神经内镜经鼻蝶窦垂体腺瘤切除术后的迟发性低钠血症

Delayed hyponatremia after neuroendoscopic transnasal transsphenoidal surgery for pituitary adenoma

目的探讨神经内镜经鼻蝶窦垂体瘤术后迟发性低钠血症的危险因素、发病机制及治疗。方法回顾性分析中南大学湘雅二医院神经外科2017年11月—2018年10月,行神经内镜经鼻蝶窦手术的96例垂体腺瘤患者的临床资料。结果96例患者中,有19例患者(19.8%)出现迟发性低钠血症,其中15例患者(78.9%)低钠血症发生于术后6~7 d,症状性低钠血症者为7例(36.8%)。低钠血症的发生率与患者的年龄有关,而与性别、肿瘤类型及大小无关。所有患者给予限水及补钠治疗后完全恢复。结论神经内镜经鼻蝶窦垂体腺瘤切除术后迟发性低钠血症多出现于术后6~7 d,高龄患者更易出现,治疗以限水及补钠为主。

Objective To explore risk factors,pathogenesis and treatment of delayed hyponatremia after transnasal transsphenoidal surgery for pituitary adenoma.Methods The clinical data of 96 patients with pituitary adenoma underwent pituitary operation via neuroendoscopic transnasal transsphenoidal approach between November 2017 and Octorber 2018 were analyzed retrospectively.Results Of 96 patients,delayed hyponatremia was found in 19,in whom,15 were found to suffer delayed hyponatremia in postoperative day 6-7,7 were symptomatic.Gender,tumor type and tumor size did not correlate with development of delayed hyponatremia,but patients'age was related to development of delayed hyponatremia.Patients with delayed hyponatremia were treated with fluid restriction and saline infusion.All patients recovered well after correction.Conclusions Delayed hyponatremia develops mostly in postoperative day 6-7,and elderly patients are more likely to suffer.Fluid restriction and saline infusion are treatment regimen.