颌骨Paget病1例的诊治并文献复习  

Diagnosis and Treatment of Paget's Disease of Mandible; a Case Report and Review

作　　者：何地[1] 平飞云[1] 徐昕[1] 胡镜宙[1] 

机构地区：[1]浙江大学医学院附属第二医院口腔科,杭州310009

出　　处：《口腔医学》2004年第5期295-296,共2页Stomatology

摘　　要：目的 探讨罕见的颌骨Paget病的临床特点和诊断方法。方法 患者因右下颌骨胀痛伴流脓就诊;检查见右下颌骨体部一瘘口有脓液及微细骨块流出;X线摄片见右下颌骨体部及升支部溶解和硬化共存影像;ECT见全身骨多处大范围明显代谢异常活跃;实验室检查血清碱性磷酸酶(ALP)显著升高。病变骨组织做病理检查。病理特征为破骨细胞和成骨细胞均增多和嗜碱性分界线的存在,诊断为颌骨Paget病。确诊后给予抗生素、降钙素和阿仑膦酸钠治疗。结果 患区Ⅰ期愈合,随访3个月X线片检查见术区未有明显变化,随访半年,局部症状复发。结论 Paget病因内罕见,颌骨和全身大部分骨骼均可累及,有典型的生物学、影像学和临床特征。颌骨的Paget病诊断需结合病史、病理学、生物学和影像学检查,该病难以根治。Objective To investigate the clinical manifestation and diagnosis of Paget' s disease of mandible. Methods An 80-year-old male paient with characteristic manifestation of Paget' s disease of mandible was reviewed in this study. His physical examination showed sewelling in the right cheek and fistula cannulas with pus and bone particle overflowing in the body of right mandible. X-ray film presented the symptomatic pain and malaise with a pattern of mixture of lytic and sclerotic change, the mandible bone size enlarged, and the bone trabeculae arrayed irregularly. Radioisotope bone scanning showed abnormal elevated metabolism in the majority of skeleton all over the body. A serum alkaline phosphatase test showed an elevated level of 2033 U/L, with a normal adult range of 50 to 136 U/L. The patient underwent teeth extraction and diagnostic biopsy. Under microscopic observation, osteoclasts and osteoblasts were both enriched and irregular blue line was observed in the resorption area. The patient was given antibiotics, calcitonin and alendronate. Results The focal area healed in phase Ⅰ. After the follow-up period of 3 months, no other complaint was delivered, and physical examination and X-ray films showed no obvious change in the operation area. Serum alkaline phosphatase level was 230 U/L. After 6 months, the similar symptom occurred in the area treated originally. Conclusion Paget's disease of bone is a rare malady domestically which can occur in mandible as well as in majority bones all over the body. Paget s disease of mandible which is difficult to be cured once and for all has a significant correlation with mandible anatomy and oral environment which is not aseptic. Typically biological, radiographic and pathologic features should be considered when its diagnosis is defined.

关 键 词：颌骨 PAGET病 诊断 右下颌 罕见 体部 文献复习 性分 存在 共存 

分 类 号：R737[医药卫生—肿瘤] R782[医药卫生—临床医学]