眶上锁孔入路与单侧经额入路手术治疗鞍区肿瘤的对比研究(文献荟萃分析)

A comparative study of supraorbital keyhole approach and unilateral subfrontal approach in craniotomy for tumors at the sellar region:a systematic analysis

目的比较眶上锁孔入路与单侧冠状切口经额入路切除鞍区肿瘤的手术效果,评价眶上锁孔入路的应用价值。方法检索目前中文及外文数据库中全部有关上述两种手术入路切除鞍区肿瘤的文献报道,从中收集手术病人的相关资料及手术结果数据。按手术入路分组,对所收集的数据进行归纳。各组数据按亚组分层,以卡方检验进行统计分析比较。结果眶上锁孔入路组纳入26篇文献相关数据,共643例病人;单侧经额入路组纳入7篇文献相关数据,共122例病人。两组病人的性别比、术前症状、肿瘤病理类型的分布在统计学上无明显差异。肿瘤切除程度、术后视力及激素水平改善、术后短期死亡率及复发率在两组间基本相似。术后并发症中,尿崩在眶上锁孔入路组的发生率(25.2%)较单侧经额入路组(25.7%)为低(P=0.002),垂体功能减退在眶上锁孔入路组的发生率(17.1%)较单侧经额入路组(13.0%)为高(P=0.039)。术后电解质紊乱、癫痫、脑脊液漏的发生率在两组间差异均无统计学意义。结论对于同等大小的中小型鞍区肿瘤,眶上锁孔入路的手术效果与传统的单侧经额入路相似,患者术后恢复快、住院时间短,美容效果好,结合神经内镜及导航后应用前景良好。

Objective To evaluate the value of supraorbital keyhole approach in application to craniot- omy for tumors at the sellar region by comparing the surgical effect with unilateral subfrontal approach. Meth- od The data bases in Chinese and English were searched to get articles about those two surgical approaches in craniotomy for tumors at the sellar region. Baseline materials and relevant informa- tion with the included articles were extracted respectively according to the different approaches. The concerned data were analyzed by different subgroups with chi-square test. Results Relevant data could be extracted from 26 articles with 634 patients in total for the supraorbital keyhole ap- proach, and 7 articles with 122 patients in total for the unilateral subfrontal approach. There was no significant difference in sexuality ratio, major symptoms before surgery, and pathology of the tumor. The rate of recovery of the vision and hormone after surgery were similar between the two approaches. Incidence of diabetes insipidus for the supraorbital keyhole approach was significantly lower （25.2%） than that for the unilateral subfrontal approach （25.7%） （P =0.002）. While the incidence rate on hypopituitarism was significandy higher for supraorbital approach （17.1%） than the unilateral subfrontal approach （ 13.0% ） （ P = 0. 039 ）. No significant difference hasbeen found in the incidence of electrolyte imbalance, epileptic seizure, cerebrospinal fluid leak, mortality, and recurrence after surgery. Conclusion The surgical effect of supraorbital keyhole approach is similar with that of unilateral subfrontal approach for the small and middle tumors at sellar region in the similar diameter. The recovery effect and cosmetic result are good. The length of hospital stay is shorter. The application prospect of this approach would be wider by combining with endoscopy and neuronavigation.