内镜辅助下行颅咽管瘤切除术后钠离子紊乱的相关因素分析

Analysis of factors relative to serum sodium disorder after endoscopic surgery for craniopharyngioma

目的探讨内镜辅助下行颅咽管瘤切除术后钠离子紊乱的相关因素。方法回顾性分析33例神经内镜辅助下行颅咽管瘤切除术病人的临床资料,按术后是否发生钠离子紊乱分为两组,并统计分析发生钠离子紊乱的风险因素。结果单因素分析显示:颅咽管瘤分型、切除程度、术前尿崩症和脑积水是颅咽管瘤术后钠离子紊乱的风险因素(P<0.05);Logistic多因素回归分析显示:中央型颅咽管瘤、术前伴尿崩症和脑积水是术后钠离子紊乱的独立危险因素(P<0.05)。术后随访10~53个月,平均24.5个月;需长期口服激素替代治疗28例;颅内感染2例,抗感染治疗后治愈;复发1例,予再次手术。结论中央型颅咽管瘤及术前伴尿崩症和脑积水的颅咽管瘤病人,术后易并发高钠血症,颅咽管瘤分型对于术后钠离子紊乱的评估有重要意义。

Objective To explore the factors relative to serum sodium disorder after endoscopic surgery for craniopharyngioma.Methods Clinical data of 33 craniopharyngioma patients undergoing endoscopic surgery were analyzed retrospectively,and the patients were divided into two groups according to whether serum sodium disorder occurred or not,then,the factors influencing serum sodium disorder were analyzed statistically.Results Univariate analysis showed the craniopharyngioma classification,extent of tumor removal,preoperative diabetes insipidus and hydrocephalus were the risk factors for serum sodium disorder after the opration(P<0.05).Multiple logistic regression analysis showed the central type of craniopharyngioma,preoperative diabetes insipidus and hydrocephalus were the independent risk factors for serum sodium disorder after the operation(P<0.05).During a mean follow-up period of 24.5 months,ranged from 10 to 53 months,hormone replacement therapy occurred in 28 patients,2 intracranial infection cases were cured with antibiotics,and 1 tumor recurrence accepted reoperation.Conclusions The patients with central type of craniopharyngioma,preoperative diabetes insipidus and hydrocephalus are prone to postoperative hypernatremia.Craniopharyngioma classification is of great significance for the evaluation of serum sodium disorder after endoscopic surgery.