颅咽管瘤手术中牺牲垂体柄是否合理?系统回顾与元分析》。

IF 3.9 2区 医学 Q1 CLINICAL NEUROLOGY
Mohammad Elbaroody,Mohamed Dokhan,Andrea Kassay,Ahmed A M Ezzat,Ahmed A Marei,Amr Helmy Eldessouky,Basem Ismail Alhayen,Muhammad Algabrouny,Adham Ezz,Mohamed F Alsawy,Ehab El Refaee,Mohamed A R Soliman
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引用次数: 0

摘要

背景和目的垂体柄牺牲是颅咽管瘤手术中的一个两难选择,需要做出明智的决定。据作者所知,这是第一项对现有文献进行荟萃分析的研究,以评估在颅咽管瘤手术中保留垂体柄是否值得,或者牺牲垂体柄是否合理。方法检索了截至 2021 年 12 月的颅咽管瘤研究,这些研究直接比较了牺牲垂体柄与保留垂体柄给患者带来的内分泌后遗症。通过固定效应和随机效应模型,使用了带有 95% CI 的比值比 (OR)。925例患者(44.6%)保留了茎突,1053例患者(50.8%)牺牲了茎突,96例患者(4.6%)术中未确定或部分保留了茎突,或作者未提及足够的数据。我们的研究发现,牺牲垂体柄与最后一次随访时出现内分泌功能障碍的风险显著增加有关(OR = 6.69,95% CI = 3.36-13.35,P < .0001);但与疾病复发/进展风险的显著降低无关(OR = 0.80,95% CI = 0.60-1.06,P = .13)。结论垂体柄牺牲会显著增加术后内分泌功能障碍的风险,而不会降低颅咽管瘤进展或复发的风险。术中保留垂体柄的能力受多种因素影响,建议尽可能保留垂体柄。建议今后开展前瞻性研究,以评估混杂因素对牺牲/保留柄的结果的影响。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Is It Justified to Sacrifice the Pituitary Stalk During Craniopharyngioma Surgery? A Systematic Review and Meta-Analysis.
BACKGROUND AND OBJECTIVES Pituitary stalk sacrifice is a surgical dilemma in craniopharyngioma surgery that needs a wise decision. To the authors' knowledge, this is the first study to conduct a meta-analysis of the current literature to assess if it is worth preserving the stalk during craniopharyngioma surgery or it is justified to sacrifice it. METHODS PubMed, Web of Science, and Embase databases were searched for craniopharyngioma studies till December 2021 that directly compared the endocrine sequelae of stalk sacrifice vs preservation in their patients. Odds ratio (OR) with 95% CI was used through fixed- and random-effects models. RESULTS Fourteen studies with a total of 2074 patients met our inclusion criteria. The stalk was preserved in 925 patients (44.6%), was sacrificed in 1053 patients (50.8%), and was not identified intraoperatively or partially preserved, or the authors did not mention enough data for 96 patients (4.6%). Our study found that sacrifice of the pituitary stalk was associated with a significantly increased risk of endocrine dysfunction at the last follow-up (OR = 6.69, 95% CI = 3.36-13.35, P < .0001); however, it was not associated with a significant decrease in the risk of recurrence/progression of the disease (OR = 0.80, 95% CI = 0.60-1.06, P = .13). CONCLUSION Pituitary stalk sacrifice significantly increased the risk of postoperative endocrine dysfunction without reducing the risk of progression or recurrence of craniopharyngioma. The ability to preserve the pituitary stalk intraoperatively is multifactorial, and stalk preservation is recommended whenever possible. Future prospective studies are recommended to assess the effect of confounding factors on the outcomes of stalk sacrifice/preservation.
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来源期刊
Neurosurgery
Neurosurgery 医学-临床神经学
CiteScore
8.20
自引率
6.20%
发文量
898
审稿时长
2-4 weeks
期刊介绍: Neurosurgery, the official journal of the Congress of Neurological Surgeons, publishes research on clinical and experimental neurosurgery covering the very latest developments in science, technology, and medicine. For professionals aware of the rapid pace of developments in the field, this journal is nothing short of indispensable as the most complete window on the contemporary field of neurosurgery. Neurosurgery is the fastest-growing journal in the field, with a worldwide reputation for reliable coverage delivered with a fresh and dynamic outlook.
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