比較顯微鼠蹊精索靜脈曲張截除術以及顯微低位鼠蹊精索靜脈曲張截除術 – 系統性文獻回顧與統合分析

謝易耕¹、陳建綸^1,2、陳煜^1,3

¹林口長庚紀念醫院, 外科部, 泌尿科系; ²長庚大學, 醫學院; ³清華大學, 醫學系

Comparing microsurgical inguinal varicocelectomy and microsurgical subinguinal varicocelectomy: a systemic review and meta-analysis

Yi-Keng Hsieh, M.D¹; Chien-Lun Chen, M.D ^{1, 2} and Yu Chen, M.D ^{1, 3}

Department of Urology, Chang Gung Memorial Hospital, Taoyuan, Taiwan¹; College of Medicine, Chang Gung University, Taoyuan, Taiwan²; School of Medicine, National Tsing Hua University, Hsinchu, Taiwan³

Purpose: Microsurgical varicocelectomy is an effective treatment for varicoceles, however data directly comparing microsurgical inguinal varicocelectomy (MIV) and microsurgical subinguinal varicocelectomy (MSV) are limited. This meta-analysis aimed to compare MIV and MSV across outcomes of operation duration, semen parameters (semen concentrations and motility), complications (recurrence and hydrocele), and visual analogue scale (VAS) score.

Materials and Methods: PubMed, Embase and Cochrane Library were systematically searched for studies comparing MIV and MSV. Randomized controlled trials (RCTs) and cohort studies reporting operation duration, semen parameters (semen concentrations and motility), complications (recurrence and hydrocele), and visual analogue scale (VAS) score were included. Meta-analysis was conducted using a fixed or random effects model.

Results: Seven studies comprising 1071 patients were included. Operation duration was six minutes shorter for MIV but without statistical significance (p=0.05). No differences were found between groups for sperm concentration or motility. When comparing pre- and post-operation, significant improvements were found for both MIV and MSV in sperm concentration (p=0.01 and p=0.02 respectively). Statistically significant differences were found in MIV in terms of sperm motility (p<0.05), but no statistically significant differences were found in MSV (p=0.06). However, noticeable trends of improvement were observed in MSV. No differences were found for recurrence (p=0.32), hydrocele formation (p=0.89) or pain score (p=0.95).

Conclusion: Microsurgical inguinal and subinguinal varicocelectomy demonstrated comparable efficacy across outcomes. Neither approach showed clear superiority regarding operative duration, semen parameter improvements or complication rates. Further high-quality studies on controversial issues like pain scores are warranted.