经鼻内窥镜鞍区肿瘤切除术并发尿崩症防治探讨

Prevention and treatment of diabetes insipidus resulted from resection of neoplasm in sella turcica by nasal endoscope

目的 探讨如何预防、治疗经鼻内窥镜鞍区肿瘤切除术并发尿崩症。方法 回顾性分析 9例鼻内窥镜下鞍区肿瘤切除术。 9例患者中 ,6例为垂体腺瘤 ,2例颅咽管瘤 ,1例囊性畸胎瘤。结果 6例垂体腺瘤中 ,1例发生轻度尿崩症 ,服用双氢克尿塞后痊愈。 2例颅咽管瘤和 1例囊性畸胎瘤发生较重尿崩症 ,先静点垂体后叶素 ,后口服双氢克脲噻、卡马西平治疗痊愈。结论 鼻内窥镜下切除鞍区肿瘤组织 ,尽量减少对垂体前后叶、柄、下丘脑等的损伤、牵拉 ,可以预防尿崩症的发生 ,减轻其症状 ;并发尿崩症后 ,维持水、电解质平衡 ,静点垂体后叶素 ,口服双氢克脲噻、卡马西平可以控制尿崩症症状 ,以待下丘脑-垂体功能恢复。

Objective To study how to prevent and treat the diabetes insipidus (DI) resulted from resection of neoplasm in sella turcica by nasal endoscope. Method Nine patients with neoplasm in sella turcicawere operated by nasal endoscope, including 6 with pituitary adenoma, 2 with craniopharyngioma, 1 with cystic teratoma. Results Among 6 patients with pituitary adenoma, in one the light DI occurred and then was cured by taking hydrochlorothiazide. In 2 patients with craniopharyngima and in 1 with cystic teratoma the heavy DI occurred and was cured by infusion of pituitrin, oral hydrochlorothiazide and carbamazepine. Conclusion When the neoplasm in sella turcica isresected by nasal endoscope, the operator should avoid as lightly as possible to drag and injury the pituitary anterior and posterior lobes, and stem, and hypothalamus so asto prevent DI and relieve its symptoms. If DI happened, maintaining body fluid,ion balance, infusion of pituitrin and oral hydrochlorothiazide and carbamazepine, may control symptoms of DI, and help functional recovery of hypothalamus andhypophysis.