背景:腹内睾丸(IAT)的管理是一项重大的临床挑战,需要将睾丸从腹腔转移到阴囊。睾丸血管的缩短长度使这一过程变得复杂。
目的:本研究的目的是对Shehata技术(ST)和FowlerStephens技术(FST)治疗IAT患者进行系统评价和荟萃分析。
方法:我们使用多个数据库进行了全面的文献检索,包括OvidMedline,科克伦,PubMed,谷歌学者,WebofSciences,EMBASE,和SCOPUS直到2024年2月。这项研究包括比较ST和FST管理腹内睾丸的研究。我们评估了萎缩率和收缩率,以及总体成功率,这两种技术。
结果:确定了六项适合进行荟萃分析的研究,将使用ST进行的睾丸固定术与169例患者进行比较,针对涉及162名患者的FST。比较显示两组之间手术时的年龄差异无统计学意义(I2=0%)(WMD0.05,95%CI-1.24至1.34;p=0.94)。FST组第一阶段的手术时间低于ST组(I2=95%)(WMD10.90,95%CI1.94至19.87;p=0.02)。ST组第二阶段的手术时间低于FST组(I2=83%)(WMD-6.15,95%CI-12.21至-0.10;p=0.05)。我们的分析表明ST具有相似的萎缩率(I2=0%)(OR:0.45,95%CI:0.20至1.01;p=0.05)。在回缩率方面,技术之间没有发现差异(I2=0%)(OR:0.64,95%CI:0.17至2.47;p=0.52)。与FST相比,ST显示出明显更高的总体成功率(I2=1%)(RR:1.14,95%CI:1.03至1.27;p=0.009)。ST和FST的总成功率分别为87%和74%,分别。ST和FST的总萎缩率分别为5%和12%,分别。ST和FST的总体回缩率分别为5%和10%,分别。
结论:ST,以其开创性的两阶段腹腔镜方法而闻名,该方法利用机械牵引来延长睾丸血管,由于其公认的安全性和有效性而越来越受欢迎。相反,Fowler-Stephens技术,一种依靠侧支血液供应进行睾丸动员的传统方法,已经接受了它与睾丸萎缩风险增加的潜在联系。
结论:这项荟萃分析显示,在IAT管理中,与Fowler-Stephens技术相比,Shehata技术具有相似或更好的结果。需要进一步的前瞻性多中心随机对照试验。
BACKGROUND: The management of intra-abdominal testis (IAT) represents a significant clinical challenge, necessitating the transposition of the testis from the abdominal cavity to the scrotum. This procedure is rendered complex by the abbreviated length of the testicular vessels.
OBJECTIVE: Our purpose in this study was to conduct a systematic review and meta-analysis comparing Shehata technique (ST) versus Fowler Stephens technique (FST) in treating patients with IAT.
METHODS: We conducted a comprehensive literature search using several databases, including Ovid Medline, Cochrane, PubMed, Google Scholar, Web of Sciences, EMBASE, and SCOPUS until February 2024. This study included research that compared ST and FST for managing intra-abdominal testis. We evaluated the rates of atrophy and retraction, as well as the overall success rates, for both techniques.
RESULTS: Six studies were identified as appropriate for meta-analysis, comparing
orchidopexy performed using the ST with 169 patients, against the FST involving 162 patients. The comparison showed no statistically significant age difference at the time of surgery between the groups (I2 = 0%) (WMD 0.05, 95% CI - 1.24 to 1.34; p = 0.94). Operative time in first the stage was lower in the FST group than ST group (I2 = 95%) (WMD 10.90, 95% CI 1.94 to 19.87; p = 0.02). Operative time in the second stage was lower in the ST group than FST group (I2 = 83%) (WMD - 6.15, 95% CI - 12.21 to -0.10; p = 0.05). Our analysis showed that ST had a similar atrophy rate (I2 = 0%) (OR: 0.45, 95% CI: 0.20 to 1.01; p = 0.05). No difference was found between techniques in terms of retraction rate (I2 = 0%) (OR: 0.64, 95% CI: 0.17 to 2.47; p = 0.52). The ST demonstrated a notably higher overall success rate compared to FST (I2 = 1%) (RR: 1.14, 95% CI: 1.03 to 1.27; p = 0.009). Overall success rate in ST and FST were 87% and 74%, respectively. Overall atrophy rate in ST and FST were 5% and 12%, respectively. Overall retraction rate in ST and FST were 5% and 10%, respectively.
CONCLUSIONS: The ST, renowned for its pioneering two-stage laparoscopic approach that leverages mechanical traction to lengthen the testicular vessels, is gaining popularity due to its recognized safety and efficacy. Conversely, the Fowler-Stephens technique, a traditional method that relies on collateral blood supply for testicular mobilization, has come under examination for its potential link to an increased risk of testicular atrophy.
CONCLUSIONS: This meta-analysis reveals that the Shehata technique has similar or better outcomes compared to the Fowler-Stephens technique in IAT management. Further prospective multicentric randomized controlled trials are warranted.