欧洲罕见内分泌疾病参考网络（Endo-ERN）内垂体腺瘤手术结果的基准评估与报告的起点：一项荟萃分析和调查研究的结果
Starting point for benchmarking outcomes and reporting of pituitary adenoma surgery within the European Reference Network on Rare Endocrine Conditions (Endo-ERN): results from a meta-analysis and survey study.
作者信息
Zamanipoor Najafabadi Amir H, van der Meulen Merel, Priego Zurita Ana Luisa, Faisal Ahmed S, van Furth Wouter R, Charmandari Evangelia, Hiort Olaf, Pereira Alberto M, Dattani Mehul, Vitali Diana, de Graaf Johan P, Biermasz Nienke R
机构信息
Department of Ophthalmology, Leiden University Medical Center, Leiden, The Netherlands.
Department of Medicine, Division of Endocrinology and Centre for Endocrine Tumors, Leiden University Medical Centre, Leiden, The Netherlands.
出版信息
Endocr Connect. 2022 Dec 13;12(1). doi: 10.1530/EC-22-0349. Print 2023 Jan 1.
OBJECTIVE
The European Reference Network on Rare Endocrine Conditions (Endo-ERN) aims to organize high-quality healthcare throughout Europe, including care for pituitary adenoma patients. As surgery is the mainstay of treatment, we aimed to describe the current surgical practice and published surgical outcomes of pituitary adenoma within Endo-ERN.
DESIGN AND METHODS
Systematic review and meta-analysis of studies reporting surgical outcomes of pituitary adenoma patients within Endo-ERN MTG6 pituitary reference centers between 2010 and 2019. A survey was completed by reference centers on their current surgical practice.
RESULTS
A total of 18 out of 43 (42%) reference centers located in 7 of the 20 (35%) MTG6-represented countries published 48 articles. Remission rates were 50% (95% CI: 42-59) for patients with acromegaly, 68% (95% CI: 60-75) for Cushing's disease, and 53% (95% CI: 39-66%) for prolactinoma. Gross total resection was achieved in 49% (95% CI: 37-61%) of patients and visual improvement in 78% (95% CI: 68-87). Mortality, hemorrhage, and carotid injury occurred in less than 1% of patients. New-onset hypopituitarism occurred in 16% (95% CI: 11-23), transient diabetes insipidus in 12% (95% CI: 6-21), permanent diabetes insipidus in 4% (95% CI: 3-6), syndrome of inappropriate secretion of antidiuretic hormone (SIADH) in 9% (95% CI: 5-14), severe epistaxis in 2% (95% CI: 0-4), and cerebrospinal fluid leak in 4% (95% CI: 2-6). Thirty-five (81%) centers completed the survey: 54% were operated endoscopically and 57% were together with an ENT surgeon.
CONCLUSION
The results of this study could be used as a first benchmark for the outcomes of pituitary adenoma surgery within Endo-ERN. However, the heterogeneity between studies in the reporting of outcomes hampers comparability and warrants outcome collection through registries.
目的
欧洲罕见内分泌疾病参考网络（Endo-ERN）旨在在全欧洲组织高质量医疗保健，包括垂体腺瘤患者的护理。由于手术是主要治疗手段，我们旨在描述Endo-ERN内垂体腺瘤的当前手术实践及已发表的手术结果。
设计与方法
对2010年至2019年间Endo-ERN MTG6垂体参考中心报告垂体腺瘤患者手术结果的研究进行系统评价和荟萃分析。参考中心完成了一项关于其当前手术实践的调查。
结果
在20个（35%）MTG6代表国家中的7个国家的43个（42%）参考中心中，共有18个中心发表了48篇文章。肢端肥大症患者的缓解率为50%（95%CI：42-59），库欣病患者为68%（95%CI：60-75），泌乳素瘤患者为53%（95%CI：39-66%）。49%（95%CI：37-61%）的患者实现了全切除，78%（95%CI：68-87）的患者视力得到改善。死亡率、出血和颈动脉损伤发生在不到1%的患者中。新发垂体功能减退发生在16%（95%CI：11-23）的患者中，短暂性尿崩症发生在12%（95%CI：6-21）的患者中，永久性尿崩症发生在4%（95%CI：3-6）的患者中，抗利尿激素不适当分泌综合征（SIADH）发生在9%（95%CI：5-14）的患者中，严重鼻出血发生在2%（95%CI：0-4）的患者中，脑脊液漏发生在4%（95%CI：2-6）的患者中。35个（81%）中心完成了调查：54%采用内镜手术，57%与耳鼻喉科医生联合手术。
结论
本研究结果可作为Endo-ERN内垂体腺瘤手术结果的首个基准。然而，研究结果报告的异质性妨碍了可比性，需要通过登记处收集结果。
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