垂体瘤显微手术后尿崩的预防和治疗

The prevention and treatment of diabetes insipidus after excision of pituitary adenoma by microsurgery

目的探讨垂体腺瘤术后尿崩症的预防和治疗，以减少术后尿崩的发生，提高垂体腺瘤手术的疗效。方法回顾总结2012年8月至2015年8月本院神经外科显微手术治疗垂体腺瘤患者84例，26例肿瘤直径〉3cm向鞍上、鞍旁生长的巨大垂体腺瘤采用经额下入路显微手术摘除肿瘤，其余58例行单鼻孔蝶窦入路切除肿瘤，统计尿崩症的预防、发生和治疗情况。结果84例患者术后出现尿崩35例f41．7％），其中26例巨大垂体腺瘤病例中发生尿崩19例（73．0％），其余58例垂体腺瘤病例术后发生尿崩16例（27．6％）。经对症治疗，尿崩持续时间〈3周的21例，持续3周～3个月的12例，发生永久性尿崩的2例。结论术前全面检查、充分准备，熟悉垂体后叶亮点的位置及肿瘤与周边组织的三维立体关系，术中避免损伤垂体、垂体柄、下丘脑及其供血血管，术后及时合理使用抗利尿药物与纠正水电解质平衡紊乱是预防和治疗垂体腺瘤术后尿崩症的关键。

Objective To explore the prevention and treatment of postoperative diabetes insipidus after excision of pituitary adenoma by mierosurgery, to decrease the incidence of postoperative complications, and improve the treatment effect of pituitary adenoma. Methods 84 cases of pituitary adenomas undergoing mierosurgical resection in our hospital from August 2012 to August 2015 were retrospectively reviewed. 26 cases of giant pituitary adenoma （precise tumor diameter 〉3 cm, extending into suprasellar and parasellar region） were excised through unilateral subfrontal approach, and other 58 cases of pituitary tumor were removed by transsphenoidal operation. The incidence, prevention, and treatment of diabetes insipidus were statistically analyzed. Results 35 cases （41.7%） had postoperative diabetes insipidns among the total 84 operations, 19 of them occurred in 26 cases of giant pituitary adenoma （73.0%）, the rest 16 cases occurred in 58 cases of pituitary adenoma （27.6%）. By symptomatic treatment, 21 patients recovered within 3 weeks, 12 patients recovered within 3 weeks to 3 months, another 2 patients didn＇t recover. Conclusions Pre-operation sufficient preparation, familiarizing the position of posterior pituitary bright spot （PPBS） and three dimensional relationship of the tumor and the surrounding tissue; intra-operation avoiding injury of pituitary gland, pituitary stalk, hypothalamus, and supplying vessels; post-operation rational anti-diuretics using and correcting electrolyte balance, are key points to prevent and treat postoperative diabetes insipidus.