颅咽管瘤围手术期内分泌变化的影响因素及激素替代治疗

Influential factors on endocrine changes and hormone replacement therapy during pri-operation period in patients with craniopharyngiomas

目的研究颅咽管瘤围手术期内分泌变化影响因素及激素替代治疗。方法回顾分析2002年1月至2006年8月手术治疗的47例颅咽管瘤患者。术前采血，测定TSH、33、T4、PRL、FSH、LH、E2、T值，8am、4pm分别检测血皮质醇1次，并于术后1周对上述指标进行常规复查。手术前后监测尿量、尿比重。将所得数据进行统计学分析。结果术后TSH、性腺激素低下和尿崩的出现率盟著高于术前，高PRL出现率明显低于术前；手术前、后甲状腺功能低下差异无统计学意义。结论颅咽管瘤术后内分泌功能紊乱加重；开颅手术及肿瘤全切除明显影响术后内分泌变化；颅咽管瘤术后需常规激素替代治疗，围手术期肾上腺皮质激素的替代治疗可明显减少低皮质醇血症的发生。

Objective To study the influential factors on endocrine changes and hormone replacement therapy during pri -operation period in patients with craniopharyngiomas. Methods 47 patients with craniopharyngiomas admissioned from January 2002 to August 2006 were analyzed retrospectively. All patients underwent microneurosurgical operations. The vein blood samples were taken before operation and one week after craniopharyngioma operation respectively. TSH, T3, T4, PRL, FSH, LH, E2, T were assayed, and plasma cortisol was tested at 8 am and 4 pm respectively. Moreover the results should be double checked at 1 week after operation. We also monitored urine volume, gravity. All the data were analyzed by statistics software SPSS 13.0. Results After surgery the incidence of hypogonadism and diebets insipidus was significantly higher than before surgery. The number of low TSH cases also increased significantly after operation. There was significantly lower incidence of hyperprolactinemia after surgery. The hypothyroidism incidence has no obvious changes peri - operation period. Conclusions The endocrine abnornkalities after surgery appear to aggravate. Surgical approach and resection degree can influent endocrine changes after surgery directly. Hormone replacement therapy should be choosed rutinely after craniopharyngioma surgery.