背景:阴囊和腹股沟睾丸固定术是两种常用的可触及未降睾丸(UDT)的手术方法,每个都有不同的优势。然而,最佳方法仍然是一个争论的问题,保证对随机对照试验(RCTs)进行全面的荟萃分析,以指导临床决策。
方法:进行了全面的文献检索,坚持PRISMA准则,选择比较阴囊和腹股沟睾丸固定术的RCT,以确定可触及的UDT。选择8个随机对照试验进行荟萃分析。结果指标包括手术时间,住院时间,总并发症,伤口感染或裂开,睾丸萎缩或肥大,和睾丸再上升率。使用修订后的Cochrane偏倚风险工具对研究质量进行评估。
结果:与腹股沟入路相比,阴囊睾丸固定术的手术时间明显缩短(WMD:-15.06分钟;95%CI:-21.04至-9.08)。然而,住院时间没有显着差异(WMD:-0.72天;95%CI:-1.89-0.45),总并发症(OR:1.08;95%CI:0.70-1.66),伤口感染或裂开(OR:0.73;95%CI:0.27-1.99),睾丸萎缩或肥大(OR:1.03;95%CI:0.38-2.78),两种方法之间的睾丸再上升(OR:1.43;95%CI:0.67-3.06)。由于特定的解剖学挑战,一小部分病例(7.3%)需要从阴囊转换为腹股沟睾丸固定术。
结论:对于可触及的UDT,阴囊和腹股沟睾丸固定术均安全有效,在住院和并发症方面具有可比性。阴囊睾丸固定术具有手术时间短的优点。临床医生可以使用这些证据对可触及的UDT的手术方法做出明智的决定。
BACKGROUND: Scrotal and inguinal orchiopexy are two commonly used surgical approaches for palpable undescended testis (UDT), each with distinct advantages. However, the optimal approach remains a matter of debate, warranting a comprehensive meta-analysis of randomized controlled trials (RCTs) to guide clinical decision-making.
METHODS: A comprehensive literature search was conducted, adhering to PRISMA guidelines, to select RCTs comparing scrotal and inguinal orchiopexy for palpable UDT. Eight RCTs were selected for meta-analysis. Outcome measures included operative time, hospitalization duration, total complications, wound infection or dehiscence, testicular atrophy or hypotrophy, and testicular re-ascent rate. The evaluation of the study\'s quality was conducted by utilizing the revised Cochrane risk-of-bias tool.
RESULTS: Scrotal orchiopexy showed significantly shorter operative time compared to the inguinal approach (WMD: - 15.06 min; 95% CI: - 21.04 to - 9.08). However, there was no significant difference in hospitalization duration (WMD: - 0.72 days; 95% CI: - 1.89-0.45), total complications (OR: 1.08; 95% CI: 0.70-1.66), wound infection or dehiscence (OR: 0.73; 95% CI: 0.27-1.99), testicular atrophy or hypotrophy (OR: 1.03; 95% CI: 0.38-2.78), and testicular re-ascent (OR: 1.43; 95% CI: 0.67-3.06) between the two approaches. A small proportion of cases (7.3%) required conversion from scrotal to inguinal orchiopexy due to specific anatomical challenges.
CONCLUSIONS: Both scrotal and inguinal orchiopexy are safe and effective for palpable UDT, with comparable outcomes in terms of hospitalization and complications. Scrotal orchiopexy offers the advantage of shorter operative time. Clinicians can use this evidence to make informed decisions on the surgical approach for palpable UDT.