Systematic Evaluation And Meta-Analysis Of The Efficacy And Safety Of Varicocele By Microscope And Laparoscopy

Objective: To systematically evaluate the efficacy and safety of microscopic and laparoscopic varicocelectomy for varicocele.Methods: A computer-based search was conducted on Cochrane Library,EMBASE,Pub Med,China journal full text database(CNKI),VIP and Wanfang databases from January 2015 to December 31,2019 for the comparative analysis of microsurgery and laparoscopic surgery in the treatment of varicocele Cochrane risk assessment bias tool and Newcastle Ottawa scale(NOS)were used to evaluate the quality of randomized controlled studies and retrospective cohort studies respectively.The meta-analysis was performed by using the software of Rev Man 5.4.1.Results: A total of 19 studies were included,including 8 retrospective cohort studies and 11 randomized controlled studies,with a total of 2075 patients,including985 patients in the microscope group and 1090 patients in the laparoscopic group.The average operation time of the microscope group was longer than that of the laparoscopic group,and the difference was statistically significant(MD = 20.76,95%CI(3.16,38.26),P < 0.05).The average hospitalization time of the microscope group was shorter than that of the laparoscopic group,and the difference was statistically significant(MD =-1.08,95% CI(-1.74,-0.42),P < 0.05)The sperm motility of the microscope group was higher than that of the laparoscopic group at 6 months after operation(MD = 5.14,95% CI(3.04,7.25),P < 0.05),and the sperm density of the microscope group was higher than that of the laparoscopic group at 6 months after operation(MD = 3.93,95% CI(2.24,5.61),P < 0.05),The incidence of postoperative complications in the microscope group was lower than that in the laparoscopic group(OR = 0.18,95% CI(0.12,0.28),P < 0.05),and the recurrence rate in the microscope group was lower than that in the laparoscopic group(OR= 0.17,95% CI(0.09,0.32),P < 0.05).Conclusion: Compared with laparoscopic varicocele,microsurgery can prolong the operation time,shorten the average hospitalization time,improve the sperm motility and density in 6 months after operation,and reduce the incidence of postoperative complications and recurrence rate,which is worthy of clinical promotion.