MR垂体柄高信号变化对经蝶内镜手术后尿崩症的预警意义  

Early warning significance of pituitary stalk hyperintensity changes in patients with diabetes insipidus after transsphenoidal endoscopic surgery

作　　者：张敬耀 李波 高健 柴新 郭威才 朱玉辐 ZHANG Jingyao;LI Bo;GAO Jian;CHAI Xin;GUO Weicai;ZHU Yufu(Department of Neurosurgery,Affiliated Hospital of Xuzhou Medical University,Xuzhou,Jiangsu 221000,China)

机构地区：[1]徐州医科大学附属医院神经外科,江苏徐州221000

出　　处：《安徽医药》2023年第10期2012-2016,共5页Anhui Medical and Pharmaceutical Journal

基　　金：2021年徐州市医学领军人才项目(XWRCHT20210031)。

摘　　要：目的探讨经蝶内镜手术前后的垂体柄及后叶高信号是否可以预测尿崩的发生率及其持续时间。方法回顾性分析2015年8月至2021年1月徐州医科大学附属医院收治的160例经蝶内镜治疗的鞍区肿物病人的临床资料。术前根据垂体柄高信号的形态特征将其分为三组:垂体柄远端卵圆形(A组),垂体柄远端呈线形(B组),整个垂体柄呈线形(C组)。比较各组尿崩症的发生情况,总结三组病人尿崩症发生率的持续时间。总结垂体柄高信号和后叶高信号与尿崩症之间的关系。结果术前发生尿崩症6例(3.7%)后叶均未见高信号。术后一过性尿崩76例(47.5%),永久性尿崩9例(5.6%)。160例病人中术后1周67例(41.8%)术前垂体后叶未见高信号其中64例(95.5%)术后发生一过性的尿崩,92例(57.5%)术前垂体柄出现高信号其中76例(82.6%)术后发生一过性尿崩,两者均与术后尿崩症的发生显著相关(P<0.001)。术前垂体后叶无高信号病人(A组52.4%;B组68.4%;C组91.7%),尿崩持续时间(A组4.86 d;B组46 d;C组336.67 d),后叶高信号的恢复时间(A组108 d;B组204 d;C组687 d),C组尿崩持续时间及后叶的恢复时间最长,B组次之,A组最短。其中C组中有3例出现了永久性尿崩,且垂体柄有持续的高信号。结论垂体柄高信号的出现和后叶高信号的缺失提示术后发生尿崩,如果垂体柄为高信号则是一过性的尿崩。根据垂体柄中高信号的长度可以预测尿崩持续的时间,这与抗利尿激素(ADH)的转运障碍的程度相一致。Objective To investigate whether the presence of hypersignal in the pituitary stalk and posterior lobe after transsphenoidal endoscopic surgery can predict the incidence and duration of diabetes insipidus.Methods The clinical data of 160 patients with sellar mass treated by transspenoidal endoscopy from August 2015 to January 2021 were retrospectively analyzed.According to the morphological characteristics of hypersignal of pituitary stalk,they were assigned into three groups:the distal end of the pituitary stalk was oval(group A),the distal end of the pituitary stalk was linear(group B),and the whole pituitary stalk was linear(group C).The incidence of diabetes insipidus in each group was compared,and the duration of the incidence of diabetes insipidus in 3 groups was summarized.The relationship between hypersignal of pituitary stalk and posterior lobe and diabetes insipidus were summarized.Results There was no high signal in posterior lobe of 6 patients(3.7%)with diabetes insipidus.Postoperative transient diabetes insipidus was found in 76 cases(47.5%)and permanent diabetes insipidus in 9 cases(5.6%).Of the 160 patients,67(41.8%)had no preoperatively high signal in the posterior pituitary lobe,64(95.5%)had postoperatively transient diabetes insipidus,and 92(57.5%)had preoperatively high signal in the pituitary stalk,76(82.6%)had postoperatively transient diabetes insipidus.Both were significantly associated with the incidence of diabetes insipidus after surgery(P<0.001).Patients without high signal in the posterior pituitary before surgery(group A 52.4%;group B 68.4%;group C 91.7%),duration of diabetes insipidus(group A 4.86 days;group B 46 days;group C 336.67 days),the recovery time of posterior lobe high signal(group A 108 days;group B,204 days;group C(687 days)had the longest duration of diabetes insipidus and the recovery time of posterior lobe in group C,followed by group B and group A.Among them,three patients in group C developed permanent diabetes insipidus with persistent hypersignal in the pituitary s

关 键 词：尿崩症 垂体柄 垂体后叶 磁共振成像 经蝶内镜手术 预测 

分 类 号：R651.11[医药卫生—外科学]