Lee C-C, Huang C-C, Lee T-J, Wang Y-C, Liu Y-T, Chang T-W, Huang A P-H, Chuang C-C
Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taoyuan City, Taiwan; Department of Biomedical Engineering, National Taiwan University, Taipei City, Taiwan.
Division of Rhinology, Department of Otolaryngology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan City, Taiwan; Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan City, Taiwan.
Rhinology. 2022 Jun 1;60(3):177-187. doi: 10.4193/Rhin21.348.
Whether endoscopic surgery for sellar/parasellar disease causes significant deficits in olfactory function remains unclear. We aimed to systematically review the olfactory outcomes in such settings based on the evidence up to date.
PubMed, EMBASE, and CENTRAL were searched through February 1, 2021. Included studies were limited to endoscopic surgery for sellar/parasellar disease with follow-up olfactory function measured by standardized olfactory testing methods or subjective assessment. The primary outcome was the change in olfactory function after surgery assessed by standardized olfactory testing methods. The secondary outcome was the change in subjective olfactory function. Random-effects model was used in obtaining combine effects. Study quality was assessed using the Newcastleâ€"Ottawa scale. Sensitivity analysis was carried out using the leave-one-out approach, and publication bias was assessed using Egger's test.
The results show no significant difference in olfaction assessed by standardized olfactory testing methods at 1-3 months post-surgery (880 patients in 16 studies) or at 6-12 months post-surgery (1320 patients in 16 studies) compared to pre-surgery, whereas a significantly lower subjective olfaction at 3 months was observed. In addition, the lack of significant change in olfaction as assessed by standardized olfactory testing methods was observed regardless of whether patients were treated with or without the nasoseptal flap (NSF) harvesting. Heterogeneity and publication bias were observed, whereas sensitivity analysis showed the meta-analysis results are robust.
The findings of this updated systematic review and meta-analysis support the conclusion that endoscopic surgery for sellar and parasellar pathology may pose no greater risk of olfactory dysfunction. In addition, the current evidence does not support there is an increased risk of diminished olfaction among patients treated with NSF during surgery.
经鼻内镜手术治疗鞍区/鞍旁疾病是否会导致嗅觉功能显著减退尚不清楚。我们旨在根据最新证据，系统评价此类手术的嗅觉预后。
检索了截至2021年2月1日的PubMed、EMBASE和CENTRAL数据库。纳入的研究仅限于经鼻内镜手术治疗鞍区/鞍旁疾病，且采用标准化嗅觉测试方法或主观评估对嗅觉功能进行随访。主要结局是采用标准化嗅觉测试方法评估术后嗅觉功能的变化。次要结局是主观嗅觉功能的变化。采用随机效应模型合并效应量。使用纽卡斯尔-渥太华量表评估研究质量。采用逐一剔除法进行敏感性分析，并用Egger检验评估发表偏倚。
结果显示，与术前相比，术后1-3个月（16项研究中的880例患者）或术后6-12个月（16项研究中的1320例患者）采用标准化嗅觉测试方法评估的嗅觉无显著差异，而术后3个月主观嗅觉显著降低。此外，无论患者是否采用鼻中隔黏膜瓣（NSF）采集，采用标准化嗅觉测试方法评估的嗅觉均无显著变化。观察到存在异质性和发表偏倚，而敏感性分析表明荟萃分析结果具有稳健性。
本次更新的系统评价和荟萃分析结果支持以下结论：经鼻内镜手术治疗鞍区和鞍旁病变可能不会增加嗅觉功能障碍的风险。此外，目前的证据不支持手术中采用NSF治疗的患者嗅觉减退风险增加。
