鞍区肿瘤术后内分泌代谢紊乱的防治和管理

Prevention and management of endocrine and metabolic disorders after operation of sellar region tumors

随着神经外科经鼻蝶内镜技术的进步,鞍区肿瘤手术全切率和安全性已明显提高。但由于肿瘤类型、大小、生物特性多变,且鞍区位置特殊,术中有时难免损伤下丘脑、垂体,造成垂体内分泌和水、盐代谢紊乱,导致患者术后出现记忆力下降、生长发育停滞、不孕不育、肥胖、多尿、电解质紊乱等,并且医患存在对下丘脑、垂体和靶腺激素替代认识不足,治疗不规范,随访不积极,严重时危及生命。本文从内分泌专科医生角度,详细阐述鞍区肿瘤术后垂体功能减退、下丘脑综合征及水、盐代谢紊乱的防治和管理,希望通过本文规范激素替代治疗,促进患者垂体功能重建,改善患者预后,提高远期生活质量,减少死亡率。

With the development of transnasal sphenoid endoscopy in neurosurgery,the total resection rate and safety of sellar region tumors have been significantly improved.However,sometimes,the hypothalamus and pituitary gland are inevitably damaged during the operation due to variable type,size and biological characteristics of the tumor,along with special location of the sellar region,which leads to pituitary endocrine and water and salt metabolism disorders,postoperative memory decline,growth arrest,infertility,obesity,polyuria and electrolyte disorders.If doctors and patients have insufficient understanding of hypothalamus,pituitary and target gland hormone replacement,nonstandard treatment and negative follow-up reexamination,this may endanger life.From the perspective of endocrinologist,this paper described the prevention and management of hypopituitarism,hypothalamic syndrome and water and salt metabolism disorders after surgery for sellar region tumors,with a view to promoting the reconstruction of pituitary function,improving the prognosis of patients,enhancing the long-term quality of life,and reducing the mortality through regulation of hormone replacement therapy.