Objective: To investigate the factors influencing the postoperative resolution of varicocele-associated scrotal pain.
Methods: Using the keywords "varicocele", "testicular pain", "scrotal pain", "painful varicocele", "ligation", and "varicocelectomy", we searched the PubMed, Embase, Cochrane Collaboration's Database, CNKI, Wanfang, and VIP Database up to October 2016 for the studies relating to surgical treatment of varicocele-associated scrotal pain. We assessed the quality of the cohort studies included using the Newcastle-Ottawa Scale and that of the randomized controlled trials included with the Cochrane Collaboration's tool. We conducted a meta-analysis using the RevMan software.
Results: Finally 14 studies were included in this meta-analysis, of which, 2 involved the history of disease, 8 involved the nature of pain, 2 involved the intensity of pain, 9 involved the grade of varicocele, 3 involved the side of varicocele, 9 involved surgical approaches, 3 involved surgical techniques, and 4 involved postoperative recurrence. The pain resolution rate was significantly higher after subinguinal ligation than after high or inguinal ligation (RR = 0.82, 95% CI: 0.76－0.89, P <0.01; RR = 0.92, 95% CI: 0.86－0.99, P = 0.02), and so was it after microsurgery than after laparoscopic varicocelectomy (RR = 0.77, 95% CI: 0.60－0.99, P = 0.04).
Conclusions: Subinguinal varicocelectomy and microsurgery are more effective options than laparoscopic and high or trans-inguinal ligation of the spermatic vein for resolution of varicocele-associated scrotal pain, while the history of disease, the nature and intensity of pain, the grade and side of varicocele, or postoperative recurrence cannot be regarded as the influencing factors.
目的： 对手术缓解精索静脉曲张伴阴囊疼痛进行研究，采用Meta分析方法探讨其影响因素。 方法： 以“varicocele”,“testicular pain”,“scrotal pain”, “painful varicocele”, “ligation”,“varicocelectomy”，“精索静脉曲张”、“精索静脉结扎术”、“疼痛”、“阴囊疼痛”、“睾丸疼痛”为主题词及自由词检索 PubMed、EMBASE、Cochrane Library、中国知网、万方全文数据库，检索时间为各数据库建库至2016年10月。按照纳入标准筛选出手术治疗精索静脉曲张伴阴囊疼痛的相关研究。对最终纳入的队列研究根据纽卡斯尔-渥太华评分(NOS)进行质量评价，随机对照研究(RCT)根据 Cochrane系统评价体系中关于评价文献质量的随机方法、分配隐藏、盲法3项标准对纳入的进行质量评价。用RevMan 5.3软件对结果进行Meta分析，结局指标为疼痛缓解率。 结果： 手术缓解精索静脉曲张伴阴囊疼痛的文章共纳入14篇，每篇文献至少涉及一种与缓解阴囊疼痛可能相关的影响因素。其中涉及病史的2篇、疼痛性质的8篇、疼痛程度的2篇、曲张程度的9篇、单双侧3篇、手术入路的9篇、有关手术方式的3篇、症状复发的4篇。Meta分析后发现，经腹股沟管下入路结扎者阴囊疼痛缓解率均高于经高位及经腹股沟入路结扎者阴囊疼痛缓解率，且差异有统计学意义［RR=0.82, 95%CI (0.76, 0.89), P<0.01］［RR=0.92, 95%CI(0.86,0.99), P=0.02］，经显微外科术式者阴囊疼痛缓解率高于经腹腔镜术式者阴囊疼痛缓解率［RR=0.77, 95%CI (0.60, 0.99), P=0.04］，且差异有统计学意义。 结论： 目前尚不能认为病史、疼痛性质、疼痛程度、曲张程度、单双侧、复发是手术缓解精索静脉曲张伴阴囊疼痛的影响因素，而显微外科手术较腹腔镜手术、经腹股沟下入路结扎较经高位和经腹股沟入路结扎，可能是目前精索静脉曲张所致阴囊疼痛经手术治疗缓解更为有效的影响因素.
Keywords: meta-analysis; scrotal pain; varicocelectomy; varicocele.