颅咽管瘤切除过程中垂体柄的最佳处理仍然是一个有争议的话题。本荟萃分析旨在评估保留垂体柄对术后尿崩症 (DI)、垂体前叶功能 (PF)、切除范围和复发的影响。通过 Ovid 搜索 Medline 中从建站到 2022 年 9 月 2 日的相关文章报告术后或末次随访时 DI 或前部 PF 发生率、切除范围或末次随访时肿瘤复发的研究均符合纳入条件。计算每个结果的风险比（RR）。进行随机效应荟萃分析，并按年龄进行额外分层。为了评估研究之间的偏倚风险，使用了漏斗图和 Egger 检验。总共审查了 3488 篇摘要和 150 篇全文文章，最终纳入了 33 项研究，总共纳入了 2366 名患者。在比较荟萃分析中，保留垂体柄显着降低术后 DI 风险（17 项研究，RR 0.67，95% CI 0.55-0.81，I2 = 75%），最后一次随访时 DI（6 项研究，RR 0.54， 95% CI 0.41-0.72，I2 = 20%），术后前部 PF 异常（15 项研究，RR 0.78，95% CI 0.69-0.89，I2 = 49%），但末次随访时前部 PF 未异常（4 项研究） ，RR 0.38，95% CI 0.09-1.63，I2 = 64%）。不完全切除率（12 项研究，RR 1.59，95% CI 0.77-3.28，I2 = 68%）或肿瘤复发率（9 项研究，RR 1.18，95% CI 0.92-1.51，I2 = 0）没有显着差异。 %) 保存组和牺牲组之间。然而，儿科患者的亚组分析显示，保留垂体柄组的不完全切除风险较高（RR 3.29，95% CI 1.17-9.26，I2 = 70%）。垂体柄保留被证明对 PF 具有保护作用，尽管仅对后部 PF 进行长期随访后，获益仍然存在。应仔细考虑儿童患者的茎保留，因为它与较高的不完全切除率相关。由于纳入了小型研究且文献中对结果的报告不充分，因此应谨慎解释这些结果。

Optimal management of the pituitary stalk during craniopharyngioma resection remains a controversial subject. This meta-analysis aimed to evaluate the effect of pituitary stalk preservation on postoperative diabetes insipidus (DI), anterior pituitary function (PF), extent of resection, and recurrence.Medline was searched via Ovid for relevant articles from inception to September 2, 2022. Studies reporting the rates of DI or anterior PF postoperatively or at last follow-up, extent of resection, or tumor recurrence at last follow-up were eligible for inclusion. The risk ratio (RR) for each outcome was calculated. Random-effects meta-analyses were performed with additional stratification by age. To assess for risk of bias across studies, funnel plots and the Egger's test were utilized.In total, 3488 abstracts and 150 full-text articles were reviewed, resulting in 33 studies with a total of 2366 patients for inclusion. In the comparative meta-analysis, pituitary stalk preservation significantly decreased the risk of DI postoperatively (17 studies, RR 0.67, 95% CI 0.55-0.81, I2 = 75%), DI at last follow-up (6 studies, RR 0.54, 95% CI 0.41-0.72, I2 = 20%), and abnormal anterior PF postoperatively (15 studies, RR 0.78, 95% CI 0.69-0.89, I2 = 49%) but not abnormal anterior PF at last follow-up (4 studies, RR 0.38, 95% CI 0.09-1.63, I2 = 64%). There were no significant differences in the rates of incomplete resection (12 studies, RR 1.59, 95% CI 0.77-3.28, I2 = 68%) or tumor recurrence (9 studies, RR 1.18, 95% CI 0.92-1.51, I2 = 0%) between the preservation and sacrifice groups. However, subgroup analysis of pediatric patients revealed a higher risk of incomplete resection (RR 3.29, 95% CI 1.17-9.26, I2 = 70%) in the stalk preservation group.Pituitary stalk preservation was demonstrated to confer protective benefit on PF, although the benefit persisted on long-term follow-up for posterior PF only. Stalk preservation in pediatric patients should be given careful consideration, as it is associated with higher rates of incomplete resection. These results should be interpreted with caution due to inclusion of small studies and inadequate reporting of outcomes in the literature.