並列タイトル等非機能性下垂体腺腫における経鼻内視鏡下経蝶形骨洞手術後の遅発性低ナトリウム血症の手術因子の検討
一般注記type:Thesis
Purpose Delayed hyponatremia can occur after pituitary surgery, resulting in prolonged hospitalization. However, theinfluence of surgical factors after such a procedure has not been well established. The impact of surgery and related factorson delayed hyponatremia was investigated.Methods This was a retrospective analysis of 137 consecutive patients who underwent transsphenoidal surgery for anonfunctioning pituitary adenoma between 2008 and 2019. Preoperative (demographics, comorbidities), intraoperative(resection extent, operation time, blood loss volume, cerebrospinal fluid leak, tumor consistency), and postoperative[hematoma, meningitis, diabetes insipidus (DI), hormonal assessment] data were collected, with statistical analysis of eachfactor performed.Results Among the 137 patients, delayed hyponatremia occurred in 31 (22.6%). Multivariate analysis revealed that thosewith hypertension had a significantly higher likelihood of avoiding delayed hyponatremia (p = 0.004). Although no correlationsof direct surgical factors with delayed hyponatremia were found, multivariate analysis of indirect surgical factorsshowed that presence of a firm tumor, transient DI, and meningitis were significantly associated with delayed hyponatremia(p = 0.014, 0.001, and 0.047, respectively). There was also a significant association of severe hyponatremia with appearanceof symptoms (p = 0.002).Conclusion There was a tendency for hypertension to be associated with delayed hyponatremia avoidance, with indirectsurgical factors including tumor consistency, transient DI, and meningitis found to have an influence on delayed hyponatremia.It was concluded that attention should be given to non-hypertensive patients with a firm tumor, transient DI, ormeningitis after pituitary surgery, as delayed hyponatremia may occur.
博士（医学）・甲第871号・令和5年3月15日
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identifier:Endocrine Vol.78 No.2 p.354-362 (2022 Nov)
identifier:1355008X
identifier:http://ginmu.naramed-u.ac.jp/dspace/handle/10564/4103
identifier:Endocrine, 78(2): 354-362
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