21例大型及巨大型颅咽管瘤患者术后水钠失衡的处理

Postoperative sodium disturbance and management of 21 cases of large or giant craniopharyngiomas

目的总结21例大型及巨大型颅咽管瘤患者术后发生钠代谢紊乱的处理体会。方法对该科21例大型(直径>4 cm)及巨大型(直径>6 cm)颅咽管瘤手术患者术后血钠失衡进行分析,根据血钠、尿钠、尿比重等情况进行诊断和相应治疗。结果发生低钠血症13例,高钠血症8例。高钠及低钠血症绝大多数在术后48～72 h内出现,最迟1例于术后6 d出现。2例死于严重下丘脑反应,其余患者均予以纠正,治愈出院。结论血钠失衡是颅咽管瘤术后最常见的并发症,尤易发生于大型及巨大型颅咽管瘤术后。虽然术后尿崩症合并高钠血症常见,但更需要注意区分脑性盐耗综合征和抗利尿激素分泌不当综合征导致的低钠血症,正确处理。

[Objective] To report the postoperative sodium disturbance and management of 21 cases with large or giant craniopharyngiomas. [Methods] 21 cases of large or giant craniopharyngiomas （diameter 〉 4 crn） underwent tumor removal and were analyzed. Each patient was evaluated and treated according to blood sodium, urine sodium and urine specific gravity. [Results] Within 48-72 hours after operations, hyponatremia was found in 13 cases, and hypematremia occurred in the other 8 cases. The latest one occurred in the 6th day after operation. 2 patients died of severe subthalamus dysfunction, the others were corrected and dis- charged without any blood sodium disturbance. [Conclusion] Blood sodium disturbance is the most common complication after craniopharyngioma operation, especially the large or giant craniophmyngiomas. Though dia- betes insipidus combined hypernatremia frequently happened after operation, hyponatremia could be caused by 2 different reasons： cerebral salt wasting syndrome （CSWS） or inappropriate secretion of ADH （SIADH）. CSWS and SIADH should be distinguished carefully and treated with different strategies.