经翼点入路显微手术治疗鞍上型颅咽管瘤

目的探讨经翼点入路显微神经外科手术治疗鞍上型颅咽管瘤疗效及安全性。方法回顾性分析采用经翼点入路显微手术治疗的28例鞍上型颅咽管瘤患者的临床资料。结果全切除24例（86％）,近全切除4例（14％）;术后并发症：尿崩症23例（有3例遗留永久性尿崩症）,高热16例,血电解质紊乱26例,癫痫8例,意识障碍5例,应激性溃疡3例,垂体功能低下12例。1例术后死于高血钠。随访26例,随访时间12—58个月,能正常生活者22例,生活需要照顾者3例,视力、视野障碍者均有不同程度恢复,全切除病例随访期内未发现复发者。结论显微外科手术治疗鞍上型颅咽管瘤临床疗效较好,术中注意保护丘脑及各穿支动脉、滋养动脉,是减少术后并发症的关键。     

颅咽管瘤术后尿崩症及电解质紊乱的治疗

目的探讨颅咽管瘤术后尿崩症及电解质紊乱的特点及治疗方法。方法对50例颅咽管瘤切除术患者术后尿崩症及电解质紊乱的治疗情况进行回顾性分析。结果50例患者在术后均发生了不同程度的各种并发症,经补液、应用垂体后叶素等个体化治疗和相应的对症支持治疗,临床痊愈出院49例,死亡1例。结论手术操作是减少颅咽管瘤术后并发症的关键,对并发症的处理应进行个体化治疗,并在治疗过程中严密监测尿量、中心静脉压、血钠、尿钠及血、尿渗透压的变化。     

显微神经外科技术治疗颅咽管瘤

目的 研究颅咽管瘤的显微神经外科手术技巧和临床效果。方法 回顾性分析采用显微神经外科技术治疗的28例颅咽管瘤患者的临床资料。结果 全切除24例（86％）、近全切除4例（14％）。尿崩症、高热、水电解质平衡失调是颅咽管瘤切除术后较常见的并发症。结论 入路的合理选择、显微技术的应用、术中垂体柄的辨认与保护及脑室外引流的应用对提高肿瘤全切除率、降低致残率和病死率有重要的临床意义。     

儿童颅咽管瘤的外科治疗

目的 探讨儿童颅咽管瘤的外科治疗方法。方法 总结、分析21例儿童颅咽管瘤的临床诊断以及手术方法。结果 肿瘤全切除11例，次全切除7例，大部分切除3例。术后发现尿崩症者14例，占66％，4例出现下丘脑损伤，占19％，其中死亡1例。结论 儿童颅咽管瘤的外科治疗仍是神经外科的难题，手术的选择必须根据患儿的病情，经济状况，手术医师的经验以及医院的综合医疗水平综合考虑。     

颅咽管瘤显微手术切除与术后放射治疗的研究

目的探讨颅咽管瘤显微手术切除相关因素和术后放射治疗的临床疗效。方法回顾性分析23例颅咽管瘤患者显微手术的入路选择及影响手术切除的相关因素和术后放射治疗的疗效。结果本组经翼点入路或改良翼点入路,经视交叉前间隙4例,经视神经．颈内动脉间隙3例,经颈内动脉外侧间隙1例,多间隙联合15例;手术全切除14例,大部切除5例,部分切除4例;术后行放射治疗13例。结论显微手术是颅咽管瘤治疗的主要手段,翼点入路或改良翼点入路是最常用的入路,肿瘤的大小、生长方式、生长部位、组织学特性是影响手术切除的主要因素;放射治疗是颅咽管瘤不全切除术后治疗的首选手段。     

经额外侧锁孔入路手术切除鞍区颅咽管瘤的应用价值

目的分析经额外侧锁孔入路手术切除鞍区颅咽管瘤的应用价值。方法 15例鞍区颅咽管瘤患者经额外侧锁孔入路手术切除,分析患者治疗效果。结果 13例患者肿瘤全切除,2例患者次全切除。视力均得到明显改善,术后3例尿崩症患者经利尿剂后好转;2例皮下积液患者经加压包扎后愈合。结论经额外侧锁孔入路手术可有效切除鞍区颅咽管瘤,充分暴露鞍区病变部位,利于全切除,安全有效,值得临床推广。     

垂体瘤术后水钠紊乱的治疗

目的总结垂体瘤手术后水钠紊乱的临床特点及治疗方法。方法对302例垂体腺瘤术前、术后每日检测血钠并观察尿量，根据其变化进行治疗。结果肿瘤全切除268例(89％)，153例(50．6％)出现尿崩症，146例在术后1～2周内恢复，4例术后2个月恢复，2例术后半年恢复，最长1例持续2年。117例(38．7％)出现血钠紊乱，其中低钠血症72例，高钠血症29例，交替性血钠紊乱16例，大多数患在术后2周内恢复。结论垂体瘤手术后水钠紊乱表现复杂多样，治疗应根据不同的原因并及时调整。术后尿崩症大多数为暂时性，可在手术后早期恢复。手术入路的选择与技巧对防止术后水钠紊乱有重要意义。     

颅咽管瘤手术切除术围手术期护理体会

目的探讨颅咽管瘤患者行手术切除的手术前、后护理措施。方法回顾我院2010年来对36例颅咽管瘤切除术前后护理资料进行分析。结果36例颅咽管瘤切除患者,行全切30例,次全切5例,症状均明显改善。结论通过颅咽管瘤切除术治疗及护理,做好安全防护,使患者早日康复。     

颅咽管瘤术后常见并发症的处理

目的探讨颅咽管瘤术后常见并发症及其防治对策。方法回顾性分析39例颅咽管瘤术后患者出现的各种并发症,结合患者具体病因,制定相应的治疗方案。结果术后全组患者均出现了不同程度的各种并发症,尿崩症：21例患者术后3d内均出现明显多饮多尿,24h尿量均超过4000mL,最多者〉500mL／h。电解质紊乱：24例患者术后钠、氯、钾代谢紊乱,其中高钠高氯血症13例,低钠血症11例。激素水平异常：20例术前或术后出现激素水平异常。其他并发症：高热3例,患者术后出现高热,体温达39-40qc;抽搐发作2例,消化道出血1例。经积极治疗后均明显好转。结论手术是目前颅咽管瘤首选的治疗方法。虽然显微外科技术发展迅速．但由于颅咽管瘤性质及生长部位的特殊性、复杂性,手术风险不容忽视。对于颅咽管瘤患者来说,术后并发症的治疗尤为重要,直接影响患者的预后,应尽早发现,积极防治。     

颅咽管瘤术后水钠代谢紊乱护理措施探讨

目的探讨颅咽管瘤术后水钠代谢紊乱护理措施。方法 2009-03-2012-03收治的颅咽管瘤67例护理措施进行总结。结果 67例颅咽管瘤术后2d～8d发生尿崩症48例,发生率71.64%;出现电解质紊乱50例,发生率74.62%,经积极控制后40例,占81.63%1月内恢复正常,9例占18.37%需长期服用糖皮质激素。结论颅咽管瘤术后容易并发水钠代谢紊乱,通过护理人员精确统计尿量、尿比重,细致观察病情变化,周密的纠正方案,可以减少水钠代谢紊乱带来的继发损害。     

巨大垂体腺瘤的显微手术治疗

目的探讨巨大垂体腺瘤显微手术治疗经验.方法采用改良翼点入路对48例巨大垂体腺瘤行显微手术治疗.结果肿瘤全切除36例,近全切除8例,大部全切除4例,其中全切除患者垂体柄保留30例.术后发生尿崩症者31例,其中21例在1～2周内恢复正常,7例在3个月内恢复,3例尿崩症持续1年左右.结论采用改良翼点入路治疗巨大垂体瘤效果确切.术中垂体柄保留是降低术后尿崩症、提高手术疗效的关键措施.     

单鼻孔经蝶入路垂体瘤的显微手术治疗

目的 探讨单鼻孔经蝶人路显微手术切除垂体瘤的临床应用及手术技巧.方法 对21例垂体瘤采用经单鼻孔-蝶窦入路显微手术患者的临床资料及手术效果进行回顾性分析.结果 肿瘤全切除14例,次全切5例,2例部分切除;13例功能性垂体瘤术后内分泌功能恢复正常或好转,12例术前有视野缺损的术后均有不同程度改善,15例术后有尿崩症状,经治疗后恢复正常.结论 单鼻孔经蝶窦入路垂体瘤的显微手术治疗创伤小,恢复快,疗效满意,是治疗垂体腺瘤安全有效的方法.     

Transient diabetes insipidus after discontinuation of therapeutic vasopressin

The use of vasopressin for the treatment of septic shock is increasing. Few reports of fluid and electrolyte complications of this therapy have been reported. A neurologically impaired, 53-year-old man with a history of syndrome of inappropriate antidiuretic hormone developed apparent transient diabetes insipidus and acute hypernatremia after being treated with vasopressin. He was treated for presumed septic shock with intravenous vasopressin 0.01-0.10 U/minute. His blood pressure did not improve with this therapy, and his course was complicated by hyponatremia during the vasopressin infusion. Discontinuation of the infusion was followed by a profound (8.4 L) diuresis and rapid onset of hypernatremia (serum sodium concentration increased from 132 to 157 mEq/L over 8 hrs). Although urine osmolality was not measured during the patient's diuresis, the rapid changes in serum sodium concentration can be explained only by an inappropriate water diuresis. The diuresis ceased when the vasopressin infusion was resumed. We concluded that these findings are most consistent with transient diabetes insipidus. The safety and efficacy of intravenous vasopressin have not been established in patients with septic shock and underlying disorders of water homeostasis. The drug may have diminished vasoconstrictive effects in this patient population. Careful monitoring of water and sodium balance is warranted in all patients treated with vasopressin for septic shock.     

颅咽管瘤术后水电解质紊乱的相关因素分析

目的：通过对91例颅咽管瘤患者的临床资料进行回顾性分析,结合文献资料探讨可能影响颅咽管瘤术后水电解质紊乱的相关因素。方法：选取中国医科大学附属第一医院2001年1月～2007年12月颅咽管瘤手术患者91例,全部为术后病理明确诊断的患者。统计术后发生水电解质紊乱的例数,对可能影响颅咽管瘤术后水电解质紊乱的相关因素进行统计学分析。结果：在可能影响颅咽管瘤术后水电解质紊乱的各种因素中,经SPSS13.0统计学软件分析,术前尿崩与术后水电解质紊乱有相关性（P〈0.05）,而性别、年龄、肿瘤钙化、囊型变、肿瘤部位、手术方式、是否复发以及肿瘤切除程度等与颅咽管瘤术后水电解质紊乱无明显相关性（P〉0.05）。结论：术中对垂体柄的保护是减少术后尿崩和水电解质紊乱的最主要因素。     

鞍区肿瘤术后低钠血症的临床处理

目的 探讨鞍区肿瘤术后抗利尿激素分泌异常综合征(SIADH)及脑性盐耗综合征(CSWS)的鉴别诊断及治疗方法.方法回顾性分析86例首次接受鞍区肿瘤术后低钠血症患者的临床表现和实验室检查,总结有效的诊断及治疗方法.将48例垂体腺瘤患者分为A组,28例颅咽管瘤和10例脑膜瘤患者分为B组;CSWS低钠者补钠、迅速扩容、补充高...     

118例神经外科显微手术效果分析与对策

目的分析神经外科显微手术的效果及对策。方法对118例神经性肿瘤患者实施显微外科切除手术。结果 86例脑肿瘤全切除74例,大部分切除12例;32例脑动脉瘤完全夹闭。手术过程中无死亡发生,2例患者由于出现大面积脑梗死发生偏瘫,1例术后出现暂时性肢体偏瘫,出院时恢复,5例发生尿崩,4例1个月内恢复,1例并发肺部感染死亡。出院时恢复效果良好105例,好转12例,死亡1例。结论外科显微手术创伤小,成功率高,复发率低,并发症少,在神经性肿瘤及脑血管病治疗方面具有显著的效果,能够延长患者的生命期限,提高生存质量。     

Residual catatonic state following neuroleptic malignant syndrome

Neuroleptic malignant syndrome (NMS) is usually a self-limited disorder, with most cases resolving within 2 weeks after antipsychotic drug discontinuation. However, the course of NMS may not always be short-lived. In this report, the authors describe five patients who developed a residual catatonic state that persisted after acute hyperthermic symptoms of NMS had subsided and compare them with 27 similar cases in the literature. Two of our patients recovered gradually with supportive treatment. Three patients were treated with electroconvulsive therapy (ECT). Of these, two showed a positive response, although one died later of intercurrent pneumonia. A third patient did not respond to ECT, but recovered gradually thereafter. Although dopamine agonists or benzodiazepines have been advocated for the treatment of residual symptoms in previous case reports, ECT was the treatment most often associated with a rapid response and no mortality, even in patients refractory to pharmacotherapy. In conclusion, catatonic and parkinsonian symptoms of NMS may persist as a residual state lasting for weeks to months after more fulminant acute symptoms abate. These residual symptoms may be more likely to develop in patients with pre-existing structural brain disorders. Although patients may improve gradually with supportive care or pharmacotherapy, ECT can often be highly effective in treating the residual catatonic state that follows NMS.     

A case of acute strychnine poisoning

In most severe cases of strychnine poisoning, the patient dies before reaching the hospital. This report describes the treatment and successful outcome of a patient who had taken a dose of strychnine that would normally be fatal. A 28-y-old man was admitted 2 h after ingestion of 1 to 1.5 g of strychnine. He had a Glasgow Coma Score of 14/15 and was severely agitated and in mild respiratory distress; blood pressure was 90/60 mmHg, pulse 110/min, and peripheral pulses weak. He had generalized hyperactive reflexes and had several generalized tonic-clonic convulsions in the emergency department. Treatment consisted of gastric lavage with water, oral administration of activated charcoal and sorbitol solution, continuous intravenous administration of midazolam and then sodium thiopental, furosemide, sodium bicarbonate and hemodialysis for acute renal failure. His clinical course included respiratory distress, agitation, generalized tonic-clonic convulsions, hyperactivity, oliguria and acute tubular necrosis prior to recovery in 23 days. This patient ingested what would normally be a fatal amount of strychnine, had signs and symptoms of severe toxicity and recovered, suggesting that with aggressive supportive care patients may have favorable outcomes.     

垂体瘤显微手术后尿崩的预防和治疗

目的 探讨垂体腺瘤术后尿崩症的预防和治疗,以减少术后尿崩的发生,提高垂体腺瘤手术的疗效.方法 回顾总结2012年8月至2015年8月本院神经外科显微手术治疗垂体腺瘤患者84例,26例肿瘤直径＞ 3cm向鞍上、鞍旁生长的巨大垂体腺瘤采用经额下人路显微手术摘除肿瘤,其余58例行单鼻孔蝶窦人路切除肿瘤,统计尿崩症的预防、发生和治疗情况.结果 84例患者术后出现尿崩35例(41.7％),其中26例巨大垂体腺瘤病例中发生尿崩19例(73.0％),其余58例垂体腺瘤病例术后发生尿崩16例(27.6％).经对症治疗,尿崩持续时间＜3周的21例,持续3周～3个月的12例,发生永久性尿崩的2例.结论 术前全面检查、充分准备,熟悉垂体后叶亮点的位置及肿瘤与周边组织的三维立体关系,术中避免损伤垂体、垂体柄、下丘脑及其供血血管,术后及时合理使用抗利尿药物与纠正水电解质平衡紊乱是预防和治疗垂体腺瘤术后尿崩症的关键.