颅咽管瘤切除术后常见并发症的处理

Management of Common Complications after Microsurgery for Craniopharyngioma

目的探讨颅咽管瘤切除术后常见并发症的特点和处理。方法对我科80例颅咽管瘤切除患者的临床资料进行回顾性分析。结果术后出现尿崩72例,出院时39例尿量恢复正常,仍有尿崩者33例;钠代谢紊乱58例,其中低钠血症31例,高钠血症14例,高钠、低钠交替13例,出院时血钠正常者51例,仍有钠代谢紊乱者7例;高热34例,出院时体温均正常;意识障碍20例,1例因长期昏迷死于循环功能衰竭,出院时11例意识清楚,8例仍有意识障碍;癫痫5例,1例死于癫痫持续状态,余4例得到良好控制。结论处理尿崩时要合理使用抗利尿制剂。引起低钠的原因有脑性盐耗综合征和抗利尿激素异常分泌综合征,治疗前者应补液、补盐,后者应适当限水、利尿。高钠血症要限钠、补液并给予抗利尿制剂。发生高热应及时降温。出现意识障碍,除做CT检查确定有无颅内血肿和脑积水外,还应从电解质和激素用药方面查找原因。癫痫是颅咽管瘤术后极危险的并发症,要及时控制,避免出现癫痫持续状态。

Objective To study the characteristics and treatment of the common complications after the resection of craniopharyngiomas. Methods The clinical data of 80 patients with craniopharyngiomas, who received surgical treatment in our department, were analyzed retrospectively. Results Of 72 patients suffering from diabetes insipidus after the microsurgery for craniopharyngiomas, 39 were clinically recovered from diabetes insipidus and, 33 had diabetes insipidus yet when they were discharged from hospital. Of 58 patients who had sodium disorders, 31 patients suffered from hyponatremia, 14 hypernatremia, and 13 sometimes hypernatremia and sometimes hyponatremia. Of 58 patients with sodium disorders, 51 were cured and 7 had sodium disorders yet when being discharged from hospital. Hyperpyrexia occurred after the operation in 34 patients, whose body temperature became normal when they left hospital. Conscious disturbance occurred after the surgery in 20 patients, of whom, 1 died of circulatory failure, 11 regained consciousness and 8 had conscious disturbance yet when they left hospital. Epilepsy occurred after the surgery in 5 patients, of whom 1 died of epileptic state and 4 were cured. Conclusions Antidiuretic should be used reasonably to treat diabetes insipidus. Hyponatremia is caused by cerebral salt wasting syndrome （CSWS） or syndrome of inappropriate secretion of antidiuretic hormone （SIADH）. CSWS should be treated by supplying sodium and water, and SIADH by diuresis and fluid restricting. Hypernatremia should be treated by restricting sodium, supplying water and antidiuretic. Hyperpyrexia should be controlled immediately. When patients have conscious disturbance, CT should be done to confirm whether hematoma or hydrocephalus occurred. In addition, the reason of conscious disturbance should be found from the electrolyte disturbances and use of cortical hormone. Epilepsy, which is a very dangerous complication after the resection of craniopharyngiomas, should be controlled immediately to avoid epileptic state.