对照试验,时间为建库至2016年2月.对纳入文献的参考文献进行手检.两位研究者独立进行文献筛查、质量评价和资料提取,并交叉核对,如有分歧通过讨论解决,必要时由第三方进行判定.采用Stata11软件进行Meta分析.结果:共纳入5个研究,448例患者进行分析.Meta分析结果显示:与UV组相比,BV组精子浓度[WMD=11.94,95％ CI(8.67,15.2[),P=0.00];正常精子数[WMD=4.57,95％CI(1.90,7.24),P=0.01];快速运动精子比例[WMD=18.72,95％ CI=(1.61,35.83),P=0.03],均术后改善的更为明显.结论:本研究结果显示,左侧Ⅱ、Ⅲ度合并右侧亚临床或Ⅰ度精索静脉曲张不育患者,BV效果优于UV.双侧精索静脉曲张不育患者应实施双侧手术.