颅咽管瘤全切除术后血钠紊乱及治疗

 

【摘要】 

目的 总结颅咽管瘤全切除术后血钠紊乱的发生规律和治疗方法。 连云港市第一人民医院神经外科陈军

方法 回顾性分析46例颅咽管瘤病人术后血钠紊乱的情况，分析血钠紊乱与病人年龄、肿瘤位置的关系。

结果 术后出现血钠紊乱者42例 （91.3%），其中单纯低钠型9例（19.6%），单纯高钠型6例 （13.0%），混合型血钠紊乱27例 （58.7%）。 42例术后血钠紊乱者中，术后3个月内恢复正常40例；1例持续高钠血症者在术后1.5年恢复正常；另1例持续高钠血症者术后2个月死于肺栓塞。15例儿童病人中7例在围手术期出现癫疒闲发作，31例成年病人无一例出现癫疒闲发作。

结论 颅咽管瘤全切除后血钠紊乱的发生率显著高于术前（P ＜0.001）；术后血钠紊乱的类型与年龄、肿瘤复发、肿瘤囊实性和肿瘤位置无关（P ＞0.05）。纠正血钠紊乱是儿童颅咽管瘤病人在围手术期预防癫疒闲发作的关键。

【关键词】  颅咽管瘤 低钠血症 高钠血症 尿崩症

　Analysis and treatment of sodium disturbance in patients after total removal of craniopharyngioma

　　　　Abstract:  Objective  To study sodium disturbance and its treatment in patients undergoing total removal of craniopharyngioma.  Methods Forty-six cases of craniopharyngioma surgically treated were analyzed retrospectively. The relations of the sodium disturbance to age and location of tumor was analyzed.  Results  Forty-two patients (91.3%) had sodium disturbance after surgery. There were three types of sodium disturbance: simple hyponatremia in 9 (19.6%), simple hypernatremia in 6 (13.0%) and mixed type of sodium disturbance in 27 (58.7%). Forty of the 42 patients with sodium disturbance after surgery recovered within 3 months. One with persistent hypernatremia recovered one year and a half after surgery. Another with persistent hypernatremia died of pulmonary embolism 2 months after surgery. Seven of the 15 child patients had seizures during perioperative period, while none of the 31 adult patients had seizures.  Conclusion  Blood sodium disturbance is significantly more frequent after total removal of the tumor than before surgery in patients with craniopharyngioma (P<0.001). The type of sodium disturbance does not correlate with age, tumor relapse or not, solid or cystic tumor and site of tumor (P>0.05). Management of sodium disturbance plays a key role in preventing seizures in children with craniopharyngioma during perioperative period.

Key words:  craniopharyngioma;  hyponatremia;  hypernatremia;  diabetes insipidus