鞍区肿瘤术后低钠血症的鉴别诊断及治疗

Differential diagnosis and treatment of hyponatremia after the tumor resection in the region of sella turcica

目的探讨鞍区肿瘤术后低钠血症的病因、鉴别诊断和治疗方法。方法回顾性分析鞍区肿瘤术后并发低钠血症25例,其中肿瘤全切除14例,次全切除6例,部分切除5例。所有患者术前、手术当日及术后每日监测血、尿钠浓度,血、尿渗透压,尿量,中心静脉压的变化,根据检查结果及临床表现进行分析,并采用相应的治疗方案。结果本组出现低钠血症者占同期鞍区肿瘤手术的21.4%。25例中脑性盐耗综合征(CSWS)15例,抗利尿激素分泌不当综合征(SIADH)10例。24例经积极治疗治愈,1例因并发肺内感染及ARDS死亡。结论鞍区侵犯下丘脑的肿瘤术后易出现低钠血症;CSWS和SIADH临床上易混淆,需认真分析,明确诊断,采用正确的治疗方法。

Objective To study the etiology, differential diagnosis and effective treatment of hyponatremia after the tumor resection in sellar area. Methods 25 patients with tumor in sellar area which have suffered hyponatremia after surgery were retrospectively analyzed. Among them 14 cases were underwent a whole resection, 6 cases great part resection, and 5 cases partial resection. Water and blood sodium and central vein pressure in these patients were daily examined after surgery. Methods of treatment were adopted according to the results of examination. Results All the patients have suffered hyponatremia after surgery, accounting for 21.4% of all patients with tumors in sellar area in the same period. There are 10 of syndrome of inappropriate antidiuretic hormone (SIADH) and 15 of cerebral salt wasting syndrome (CSWS). Twenty-four patients were cured, one died of pneumonia(ARDS). Conclusions After surgery, the hyponatremia is prone to emergence in the patients with tumors in sellar area and simultaneously invading the hypothalamus. SIADH and CSWS are easily confused in clinical diagnosis, so a careful differentiation should always be done and followed a right therapy.