Intraoperative Urinary Volume Change Rule Of Tumors In Sellar Region

Objective: the tumors in the sellar region are familiar region in cranial.Specially, craniopharyngioma and pituitary adenoma are two types of benign tumors which are closely related to the hypothalamus- neurohypophysis structure(HHS). The change of urine is a common postoperative complications, main performance for urine volume increased > 250 ml/h, accompanied by electrolyte disorder, and abnormal secretion of antidiuretic hormone status. The hypothalamus- neurohypophysis structure is one of the important structures control the change of urine, it regulated the release of vasopressin(AVP) to control the kidney collecting duct for urine absorption, antidiuretic hormone by hypothalamic supraoptic and paraventricular nuclei large cell secretion, is transported through the pituitary stalk to neurohypophysis for storage. So in the operation, the hypothalamus- pituitary function neural injury, is considered to be the main cause of postoperative symptoms of polyuria. We hope that by intraoperative detection of urine, blood antidiuretic hormone changes, interpretation of craniopharyngioma and intraoperative hypothalamus pituitary adenoma patients-neurohypophysis structural damage mechanism, function change process, and the influence on the body, providing theoretical basis for the patient’s postoperative treatment.Methods: from January 2013 to April 2014, 28 months in tianjin huanhu hospital, the same doctor exerted surgical treatment of two groups of patients, respectively, 19 patients with craniopharyngioma and 23 patients with pituitary adenoma, and all use of general eyebrow bow additional lateral surgical approach, surgical operation treatment, improve preoperative examination, adding hormone level is insufficient, correct electrolyte disorder, during the whole operation, to control the total quantity of the liquid type, detection of blood pressure, heart rate, blood oxygen vital signs, intraoperative recording operation process, with important operation node, since the skin incision surgery to skin suture, once every 5 minutes interval record urine output, and urine specific gravity measurement, after the change of urine, measurement of biochemical indexes and arterial blood gas analysis, through statistical analysis, looking for intraoperative urine change rule and influence factors, the adoption of radiation immunoassay intraoperative antidiuretic hormone surgery, difficult to collect samples cost is expensive, therefore randomly selected from all the three groups, a total of 6 patients, and in all the important operation node, and the change of urine after extraction of arterial blood, determination of intraoperative antidiuretic hormone levels, analyze its relationship with the change rule of urine.Postoperative patients with postoperative urine output rise time, 1-3 days after operation, electrolyte, biochemical, hormone, and the totally time in the hospital.Results: the study shows that the 23 cases of pituitary adenoma patients, intraoperative urine is smooth, no obvious fluctuation, after operation within 27.5±4.25 hours,12patients have polynuria, 2 days appear electrolyte disorder, characterized by low natremia average tendency for average is 133.4±1.58mmol/l. And the other group involving 19 cases of craniopharyngioma separation operation, intraoperative dissection lesions in urine decreased after operation, 73.56% ±14.6%, and reach the biggest drop within 45 minutes after the separation, urine specific gravity, 3 patients with AVP levels, the separation of antidiuretic hormone levels are elevated preoperative blood after 2.3, 3.6, 5.4, after all patients appear polyuria, an average of 5 hours.2 days postoperatively in electrolyte disorder, characterized by high blood sodium, are characterized by hyponatremia with an average of 147.3± 1.43 mmol/L, patients perioperative blood electrolyte, blood sugar levels such as biochemical indicators in no difference(P > 0.05)Conclusions: This group of cases, patients with pituitary adenoma, intraoperative surgical operation, the nerve under the pituitary gland and the pituitary stalk of harassment, does not affect the intraoperative urinary volume generated, and antidiuretic hormone level changes of postoperative urinary symptoms more lightly, shortly in duration of electrolyte disorder.And the patients with craniopharyngioma, intraoperative surgical operation, to the pituitary gland and the pituitary stalk segment of harassment, resulting in decreased intraoperative urinary volume, antidiuretic hormone levels rise, postoperative polyuria appeared earlier, electrolyte disorder.