颅咽管瘤和Rathke囊肿围手术期水钠紊乱的发生特点及其处理  

Water-sodium balance disorders following Craniopharyngiomas and Rathke cleft cyst resection:a retro spective observational study

作　　者：曹永福[1] 漆松涛[1] 刘忆[1] 潘军[1] 

机构地区：[1]南方医科大学附属南方医院神经外科,广州510515

出　　处：《中国神经精神疾病杂志》2013年第10期607-611,共5页Chinese Journal of Nervous and Mental Diseases

基　　金：国家自然科学基金(编号:81072067);广东省自然科学基金(编号:S2011010003063);广东省自然科学基金(编号:S2012020010939);南方医科大学前期研究资助项目(编号:2012)

摘　　要：目的探讨颅咽管瘤(craniopharyngioma,CP)和Rathke囊肿(Rathke cleft cyst,RCC)围手术期水钠紊乱的发生发展及其处理。方法回顾性对比分析我科2004年1月至2011年12月8年间178例CP和38例RCC术后水钠紊乱的资料,探讨尿崩症(diabetes insipidus,DI)和低钠血症发生及进展的规律。结果DI及低钠血症是CP和RCC术后常见并发症,其总体发生率分别为95.4%、44.40%。CP和RCC患者中,DI开始发生时间均集中在术后第1d(61.80%vs.52.60%,P=0.606);DI最严重时,两组所在时间点的中位数分别为第5.5天、第3天。低钠血症开始发生时间均集中在术后第2、3天或第7、8天(63.70%vs.75.00%,P>0.05),低钠血症最严重时,两组所在时间点的中位数均为术后第8天;两者均以尿崩伴低钠血症多见(43.51%);相比RCC组,CP组术后DI及低钠血症严重,血钠波动大,容易发展成长期DI(52.8%vs.10.5%,P=0.004),并且术后持续DI并伴高钠发生远期尿崩可能性大(78.90%vs.48.00%,P=0.037)。结论 DI及低钠血症是CP和RCC术后常见的并发症,并以CP更严重,提示术后10d内需加强监测并纠正水钠紊乱,可能会降低远期DI的发生。Objective To prospectively study the development and management of disorders of water-sodium balance following Craniopharyngiomas （CP）and Rathke cleft cyst （RCC）resection. Methods One hundred seventy-eight cases of CP and 38 cases of RCC who had undergone tumor resection between January 2004 and December 2011 in Nanfang Hospital were studied retrospectively. Results Postoperative Diabetes insipidus （DI） occurred in 95.40% of all the patients, in 98.90% of the CP and in 78.90%o of the RCC. 61.8% of postoperative DI occurred in the CPs and 52.6% of postoperative DI occurred in RCCs on postoperative day one. The maximum of medians of diuresis occurred on postoperative Day 3 in RCCs and Day 5.5 in CP. The onset of hyponatremia in both CPs and RCCs occurred similarly on postoperative Day 2 or Day 7. Nadir of medians of hyponatremia in both CPs and RCCs occurred on postoperative Day 8. During three month follow-up, CPs had higher incidence of permanent DI and higher possibility of DI with high serum sodium compared with RCCs （52.80% vs. 10,50%, P=0.004; 78.90% vs. 48.00%, P=0.037）. Conclusions DI and hyponatremia are the frequent postoperative complications of the CP and RCC, suggesting that monitoring within the postoperative 10d is necessary to reduce the occurrence of the permanent DI.

关 键 词：颅咽管瘤 RATHKE囊肿 水钠电解质紊乱 尿崩症 低钠血症 

分 类 号：R651.1[医药卫生—外科学]