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首页> 外文期刊>Therapeutic advances in endocrinology and metabolism. >Current best practice in the management of patients after pituitary surgery
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Current best practice in the management of patients after pituitary surgery

机译：垂体手术后患者管理的最新最佳实践

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Sellar and parasellar masses are a common finding, and most of them are treated surgically via transsphenoidal approach. This type of surgery has revolutionized the approach to several hypothalamic-pituitary diseases and is usually effective, and well-tolerated by the patient. However, given the complex anatomy and high density of glandular, neurological and vascular structures in a confined space, transsphenoidal surgery harbors a substantial risk of complications. Hypopituitarism is one of the most frequent sequelae, with central adrenal insufficiency being the deficit that requires a timely diagnosis and treatment. The perioperative management of AI is influenced by the preoperative status of the hypothalamic–pituitary–adrenal axis. Disorders of water metabolism are another common complication, and they can span from diabetes insipidus, to the syndrome of inappropriate antidiuretic hormone secretion, up to the rare cerebral salt-wasting syndrome. These abnormalities are often transient, but require careful monitoring and management in order to avoid abrupt variations of blood sodium levels. Cerebrospinal fluid leaks, damage to neurological structures such as the optic chiasm, and vascular complications can worsen the postoperative course after transsphenoidal surgery as well. Finally, long-term follow up after surgery varies depending on the underlying pathology, and is most challenging in patients with acromegaly and Cushing disease, in whom failure of primary pituitary surgery is a major concern. When these pituitary functioning adenomas persist or relapse after neurosurgery other treatment options are considered, including repeated surgery, radiotherapy, and medical therapy.
机译：蝶鞍肿块和鞍旁肿块是常见的发现，大多数通过经蝶窦入路手术治疗。这种手术彻底改变了几种下丘脑-垂体疾病的治疗方法，通常是有效的，并且患者可以耐受。然而，鉴于在有限的空间中解剖结构复杂且腺，神经和血管结构的密度很高，经蝶窦手术具有很大的并发症风险。垂体功能减退是最常见的后遗症之一，其中肾上腺皮质功能不全是需要及时诊断和治疗的缺陷。 AI的围手术期管理受下丘脑-垂体-肾上腺轴的术前状态影响。水代谢紊乱是另一种常见的并发症，其范围从尿崩症到抗利尿激素分泌不适当的综合症，再到罕见的脑盐消耗综合症。这些异常通常是短暂的，但需要仔细监控和管理，以避免血钠水平的突然变化。脑脊液漏出，视神经fluid裂等神经系统结构受损以及血管并发症也会使经蝶窦手术后的病程恶化。最后，手术后的长期随访视基础病理而异，在肢端肥大症和库欣病患者中最具挑战性，因为他们主要担心垂体手术失败。当这些垂体功能性腺瘤在神经外科手术后持续存在或复发时，可以考虑其他治疗选择，包括重复手术，放疗和药物治疗。

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