内镜颅底手术后的嗅觉结果：系统评价和荟萃分析。
Olfactory outcomes after endoscopic skull base surgery: A systematic review and meta-analysis.
机构信息
Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota, U.S.A.
Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, U.S.A.
出版信息
Laryngoscope. 2019 Sep;129(9):1998-2007. doi: 10.1002/lary.28003. Epub 2019 Apr 29.
OBJECTIVES
Determine the effect of endoscopic skull base surgery (ESBS) on long-term olfactory outcomes after surgery.
METHODS
An English-language search was conducted using the Cochrane, MEDLINE, Scopus, and Embase databases from January 2000 to October 2017 for adult patients undergoing ESBS with subjective and objective olfaction outcomes. Two authors independently examined articles to identify those meeting inclusion criteria. Studies examining objective olfactory outcomes after ESBS were included in the meta-analysis. A random-effects meta-analysis of patients undergoing sellar and parasellar ESBS was conducted to compare preoperative and postoperative olfactory outcomes using the University of Pennsylvania Smell Identification Test (UPSIT) and Cross-Cultural Smell Identification Test (CCSIT).
RESULTS
Among 339 eligible articles, 29 articles met inclusion criteria. Twenty-five of these focused on sellar and parasellar tumors. Individual articles not meeting criteria for meta-analysis were qualitatively reported. Meta-analysis showed there was no difference in preoperative and postoperative olfactory function after sellar and parasellar ESBS based on the UPSIT (five studies, mean difference [MD] = -1.03; 95% CI: -3.98, 1.93; P = .50) and the CCIST (three studies, MD = -0.77; 95% CI: -3.03, 1.49; P = .50). A pooled overall meta-analysis revealed similar results (eight studies, effect size = -0.30; 95% CI: -0.79, 0.18; P = .22). However, heterogeneity for all meta-analyses was high (I > 95%, P < .01), suggesting significant variation in the included studies.
CONCLUSIONS
Based on published objective olfaction outcomes after sellar and parasellar ESBS, there was no significant difference between preoperative and postoperative olfaction. Further prospective studies using validated objective measures of olfaction are required to improve our understanding on this subject.
LEVEL OF EVIDENCE
2a Laryngoscope, 129:1998-2007, 2019.
目的
确定内镜颅底手术（ESBS）对术后长期嗅觉结果的影响。
方法
对 2000 年 1 月至 2017 年 10 月期间 Cochrane、MEDLINE、Scopus 和 Embase 数据库中的英文文献进行了检索，纳入接受 ESBS 并具有主观和客观嗅觉结果的成年患者的研究。两位作者独立检查文章，以确定符合纳入标准的文章。纳入研究 ESBS 后客观嗅觉结果的meta 分析。采用宾夕法尼亚大学嗅觉识别测试（UPSIT）和跨文化嗅觉识别测试（CCSIT）对接受鞍区和鞍旁 ESBS 的患者进行随机效应 meta 分析，比较术前和术后嗅觉结果。
结果
在 339 篇合格文章中，有 29 篇文章符合纳入标准。其中 25 篇集中于鞍区和鞍旁肿瘤。个别不符合 meta 分析标准的文章进行了定性报道。meta 分析显示，基于 UPSIT（5 项研究，平均差值 [MD] = -1.03；95%置信区间：-3.98，1.93；P =.50）和 CCSIT（3 项研究，MD = -0.77；95%置信区间：-3.03，1.49；P =.50），鞍区和鞍旁 ESBS 前后嗅觉功能无差异。总体汇总 meta 分析显示结果相似（8 项研究，效应大小 = -0.30；95%置信区间：-0.79，0.18；P =.22）。然而，所有 meta 分析的异质性均较高（I > 95%，P <.01），提示纳入研究之间存在显著差异。
结论
基于发表的鞍区和鞍旁 ESBS 术后客观嗅觉结果，术前和术后嗅觉无显著差异。需要进一步使用经过验证的嗅觉客观测量方法进行前瞻性研究，以提高我们对这一主题的理解。
证据水平
2a 级喉镜，129：1998-2007，2019。
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