经鼻蝶窦显微镜下和神经内镜下切除垂体腺瘤的国外经验荟萃分析

Transnaso-sphenoidal microsurgery and neuroendoscopic resection of pituitary adenoma： a meta- analysis of foreign experiences

目的评价经鼻蝶窦显微镜下和神经内镜下垂体腺瘤切除术的临床疗效。方法通过检索PubMed、WebofScience、Embase、Cochrane Library等数据库，搜集所有报道神经内镜和显微镜下手术治疗垂体腺瘤的随机对照试验或病例对照研究的英文文献，采用ReviewManager5．3软件对数据进行荟萃分析。结果经过筛选共纳入22篇文献。研究对象共计1987例患者，其中内镜组1000例，显微镜组987例。全切除率方面，采用固定效应模型合并OR值为1．62（95％CI：1．21，2．17，P=0．001）；而在术后并发症方面，脑脊液漏、尿崩症、脑膜炎、鼻腔并发症两组差异均无统计学意义（均P〉0.05）。两组术后住院时间神经内镜组较显微镜组短（P〈0．05），而手术时间两组差异无统计学意义（P〉0.05）。结论根据目前已有的文献，经蝶窦神经内镜下垂体腺瘤切除术的全切除率要显著高于经鼻蝶窦显微手术。虽然在术后并发症、手术时间方面两者无明显差别，但在缩短术后住院时间方面神经内镜存在一定优势。

Objective To evaluate the clinical efficacy of transnaso-sphenoidal microsurgery and neuroendoscopic resection of pituitary adenoma. Methods All the English literature about the randomized controlled trials or case-control studies reporting neuroendoscopy and treatment of pituitary adenoma under the microscope were collected by searching the database, including PubMed, Web of Science, Embase, and the Cochrane Library. The data were used to conduct recta-analysis using Review Manager 5. 3 software. Results A total of 22 literatures were enrolled after screening. A total of 1 987 patients were studied, including 1 000 in a neuroendoscope group and 987 in a microscope group. In terms of total resection rate, the combined odds ratio using the fixed effect model was 1.62 （95% CI 1.21 -2 17, P =0.1301 ）; and in terms of postoperative complications, there were no significant differences in cerebrospinal fluid leakage, diabetes insipidus, meningitis, nasal complications between the two groups （all P 〉0. 05）. The postoperative hospital stay of the neuroendoscope group was shorter than that of the microscope group （P 〈 0. 05）, and there was no significant difference in operation time between the two groups （P 〉 0. 05）. Conclusions According to the literature available, the total resection rate of neuroendoscopic transnaso-sphenoidal resection of pituitary adenoma was significantly higher than that of transnasal sphenoidal microsurgery. There was no significant difference between the postoperative complications and the operation time, but neuroendoscopy had some advantages for shortening the hospitalization time after procedure.