经蝶垂体腺瘤切除后尿崩症的临床研究

Diabetes insipidus following transsphenoidal pituitary adenomectomy

随机对４１例经蝶垂体腺瘤手术后的尿崩症和多尿进行了严密的监测和系统观察。其中２３例出现尿崩症（５６％），１３例多尿（３２％），均为暂时性。ＡＣＴＨ分泌腺瘤中７０％（７／１０例）出现尿崩症。泌乳素（ＰＲＬ）腺瘤中为６３％（５／８例），无功能腺瘤中为５０％（５／１０例），生长素（ＧＨ）分泌腺瘤中为４６％（５／１３例）；巨大腺瘤（最大径＞３ｃｍ）中尿崩症的发生率３３％（３／９例）；大腺瘤为５６％（９／１６例）；微腺瘤为６９％（１１／１６例）。文章论述了经蝶术后尿崩症出现的规律，提出了诊断的标准，发现导致尿崩的主要原因是累及垂体后叶。认为术中切除微腺瘤的同时切除瘤周部分垂体前后叶组织是全切肿瘤防止复发的重要方法，但发生尿崩症较多。大腺瘤的术后尿崩症则可能与手术对于垂体柄及后叶的牵拉和轻微挫伤有关。文章强调了监测生命体征，维持水电解质平衡的重要性和在严重病例中应用抗利尿药物的必要性。

Abstract Diabetes insipidus (DI) is a main complication after transsphenoidal pituitary adenomectomy.In this article, this complicati on was observed in 41 patients postoperatively.The patients 15 males and 26 females, ranged from 14 to 66 years old (M =37.2 yrs.). The urinary volume, urinary specific gravity,plasam and urine osmolality were measured in this study. In this 41 patients, 23 patients (56.1%)suffered from DI, 13 patients (31. 7 %) from polyuria. The occurrence rate of DI in ACTH adenomas was the highest (70 %), than in PRL (62. 5 %) and in nonfunction adenomas (50 %), the lowest in GH (46 %). The occurrence rate of DI was related to the size of the adenomas in which the microadenomas were 69%, the large adenomas were 50% and the huge adenomas were 33.3 %. The postoperative course of DI follwed by transsphenoidal adenomectomy was dicussed. It must point out that DI was significantly related to the removal of the microadenomas as well as the surrounding pituitary tissue in order to decrease or to prevent the recurrence of the tumor. But the incidence of DI was rather high.DI in the large adenomas, could be related to interfere the pituitary stalk or the posterior lobe. In this article, it was emphasized to examine the electrolyte and vital sign and use several antidiuretic drugs in severe patients.