颅咽管瘤切除术后水钠代谢紊乱机制研究(附102例分析)

Mechanism of postoperative electrolyte disturbances of craniopharyngioma:analysis of 102 cases

目的探讨颅咽管瘤术后水钠代谢紊乱的原因和最佳处理方式。方法对102例经胼胝体切开穹窿间入路切除巨大颅咽管瘤的病人,记录术后尿量、血电解质、抗利尿激素(ADH)、醛固酮(ALD)、皮质醇水平,比较术后激素水平变化与水、钠代谢紊乱的关系。结果本组均出现水、钠代谢紊乱,术后2周完全恢复52例,4周基本恢复33例,6周恢复12例,需长时间人工调整电解质水平5例。术后ADH、ALD和皮质醇的不足是导致术后水钠代谢紊乱的主要原因。结论颅咽管瘤切除术后水、钠代谢紊乱与手术损伤下丘脑有关,紊乱类型与ADH、ALD和醛固酮的缺乏情况有关;及时给予相应激素及对症治疗,可获满意疗效。

Objective To in vestigate into the causes and best treatments of postoperative electrolyte disturbance in craniopharyngioma patients. Methods Clinical materials of 102 craniopharyngioma patients were analyzed. Huge craniopharyngiomas were resected via the corpus callosurn and fomix approach, and the urine volume, blood electrolyte and blood levels of antidiuretic hormone （ADH）, aldosterone （ALD） and cortisol were measured alter the operation. The variations of hormones were compared with the types of electrolyte disturbances in order to find the inter-relationship. Results All the cases presented electrolyte disturbances, 52 of which recovered completely alter 2 weeks, 33 on the whole alter 4 weeks, 12 alter 6 weeks, and 5 need long-term regulation Of electrolyte level. The deficiencies of ADH, ALD and cortisol were the main causes for the postoperative electrolyte disturbance. Conclusions Electrolyte disturbances alter craniopharyngioma resection are caused by injury of the hypothalamus. The low level of ADH, ALD and corticosteroid contributes to the different types of electrolyte disturbances, and can be cured by providing correct hormones in time.