鞍区肿瘤手术后尿崩症及水钠失衡紊乱的临床分析.DOCVIP

临床医学论文-鞍区肿瘤手术后尿崩症及水钠失衡紊乱的临床分析 【关键词】? 鞍区肿瘤 ??? Postoperative diabetes insipidus and watersodium disorder in patients with sellar region tumor 　　【Abstract】 AIM: To explore the influence of different surgical approaches and pathologic types of tumors on postoperative diabetes insipidus and electrolyte disorder in sellar region. METHODS:? The surgical approaches, pathologic types and syndrome after surgeries were analyzed retrospectively in 109 patients with tumors in sellar region. RESULTS:? In terms of types of tumors, diabetes insipidus and watersodium after surgery were found in 86 cases （78.9 %）, with the highest in cases of craniopharyngioma (100%) and the lowest in cases of epidermoid tumor and meningiomas (60.0%-64.3%), and in terms of surgical approaches, the highest was found by ventriculus lateralisinterventricular foramenthe third ventricle (89.0%) and the lowest by hypotemporal lobe approach (79.0%). CONCLUSION:?Surgical approaches and pathologic types have great influence on postoperative diabetes insipidus and electrolyte disorder in sellar region. 　　【Keywords】 neoplasms, sellar; diabetes insipidus; microsurgery; watersodium disorder; lnappropriate ADH syndrome 　　【摘要】 目的： 探讨手术方式及肿瘤性质的不同对鞍区肿瘤术后发生尿崩和水钠失衡的影响.? 方法： 对109例鞍区肿瘤的手术方式、病理类型、术后尿崩水钠失衡进行回顾性分析.? 结果： 术后发生尿崩及水电解质平衡紊乱者86例（78.9 %）. 颅咽管瘤术后并发尿崩及水钠平衡紊乱比率最高(100%)，胆脂瘤及脑膜瘤的发生率最低(60.0%~64.3%)；经侧脑室室间孔第Ⅲ脑室入路者，术后发生率最高(89.0%)，颞下入路最低(79.0%). 结论： 手术方式及肿瘤性质对鞍区肿瘤术后尿崩和水钠失衡的发生有很大影响. 　　【关键词】 鞍区肿瘤；尿崩症；显微外科手术；水钠失衡；ADH分泌不当综合征 　　0引言 　　鞍区肿瘤毗邻颅内一些重要结构，手术切除可能会对垂体，垂体柄，下丘脑等造成直接或间接损伤，并发中枢性尿崩症，水电解质平衡紊乱，对术后患者的恢复产生重要影响［1，2］. 预防，诊断和治疗这些并发症是保证术后疗效的关键. 我们回顾性分析西安交通大学第一医院神经外科经颅鞍区肿瘤手术病例，并对不同病理类型及不同手术方式对上述并发症产生的影响进行了分析. 　　1对象和方法 　　1.1对象 　　199901/200312西安交通大学第一医院神经外科住院患者，经显微手术切除的鞍区肿瘤109(男58，女51)例，年龄11~74（平均46.8）岁. 其中垂体腺瘤67例,颅咽管瘤19例,脑膜瘤14例,胆脂瘤5例,脊索瘤4例；患者入院时临床表现主要为头痛，视力障碍，内分泌紊乱，海绵窦综合征及多饮多尿症状等. 术前对部分垂体腺瘤患者给予糖皮质激素治疗，伴有水电解质平衡紊乱患者给予对症治疗.?　　1.2方法 　　采取显微手术进行肿瘤全切，次全切，大部及部分切除，手术方式包括采用单额下入路53例，扩大翼点入路45例，经侧脑室室间孔第Ⅲ脑室入路9例，颞下入路2例. 术后1~7 d记出入液量，定期检查肾功，血清电解质