■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.
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.