Xia Kailai, Peng Jihong, Zhou Yunhao, Liu Xiaoqing, Chen Hongyu, Xu Haiyang, Wang Shuangji, Deng Aini, Tang Hua, Hu Jinyang
Department of Neurosurgery, The First College of Clinical Medical Science, Three Gorges University & Yichang Central People's Hospital, Yichang, Hubei, China.
College of Basic Medical Sciences, China Three Gorges University, Yichang, Hubei, China.
Front Surg. 2025 Jun 4;12:1579498. doi: 10.3389/fsurg.2025.1579498. eCollection 2025.
The challenge in treating pituitary apoplexy lies in choosing between conservative management and surgical intervention, with a current lack of high-level medical evidence to guide the selection of treatment options. This study compares the recovery rates of typical clinical manifestations following surgical and conservative treatments, aiming to provide evidence-based medical support for clinical treatment decisions.
Relevant literature published between 1991 and 2024 was searched using PubMed, Embase, Cochrane Libraries, and CNKI. After a rigorous screening process to apply the inclusion and exclusion criteria, the primary clinical observation indicators were carefully extracted. The recovery rates of the main clinical observation indicators were evaluated using Reman v5.3. A fixed-effects model was employed to determine the merged odds ratio (OR) values, utilizing the Mantel-Haenszel estimation method. Publication bias was assessed using a funnel plot. Heterogeneity between studies was analyzed with the Cochran Q (Chi-square) test and I² statistics.
The meta-analysis results indicated that surgical treatment significantly improved recovery from ocular muscle paralysis compared to conservative treatment (OR: 0.31; 95% CI 0.10-0.92; = 0.04). However, no statistically significant differences were observed in postoperative recovery of visual acuity (OR: 1.15; 95% CI 0.54-2.44; = 0.72), visual field recovery (OR: 1.48; 95% CI 0.77-2.82; = 0.24), or pituitary endocrine function (OR: 0.67; 95% CI 0.27-1.67; = 0.38).
Our research findings suggest that patients with pituitary apoplexy presenting with ocular palsy may benefit more from surgical treatment.
垂体卒中治疗的挑战在于在保守治疗和手术干预之间做出选择，目前缺乏高级别医学证据来指导治疗方案的选择。本研究比较手术和保守治疗后典型临床表现的恢复率，旨在为临床治疗决策提供循证医学支持。
使用PubMed、Embase、Cochrane图书馆和中国知网检索1991年至2024年期间发表的相关文献。经过严格的筛选过程以应用纳入和排除标准后，仔细提取主要临床观察指标。使用RevMan v5.3评估主要临床观察指标的恢复率。采用固定效应模型，利用Mantel-Haenszel估计方法确定合并比值比（OR）值。使用漏斗图评估发表偏倚。采用Cochran Q（卡方）检验和I²统计量分析研究间的异质性。
荟萃分析结果表明，与保守治疗相比，手术治疗显著提高了眼肌麻痹的恢复率（OR：0.31；95%CI 0.10 - 0.92；P = 0.04）。然而，在视力术后恢复（OR：1.15；95%CI 0.54 - 2.44；P = 0.72）、视野恢复（OR：1.48；95%CI 0.77 - 2.82；P = 0.24）或垂体内分泌功能（OR：0.67；95%CI 0.27 - 1.67；P = 0.38）方面未观察到统计学显著差异。
我们的研究结果表明，患有眼肌麻痹的垂体卒中患者可能从手术治疗中获益更多。
