鞍区肿瘤术后低钠血症鉴别诊断与治疗  

DIFFERENTIAL DIAGNOSIS AND TREATMENT OF HYPONATREMIA AFTER THE TUMOR RESECTION IN THE REGION OF SELLA TURCICA

作　　者：高乃康[1] 杨继文[1] 田复明[1] 徐成伟[1] 苏优勒[1] 窦长武[1] 薜际航[1] 富春雨[1] 李明洙[1] 

机构地区：[1]内蒙古医学院附属医院神经外科,内蒙古呼和浩特010050

出　　处：《内蒙古医学院学报》2010年第6期665-668,共4页Acta Academiae Medicinae Neimongol

基　　金：内蒙古卫生厅医疗卫生科研计划项目（2005040）

摘　　要：目的：探讨鞍区肿瘤术后低钠血症的病因、诊断、鉴别诊断和治疗方法。方珐：回顾性分析鞍区肿瘤术后并发低钠血症61例，所有病人术前、手术当日及术后每日监测血、尿钠浓度，血、尿渗透压，尿量，中心静脉压的变化，根据检查结果及临床表现进行分析，并采用相应的治疗方案。其中垂体腺瘤34例，颅咽管瘤18例，脑膜瘤4例，胶质瘤3例，其它2例。结果：本组出现低钠血症者占同期鞍区肿瘤手术的16．85％（61／362），其中脑性耗盐综合征（csws）34例，抗利尿激素分泌失调综合征（SIADHS）27例。2例病人治疗中发生广泛脑水肿和多发脑梗而遗留功能障碍，其余均治愈。结论：鞍区肿瘤累及下丘脑，手术后易出现低钠血症，CSWS和SI—ADHS在临床上容易混淆，认真分析、明确诊断，即可选择正确的治疗方法。Objective： To study the etiology, diagnosis differential diagnosis and treatment of hyponatremia after the tumor resection in the region of sella turcica. Methods：61 patients with tumor in sella turcica which have suffered hyponatremia after surgery were retrospectively analysed. Water and blood sodium and central venous pressure in all patients were daily examined after surgery. Methods of treatment were adopted according to the results of examination. Among them 34 cases were pituitary adenoma, 18 cases of craniopharyngioma, 4 cases of meningioma, 3cases of neurogliocytoma and 2 cases of others. Results：All the patients have suffered hyponatremia after surgery,accounting for 16.85% （61/ 362） of all patients with tumors in sella turcica in the same period. There are 27 cases of syndrome of inappropriate ADH secretion （SIADHS） and 34 cases of cerebral salt wasting syndrome （CSWS）. While 2 cases left over functional disturbance due to widespread brain edema and extensive cerebral infarction,others cured. Conclusion：After surgery, the hyponatremia is prone to emergence in the patients with tumors in sella turcica and simultaneously invading the hypothalamus. SIADHS and CSWS are easily confused in clinical diagnosis, so a careful differentiation should always be done and followed a right therapy.

关 键 词：鞍区 低钠血症 脑性耗盐综合征 抗利尿激素分泌失调综合征 

分 类 号：R591.1[医药卫生—内科学]