减压成形术治疗颌骨牙源性囊性病变的疗效分析

发布时间：2017-12-27 13:26

本文关键词：减压成形术治疗颌骨牙源性囊性病变的疗效分析　出处：《浙江大学》2016年硕士论文　论文类型：学位论文

【摘要】：目的：通过分析不同颌骨牙源性囊性病变减压成形术后病损面积的变化情况,探究该术式在治疗不同囊性病变的效果差异,为临床应用提供参考。方法：选取2012年6月-2015年12月就诊于浙江大学附医学院属口腔医院口腔颌面外科经临床及摄片检查后被临床诊断为颌骨牙源性囊性病变、先前未曾接受相关治疗,并于本院病房住院行减压成形术治疗,有较完善术前及术后复诊记录的患者32例,应用Photoshop CS5对病损面积进行测量,统计并分析各类囊性病变的病损变化情况及差异。结果：(1)减压成形术能使病灶范围即有明显的缩小,具有统计学意义(P0.01),术后6个月,有效比例(AS50%)达84.4%(27/32),8个月可达92.3%(24/26),而效果良好比例(AS80%)随着开窗时长逐渐上升；对根尖囊肿(5例)及含牙囊肿(4例)的治疗效果明显,且均无需二期手术；对牙源性角化囊性瘤(20例)的治疗效果较好,6个月即有90%的病例显示有效,8个月后仅1例无效,除1例痊愈外均需二期手术；对成釉细胞瘤的治疗效果欠佳,3例成釉细胞瘤中1例无效,2例效果一般。(2)减压成形术后3个月、3-6个月、6个月以上的病变面积均有显著的差异(P0.05)。不同种类囊性病变在不同时期的表现也有差异。根尖囊肿的病变范围在前3个月内就出现较明显的缩小(79.98±34.67%)；含牙囊肿、牙源性角化囊性瘤在3个月内病变缩小程度分别为35.58±27.38%和41.56±23.63%,3-6个月内逐渐增至71.60±5.07%和60.56±18.14%；而成釉细胞瘤的病变面积缩小较缓慢,6-14个月平均缩小51.01±20.83%。(3)随着囊腔的开放,根尖囊肿、含牙囊肿、牙源性角化囊瘤的病变面积缩小速率均逐渐减小,以最初2个月速率最大；而成釉细胞瘤的病变缩小速率的特征不明显,整个开放的过程中病变的缩小速率整体比较缓慢。结论：减压成形术对根尖囊肿、含牙囊肿的治疗效果较好且稳定；作为牙源性角化囊性瘤的一期治疗,减压成形术能明显改善患者面部的膨隆畸形,缩小病变范围,促进骨的修复,有利于二期手术的实施,是一种有效可行的治疗方法。而对于成釉细胞瘤,该术式仅可作为尝试性一期保守治疗,术后应密切观察,病变范围无明显缩小或出现扩大时应停止开放状态,并及时行手术切除。减压成形术后病变缩小的效果在6-8个月就较为显著,且之后的缩小速率缓慢,因此二期手术可在术后6-8个月就可进行,缩短治疗时长,利于该术式在临床的普及和实施。
[Abstract]:Objective: to analyze the change of lesion area after different decompaction of odontogenic cystic lesions of different jaws, and to explore the effect difference of this method in treating different cystic lesions, so as to provide references for clinical application. Methods: from June 2012 December -2015 in Zhejiang University Hospital of Medicine College of oral and maxillofacial surgery by clinical and radiographic examination after clinical diagnosis of odontogenic cystic lesions, not previously treated, and hospitalized for decompression treatment in the hospital ward, 32 cases were recorded in patients with better operation before and after operation, measure the lesion area by Photoshop CS5, and statistical analysis of the changes and differences of various types of cystic lesions. Results: (1) decompression can make the range of lesions is significantly reduced, with statistical significance (P0.01), 6 months after the operation, the effective ratio was 84.4% (AS50%) (27/32), 8 months up to 92.3% (24/26), and the good effect ratio (AS80%) with the window length gradually on the rise; apical cyst (5 cases) and dentigerous cyst (4 cases) and the treatment effect is obvious, and there were no two stage operation; of keratocystic odontogenic tumor (20 cases) a better therapeutic effect, 6 months in 90% cases showed effective after 8 months, only 1 cases were invalid in addition, 1 cases were cured and two required surgery; the poor ameloblastoma curative effect, 3 cases of ameloblastoma and 1 cases invalid, 2 cases of general effect. (2) there were significant differences in the lesion area of 3 months, 3-6 months and 6 months after decompression (P0.05). The manifestations of different types of cystic lesions were also different in different periods. The lesion apical cyst appeared significantly reduced within the first 3 months (79.98 + 34.67%); keratocystic odontogenic tumor dentigerous cyst, within 3 months of lesions reduced were respectively 35.58 + 27.38% and 41.56 + 23.63%, 3-6 months gradually increased to 71.60 + 5.07% and 60.56 + 18.14%; the lesion area of ameloblastoma decreased slowly, 6-14 months average decrease of 51.01 + 20.83%. (3) with cystic cavity opening, lesion area of radicular cyst and dentigerous cyst, odontogenic tumor reduction rate decreased, the maximum in the first 2 months rate; and ameloblastoma lesions reduced rate characteristic is not obvious, the overall rate of the whole process of small lesions in the open slowly. Conclusion: decompression of radicular cyst and dentigerous cyst curative effect is good and stable; as a period of treatment of keratocystic odontogenic tumor, decompression can significantly improve patients with facial swelling deformity, narrowing the range of lesion, promote bone repair, which is conducive to the implementation of two stage operation, is a effective treatment method. For ameloblastoma, this procedure can only be used as a trial conservative treatment. After operation, we should observe closely. If the lesion scope does not shrink obviously or expand, it should be stopped. The effect of decompression after decompression plasty is more significant in 6-8 months, and the rate of reduction is slower. Therefore, two stage surgery can be performed 6-8 months after operation, shortening the duration of treatment, which is conducive to the popularization and implementation of this procedure in clinical practice.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R782

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