颅咽管瘤的QST分型特点和手术治疗

The characteristics and surgical treatments of various types of craniopharyngiomas classified by QST

目的探讨不同QST分型颅咽管瘤患者的临床特点以及QST分型对手术的指导作用。方法回顾性纳入2010年1月至2012年1月南方医科大学南方医院神经外科收治的117例原发颅咽管瘤患者。收集患者的年龄、性别、病理学分型、手术入路、术中情况、肿瘤的大小、有无脑积水、QST分型、内分泌指标以及随访结果。结果117例患者的全切除率达100％。随访时间为60—86个月，平均（69．6±13．8）个月。对于不同QST分型的颅咽管瘤患者，其发生年龄、病理学分型、有无脑积水、内分泌指标水平、手术入路以及预后的差异均有统计学意义（均P〈0．05）。Q型颅咽管瘤儿童多见，且均为造釉细胞型。鳞状乳头型颅咽管瘤均为s型和T型，多见于成人。T型颅咽管瘤患者的脑积水发生率显著高于Q型和s型颅咽管瘤患者（均P〈0．05）。垂体前叶功能s型颅咽管瘤患者最佳，T型次之，Q型最差。总的预后良好率为91．5％（107／117），预后不良率为8．5％（10／117），其中s型颅咽管瘤患者的预后最佳。肿瘤复发率为12．0％（14／117）。不同年龄、肿瘤最大径、病理学分型、QST分型的患者其复发率的差异均无统计学意义（均P〉0．05）。结论基于起源部位和膜性概念的颅咽管瘤QST分型不仅与颅咽管瘤的临床特征相关，可为选择恰当的外科手术^路提供重要依据，亦与治疗难度和预后相关。

Objective To explore the characteristics and guidance for surgical treatments of various types of craniopharyngiomas classified by QST. Methods A total of 117 cases of primary craniopharyngiomas admitted to Department of Neurosurgery, Nanfang Hospital, Southern Medical University from January 2010 to January 2012 were enrolled into this study. The patient＇s age, gender, pathologies, surgical approaches, operative situations, tumor size, hydrocephalus, QST classifications, endocrine levels and follow-up data were collected. Results The rate of gross total resection was 100% in 117 patients. The follow-up time ranged from 60 to 86 months （mean： 69.6 ＋ 13.8 months）. The ages, pathologies, hydrocephalus, endocrine levels, surgical approaches and prognosis of different patients classified by QST had statistical significance （all P 〈 0.05 ）. The Q-type craniopharyngioma which was all adamantinomatous most commonly attacked children, while all squamous craniopharyiomas were S and T types and commonly affected adults. Patients of T type showed higher probability of developing hydrocephalus than S and Q types （ both P 〈 0. 05）. However, in terms of anterior pituitary function, S type was the best followed by T type and Q type was the worst. The rate of favorable prognosis was 91.5% （107/117） while unfavorable prognosis was 8. 5% （10/117） and S type was the best. The tumor recurrence rate was 12.0% （14/117）. There was no significant difference in the recurrence rate among patients with varying ages, tumor sizes, pathological types and QST types （ all P 〉 0.05 ）. Conclusions QST classification based on originating location and membranous concept is related to clinical symptoms of craniopharyngiomas, which could not only provide basis for choice of surzical approaches but also indicate the difficulty and Droznosis of treatment.