开颅入路与神经内镜经鼻入路治疗颅咽管瘤效果的meta分析  

Meta-Analysis of the Efficacy of Open Transcranial Approach and Endoscopic Endonasal Approach for Craniopharyngiomas

作　　者：简历 杨建[1] 司东明[1] 徐可[1] 李鹏飞[1] JIAN Li;YANG Jian;SI Dongming;XU Ke;LI Pengfei(Neurosurgery Department,the First Affiliated Hospital of Henan Univerisity of Traditional Chinese Medicine,Zhengzhou 450000,China)

机构地区：[1]河南中医药大学第一附属医院神经外科,河南郑州450000

出　　处：《河南医学研究》2023年第1期31-37,共7页Henan Medical Research

摘　　要：目的 系统评价开颅入路(TCA)与神经内镜经鼻入路(EEA)治疗颅咽管瘤的效果。方法 通过电脑检索Cochrane Library、Embase、PubMed、中国知网、万方数据、维普网等中、英文数据库,时间从建库至2022年10月。选取包含TCA与EEA的临床研究,采用RevMan 5.3软件进行meta分析。结果 共纳入10项回顾性研究,共计519例患者,其中264例患者接受TCA手术治疗,255例(术后失访1例)接受EEA手术治疗。9项研究比较了TCA和EEA手术治疗颅咽管瘤的全切除率,meta分析结果显示EEA全切率更高(MD=0.45,95%CI:0.30~0.67,I2=82%,P<0.001);4项研究比较了手术操作时间、5项研究比较了住院时间,meta分析结果显示EEA可增加手术操作时间(MD=3.80, 95%CI:3.00~4.60,I2=58%,P<0.001)及住院时间(MD=25.52,95%CI:11.28~39.76,I2=0,P<0.001);9项研究比较了术后垂体功能减退,meta分析结果显示两者在垂体内分泌功能损害方面差异无统计学意义(OR=1.22,95%CI:0.77~1.92,I2=0,P=0.39);6项研究比较了新发永久性尿崩,meta分析结果显示EEA可降低永久性尿崩症的发生率(OR=2.09,95%CI:1.33~3.29,I2=0,P=0.001);9项研究比较了颅神经损伤,meta分析结果显示EEA可降低颅神经损伤发生率(OR=5.29,95%CI:2.39~11.71,I2=0,P<0.001);10项研究比较了脑脊液漏,meta分析结果EEA显示可增加脑脊液漏发生率(OR=0.13,95%CI:0.05~0.34,I2=0,P<0.001)。结论 EEA切除颅咽管瘤可提高肿瘤全切率,降低尿崩症、颅神经损伤发生率,但同时增加了脑脊液漏发生率,延长了手术时间及住院时间。Objective To systematically evaluate the efficiency of the open transcranial approach(TCA) versus endoscopic endonasal approach(EEA)in the treatment of craniopharyngiomas.Methods The current work performed a comprehensive search of the Chinese and English databases, including Cochrane Library, Embase, PubMed, CNKI, Wanfang Data and Weipu from the establishment of the databases to October 2022.Results A total of 10 retrospective studies, involving 519 patients [264 treated with TCA, and 255 with EEA(1 lost to follow-up)] were included. The rate of gross total resection of TCA and EEA surgery for craniopharyngiomas was compared in nine studies. Meta-analysis results showed that the rate of gross total resection by EEA was higher(OR=0.45, 95% CI: 0.30-0.67, I~2=82%, P<0.001). The comparison of operation time was made in four and length of hospitalization in five. The EEA surgery increased the operation time(MD=3.80, 95% CI: 3.00-4.60, I~2=58%, P<0.001), and length of stay(MD=25.52, 95% CI:11.28-39.76, I~2=0, P<0.001). The comparison of postoperative hypopituitarism in nine studies showed no significant difference in pituitary endocrine function impairment(OR=1.22, 95% CI: 0.77-1.92, I~2=0, P=0.39). The comparison of the new permanent diabetes insipidus in six studies showed that the EEA cohort had a lower incidence of permanent diabetes insipidus(OR=2.09, 95% CI:1.33-3.29, I~2=0, P=0.001). Meanwhile, EEA surgery reduced the incidence of cranial nerve injury(OR=5.29, 95% CI:2.39-11.71, I~2=0, P<0.001) in nine studies. As for the comparison of cerebrospinal fluid leakage in all 10 studies, the EEA cohort had a greater incidence of cerebrospinal fluid leakage(OR=0.13, 95% CI: 0.05-0.34, I~2=0, P<0.001).Conclusion The EEA surgery of craniopharyngioma significantly has a greater rate of gross total resection, and lower incidence of diabetes insipidus and cranial nerve injury, but a greater incidence of cerebrospinal fluid leakage, longer operation time and hospital stay.

关 键 词：开颅入路 神经内镜经鼻入路 颅咽管瘤 疗效 META分析 

分 类 号：R739.4[医药卫生—肿瘤]