Gasket-Seal技术在颅底肿瘤内镜手术颅底重建中应用的荟萃分析

目的 评价Gasket-Seal技术在颅底肿瘤内镜手术颅底重建中应用的效果.方法 在中外文文献数据库中检索2007年10月至2016年10月已发表的关于应用Gasket-Seal技术进行颅底肿瘤内镜手术颅底重建的病例对照研究.利用Review Manager(5.3版)软件进行荟萃分析.结果 按文献入选标准共纳入5篇病例对照研究,共210例颅底肿瘤内镜手术患者纳入荟萃研究.荟萃分析表明,与非GS组相比,GS组患者术后远期脑脊液漏发生率低(OR=0.32,95％CI=0.11～0.89,P=0.03),术后脑膜炎发生率低(OR=0.10,95％CI=0.01～0.67,P=0.02).根据GS组是否联合NSF进行亚组分析,结果表明两亚组术后远期脑脊液漏发生率间比较,差异无统计学意义(P=0.85).在GS组中,采用人工骨组与采用同种骨(包括自体骨和异体骨)组病例术后脑脊液漏发生率比较,差异无统计学意义(P=0.25).结论 应用Gasket-Seal技术能安全有效地完成颅底肿瘤内镜手术中的颅底重建.相较其他颅底重建方法,术后脑脊液漏及脑膜炎的发生率更低.

Meta-analysis of Gasket-Seal technique in endoscopic skull base reconstruction for skull base tumors

Objective To assess the efficacy of the Gasket-Seal technique in endoscopic skull base reconstruction in patients with skull base tumors. Method Correlated case control studies comparing Gasket-Seal technique (GS group) with other reconstruction techniques (non-GS group) in endoscopic skull base reconstruction were searched in literature databases. Review Manager (v5.3) was used for meta-analysis. Result 5 case control studies including 210 cases were selected for analysis in accordance with the enrollment criteria. The incidence of postoperative long-term CSF leakage (OR=0.32, 95％CI=0.11-0.89, P=0.03) and postoperative meningitis (OR=0.10, 95％CI=0.01-0.67, P=0.02) of GS group was lower compared with non-GS group. No significant inter-subgroup differences were observed in terms of the inci-dence of postoperative CSF leakage for both groups, according to subgroup analysis in light of combined with or without NSF in GS group (P=0.85). Patients receiving artificial bone or allogenic bone (e.g., autologous and allograft bone) were similar in regard of the CSF leakage (P=0.25). Conclusion The application of Gasket-seal technique may facilitate the completion of endoscopic skull base reconstruction, which is safe and effective compared with other reconstruction tech-niques, with lower incidence of postoperative cerebrospinal fluid leakage and postoperative meningitis.