目的:中心性尿崩症或加压素缺乏症(AVP-D)是经蝶窦手术(TSS)后最常见的水分平衡障碍,在研究中患病率不同。我们旨在确定使用TSS治疗的垂体肿瘤患者中新出现的短暂性或永久性AVP-D的发生率。
方法:我们对Medline,Embase和CochraneLibrary于2000/01-2021/01/01/31之间进行,用于报告垂体腺瘤结局的研究,TSS术后颅咽管瘤和Rathke裂隙囊肿(RCC),并提供术后AVP-D的定义。我们使用Freeman-Tukey转化随机效应荟萃分析将结果合并为具有95%置信区间(CI)的比例。
结果:来自11694项研究,包括51个。短暂性或永久性AVP-D的发生率为:全组的17%(95%CI,13-21)和3%(95%CI,2-5),16%(95%CI,12-21)和2%(95%CI,2-3)在垂体腺瘤,颅咽管瘤的31%(95%CI,24-39)和30%(95%CI,22-39),RCC中35%(95%CI,16-57)和14%(95%CI,6-23),分别。根据诊断标准,短暂性或永久性AVP-D的发生率为:低渗多尿,14%(95%CI,8-22)和3%(95%CI,1-4),低渗多尿和高钠血症,21%(95%CI,13-29)和5%(95%CI,2-11),去氨加压素给药,22%(95%CI,15-29)和9%(95%CI,0-30),分别。
结论:在TSS之后,一小部分垂体腺瘤患者具有永久性AVP-D(2%),但是颅咽管瘤的患病率达到30%,RCC的患病率达到14%。术后AVP-D的诊断标准仍然可变,影响报告的这种情况的发生率。
OBJECTIVE: Central diabetes insipidus or vasopressin deficiency (AVP-D) is the most frequent water balance disorder after transsphenoidal surgery (TSS) with variable prevalence amongst studies. We aimed to determine rates of newly-developed transient or permanent AVP-D in patients with pituitary tumours treated with TSS.
METHODS: We performed systematic review of Medline, Embase and Cochrane Library between 01/01/2000-31/01/2021 for studies reporting on outcomes for pituitary adenoma, craniopharyngioma and Rathke\'s cleft cyst (RCC) after TSS and providing definition of post-operative AVP-D. We pooled the results as proportions with 95% confidence intervals (CIs) using Freeman-Tukey transformation random effects meta-analysis.
RESULTS: From 11694 studies, 51 were included. Rates of transient or permanent AVP-D were: 17% (95% CI, 13-21) and 3% (95% CI, 2-5) in total group, 16% (95% CI, 12-21) and 2% (95% CI, 2-3) in pituitary adenomas, 31% (95% CI, 24-39) and 30% (95% CI, 22-39) in craniopharyngiomas, 35% (95% CI, 16-57) and 14% (95% CI, 6-23) in RCCs, respectively. Based on diagnostic criteria, rates of transient or permanent AVP-D were: for hypotonic polyuria, 14% (95% CI, 8-22) and 3% (95% CI, 1-4), for hypotonic polyuria and hypernatraemia, 21% (95% CI, 13-29) and 5% (95% CI, 2-11), for desmopressin administration, 22% (95% CI, 15-29) and 9% (95% CI, 0-30), respectively.
CONCLUSIONS: Following TSS, a small proportion of patients with pituitary adenoma have permanent AVP-D (2%), but prevalence reaches 30% in ones with craniopharyngioma and 14% in those with RCC. Diagnostic criteria for post-operative AVP-D remain variable affecting reported rates of this condition.