垂体瘤内镜与显微镜手术的Meta分析

Meta analysis of endoscopic and microscopic surgeries for pituitary tumor

目的通过Meta分析评估内镜下经鼻蝶切除和显微镜手术治疗垂体瘤的安全性及疗效。方法通过检索PubMed/Medline、Cochrane Library、Google Scholar、万方数据库和中国生物医学文献数据库(CBM),搜集1999年12月-2011年12月关于内镜下经鼻蝶切除和显微镜手术治疗垂体瘤的随机对照研究(randomized controlled trial,RCT)或病例对照研究,采用RevMan5.1软件对手术资料和预后等进行Meta分析。结果纳入12篇病例对照研究和1篇RCT,共计849例病人,其中内镜手术者426例,显微镜手术者423例。Meta分析结果显示:内镜手术较显微镜手术的手术时间长,术后住院时间短(均P<0.00001);而在肿瘤全切率、术后激素恢复情况、术后脑脊液漏、尿崩等方面无统计学意义(均P>0.05)。结论内镜和显微镜手术治疗垂体瘤疗效差别不大,内镜手术的手术时间较长,但术后住院时间短。

Objective To evaluate the safety and efficacy of endoscopic transsphenoidal surgery and microscopic surgery for pituitary tumor by Meta analysis. Methods The literatures about the randomized controlled trial （RCT） and case-control studies of endoscopic transsphenoidal surgery and microscopic surgery for pituitary tumor were collected from PubMed/Medline, the Cochrane Library, Google Scholar, Wanfang database and CBM database and manual retrieval from December 1999 to December 2011. RevMan5.1 software was used for Meta analysis of operative data and prognosis. Results Twelve case-control studies and one RCT study were selected finally. There were 849 patients in total including 426 receiving endoscopic surgery and 423 undergoing microscopic surgery. The comprehensive results of Meta analysis showed as follows： compared with microscopic surgery, the operation time of endoscopic surgery was longer and hospital stay was shorter （both P 〈 0.00001）. While there was no statistical significance in rate of tumor removal, postoperative recovery of hormone level, postoperative cerebrospinal fluid leak and diabetes insipidus （all P 〉 0.05）. Conclusions There is little difference in efficacy between endoscopic surgery and microscopic surgery for pituitary tumor. The endoscopic surgery has longer operative time but shorter hospital stay.