摘要：Varicocele repair in adolescent remains controversial. Our aim is to identify and combine clinical trials results published thus far to ascertain the efficacy of varicocelectomy in improving testis volume and semen parameters compared with nontreatment control. A literature search was performed using Medline, Embase and Web of Science, which included results obtained from meta-analysis, randomized and nonrandomized controlled studies. The study population was adolescents with clinically palpable varicocele with or without the testicular asymmetry or abnormal semen parameters. Cases were allocated to treatment and observation groups, and testis volume or semen parameters were adopted as outcome measures. As a result, seven randomized controlled trials （RCTs） and nonrandomized controlled trials studying bilateral testis volume or semen parameters in both treatment and observation groups were identified. Using a random effect model, mean difference of testis volume between the treatment group and the observation group was 2.9 ml （95% confidence interval [CI]： 0.6, 5.2; P 〈 0.05） for the varicocele side and 1.5 ml （95% CI- 0.3, 2.7; P 〈 0.05） for the healthy side. The random effect model analysis demonstrated that the mean difference of semen concentration, total semen motility, and normal morphology between the two groups was 13.7 x 106 ml-1 （95% CI： -1.4, 28.8; P= 0.075）, 2.5% （95% CI：-3.6, 8.6; P= 0.424）, and 2.9% （95% CI： -3.0, 8.7; P= 0.336） respectively. In conclusion, although varicocelectomy significantly improved bilateral testis volume in adolescents with varicocele compared with observation cases, semen parameters did not have any statistically significant difference between two groups. Well-planned, properly conducted RCTs are needed in order to confirm the above-mentioned conclusion further and to explore whether varicocele repair in adolescents could improve subsequently spontaneous pregnancy rates.

摘要：近年来在医学领域中,采用一种新的研究分析称为meta-analysis.它是对具有相同目的多个独立研究结果进行综合统计分析和评价.为更好地利用和开发现有统计资料的一种有效方法.它不仅应用于临床试验研究.同时也广泛应用于流行病学研究.meta-analysis方法最早见于1955年Beecher发表的“安慰剂的功效”一文.1971年Light和Smith提出可以从不同研究结果,汇总原始数据进行综合分析.1976年Glass首次提出这种类型的研究称为“Mete-analysis”.从词义meta定义为进一步综合.近十多年来,meta-analysis方法在医学领域使用日益增长.80年代即有50种杂志发表有介绍和应用该方法的文章.meta—analysis分析的目的主要为:(1)改进和提高由于样本的大小而影响统计效能.(2)进一步确定某些研究结果不一致时的可靠性.因此meta-analysis方法适用于随机对照临床试验研究.特别是在每次试验病例较少、单个试验不易得出结论时.可以将多个试验设计相同的研究资料进行综合再分析.以得出更为明确的结论.

摘要：华蟾素是一种从蟾蜍中提取的化合物,是一种传统的中草药,已被证实在癌症治疗中具有疗效。华蟾素注射液广泛应用于中国中晚期肝癌患者。本研究的目的是明确华蟾素注射液对这类特定患者的影响。在PubMed,EMBASE,CENTRAL和其他四个主要的中国数据库中检索使用华蟾素注射液治疗中晚期肝癌随机对照试验。根据Cochrane协作和RevMan 5.3的建议进行系统评价和meta-分析。根据Cochrane手册计算风险比(RR)和相应的95%置信区间,使用随机效应模型来统计数据。最后共纳入了11项随机对照试验,728名患者。所有试验均显示,使用华蟾素注射干预组的总反应率,Karnofsky表现评分(KPS)的总反应率,1–2年生存率和生活质量均有明显改善。但是6个月生存率和临床受益率各组之间没有统计学差异。本研究发现华蟾素注射液对中晚期肝癌患者的总反应率和1至2年生存率的有益作用。因此我们认为华蟾素注射液治疗中晚期肝癌的疗效可能优于对照组。鉴于大多数试验质量较低,因此需要严格按照CONSORT for TCM设计的更高质量的前瞻性随机试验来进一步验证。