儿童颅咽管瘤围手术期内分泌和水电解质紊乱的临床研究

目的探讨儿童颅咽管瘤手术前后内分泌和水电解质代谢紊乱的变化规律和处理要点。方法对手术前后同时存在内分泌和水钠失衡的17例儿童颅咽管瘤进行显微手术治疗。手术前后每日监测血电解质、尿量和24h尿钠；入院时和术后3d检测生长激素（GH）、甲状腺激素（T3、T4）、性激素、皮质醇及抗利尿激素，对手术前后的变化进行对比分析并作针对性治疗。结果手术前后均易发生生长激素、皮质醇和性激素缺乏，以及尿崩症和低钠血症，但二者之间无必然联系；术后内分泌障碍发生几率较术前少，而水电解质代谢紊乱较术前重；手术前后生长激素、甲状腺激素、性激素、皮质醇和24h尿钠的测定结果比较差异无统计学意义（P〉0．05）；而手术前后血浆抗利尿激素（ADH）水平和血浆渗透压比较差异有统计学意义（P〈0．05）。内分泌和水电解质代谢紊乱的类型和程度与肿瘤侵犯的部位、脑积水和手术损伤下丘脑-垂体柄等有关。术后高钠血症和尿崩症各死亡1例。结论内分泌和水电解质代谢紊乱是儿童颅咽管瘤围手术期常见并发症，对其正确诊断及积极治疗能提高手术疗效。

Clinical analysis of endocrine dysfunction hydroelectrolytic disorder in children with craniopharyngioma before and after operation

Objective To study the characteristics of the endocrine dysfunction and hydroelectrolytic disorder in children with craniopharyngioma during perioperative period. Methods Seventeen patients undergoing mieroneurosurgery for eraniopharyngioma proved surgically and pathologically were retrospectively analyzed. The electrolyte and sodium in 24 h urine of these patients were daily measured before and after operation. Endocrine function including growth hormone, thyroid hormone, sex hormone, corticosteroid and antidiuretic hormone was monitored at admission, date and post-operative 3 day respectively. The treatment was given and the data was statistically analyzed. Results The endocrine dysfunction and hydroelectrolytic disorders among children with eraniopharyngioma before and after operation were observed frequently. Despite complicated clinical situation, the decrease in growth hormone, cortisol, and sex hormone, and the diabetes insipidus and hyponatremia mostly occurred. Comparing the data of growth hormone, thyroid hormone, sex hormone and corticosteroid, there was no significant difference before and after operation. While postoperative plasma antidiuretic hormone concentration and plasma osmotic pressure were significantly lower than that of preoperative period. Two cases died after operation. The endocrine dysfunction and hydroelectrolytic disorders were closely related to the simultaneously hypothalamie involvement, hydrocephalus before surgery and the damage to the hypothalamus-pituitary body due to the operation. Condusion Endocrine dysfunction and hydroelectrolytic disorders are common among children with eraniopharyngioma before and after operation. Reasonable management of these disorders is important to improve the surgical outcome.