■脑脊髓液(CSF)漏很常见,可能导致内镜下经蝶入路垂体腺瘤切除术后严重的并发症。然而,术后脑脊液漏的危险因素仍存在争议。本文对内镜下经鼻蝶入路垂体瘤切除术后脑脊液漏的危险因素进行系统评价。
■遵循PRISMA和AMSTAR指南来评估系统综述的方法学质量。PubMed,Medline,Embase,WebofScience,科克伦,临床路径,CNKI,CBM,万芳,我们在VIP数据库中搜索了所有关于术后脑脊液漏危险因素的研究.纳入研究的质量通过纽卡斯尔-渥太华量表进行评估。使用ReviewManager5.4软件计算具有统计学意义的潜在因素的合并效应大小。
■共纳入18篇文献中的6775例垂体腺瘤患者,术后脑脊液漏包含482例(占7.11%)。所有文章的质量评分均>5,表明质量良好。荟萃分析显示,较高的BMI水平会增加CSF泄漏的风险(MD=1.91,95%CI(0.86,2.96),较大的肿瘤大小[OR=4.93,95%CI(1.41,17.26)],更大的肿瘤侵袭(OR=3.01,95%CI(1.71,5.31),较硬的肿瘤质地[OR=2.65,95%CI(1.95,3.62)],术中脑脊液漏[OR=5.61,95%CI(3.53,8.90)],多次操作[OR=2.27,95%CI(1.60,3.23)]。
■BMI,多个操作,肿瘤大小,肿瘤侵袭,坚硬的质地,术中脑脊液漏是术后脑脊液漏的危险因素。临床医生应重视这些危险因素,并进行严格的颅底重建和仔细的术后管理。
Cerebro spinal fluid (CSF) leakage is common and might lead to severe postoperative complications after endoscopic transsphenoidal pituitary adenoma resection. However, the risk factors of postoperative CSF leakage are still controversial. This article presents a systematic
review to explore the explicit risk factors of CSF leakage after endoscopic transsphenoidal pituitary adenomere section.
PRISMA and AMSTAR guidelines were followed to assess the methodological quality of the systematic
review. PubMed, Medline, Embase, Web of Science, Cochrane, Clinical Trails, CNKI, CBM, Wan Fang, and VIP databases were searched for all studies on postoperative CSF leak risk factors. The quality of the included studies was assessed by the Newcastle-Ottawa scale.
Review Manager 5.4 software was used to calculate the pooled effect size of potential factors with statistical significance.
A total of 6775 patients with pituitary adenoma across 18 articles were included, containing 482 cases of postoperative CSF leakage (accounting for 7.11%). All of the articles had a quality score > 5, indicating good quality. Meta-analysis showed that an increased risk of CSF leak was found for higher levels of BMI (MD=1.91, 95% CI (0.86,2.96), bigger tumor size [OR=4.93, 95% CI (1.41,17.26)], greater tumor invasion (OR=3.01, 95% CI (1.71, 5.31), the harder texture of tumor [OR=2.65, 95% CI (1.95,3.62)], intraoperative cerebrospinal fluid leakage [OR=5.61, 95% CI (3.53,8.90)], multiple operations [OR=2.27, 95% CI (1.60,3.23)].
BMI, multiple operations, tumor size, tumor invasion, hard texture, and intraoperative cerebrospinal fluid leakage are the risk factors of postoperative CSF leakage. Clinical doctors should pay attention to these risk factors, and conduct strict skull base reconstruction and careful postoperative management.