本文選題：精索靜脈曲張　切入點(diǎn)：顯微外科　出處：《中南大學(xué)》2013年碩士論文　論文類型：學(xué)位論文

【摘要】：目的 系統(tǒng)評(píng)價(jià)腹腔鏡和顯微外科治療精索靜脈曲張的療效安全性,為臨床醫(yī)生選擇安全有效的術(shù)式提供循證依據(jù)。 方法 采用電子與手工檢索相結(jié)合的辦法,先相關(guān)文獻(xiàn)進(jìn)行初檢,進(jìn)行電子檢索的數(shù)據(jù)庫有Pubmed/Medline database(1995.1-2012.10)、OVID(1995.1-2012.10) EMBASE(1995.1-2012.10)、中國生物醫(yī)學(xué)數(shù)據(jù)庫(CBM,1995.1-2012.10)相關(guān)期刊論文(CNKI:1995.1-2012.10)、中國循證醫(yī)學(xué)/Cochrane中心數(shù)據(jù)庫(CEBM\CCD)、Cochrane圖書館；手工檢索最新發(fā)表的相關(guān)雜志文獻(xiàn),并通過各種主流搜索引擎查找與研究相關(guān)文獻(xiàn)。收集所有關(guān)于手術(shù)治療精索靜脈曲張的、且是隨機(jī)對(duì)照試驗(yàn)(RCTs)的相關(guān)研究文獻(xiàn)。對(duì)所有文獻(xiàn)進(jìn)行嚴(yán)格的初步篩選,對(duì)選出的文獻(xiàn)獲取全文,并采用Cochrane協(xié)作網(wǎng)推薦的偏倚風(fēng)險(xiǎn)評(píng)價(jià)工具對(duì)試驗(yàn)進(jìn)行評(píng)價(jià)。文獻(xiàn)數(shù)據(jù)由兩名研究者獨(dú)立提取,采用RevMan5.1軟件進(jìn)行Meta分析。 結(jié)果 通過初選和排除后,最終有5個(gè)RCTs符合納入標(biāo)準(zhǔn),病例數(shù)共為554例。Meta分析結(jié)果示： (1)在5個(gè)研究中有3個(gè)試驗(yàn)提取到腹腔鏡和顯微外科治療精索靜脈曲張術(shù)后精子數(shù)量提高的相關(guān)數(shù)據(jù),經(jīng)RevMan5.1軟件統(tǒng)計(jì)分析合并數(shù)據(jù)后得WMD=4.28,95%CI=(4.16,6.99),P0.00001,Z=7.72,認(rèn)為腹腔鏡手術(shù)治療精索靜脈曲張?jiān)谑中g(shù)時(shí)間上要比顯微手術(shù)短。 (2)在5個(gè)研究中有3個(gè)試驗(yàn)提取到腹腔鏡和顯微外科治療精索靜脈曲張住院時(shí)間的相關(guān)數(shù)據(jù),經(jīng)RevMan5.1軟件統(tǒng)計(jì)分析合并數(shù)據(jù)后得WMD=0.24,95%CI=(0.44,0.93),P=0.49,Z=0.69,認(rèn)為兩組在住院時(shí)間上的差異無統(tǒng)計(jì)學(xué)意義。 (3)在5個(gè)研究中有3個(gè)試驗(yàn)提取到腹腔鏡和顯微外科治療精索靜脈曲張手術(shù)時(shí)間的相關(guān)數(shù)據(jù),經(jīng)RevMan5.1軟件統(tǒng)計(jì)分析合并數(shù)據(jù)后得WMD=40.31,95%CI=(37.77,42.86),P0.00001,Z=31.03,認(rèn)為在手術(shù)時(shí)間這個(gè)指標(biāo)上腹腔鏡手術(shù)治療精索靜脈曲張時(shí)要比顯微外科手術(shù)短。 (4)在5個(gè)研究中有3個(gè)試驗(yàn)提取到腹腔鏡和顯微外科治療精索靜脈曲張術(shù)后鞘膜積液發(fā)生率的相關(guān)數(shù)據(jù),經(jīng)RevMan5.1軟件統(tǒng)計(jì)分析合并數(shù)據(jù)后得WMD=0.05,95%CI=(0.01,0.27),P=0.0005,Z=3.49,認(rèn)為在術(shù)后鞘膜積液發(fā)生率上顯微外科治療精索靜脈曲張時(shí)比腹腔鏡少。 (5)在5個(gè)研究中有3個(gè)試驗(yàn)提取到腹腔鏡和顯微外科治療精索靜脈曲張術(shù)后復(fù)發(fā)率的相關(guān)數(shù)據(jù),經(jīng)RevMan5.1軟件統(tǒng)計(jì)分析合并數(shù)據(jù)后得WMD=0.10,95%CI=(0.04,0.25),P0.00001,Z=5.01,認(rèn)為在術(shù)后復(fù)發(fā)率上顯微外科治療精索靜脈曲張時(shí)比腹腔鏡少。 結(jié)論 以上結(jié)果表明：顯微外科和腹腔鏡兩種術(shù)式在治療精索靜脈曲張的術(shù)后精子數(shù)量提高和住院時(shí)間兩種指標(biāo)上沒有顯著差異。而在術(shù)后鞘膜積液發(fā)生率和術(shù)后復(fù)發(fā)率兩個(gè)指標(biāo)上顯微外科要優(yōu)于腹腔鏡手術(shù)。在手術(shù)時(shí)間這個(gè)指標(biāo)上腹腔鏡要短于顯微外科。但由于存在發(fā)表偏倚、選擇偏倚的可能,我們期待出現(xiàn)更高質(zhì)量的研究為以上結(jié)論提供更為可靠的證據(jù)。
[Abstract]:Purpose. To evaluate the efficacy and safety of laparoscopy and microsurgery in the treatment of varicocele, and to provide evidence-based basis for clinicians to select safe and effective procedures. Method. With the combination of electronic and manual retrieval, the related documents are first checked. The databases for electronic retrieval are Pubmed/Medline database, 1995.1-2012.10) OVIDE (1995-2012.10) EMBASE, China Biomedical Database (CBM), China Journal Full-text Database, CNKI: 1995.1-2012.10, China Evidence-based Medicine / Cochrane Central Database, CEBM\ CCDCDCCD-Cochrane Library; handheld search for the latest published relevant journal literature. And through all kinds of mainstream search engines to find and study the relevant literature. Collect all the relevant research literature about the surgical treatment of varicocele, and it is a randomized controlled trial (RCTs). The full text of the selected documents was obtained and the bias risk assessment tool recommended by Cochrane Cooperative Network was used to evaluate the experiment. The literature data were extracted by two researchers independently and the Meta analysis was carried out by RevMan5.1 software. Results. After primary selection and exclusion, 5 RCTs met the inclusion criteria and the total number of cases was 554. Meta-analysis showed that:. In 3 of the five studies, data on the increase in sperm count after laparoscopic and microsurgical treatment of varicocele were obtained. After the statistical analysis of the combined data by RevMan5.1 software, we found that the operation time of laparoscopic surgery for varicocele was shorter than that for microsurgery. (2) in 3 of the 5 studies, the data of hospitalization time of varicocele treated by laparoscopy and microsurgery were extracted. The data were analyzed by RevMan5.1 software and the data were analyzed. The results showed that there was no significant difference between the two groups in terms of hospitalization time. In 3 of the five studies, data were extracted on the operative time of laparoscopic and microsurgical treatment of varicocele. After the statistical analysis of the combined data by RevMan5.1 software, we found that the value of WMD-40.31 ~ 95CII was 37.77-42.86P0.00001 ~ (31.03). It was concluded that the operative time of laparoscopic surgery for varicocele was shorter than that for microsurgical treatment of varicocele. Data on the incidence of hydrocele after varicocele treatment by laparoscopy and microsurgery were obtained in 3 of the 5 studies. After the statistical analysis of the combined data by RevMan5.1 software, it was found that the incidence of postoperative hydrocele in microsurgical treatment of varicocele was less than that of laparoscopy. Data on recurrence rate of varicocele treated by laparoscopy and microsurgery were obtained in 3 of the 5 studies. Based on the statistical analysis of the combined data by RevMan5.1 software, it was found that the microsurgical treatment of varicocele in microsurgery was less than that in laparoscopy. Conclusion. The results showed that there was no significant difference between microsurgery and laparoscopy in the improvement of sperm count and the length of stay in the treatment of varicocele, but the incidence of hydrocele and postoperative recovery were not significantly different between microsurgery and laparoscopy. Microsurgery is superior to laparoscopic surgery in two indicators of incidence. In terms of operating time, laparoscopy is shorter than microsurgery. But due to publication bias, With the possibility of bias, we expect higher quality research to provide more reliable evidence for these findings.
【學(xué)位授予單位】：中南大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2013
【分類號(hào)】：R697.24

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本文編號(hào)：1645447