鼻内镜与显微镜下切除垂体瘤的安全性和疗效分析  

Endoscopic transsphenoidal surgery versus microsurgery for the resection of pituitary adenomas：a systematic review

作　　者：祝梅杰 杨见明[1] 王雅堂[1] 曹卫[1] 朱永军[1] 邱录斌[1] 陶冶[1] 徐艳[1] 许海燕[1] 

机构地区：[1]安徽医科大学第二附属医院耳鼻咽喉头颈外科,合肥230601

出　　处：《中华耳鼻咽喉头颈外科杂志》2014年第3期236-239,共4页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

基　　金：基金项目：安徽省科技厅重点课题（12070403060）

摘　　要：目的 评价鼻内镜与显微镜下切除垂体瘤的安全性和疗效.方法 选取发表于2000年1月至2013年7月对比分析鼻内镜下与显微镜下切除垂体瘤随机或半随机对照试验研究,应用RevMan 5.1软件的Meta分析方法评价完全切除率及并发症等相关结局指标.结果 共有12篇随机或半随机对照研究纳入分析,包括848例患者,其中鼻内镜组380例,显微镜组468例.纳入文献的基本特征分析结果提示：除鼻内镜组随访时间明显短于显微镜组（OR=-2.29,95％ CI为-4.18～-0.39,P=0.02）外,其余如性别比、年龄分布等方面差异均无统计学意义（P值均＞0.05）.鼻内镜组与显微镜组相比,肿瘤完全切除率较高（OR=0.61,95％CI为0.39 ～0.96,P=0.03）,尿崩症发生率（OR=0.45,95％CI为0.30 ～0.66,P＜0.0001）及其他并发症的发生率（OR=0.26,95％ CI为0.12～0.57,P=0.0008）明显降低,手术期间失血量较少（OR=-0.62,95％ CI为-1.19～0.05,P=0.03）,住院时间（OR=-1.53,95％ CI为-2.18～-0.88,P＜0.00001）明显缩短.而两组间手术时间、脑脊液漏发生率及视力改善率差异均无统计学意义.结论 相比于显微镜,鼻内镜更适用于垂体瘤切除术.Objective To evaluate the efficacy and safety between endoscopic and microscopic surgery for transsphenoidal pituitary adenoma.Methods Randomized or semi-random controlled trials comparing endoscopic with microscopic surgery for transsphenoidal pituitary adenoma and published between January 2000 and July 2013 were recruited.This meta-analysis （RevMan 5.1 software） was conducted to estimate short-term and long-term complications.Fixed random effect model or semi-random effect model was established to analyse the data.Results Twelve randomized or semi-random controlled trials were included in this study.Among 848 patients studied,380 of them were treated with endoscopic and 468 were treated with microscopic.The analysis of the basic characteristics of these patients included in these studies showed that：compared with microscopic,the follow-up of patients in endoscopic group was shorter [OR =-2.29,95% CI（-4.18,-0.39）,P =0.02],while there were no significant difference in gender proportion and the age of patients between the two groups （P 〉 0.05）.Also,compared with endoscopic,there was a significant addition in the incidence of diabetes insipidus [OR =0.45,95% CI（0.30,0.66）,P 〈0.0001] and other complications [OR =0.26,95% CI（0.12,0.57）,P =0.0008] in the microscopic group,the blood loss during surgery was more [OR =-0.62,95% CI（-1.19,0.05）,P =0.03],the rate of complete tumor resection lower [OR =O.61,95% CI（0.39,0.96）,P =0.03],and the hospitalization [OR =-1.53,95% CI（-2.18,-0.88）,P 〈 0.00001] was also significantly longer,there was no significant difference in the incidence of cerebrospinal fluid leakage,operation time and vision improvement rate （P 〉 0.05）.Conclusion For patients with pituitary tumors,endoscopic surgery may be more suitable compared with microscopic.

关 键 词：垂体肿瘤 Meta分析 内窥镜检查 耳鼻喉外科手术 显微外科手术 

分 类 号：R736.4[医药卫生—肿瘤]