鞍区肿瘤术后并发症的临床分析

Clinical analysis of postoperative complications in patients with sellar tumors

目的探讨鞍区肿瘤开颅显微外科手术并发症的原因和防治。方法回顾性分析70例鞍区肿瘤术后并发症及其治疗情况。结果并发水、电解质代谢紊乱42例,垂体前叶机能减退32例,上消化道出血10例,中枢性高热12例,持续昏迷3例,视力、视野恶化3例,脑出血2例,脑梗塞3例。结论鞍区肿瘤术后并发症以尿崩症、垂体前叶机能减退较常见,以下丘脑广泛性损伤是最为严重;术中规范、轻柔的手术操作,保护穿支血管,预防术中、术后的脑血管痉挛,围手术期的处理等,对减少术后并发症有重要意义。

Objective To investigate the occurrence, prevention and treatment of the complications in patients with sellar tumors after transcranial microsurgery. Methods To retrospectively analyze the complications and treatment of 70 cases of sellar tumors after transeranial mieresurgery. Results There were 42 eases accompanied with disorders in fluid and electrolyte balance, 32 cases with hypofunction of anterior pituitary, 10 cases with hemorrhage of upper digestive tract, 12 eases with central hyperpyrexia, 3 eases with persistent coma, 3 eases with deteriorated vision and visual field, 3 eases with cerebral hemorrhage, 3 cases with cerebral infarction. Conclusion Diabetes insipidus and hypofunction of anterior pituitary are the most frequent postoperative complications in patients with sellar tumors. Extensive injury in hypothalami is the most serious complication. It is important to conduct normal and gentle operation, protect perforating branch artery, avoid cerebral vasospasm, administer dehydrant and glucocorticoid perioperatively and manage hydrocephalus for decreasing postoperative complications.