目的：系统评价显微外科和腹腔镜及开放手术治疗精索静脉曲张临床疗效及安全性。方法通过计算机检索系统检索有关显微外科治疗精索静脉曲张的文献，并行Meta分析。结果 Meta分析显示MV复发率及鞘膜积液发生率优于腹腔镜，妊娠率、早期并发症、睾丸萎缩率及住院时间与腹腔镜类似，手术时间长于腹腔镜；MV妊娠率、早期并发症，复发率及鞘膜积液发生率优于开放手术，睾丸萎缩率与开放手术类似，手术时间长于开放手术。结论 MV可以有效保护睾丸动脉及淋巴管，使术后睾丸萎缩、睾丸鞘膜积液、复发等并发症减少，妊娠率提高，但手术时间略长。%Objective To evaluate the efficacy and safety of microsurgical varicocelectomy (MV) and open and laparoscopic surgery for varicocele.Methods Clinical literatures about microsurgical varicocelectomy and varicocele were reviewed and identified for meta-analysis.Results The meta-analysis showed the incidence of varicocele recurrence and postoperative hydrocele was significantly lower in the MV group than that in the laparoscopic surgery group. The pregnancy rate, duration of hospital stays and incidence of testicular atrophy were similar in both groups. The pregnancy rate, incidence of varicocele recurrence and postoperative hydrocele was significantly lower in the MV group than that in the open surgery group. The incidence of testicular atrophy were similar in both groups. The MV group had a longer operation time, as compared with that of laparoscopic and surgery.Conclusion MV can protect testicular artery and lymph vessel, and has a lower incidence of varicocele recurrence, testicular atrophy and postoperative hydrocele,a higher pregnancy rate and longer operation time.
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