手术治疗不孕不育患者效果的某eta分析

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1、Objectives：Toevaluatetheeffectofvaricoceletreatmentonpregnancyrateinsubfertilecouples.Methods:Searcheswereappliedtothefollowingelectronicdatabase:Pubmed(1966.1-2008.3);CNKI(1980-2008);CochraneLiberary.Meanwhile,handsearchwasappliedinrecentChineseJour

2、nalofAndrologyandothertwoJournals..Inaddition,Wealsocheckedcrossreferences,referencesfromreviewarticles,andcontactedresearchersinthefield.RCTswereincludediftheywererelevanttotheclinicalquestionposed,iftheyreportedpregnancyratesasanoutcomemeasure,andi

3、ftheyreporteddataintreated(surgicalligationorradiologicalembolizationoftheinternalspermaticvein)anduntreatedgroups.Datawereextractedindependentlybytworeviewer.StatisticalanalysiswereperformedwithRavman4.2.Result:Ninestudiesmettheinclusioncriteriafort

4、hisreview.Onewasanextensionofapreviouslypublishedstudy(Nieschlag1995/1998),whichlefteightstudiesforanalysis(Nilsson1979;Breznik1993;Madgar1995;Yamamoto1996;Nieschlag1995/1998;Grasso2000;Unal2001;Krause2002).Alleightonlyincludedmenfromcoupleswithsubfe

5、rtilityproblems,ThecombinedPetooddsratio(OR)oftheeightstudiesis1.10(95%CI0.73to1.67),indicatingnobenefitofvaricoceletreatmentoverexpectantmanagementinsubfertilitycouplesinwhomvaricoceleinthemanistheonlyabnormalfinding.Conclusion:Thereisnoevidencethat

6、treatmentofvaricoceleinmenfromcoupleswithotherwiseunexplainedsubfertilityimprovesthecouple’schanceofconception.Keywords:surgery;Embolization;Varicocele;Infertility,Pregnancy;Meta-analysisPostgraduate:ZhangQun-FengDirectedbyProfessorLuoZhi-Gang6前言精索静脉

7、曲张及治疗精索静脉曲张（Varicocele，VC）是指精索蔓状静脉丛因各种原因引起的静脉回流不畅，或因静脉瓣膜损坏引起的血液倒流，形成阴囊局部静脉扩张、迂曲的病理现象。常见于左侧。精索静脉高位结扎断流术治疗男性不育已经有50多年历史，但是精索静脉曲张对不育的影响机制仍不是完全清楚，精索静脉高位结扎断流术对生育力的恢复机理也不完全清楚。精索静脉曲张与男性不育存在着密切的关系。评估一般的男性群体，精索静脉[4]曲张发病率约为15％(8%-20%)。在原发不育的患者中，精索静脉曲张发病率约占[5]3

8、5％(19-41%)，继发性不育者可高达80％(69-94%)，且无种族差异。因此，精索静脉曲是不育男性中最常见的身体异常。精索静脉曲张和男性的精液参数异常有关并且[6]可能是男性不育原因之一。精索静脉曲张对精子产生的不利影响可能有以下几个方面：睾丸受损的血流导致了阴囊温度的增加、低氧、睾丸压力的增加、肾上腺代谢产[7][8][9]物的逆流。传统的治疗方法是体内的精索静脉高位结扎。除了腹膜后精索内静脉高位结扎（首次由Ivaniwwsvitch描述，Palomo改良）外还有几项外科技术已经应用于临