135例垂体腺瘤术后水钠紊乱影响因素分析

发布时间：2018-04-01 05:33

本文选题：垂体腺瘤　切入点：水钠紊乱　出处：《新疆医科大学》2016年硕士论文

【摘要】：目的:探讨垂体腺瘤术后水钠紊乱的原因及相关因素。方法:回顾性分析我院神经外科经鼻蝶手术治疗的135例垂体腺瘤患者临床资料,收集围手术期临床数据如:是否有尿崩、低钠血症,年龄、性别、大小、生长方式(是否突破鞍隔)、质地、侵袭性、腺瘤分型、是否复发等,应用2?检验和Logistic回归分别检验垂体腺瘤术后发生尿崩症和低钠血症的影响因素,并着重对其发病机制与相关诊疗进行分析讨论。结果:135例患者中,共发生尿崩47例,2?检验提示尿崩的发生在年龄、生长方式、大小、侵袭性4个因素上差异性显著(2?=6.390,P=0.041;2?=4.298,P=0.038;2?=6.196,P=0.045;2?=5.892,P=0.015),将以上四个因素纳入Logistic回归提示:尿崩症与年龄、大小、侵袭性3个因素相关(β=0.782,P=0.007,OR=2.186;β=-0.724,P=0.019,OR=0.485;β=1.256,P=0.006,OR=3.510)。共发生低钠血症33例,卡方检验提示低钠血症的发生在性别、生长方式、大小、病理类型4个因素上差异性显著(2?=4.129,P=0.042;2?=9.753,P=0.002;2?=17.956,P=0.000;2?=4.220,P=0.040),将以上四个因素纳入Logistic回归提示:垂体腺瘤术后低钠血症仅与生长方式(是否突破鞍膈)相关(β=1.101,P=0.014,OR=3.006),其他因素如年龄、性别、大小、质地、侵袭性、腺瘤分型、是否复发等与术后低钠血症无明显相关。结论:1.尿崩症与年龄成正相关,即年龄越大,越容易发生尿崩症;2.尿崩症与腺瘤大小成负相关,即微腺瘤较大腺瘤和巨大腺瘤更容易发生尿崩症;3.尿崩症与腺瘤侵袭性成正相关,即具有侵袭性的腺瘤较无侵袭性的腺瘤更容易发生尿崩症;4.低钠血症仅与腺瘤生长方式(是否突破鞍隔)相关,为正相关,即突破鞍隔的腺瘤术后较未突破鞍隔的腺瘤更容易发生低钠血症,与其他因素如年龄、性别、大小、质地、侵袭性、腺瘤分型、是否复发等无明显相关。
[Abstract]:Objective: to investigate the causes and related factors of water and sodium disturbance after pituitary adenoma operation. Methods: the clinical data of 135 patients with pituitary adenoma treated by transsphenoidal surgery in our hospital were analyzed retrospectively, and the perioperative clinical data were collected, such as whether there was an avalanche of urine. Hyponatremia, age, sex, size, growth pattern (do you break through Sellar septum, texture, invasion, adenoma typing, recurrence, etc.). The influencing factors of diabetes insipidus and hyponatremia after operation of pituitary adenoma were examined by Logistic regression and the pathogenesis of diabetes insipidus and related diagnosis and treatment were analyzed and discussed. The results showed that there were significant differences in age, growth pattern, size and invasiveness in the occurrence of urinary avalanche. 6. 390 Pu. 0.041? 2? 4. 298 Pu. 0. 038. 2? P0. 045? The above four factors were included in the Logistic regression analysis: diabetes insipidus was correlated with age, size and invasiveness (尾 -0.782P0. 007 OR2.1866; 尾 -0.724P0. 019 ORA 0.485; 尾 1. 256P0.006OR3.5100.33 cases of hyponatremia occurred in sex, growth pattern, size, size, and size of hyponatremia), the results showed that there were 33 cases of hyponatremia, and the results of Qa Fang test showed that hyponatremia occurred in sex, growth pattern, size, and size of hyponatremia. There were significant differences among the four factors in pathological types. 4. 129 Pu. 0. 042? 9. 753? 0.000? Logistic regression showed that hyponatremia after pituitary adenoma surgery was only associated with growth pattern (尾 -1.101) (尾 1.101) and OR3.006, other factors such as age, sex, size, texture, invasiveness, adenoma classification, and other factors, such as age, sex, size, texture, invasiveness, and type of adenoma. Conclusions 1. Diabetes insipidus is positively correlated with age, that is, diabetes insipidus is more likely to occur in older patients. 2.diabetes insipidus is negatively correlated with adenoma size. That is, larger and larger adenomas are more likely to develop diabetes insipidus. 3. Diabetes insipidus is positively correlated with adenoma invasiveness. That is, invasive adenomas are more likely to develop diabetes insipidus than noninvasive adenomas. Hyponatremia is only associated with the growth pattern of adenomas (whether or not it breaks the saddle septum). In other words, hyponatremia was more likely to occur in adenomas after operation than those without Sella septum, and had no significant correlation with other factors such as age, sex, size, texture, invasiveness, type of adenoma, recurrence of adenoma and so on.
【学位授予单位】：新疆医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R736.4

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