开窗减压术联合Ⅱ期手术治疗颌骨成釉细胞瘤的疗效分析:临床回顾性研究  

Effect of decompression combined with secondary surgery on the treatment of jaw ameloblastoma:A clinical retrospective study

作　　者：樊泽宇 王泽正 张磊[3] 肖涛 谢狄亚 雷东莹 王志勇[1] FAN Zeyu;WANG Zezheng;ZHANG Lei;XIAO Tao;XIE Diya;LEI Dongying;WANG Zhiyong(Department of Oral and Maxillofacial Surgery,Nanjing Stomatological Hospital,Medical School of Nanjing University,Nanjing 210000,China)

机构地区：[1]南京大学医学院附属口腔医院口腔颌面外科,江苏南京210000 [2]南京医科大学第四附属医院(浦口医院)口腔科,江苏南京210000 [3]南京大学医学院附属口腔医院口腔病理科,江苏南京210000

出　　处：《口腔医学》2021年第12期1104-1110,共7页Stomatology

基　　金：江苏省重点研发计划(2018-28-492);南京市重点研发计划(2018-14-477)。

摘　　要：目的研究开窗减压术联合Ⅱ期手术及单纯刮治术、单纯切除术治疗颌骨成釉细胞瘤(ameloblastoma,AM)的疗效,为临床治疗方案的选择提供参考。方法对92例颌骨AM患者进行回顾性分析,通过image J软件测量,运用配对t检验和卡方检验分析开窗减压术联合Ⅱ期手术治疗的有效率、颌骨恢复量及下牙槽神经损伤率。运用卡方检验、Cox多因素回归模型及Kaplan-Meier等方法评估分析颌骨AM患者的复发率,探究年龄、性别、发病部位、组织病理分型、不同手术方法对于颌骨AM复发率的影响。结果92例患者的年龄分布为8~76岁,其中0~20岁16例、20~40岁42例、40岁以上34例。性别分布男54例,女38例。根据临床分型分为单囊型33例,经典型59例。根据组织病理学分型,单囊型:33例;滤泡型:28例;丛状型:24例;基底细胞型:5例;棘皮瘤型:1例;颗粒细胞型:1例。行单纯刮治术治疗的42例,行单纯切除术的25例,行开窗+Ⅱ期手术的25例。开窗减压术治疗的患者中可测量病例的有效率为76.5%,病变平均缩小率为52.7%(P<0.05)。可测量的颌骨AM患者中有14例开窗减压术前的瘤腔周围最薄处颌骨厚度<5 mm,10例经开窗减压术后恢复至5 mm以上(P<0.05)。开窗减压术+Ⅱ期刮治手术治疗下颌骨AM后的下唇麻木率为31.6%,行单纯刮治术治疗后的下唇麻木率为36.1%(P>0.05)。92例患者中33例复发,总复发率为35.87%,开窗+Ⅱ期刮治术复发率(21.05%)比单纯刮治术复发率(54.76%)更低(P<0.05),单纯切除术(24.00%)比单纯刮治术(54.76%)复发率更低(P<0.05)。性别、年龄、病理分型、发病部位、手术方式的多因素Cox回归检验显示这些因素对颌骨AM复发的影响无统计学意义(P>0.05)。刮治术,开窗+刮治术,切除术的3年累积复发率分别为24.39%,16.00%,4.00%。结论开窗减压术能降低颌骨成釉细胞瘤瘤腔面积,增加骨厚度,有利于成釉细胞瘤患者的颌骨保存。开窗+Ⅱ期刮�Objective To study the efficacy of decompression combined with secondary surgery,curettage and resection in the treatment of jaw ameloblastoma(AM),and to provide reference for selection of clinical treatment.Methods A retrospective analysis of 92 patients with AM in the jaw was performed,and measured by image J software,using paired t-test and chi-square test to analyze the effective rate of decompression combined with secondary surgery,jaw recovery and inferior alveolar nerve injury rate.The recurrence rate of patients with AM in the jaw was evaluated using chi-square test,cox multifactor regression model and Kaplan-Meier method to investigate the effect of age,site of onset,different surgical methods,gender and histopathological typing on recurrence rate.The effective rate of fenestration,the amount of jaw recovery and the injury rate of inferior alveolar nerve were analyzed by image J software.Results The age distribution of 92 patients ranged from 8 to 76 years,of which 16 were 0-20 years old;42 were 20-40 years old,and 34 were over 40 years old.Gender distribution was 54 males and 38 females.According to clinical classification,33 cases were divided into single cyst type and 59 cases were classic type.According to histopathology,they were divided into single cyst type:33 cases;follicular type:28 cases;plexiform type:24 cases;basal cell type:5 cases;acanthoma type:1 case;granular cell type:1 case.42 cases underwent curettage alone;25 underwent resection alone;25 underwent decompression combined with secondary surgery.The effective rate of measurable patients was 76.5%and the average reduction ratio of lesion was 52.7%in patients who used decompression treatment(P<0.05).In 14 patients with measurable AM of jaw,the thickness of the thinnest jaw near the tumor cavity was less than 5 mm before decompression and 10 patients recovered to more than 5 mm after decompression(P<0.05).The lower lip numbness rate of patients who used decompression combined with secondary curettage for AM of the mandible was 31.6%,and the

关 键 词：开窗减压术 成釉细胞瘤 复发率 切除术 二期手术 刮治术 

分 类 号：R739.82[医药卫生—肿瘤]