■延迟的术后低钠血症(DPH)对于鞍区病变很常见。然而,尚未在大型患者队列中研究Rathke囊肿(RCC)鼻内镜手术(EES)后DPH的真实患病率和相关因素.
■在我们机构进行了超过6年的回顾性分析,根据我们的纳入标准,纳入经EES治疗的RCC患者.患者人口统计学,临床特征,images,和外科手术记录。术前常规测定血清钠,术后第1天,此后每2天直至出院。对于DPH患者,电解质,血细胞比容,血清蛋白水平,每天测量血浆和尿渗透压以探索潜在的病因。
■在149名符合条件的患者中,25(16.8%)开发了DPH,这与其他鞍区病变相似,除了颅咽管瘤,在我们机构的同一时期。单因素分析提示的重要危险因素是囊肿位置,术后氢化可的松治疗的要求,术后脑膜炎,术中脑脊液(CSF)漏,及囊壁次全切除(STR)(均p<0.05)。此外,其他11例采用不同手术策略(积极切除)和相关因素的鞍上RCC患者纳入多因素分析。鞍上位置[优势比(OR)8.387,95%置信区间(CI)1.014-69.365,p=0.049],术后氢化可的松治疗的需求(OR4.208,95CI1.246-14.209,p=0.021),术中脑脊液漏(OR6.631,95CI1.728-25.440,p=0.006)是DPH的独立预测因子。
■DPH是肾癌EES后常见的并发症。上层位置,术后氢化可的松治疗的要求,术中脑脊液漏是最可靠的危险因素。皮质醇缺乏和抗利尿激素不当综合征(SIADH)被认为是RCC中DPH的主要病因。保守切除囊壁可减少DPH的发生。
UNASSIGNED: Delayed postoperative hyponatremia (DPH) is common for sellar lesions. However, the true prevalence and associated factors of DPH after endoscopic endonasal surgery (EES) for Rathke\'s cleft cyst (RCC) have not been studied in a large patient cohort.
UNASSIGNED: A retrospective analysis was conducted over 6 years at our institution, and patients with RCC treated by EES were enrolled according to our inclusion criteria. Patient demographics, clinical characteristics, images, and surgical procedures were documented. Serum sodium was routinely measured before surgery, on postoperative day 1, and every 2 days thereafter until discharge. For patients with DPH, electrolyte, hematocrit, serum protein levels, and plasma and urinary osmolality were daily measured to explore potential etiology.
UNASSIGNED: Of the 149 eligible patients, 25 (16.8%) developed DPH, which was similar to other sellar lesions, except craniopharyngioma, in the same period in our institution. Significant risk factors suggested by univariate analysis were cyst location, requirement of postoperative hydrocortisone therapy, postoperative meningitis, intraoperative cerebrospinal fluid (CSF) leakage, and subtotal resection (STR) of the cyst wall (all p < 0.05). In addition, other supplementary 11 cases of suprasellar RCC with different surgical strategies (aggressive resection) and relevant factors were enrolled into multivariate analysis. Suprasellar location [odds ratio (OR) 8.387, 95% confidence interval (CI) 1.014-69.365, p = 0.049], requirement of postoperative hydrocortisone therapy (OR 4.208, 95%CI 1.246-14.209, p = 0.021), and intraoperative CSF leakage (OR 6.631, 95%CI 1.728-25.440, p = 0.006) were found to be the independent predictors of DPH.
UNASSIGNED: DPH is a common complication after EES for RCC. Suprasellar location, requirement of postoperative hydrocortisone therapy, and intraoperative CSF leakage are the most reliable risk factors. Cortisol deficiency and syndrome of inappropriate antidiuretic hormone (
SIADH) are considered as the main etiologies of DPH in RCC. Conservative excision of the cyst wall may reduce DPH occurrence.