| Objective:Meta-analysis was used to compare the effects of microscopic and laparoscopic spermatic vein ligation on the testis of postoperative patients.Methods:The databases Pub Med,Embase,The Cochrane Library,CNKI,VIP and Wanfang were used to search(until February 2023)and the published randomized controlled trials of microsurgery versus laparoscopic surgery for Varicocele(VC)were collected.In order to prevent the omission of literature,the cited references of the included literature were retrieved.Two researchers conducted literature screening,literature quality evaluation and data collection respectively.6 months after operation(sperm number,sperm density,sperm survival rate,normal morphology rate of semen and sperm,sperm A+B active sperm number,forward movement percentage of semen and sperm,follicle-stimulating hormone FSH)level,Luteinizing hormone(LH)level,testosterone(T)level),incidence of postoperative scrotal edema,incidence of postoperative hydrocele,and incidence of postoperative testicular atrophy were used as outcome indicators.Meta-analysis was performed using Rev Man5.4 software.Results:A total of 25 literatures were included in this meta-analysis,all of which were randomized controlled trials.A total of 24 Chinese and 1 English literature were included.2115 patients with VC were included.The experimental group underwent microscopic surgery,while the control group underwent laparoscopic surgery.The results of meta-analysis showed as follows: 1.The incidence of scrotal edema after microscopic surgery(1.99%)was lower than that after laparoscopic surgery(10.7%)(OR=0.19,95%CI(0.11,0.33),P < 0.00001).2.The incidence of testicular atrophy after microsurgery(0.72%)was lower than that after laparoscopic surgery(2.9%)(OR=0.35,95%CI(0.12,0.98),P=0.04).3.The incidence of hydrocele after microsurgery(1.98%)was lower than that after laparoscopic surgery(5.79%)(OR=0.37,95%CI(0.19,0.73),P=0.004).4.6 months after surgery,the LH level of microscopic surgery was lower than that of laparoscopic surgery(SMD=-0.63,95%CI(-1.00,-0.26),P=0.0008).5.T-level microscopic surgery was higher than laparoscopic surgery 6 months after surgery(SMD=0.61,95%CI(0.35,0.86),P < 0.00001);6.The total number of sperm in microscopical surgery was higher than that in laparoscopic surgery(SMD=2.91,95%CI(1.41,4.41),P=0.0001).7.The sperm density of microscopical operation was higher than that of laparoscopic operation 6 months after surgery(SMD=1.13,95%CI(0.77,1.49),P< 0.00001).8.The survival rate of semen and sperm 6 months after microsurgery was higher than that of laparoscopic surgery(SMD=0.95,95%CI(0.45,1.45),P=0.0002).9.The normal morphologic rate of sperm in microscopical surgery was higher than that in laparoscopic surgery(SMD=0.64,95%CI(0.21,1.08),P=0.004).10.Six months after surgery,the sperm count of class A+B active sperm was higher in microscopic surgery than in laparoscopic surgery(SMD=0.98,95%CI(0.44,1.51),P=0.0003).11.There was no significant difference in the percentage of forward sperm movement between the two groups 6 months after surgery(SMD=0.55,95%CI(-0.04,1.15),P=0.07).12.There was no significant difference in FSH level between the two groups 6 months after surgery(SMD=-0.14,95%CI(-1.19,-0.35),P=0.81).Conclusion:The results of this Meta-analysis indicate that during the treatment of VC,both microsurgery and laparoscopic surgery have a certain effect on the recovery of testicular function,and testicular function recovers better after microsurgery.The patient’s semen quality and testosterone level are higher 6 months after microsurgery.Compared with laparoscopy,the incidence of postoperative scrotal edema,testicular hydrocele,and testicular atrophy were lower under microscopy.There was no significant difference in FSH level and sperm forward movement percentage between the two groups at 6 months after surgery. |
PDF Full Text Request