神经内镜与显微镜下经鼻蝶入路手术切除无功能性垂体腺瘤疗效和安全性的Meta分析

Curative effects of endoscopic and microscopic transsphenoidal surgeries on non-functioning pituitary adenomas and their safety: a Meta analysis

目的系统评价神经内镜与显微镜下经鼻蝶入路手术切除无功能性垂体腺瘤的疗效和安全性。方法计算机检索PubMed、Embase、Cochrane Center、中国生物医学文献数据库、维普中文科技期刊全文数据库、万方数据库、中国知网等中英文数据库有关神经内镜、显微镜下经鼻蝶入路无功能性垂体腺瘤切除术的文献,时限为2018年7月之前。指标包括肿瘤切除率、脑脊液渗漏发生率和视力恢复率。结果共纳入19篇文献,2 383例。Meta分析结果:神经内镜手术全切除率比显微镜手术要高(75%vs 62%,P<0.001),神经内镜组视力恢复率也高于显微镜组(82%vs 59%,P<0.001)。两组脑脊液漏发生率无统计学差异(4%vs 6%,P=0.078)。结论与显微镜下手术相比,神经内镜手术切除无功能性垂体腺瘤的疗效更好。

Objective To evaluate the curative effects of endoscopic and microscopic transsphenoidal surgeries on non-functional pituitary adenomas (NFPA)and their safety. Methods The data bases including PubMed, Embase, Cochrane center, WanFang, VIP and CNKI were searched for the studies of curative effects of microscopic and endoscopic transsphenoidal surgeries on non-functioning pituitary adenomas and their safety published before July, 2018. Meta- analysis of their curative effects and safety was performed. Results Of 19 eligible studies involving 2383 patients derived from the above- mentioned data bases, 5 were double arm studies including 1 randomized controlled trial and 4 retrospective studies and 14 were single arm studies. The rates of gross tumor resection and postoperative visual improvement were significantly higher in the endoscopic group than those in microscopic group (P<0.001). There was insignificant difference in the rate of occurrence of cerebrospinal fluid leakage between both the groups (P=0.078). Conclusions The clinical effect of the endoscopic transsphenoidal surgery on NFPA is significantly better than that of the microscopic transsphenoidal surgery, but they are similar in the rate of occurrence of postoperative cerebrospinal leakage.