精索静脉曲张结扎术改善精液质量效应的Meta 分析

目的:对于精索静脉曲张结扎术在改善精液质量中的效应进行Meta分析,明确不同手术方式是否具有改善精液质量的作用及其程度,对精索静脉曲张导致男性不育手术治疗的决策提供参考依据。方法:计算机检索MEDLINE(1985~2011.10)、EMbase(1990~2011.10),中国生物医学文献光盘数据(1979~2011.10),中国生物医学期刊文献数据库(CMCC,1979~2011.10)、CNKI数字图书馆(1990~2011.10),手工检索《中国男科学》等四种相关杂志,纳入研究精索静脉曲张结扎术对改善精液质量效应的临床随机对照实验,两名分析人员独立进行文献筛查,质量评价和数据提取,并相互核对,有分歧时通过向专家咨询并改进检索策略后解决。RevMan 4.3.1软件用于Meta分析。结果:初步检出256篇文献,经过筛选纳入8篇随机对照实验,患者1472例。通过Meta分析显示,腹腔镜下结扎术,腹膜后小切口结扎术,经腹股沟管结扎术和腹股沟下显微结扎术均可改善精液参数。腹腔镜下结扎术可使精子活率提高11.70%,95%可信区间(95%CI)7.32,16.08],P<0.00001,精子密度提高20.68×106/mL,95%CI为15.01,26.43],P<0.00001,降低精子畸形率15.69%,95%CI为-18.16,-13.22],P<0.00001。腹膜后小切口结扎术使精子活率提高13.35%,95%CI5.28,21.43],P<0.00001,密度提高11.20×106/mL,95%CI为1.65,20.75],P<0.00001,降低畸形率16.44%,95%CI为-19.29,-13.60],P<0.00001。经腹股沟管结扎术使活率提高10.76%,95%CI8.79,12.72],P<0.00001,精子密度提高11.24×106/mL,95%CI为3.25,19.22],P<0.00001,降低畸形率15.01%,95%CI为-15.75,-14.27],P<0.00001,提高精子正常形态率1.99%,95%CI为1.07,2.91],P<0.00001。腹股沟下显微结扎术使精子活率提高12.99%,95%CI为9.81,16.18],P<0.00001,密度提高17.20×106/mL,95%CI为7.68,26.71],P<0.00001,降低畸形率6.73%,95%CI为-12.77,-0.68],P<0.00001。结论:患有精索静脉曲张的男性不育症患者经过手术治疗可以有效改善精液分析参数,对于提高精子活率,密度及降低畸形率具有一定疗效。

Efficacy of Varicocelectomy in Improving Semen Quality: A Meta-analysis

Objective: To determine the efficacy of different varicocelectomy in improving semen parameters by a Meta-analysis.To provide evidence for varicocele infertile patients to choose varicocelectomy.Methods: Search of MEDLINE(1985~2011.10),EMbase(1990~2011.10),China Biology Medicine Literature Disc Database(1979~2011.10),CMCC(1979~2011.10),CNKI(1990~2011.10)is done by computer.Besides,four related megazines were searched manually such as Chinese Journal of Andrology to get randomized controlled clinical trials about the efficacy of varicocelectomy in improving sperm quality.Two reviewers screened the literature,evaluate the document quality and extract the data independently and check the result together.Discussion or consulation of the experts when di-verging met.RevMan software version 4.3.1 developed by the Cochrane Collaborative for Meta-analysis.Results: A meta-analysis was performed to evaluate randomized controlled trials.Of 256 studies identified through the electronic and hand search of references,only 8 studies including 1,472 patients met our inclusion criteria.Meta-analysis shows that laparoscopic ligation,retroperitoneal ligation,in-guinal ligation and subinguinal microscopic surgery could improve the sperm parameters.After laparoscopic ligation sperm motility in-creased by 11.70%,95%CI(confidence interval) 7.32,16.08],P<0.00001,concentration increased by 20.68×106/mL,95%CI15.01,26.43],the deformity rate is decreased by 15.69%,95%CI-18.16,-13.22],P<0.00001.After retroperitoneal ligation sperm motility increased by 13.35%,95%CI5.28,21.43],P<0.00001,concentration increased by 11.20×106/mL,95%CI1.65,20.75],P<0.00001,the deformity rate is decreased by 16.44%,95%CI-19.29,-13.60],P<0.00001.After inguinal ligation sperm motility increased by 10.76%,95%CI8.79,12.72],P<0.00001,concentration increased by 11.24×106/mL,95%CI 3.25,19.22],P<0.00001,deformity rate is de-creased by 15.01%,95%CI为-15.75,-14.27],P<0.00001,the normal morphology rate is increased by 1.99%,95%CI1.07,2.91],P<0.00001.After subinguinal microscopic surgery sperm motility increased by 12.99%,95%CI9.81,16.18],P<0.00001,concentration in-creased by 17.20×106/mL,95%CI7.68,26.71],P<0.00001,deformity rate is decreased by 6.73%,95%CI-12.77,-0.68],P<0.00001.Conclusion: Surgical varicocelectomy significantly improves semen parameters in infertile men with varicocele and abnormal semen parameters.It has efficacy on improving the sperm motility,density and decrease the deformity rate.