目的评价预防性手术治疗儿童无症状脂肪瘤型脊髓拴系的风险和意义。方法在PubMed、Embase、Scopus、Web of Science、Cochrane databases数据库中检索手术治疗和单纯随访的儿童无症状脂肪瘤型脊髓拴系的相关研究，采用RevMan5．3和R软件对数据进行合并分析。结果共纳入5篇非随机临床对照试验的文献，合计403例患者，总随访时间为4．4～10．0年。其中单纯随访组124例，发生神经功能障碍者32例（25．8％）；手术组279例，发生神经功能障碍者30例（10．8％），差异有统计学意义（P=0．05）。同时检索到9篇单纯手术的文献（278例）和1篇观察自然史的文献（56例）。合并统计单纯手术的9篇文献，采用随机效应模型计算术后神经功能障碍的发生率为10．0％，与随访组的28．6％（16／56）比较，差异有统计学意义（P〈0．01）。结论对于儿童无症状脂肪瘤型脊髓拴系，目前有限的文献资料支持预防性手术可以使患儿获益，今后尚需要更大样本的循证医学证据。
Objective: To study the relationship between histopathology and clinical prognosis of invasive pituitary adenoma subjected to transsphenoidal surgery. Methods: The enrolled were 82 patients with invasive pituitary adenomas undergoing transsphenoidal surgery during Jan. 2000 - May 2003 in our department with full MR imaging findings, pathology data and follow-up information. The follow-up duration was 5-30 months. Results: MR imaging findings of invasive pituitary adenoma included: depression of the sellar floor, involvement of sphenoid sinus and cavernous sinus, breakthrough of diaphragma sellae, encasement of internal carotid artery, etc. Pathological examination revealed that the invasion rate of dura in sella turcica was the highest among the structures around tumor. Pituitary adenoma apoplexy was found in 20 cases (24.4%). The total removal rate for PRL-secreting adenomas was significantly lower than that for non-secreting adenomas (P<0.01), but non-, GH-, ACTH-secreting adenomas had no significant differences. The recurrence rate of PRL-secreting adenomas was higher than that of non- and GH-secreting adenomas (P<0.05). Conclusion: Among invasive pituitary adenomas, the therapeutic effects of non-and GH-secreting pituitary adenomas are better than that of PRL-secreting adenomas. Invasive biological behaviors of invasive pituitary adenomas result in radical operation failure and postoperative recurrence.
