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组织密封剂对头骨底部重建结果的影响:系统性审查和元分析

Jonathan C Pang¹, Benjamin F Bitner¹, Madeline M Nottoli¹

¹Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Orange, California, U.S.A.

The Laryngoscope

|March 12, 2024

概括

组织密封剂在内镜骨底部手术 (ESBS) 后不会显著降低脑脊液 (CSF) 泄漏的风险. 需要进一步进行高质量的研究,以确定这些附加剂在头骨底部重建中的临床价值.

科学领域:

神经外科神经外科
耳鼻喉科耳鼻喉科耳鼻喉科
手术创新在外科创新.

背景情况:

头骨底部重建原理已经进步,但组织密封剂在预防术后脑脊液 (CSF) 泄漏方面的有效性仍在争论中.
内镜骨底部手术 (ESBS) 为复杂的重建提供了最少的侵入性方法.

研究的目的:

评估ESBS期间在骨底部缺陷修复中使用组织密封剂相关的术后CSF泄漏的发生率.
为了比较具有和没有组织密封剂的重建之间的结果.

主要方法:

27项非随机研究的系统综述和元分析 (2403名患者).
在科学网,PubMed/MEDLINE,Scopus和Cochrane图书馆搜索了报告ESBS后CSF泄漏的研究.
基于组织密封剂的使用和类型,分析了CSF泄漏发生率的风险差异 (RD).

主要成果:

与没有密封剂相比,使用组织密封剂并没有显著降低手术后的脊髓泄漏风险 (RD:0.02 [-0.01,0.05]).
对特定密封剂 (持续密封剂,纤维素,DuraSeal,Adherus,生物,Tisseel/Tissucol) 的分分析也没有显示出对泄漏发生率的重大影响.
在将持久密封剂使用与纤维素使用进行比较时,没有发现显著差异.

结论:

目前的证据表明,组织密封剂不会显著影响ESBS中手术后的CSF泄漏发生率.
需要更高质量的研究来最终确定在头骨底部重建中使用辅助密封剂的临床价值.
局限性包括由于源文献限制,无法根据泄漏特征或缺陷特征对分析进行分层.

关键词:

大脑脊髓液泄漏问题通过内镜进行内的方法.多层重建重建的多层重建密封剂密封剂密封剂骨基础手术是什么?组织粘合剂组织粘合剂

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