颅咽管瘤183例临床分析

目的探讨鞍区颅咽管瘤患者的临床特点，手术前后神经内分泌激素变化规律，为颅咽管瘤患者内分泌激素监控和更好地替代治疗、进一步实施教育提供依据。方法回顾性分析183例颅咽管瘸患者临床表现、手术前及手术后不同时期内分泌激素变化等的临床资料。结果患者术后甲状腺、肾上腺、性腺激素（泌乳素除外）测定较术前均下降，差异有统计学意义（P〈0．05或〈0．01）；术后10d与术后3d比较，甲状腺（除T4外）、肾上腺、性腺激素水平虽有好转，但差异无统计学意义（P〉0．05）。术后糖皮质激素替代治疗143例（78．14％）；甲状腺激素替代治疗89例（48．63％）；抗利尿激素替代治疗40例（21．86％）。结论颅咽管瘤患者以儿童及青少年起病多见，临床表现复杂，手术前后均存在内分泌激素水平紊乱。肿瘤本身的占位效应及手术创伤是造成内分泌激素水平低下的根本原因。及早激素替代治疗，定期内分泌激素监控，对改善患者预后、提高患者生活质量具有重要临床意义。

A clinical analysis of 183 patients with craniopharyngioma

Objective To explore the clinical characteristics,changes of neuroendocrine hormone before and after operation in patients with craniopharyngioma,so as to provide the basis for the replacement therapy after operation and educational practice. Methods The clinical data of 183 patients with craniopharyngioma were retrospectively analyzed. Results （ 1 ）Symptoms mainly were headache with nausea, diseyesight, the second symptom was polydipsia and polyuria,in child, growth and development retardation was more, and another was hypothalamus syndrome. （2）Functions in endocrine：functions in thyreoid, adrenal and gonad （except PRL）, the dysfunctions in neurohypophysis was displayed with completed insipidus and immaturity insipidus,contrasted it anteoperation to that postoperation,it was obvious in statistics meanings （P 〈 0.05）. Conclusions In patients with craniopharyngioma, children and adolescent is more than the other people, clinical situation is complicated, neuroendocrine hormone is derangement before and after operation, tumor itself to oppress and operation trauma are the basic reasons for the hypofunction of neuroendocrine hormone, hormones replacement therapy and monitoring should be catch earlier.