Wen Guodao, Tang Chao, Zhong Chunyu, Li Xiang, Li Junyang, Li Liwen, Yang Youqing, Ma Chiyuan
Department of Neurosurgery, Jinling Hospital, School of Medicine, Nanjing University, 305 East Zhongshan Road, Nanjing, 210002, China.
School of Medicine, Nanjing Medical University, 104 Hanzhong Road, Nanjing, 210002, China.
PLoS One. 2016 Apr 28;11(4):e0153397. doi: 10.1371/journal.pone.0153397. eCollection 2016.
Over the past several decades, the endoscopic endonasal transsphenoidal approach (EETA) has gradually become a preferred option of pituitary adenomas surgery because of its minimal invasiveness and high efficiency. However, some EETA operations were performed through one nostril (mononostril), while other EETA operations were performed through both nostrils (binostril). Therefore, we conducted this study to compare the pros and cons of these two methods in an attempted to confirm which method is more effective.
We executed a systematic literature search of PubMed, the Cochrane Library, and the Web of Science and Medline (1992-2015). The language is limited to English and all studies should meet the inclusion criteria. Comparisons were made for postoperative outcomes, complications, and other relevant parameters between the mononostril and the binostril group. Statistical analyses of categorical variables were undertaken by the use of Stata 12.0 and SPASS 19.0.
Thirty studies, involving 4805 patients, were included. The two groups had similar results in GTR rate (included GTR rate of macroadenomas), hormonal remission rate, improvement in visual function, postoperative CSF leak, permanent diabetes insipidus, meningitis, and sinusitis. The binostril group had less temporary diabetes insipidus (2.9% vs. 5.3%, p = 0.022), less anterior pituitary insufficiency (2.3% vs. 6.4%, p = 0.000) and few hospitalization days (3.2 days vs. 4.4 days, p<0.05) than the mononostril group. However, the mononostril group had less rate of epistaxis (0.4% vs. 1.5%, p = 0.008) than the binostril group. For invasive macroadenomas, the binostril group seem to demonstrate a tendency towards better outcomes though there was no subgroup analysis between the two groups.
The binostril approach had less temporary diabetes insipidus, anterior pituitary insufficiency, and a shorter length of hospital stay, although they demonstrated a higher rate of epistaxis than the mononstril group. Additionally, the binostril group seemed to suggest a tendency towards better outcomes for invasive macroadenomas.
在过去几十年中，鼻内镜经鼻蝶窦入路（EETA）因其微创性和高效性，逐渐成为垂体腺瘤手术的首选方式。然而，一些EETA手术是通过单鼻孔（单鼻孔入路）进行的，而其他EETA手术则是通过双鼻孔（双鼻孔入路）进行的。因此，我们开展本研究以比较这两种方法的优缺点，试图确定哪种方法更有效。
我们对PubMed、Cochrane图书馆、科学网和Medline（1992 - 2015年）进行了系统的文献检索。语言限于英文，所有研究均应符合纳入标准。对单鼻孔组和双鼻孔组的术后结果、并发症及其他相关参数进行比较。分类变量的统计分析使用Stata 12.0和SPASS 19.0进行。
纳入30项研究，涉及4805例患者。两组在肿瘤全切除率（包括大腺瘤的肿瘤全切除率）、激素缓解率、视力功能改善、术后脑脊液漏、永久性尿崩症、脑膜炎和鼻窦炎方面结果相似。双鼻孔组的暂时性尿崩症发生率较低（2.9%对5.3%，p = 0.022），垂体前叶功能减退发生率较低（2.3%对6.4%，p = 0.000），住院天数较少（3.2天对4.4天，p<0.05），均低于单鼻孔组。然而，单鼻孔组的鼻出血发生率低于双鼻孔组（0.4%对1.5%，p = 0.008）。对于侵袭性大腺瘤，双鼻孔组似乎显示出更好结果的趋势，尽管两组间未进行亚组分析。
双鼻孔入路的暂时性尿崩症、垂体前叶功能减退发生率较低，住院时间较短，尽管其鼻出血发生率高于单鼻孔组。此外，双鼻孔组对于侵袭性大腺瘤似乎显示出更好结果的趋势。
