垂体病变经鼻蝶术后继发性垂体柄损伤

doi:10.3877/cma.j.issn.2095-9141.2023.02.001

中华神经创伤外科电子杂志 ›› 2023, Vol. 09 ›› Issue (02) : 65 -68. doi: 10.3877/cma.j.issn.2095-9141.2023.02.001

述评

垂体病变经鼻蝶术后继发性垂体柄损伤

王守森^†(

), 林昆哲

350025　福州，解放军联勤保障部队第九〇〇医院神经外科

收稿日期:2023-03-30 出版日期:2023-04-15
通信作者: 王守森

Secondary pituitary stalk injury after transsphenoidal surgery for pituitary lesions

Shousen Wang^†(), Kunzhe Lin

Department of Neurosurgery, the 900^th Hospital of the Joint Logistics Team, Fuzhou 350025, China

Received:2023-03-30 Published:2023-04-15
Corresponding author: Shousen Wang

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水、电解质平衡紊乱是垂体病变经鼻蝶术后常见并发症，常与神经垂体损伤有关。经鼻蝶入路鞍内病变切除术后易发生鞍内空虚和鞍膈下沉，可使垂体柄受到向下的拉力，导致继发性垂体柄损伤，进而引起抗利尿激素排泌异常，呈现尿量与血钠的异常变化进程。本文针对垂体病变经鼻蝶术后继发性垂体柄损伤及相关水、电解质紊乱表现形式作一述评，以期为围术期管理提供新的理论依据，尤其有利于正确认识抗利尿激素分泌异常综合征之后的"报复性多尿期"。

关键词: 垂体病变, 经鼻蝶入路, 垂体柄损伤, 尿崩症, 抗利尿激素分泌异常综合征

Disturbances of water and electrolyte balance are common complications after transsphenoidal surgery for pituitary lesions, and often related to neurohypophyseal injury. After resection of the intracellar lesion via transsphenoidal approach, intrasellar emptiness and sinking of the the diaphragma sellae are easy to occur, which can cause secondary damage to the pituitary stalk due to downward traction, resulting in abnormal secretion of antidiuretic hormone and abnormal changes in urine volume and blood sodium levels. This article reviews the secondary pituitary stalk injury and related manifestations of water and electrolyte disturbances in patients with secondary pituitary stalk injury after transsphenoidal surgery for pituitary lesions, aiming to provide new theoretical basis for perioperative management, especially for a correct understanding of the "retaliatory polyuria period" after the syndrome of inappropriate antidiuretic hormone secretion.

Key words: Pituitary lesion, Transsphenoidal approach, Pituitary stalk injury, Diabetes insipidus, Syndrome of inappropriate antidiuretic hormone secretion

图1 垂体病变经鼻蝶术后尿量与血钠变化进程示意图

Fig.1 Schematic diagram of changes in urine volume and blood sodium after transsphenoidal surgery for pituitary lesions

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