经口腔改良扩大刮治术治疗下颌骨巨型壁性成釉细胞瘤VIP专享VIP免费

[收稿日期]2010-12-09；[修回日期]2011-01-29[作者简介]郭纪明(1952-),男,学士,副主任医师；陈正岗(1973-),男,博士,主治医师,E-mail:chenzhg1973@163.com.*并列第一作者[通信作者]郭纪明,E-mail:qdgjm@126.comc2011年版权归《中国口腔颌面外科杂志》编辑部所有［文章编号］1672-3244(2011)02-0151-06经口腔改良扩大刮治术治疗下颌骨巨型壁性成釉细胞瘤郭纪明1*，陈正岗1*，邱建忠1，周建华1，王克涛2，董作青2（1.青岛大学医学院附属青岛市市立医院口腔医学中心，山东青岛266075；2.山东大学齐鲁医院口腔颌面外科，山东济南250012）[摘要]目的：探讨应用经口腔改良扩大刮治术治疗下颌骨巨型壁性成釉细胞瘤的治疗效果。方法：对2000—2010年收治的18例下颌骨巨型壁性成釉细胞瘤患者采用经口腔改良扩大刮治术（经口内切口刮除肿瘤；将术后骨腔浅层内壁以磨钻磨除；再以液氮冻融2次；填塞碘仿纱条，术后定期换药至骨腔平复）进行治疗，进行定期临床和影像学随访，随访期3个月～5a，评价治疗效果。结果：术后3个月，影像学显示术后骨腔开始缩小，部分新生骨钙化；术后6个月～1a，全部病例外形及颞下颌关节功能恢复良好，影像学显示术后骨腔明显缩小，可见堆积状新骨形成，新生骨明显钙化，骨皮质影像接近正常；术后1～1.5a，原膨隆的面部基本恢复正常，影像学显示术后骨腔内大量骨小梁形成，钙化良好，牙槽突高度略差；术后3.5～5a，骨腔体积平均缩小80%～90%，最小者为40%～50%。全部病例均未见肿瘤复发。结论：经口腔改良扩大刮治术治疗下颌骨巨型壁性成釉细胞瘤能有效去除肿瘤,显著缩小囊腔，促进新骨形成，改善面部畸形，有效恢复颞下颌关节的生理功能，保存下颌骨的连续性。[关键词]壁性成釉细胞瘤；刮治术；下颌骨[中图分类号]R739.8[文献标志码]ATreatmentofhugemandiblemuralameloblastomabymodifiedtransoralradicalcurettageGUOJi-ming1,CHENZheng-gang1,QIUJian-zhong1，ZHOUJian-hua1,WANGKe-tao2,DONGZuo-qing2.(1.StomatologicalCenterofAffiliatedQingdaoMunicipalHospital,MedicalCollege,QingdaoUniversity.Qingdao,266075;2.DepartmentofOralandMaxillofa-cialSurgery,QiluHospital,ShandongUniversity.Jinan,250012,ShandongProvince,China)[Abstract]PURPOSE:Toevaluatetheeffectivenessofmodifiedtransoralradicalcurettageontreatmentofhugemandibularmuralameloblastoma.METHODS:Eighteenpatientswithhugemandibularmuralameloblastomawereselect-edandfollowedupfor3monthsto5yearsaftermodifiedtransoralradicalcurettage.Duringregularre-visit,clinicalandradiologicalexaminationsofthesepatientswereconductedandanalyzed.RESULTS:Threemonthsafteroperation,radio-logicalimagingshowedthecavitybegantoreduceandcalcificationcouldbedetectedinnewbornbone.From6monthsto1yearpostoperatively,allpatients’appearanceandfunctionofthetemporomandibularjoint(TMJ)improvedgreatly.Thecavitydiminisheddistinctlyandnewbornboneaccumulatedwithcalcification.Imageofcorticalboneseemednormal.From1yearto1.5yearssubsequently,facialcontourreturnedtonormal.Alargenumberoftrabecularbonewasproducedwithfullcalcification,whiletheheightofalveolarbonewasdeficient.From3.5to5years,thelesionshrankbyameanof80%-90%.Norecurrencehappenedforall18cases.CONCLUSIONS:Modifiedtransoralradicalcurettageisaneffec-tivetreatmentforhugemandibularmuralameloblastoma,whichcandecreasethecysticvolumesignificantly,promotenewboneformation,enhancefacialdeformity,improveTMJfunction,andkeeptheintegrityofthemandible.[Keywords]Muralameloblastoma；Curettage；MandibleChinaJOralMaxillofacSurg,2011,9(2):151-156．中国口腔颌面外科杂志2011年3月第9卷第2期ChinaJournalofOralandMaxillofacialSurgeryVol．9No．2March,2011151··成釉细胞瘤（ameloblastoma,AM）是口腔颌面部最常见的牙源性肿瘤，占颌骨牙源性肿瘤的63.2%，80%～90%发生于下...