下颌骨大型角化囊性瘤开窗减压术临床分析.docVIP

下颌骨大型角化囊性瘤开窗减压术临床分析 　　[摘要]目的：探讨下颌骨大型牙源性角化囊性瘤（keratocystic odontogenic tumor，KCOT）开窗减压术临床效果。方法：对23例下颌骨大型角化囊性瘤开窗减压治疗，术后1周制作戴用囊腔塞治器，嘱患者餐后及睡前用温开水或生理盐水自行冲洗囊腔，随访12～24个月，全景片及CT检查，观察囊腔轴径的变化，评估骨腔缩小的程度。结果：23例患者经开窗减压治疗后囊腔均明显缩小，全景片示囊腔面积变小，周围有骨组织形成。总有效率为100%。结论：开窗减压术治疗大型牙源性角化囊性瘤是一种可靠、安全、有效的治疗方法，单房型角化囊性瘤疗效优于多房型。 　　[关键词]牙源性角化囊性瘤；下颌骨；减压术 　　[中图分类号]R782 [文献标识码]A [文章编号]1008-6455（2014）17-1435-03 　　Clinical analysis of decompression of large mandibular keratocystic odontogenic tumor 　　XUE Chuan-peng，LIU Yan 　　（Department of Stomatology，Siyang Peoples Hospital，Siyang 223700，Jiangsu，China） 　　Abstract： objective To explore the clinical effect of decompression in the treatment of large mandibular KCOT. Methods 23 cases of mandibular large KCOT were performed by decompression， post-operation a week cyst plugs were made for wearing， patients were asked to clean cystic cavity with warm water or saline themselves after dinner and before going to bed. Patients were followed up for 12～24 months. observation length changes of cystic diameter by Pantomogram and CT scan， assessing the degree of bone cavity shrink. Results All 23 cases cysts significantly shrank after decompression treatment， pantomogram showed lesion size smaller， surrounding bone tissue formation. Total effective rate was 100. Conclusion Decompression of large KCOT is a kind of reliable，safe and effective method of treatment.Furthermore，among keratocystic tumor cases，curative effect of the unilocular type was superior to multilocular type. 　　Key words：keratocystic odontogenic tumor； mandible；decompression 　　牙源性角化囊性瘤是口腔颌面外科一种常见疾病，传统的囊肿刮治术，下颌体及升支部遗留的较大骨腔很容易继发感染，囊肿复发率高，易发生病理性骨折，部分巨大的角化囊性瘤只能采用下颌骨节段性切除加骨移植术，而下颌骨节段性切除虽可完整切除下颌骨病变，降低复发率，但此类术式需考虑颌骨重建问题，手术创伤大，加重患者经济负担，尤其对青少年患者，严重影响其颌骨的发育，常常导致颜面部畸形并造成咬合功能的缺陷，以往处理比较棘手。本组病例是针对位于下颌角及下颌升支巨大型下颌骨牙源性角化囊性瘤的治疗进行探讨。牙源性角化囊性瘤多发生在下颌角及升支，可累及下颌切迹、喙突、髁突等部位。开窗减压术是一种较为成熟的临床技术，特别适用于青少年较大牙源性角化囊性瘤的保守治疗[1]，将微创外科的理念引入临床，现报道如下。 　　1 资料和方法 　　1.1 一般资料：选取2009年2月～2011年6月我院收治的23例（男13例，女10例）下颌骨角化囊性瘤病例（术中快速冰冻