垂体腺瘤经蝶窦入路术后继发迟发性低钠血症的危险因素

目的 探讨垂体腺瘤经蝶窦入路术后发生迟发性低钠血症的危险因素。方法 回顾性分析2012年3月~2020年7月经鼻蝶入路手术切除的671例垂体腺瘤的临床资料。结果 术后47例（7.0%）发生迟发性低钠血症，发生时间在术后3~13 d，中位数7.5 d；血钠浓度114~131 mmol/L，平均（124.3±4.8）mmol/L；治疗时间1~9 d，中位数3 d。多因素logistic回归分析显示，女性、术前存在垂体功能减退、术后ACTH轴异常、肿瘤腔高度显著变化是发生迟发性低钠血症的独立危险因素（P<0.05）。结论 迟发性低钠血症是垂体腺瘤术后常见的并发症，尤其是女性、垂体功能减退的病人；肿瘤腔高度显著变化与术后迟发性低钠血症有关，建议肿瘤切除后填塞瘤腔。

Risk factors for delayed hyponatremia in patients with pituitary adenoma after surgery through transsphenoidal approach

Objective To investigate the risk factors of delayed hyponatremia in the patiuents with pituitary adenoma after the surgery through transsphenoidal approach. Methods The clinical data of 671 patients with pituitary adenoma who underwent surgery through sphenoid approach from March 2012 to July 2020 were retrospectively analyzed. Results Delayed hyponatremia occurred in 47 patients (7.0%) after the operation. The occurrence time ranged from 3 days to 13 days after the operation, with a median of 7.5 days. The serum sodium concentration ranged from 114 mmol/L to 131 mmol/L, with an average of (124.3±4.8) mmol/L. The treatment time ranged from 1 day to 9 days, with a median of 3 days. Multivariate logistic regression analysis showed that female, preoperative hypopituitarism, postoperative ACTH axis abnormality and significant changes in tumor cavity height were independent risk factors for delayed hyponatremia (P<0.05). Conclusions Delayed hyponatremia is a common complication of the patients with pituitary adenoma after surgery, especially in female aptients and those with preoperative hypopituitarism. Significant changes in the height of the tumor cavity are related to delayed hyponatremia after surgery. It is recommended to pack the tumor cavity after tumor resection.