Tabaee Abtin, Anand Vijay K, Barrón Yolanda, Hiltzik David H, Brown Seth M, Kacker Ashutosh, Mazumdar Madhu, Schwartz Theodore H
Department of Otolaryngology, New York Presbyterian Hospital-Weill Medical College of Cornell University, New York, NY 10003, USA.
J Neurosurg. 2009 Sep;111(3):545-54. doi: 10.3171/2007.12.17635.
Surgery on the pituitary gland is increasingly being performed through an endoscopic approach. However, there is little published data on its safety and relative advantages over traditional microscope-based approaches. Published reports are limited by small sample size and nonrandomized study design. A meta-analysis allows for a description of the impact of endoscopic surgery on short-term outcomes.
The authors performed retrospective review of data from their institution as well as a systematic review of the literature. The pooled data were analyzed for descriptive statistics on short-term outcomes.
Nine studies (821 patients) met inclusion criteria. Overall, the pooled rate of gross tumor removal was 78% (95% CI 67-89%). Hormone resolution was achieved in 81% (95% CI 71-91%) of adrenocorticotropic hormone secreting tumors, 84% (95% CI 76-92%) of growth hormone secreting tumors, and 82% (95% CI 70-94%) of prolactin secreting tumors. The pooled complication rates were 2% (95% CI 0-4%) for CSF leak and 1% (95% CI 0-2%) for permanent diabetes insipidus. There were 2 deaths reported in the literature that were both related to vascular injury, giving an overall mortality rate of 0.24%.
The results of this meta-analysis support the safety and short-term efficacy of endoscopic pituitary surgery. Future studies with long-term follow-up are required to determine tumor control.
垂体手术越来越多地通过内镜入路进行。然而，关于其安全性以及相对于传统显微镜入路的相对优势，发表的数据很少。已发表的报告受到样本量小和非随机研究设计的限制。荟萃分析有助于描述内镜手术对短期结局的影响。
作者对其机构的数据进行了回顾性分析，并对文献进行了系统回顾。对汇总数据进行分析，以获取短期结局的描述性统计信息。
9项研究（821例患者）符合纳入标准。总体而言，肿瘤全切率的合并率为78%（95%置信区间67-89%）。促肾上腺皮质激素分泌型肿瘤的激素缓解率为81%（95%置信区间71-91%），生长激素分泌型肿瘤为84%（95%置信区间76-92%），泌乳素分泌型肿瘤为82%（95%置信区间70-94%）。脑脊液漏的合并并发症发生率为2%（95%置信区间0-4%），永久性尿崩症为1%（95%置信区间0-2%）。文献报道有2例死亡均与血管损伤有关，总死亡率为0.24%。
该荟萃分析的结果支持内镜垂体手术的安全性和短期疗效。需要进行长期随访的进一步研究来确定肿瘤控制情况。
