PDF(Pubmed)
Abstract：
UNASSIGNED: The ideal surgical approach for the management of varicocele in children and adolescents remains controversial. Several techniques are available including artery- or lymphatic-sparing with optical magnification (via open inguinal or sub-inguinal approach), laparoscopic, antegrade and retrograde embolization/sclerotherapy.
UNASSIGNED: We aimed to appraise the clinical outcomes of these techniques in children and adolescents.
UNASSIGNED: A systematic review was conducted (1997-2023). Meta-analysis or proportional meta-analysis for non-comparative studies (Freeman-Tukey transformation) using the random effects model was conducted. Results are expressed as overall proportion % and 95% confidence interval (CI).
UNASSIGNED: We identified 1910 studies; 632 duplicates were removed, 1278 were screened, 203 were reviewed and 56 were included, with 12 reporting on 2 different techniques (total of 68 data sets). Optical magnification via inguinal approach (498 cases): recurrence 2.5% (0.6-5.6), hydrocele 1.6% (0.47-3.4), testicular atrophy 1% (0.3-2.0), complications 1.1% (0.2-2.6); optical magnification via sub-inguinal approach (592 cases): recurrence 2.1% (0.7-4.4), hydrocele 1.26% (0.5-2.3), testicular atrophy 0.5% (0.1-1.3), complications 4% (1.0-8.8). Laparoscopic with mass-ligation/division (1943 cases): recurrence 2.9% (1.5-4.6), hydrocele 11.4% (8.3-14.9); complications 1.5% (0.6-2.9); laparoscopic with lymphatic-sparing (974 cases): recurrence 2.4% (1.5-3.5), hydrocele 1.2% (0.45-3.36), complications 1.2% (0.05-3.9); laparoscopic with artery-sparing (228 cases): recurrence 6.6% (2.3-12.9), hydrocele 6.5% (2.6-12.0). Antegrade embolization/sclerotherapy (403 cases): recurrence 7.6% (5.2-10.4), hydrocele 0.8% (0.17-1.9), technical failure 0.6% (0.1-1.6), complications 4.0% (2.3-6.1); retrograde embolization/sclerotherapy (509 cases): recurrence 6.9% (4.6-9.5), hydrocele 0.8% (0.05-2.5), technical failure 10.2% (4.6-17.6), and complications 4.8% (1.0-11.2).
UNASSIGNED: The recurrence rate varies between 2.1% and 7.6% and is higher with the embolization/sclerotherapy techniques. Post-operative hydrocele rate varies between 0.8% and 11.4% and is higher with the laparoscopic mass-ligation/division technique. Testicular atrophy has not been reported with the laparoscopic and embolization/sclerotherapy techniques. The retrograde embolization technique is associated with 10% technical failure (inability to complete the procedure). The laparoscopic lymphatic-sparing technique is characterized by the lowest recurrence rate, incidence of hydrocele and other complications, and no reports of testicular atrophy.
UNASSIGNED: We aimed to appraise the clinical outcomes of these techniques in children and adolescents.
UNASSIGNED: A systematic review was conducted (1997-2023). Meta-analysis or proportional meta-analysis for non-comparative studies (Freeman-Tukey transformation) using the random effects model was conducted. Results are expressed as overall proportion % and 95% confidence interval (CI).
UNASSIGNED: We identified 1910 studies; 632 duplicates were removed, 1278 were screened, 203 were reviewed and 56 were included, with 12 reporting on 2 different techniques (total of 68 data sets). Optical magnification via inguinal approach (498 cases): recurrence 2.5% (0.6-5.6), hydrocele 1.6% (0.47-3.4), testicular atrophy 1% (0.3-2.0), complications 1.1% (0.2-2.6); optical magnification via sub-inguinal approach (592 cases): recurrence 2.1% (0.7-4.4), hydrocele 1.26% (0.5-2.3), testicular atrophy 0.5% (0.1-1.3), complications 4% (1.0-8.8). Laparoscopic with mass-ligation/division (1943 cases): recurrence 2.9% (1.5-4.6), hydrocele 11.4% (8.3-14.9); complications 1.5% (0.6-2.9); laparoscopic with lymphatic-sparing (974 cases): recurrence 2.4% (1.5-3.5), hydrocele 1.2% (0.45-3.36), complications 1.2% (0.05-3.9); laparoscopic with artery-sparing (228 cases): recurrence 6.6% (2.3-12.9), hydrocele 6.5% (2.6-12.0). Antegrade embolization/sclerotherapy (403 cases): recurrence 7.6% (5.2-10.4), hydrocele 0.8% (0.17-1.9), technical failure 0.6% (0.1-1.6), complications 4.0% (2.3-6.1); retrograde embolization/sclerotherapy (509 cases): recurrence 6.9% (4.6-9.5), hydrocele 0.8% (0.05-2.5), technical failure 10.2% (4.6-17.6), and complications 4.8% (1.0-11.2).
UNASSIGNED: The recurrence rate varies between 2.1% and 7.6% and is higher with the embolization/sclerotherapy techniques. Post-operative hydrocele rate varies between 0.8% and 11.4% and is higher with the laparoscopic mass-ligation/division technique. Testicular atrophy has not been reported with the laparoscopic and embolization/sclerotherapy techniques. The retrograde embolization technique is associated with 10% technical failure (inability to complete the procedure). The laparoscopic lymphatic-sparing technique is characterized by the lowest recurrence rate, incidence of hydrocele and other complications, and no reports of testicular atrophy.
摘要：
■治疗儿童和青少年精索静脉曲张的理想手术方法仍存在争议。有几种技术可用，包括光学放大（通过开放腹股沟或腹股沟下入路）保留动脉或淋巴，腹腔镜,顺行和逆行栓塞/硬化治疗。
■我们旨在评估这些技术在儿童和青少年中的临床结果。
■进行了系统评价（1997-2023年）。使用随机效应模型进行非比较研究（Freeman-Tukey转换）的荟萃分析或比例荟萃分析。结果表示为总比例%和95%置信区间(CI)。
■我们确定了1910项研究；删除了632个重复项，1278人被筛选，审查了203份，包括56份，12份报告涉及2种不同的技术(共68个数据集)。经腹股沟入路光学放大（498例）：复发2.5％（0.6-5.6），鞘膜积液1.6%(0.47-3.4)，睾丸萎缩1%（0.3-2.0），并发症1.1％（0.2-2.6）；经腹股沟下入路光学放大（592例）：复发2.1％（0.7-4.4），鞘膜积液1.26%（0.5-2.3），睾丸萎缩0.5%（0.1-1.3），并发症4%(1.0-8.8)。腹腔镜下包块结扎/分割（1943例）：复发2.9％（1.5-4.6），鞘膜积液11.4％（8.3-14.9）;并发症1.5％（0.6-2.9）;腹腔镜保留淋巴（974例）：复发2.4％（1.5-3.5），鞘膜积液1.2%(0.45-3.36)，并发症1.2％（0.05-3.9）；腹腔镜保留动脉（228例）：复发6.6％（2.3-12.9），鞘膜积液6.5%(2.6-12.0)。顺行栓塞/硬化治疗（403例）：复发7.6％（5.2-10.4），鞘膜积液0.8%(0.17-1.9)，技术故障0.6%(0.1-1.6)，并发症4.0%(2.3-6.1);逆行栓塞/硬化治疗(509例):复发6.9%(4.6-9.5),鞘膜积液0.8%(0.05-2.5)，技术故障10.2%(4.6-17.6)，并发症4.8%(1.0-11.2)。
■复发率在2.1％至7.6％之间变化，而栓塞/硬化治疗技术的复发率更高。术后鞘膜积液率在0.8％至11.4％之间变化，而腹腔镜下的包块结扎/分割技术更高。腹腔镜和栓塞/硬化治疗技术尚未报道睾丸萎缩。逆行栓塞技术与10％的技术失败（无法完成手术）有关。腹腔镜淋巴保留技术的特点是复发率最低，鞘膜积液和其他并发症的发生率，也没有睾丸萎缩的报告.
■我们旨在评估这些技术在儿童和青少年中的临床结果。
■进行了系统评价（1997-2023年）。使用随机效应模型进行非比较研究（Freeman-Tukey转换）的荟萃分析或比例荟萃分析。结果表示为总比例%和95%置信区间(CI)。
■我们确定了1910项研究；删除了632个重复项，1278人被筛选，审查了203份，包括56份，12份报告涉及2种不同的技术(共68个数据集)。经腹股沟入路光学放大（498例）：复发2.5％（0.6-5.6），鞘膜积液1.6%(0.47-3.4)，睾丸萎缩1%（0.3-2.0），并发症1.1％（0.2-2.6）；经腹股沟下入路光学放大（592例）：复发2.1％（0.7-4.4），鞘膜积液1.26%（0.5-2.3），睾丸萎缩0.5%（0.1-1.3），并发症4%(1.0-8.8)。腹腔镜下包块结扎/分割（1943例）：复发2.9％（1.5-4.6），鞘膜积液11.4％（8.3-14.9）;并发症1.5％（0.6-2.9）;腹腔镜保留淋巴（974例）：复发2.4％（1.5-3.5），鞘膜积液1.2%(0.45-3.36)，并发症1.2％（0.05-3.9）；腹腔镜保留动脉（228例）：复发6.6％（2.3-12.9），鞘膜积液6.5%(2.6-12.0)。顺行栓塞/硬化治疗（403例）：复发7.6％（5.2-10.4），鞘膜积液0.8%(0.17-1.9)，技术故障0.6%(0.1-1.6)，并发症4.0%(2.3-6.1);逆行栓塞/硬化治疗(509例):复发6.9%(4.6-9.5),鞘膜积液0.8%(0.05-2.5)，技术故障10.2%(4.6-17.6)，并发症4.8%(1.0-11.2)。
■复发率在2.1％至7.6％之间变化，而栓塞/硬化治疗技术的复发率更高。术后鞘膜积液率在0.8％至11.4％之间变化，而腹腔镜下的包块结扎/分割技术更高。腹腔镜和栓塞/硬化治疗技术尚未报道睾丸萎缩。逆行栓塞技术与10％的技术失败（无法完成手术）有关。腹腔镜淋巴保留技术的特点是复发率最低，鞘膜积液和其他并发症的发生率，也没有睾丸萎缩的报告.
