›› 2021, Vol. 41 ›› Issue (12): 1104-1110.

• 临床研究 • 上一篇    下一篇

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

樊泽宇1,2,王泽正1,张磊3,肖涛4,谢狄亚1,雷东莹1,王志勇1   

  1. 1. 南京大学医学院附属口腔医院,南京市口腔医院
    2. 南京医科大学第四附属医院
    3. 南京大学医学院附属口腔医院
    4. 南京医科大学附属口腔医院
  • 收稿日期:2021-08-05 修回日期:2021-10-12 出版日期:2021-12-28 发布日期:2021-12-31
  • 通讯作者: 王志勇 E-mail:Wangzhiyong67@163.com
  • 基金资助:
    荧光分子手术导航系统的研发及其在口腔癌中的应用;基于荧光分子成像技术引导口腔癌精准手术的临床转化研究

Effect of decompression combined with secondary surgery in the treatment of jaw ameloblastoma: a clinical retrospective study

  • Received:2021-08-05 Revised:2021-10-12 Online:2021-12-28 Published:2021-12-31
  • Contact: Zhi-Yong -Wang E-mail:Wangzhiyong67@163.com

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。根据组织病理学分为: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。开窗减压术治疗下颌骨AM患者中可测量患者的有效率为77.8%,病变平均缩小率为52.7%(P<0.05)。可测量的颌骨AM患者中14例开窗减压术前的瘤腔周围最薄处颌骨厚度<5 mm,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35.9%,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%)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、开窗与否、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%,4%。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期刮治术以及单纯切除术相对单纯刮治术均能降低成釉细胞瘤患者复发率。同时,开窗减压术不会增加II期手术的复发风险。

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

Abstract: 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 the 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 the 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 77.8% and the average reduction ratio of the 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 5mm before decompression and recovered to more than 5mm 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 numbness of the lower lip after treatment with simple curettage was 36.1% (P > 0.05). The recurrence rate of decompression combined with secondary curettage (21.05%) was lower than that of curettage alone (54.76%) (P < 0.05). The recurrence rate of simple resection (24%) was lower than that of simple curettage (54.76%). Gender, age, pathological classification, pathogenesis, multi-factor Cox regression inspection of the surgical method, showed that these factors have no statistically significant impact on the recurrence of jaw AM (P> 0.05). The 3-year cumulative recurrence rates of curettage, decompression combined with secondary curettage and resection were 24.39%, 16% and 4%, respectively. Conclusions: Decompression can reduce the tumor cavity area of jaw ameloblastoma and increase bone thickness, which is beneficial to the preservation of jaws of patients with ameloblastoma. Decompression does not increase the risk of recurrence of Second stage operation. Decompression can reduce the lumen area of AM and increase bone thickness, which is beneficial for jaw bone preservation in patients with AM. Also, decompression combined with secondary curettage and direct resection compared with simple curettage could reduce the recurrence rate of AM.

Key words: decompression, ameloblastoma, recurrence rate, resection, secondary operation, curettage

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