Clinical value of fenestration decompression in the treatment of jaw cysts
-
摘要:
目的 探讨开窗减压术治疗颌骨囊肿的价值。 方法 回顾性收集2015年6月—2019年5月在诸暨市人民医院口腔颌面外科诊治的88例颌骨囊肿患者的临床资料,依据手术方法不同分为研究组(开窗减压术,48例)与对照组(传统颌骨囊肿刮治术,40例),记录2组手术情况,比较2组手术前后囊腔病变情况,记录囊腔体积减少量、囊腔面积减少量和骨密度的变化;统计2组手术并发症发生情况,跟踪观察2组邻压牙髓坏死状况,比较随访复发率的差异。 结果 研究组的手术时间、术中出血量、术后住院时间分别为(29.83±2.18)min、(12.43±2.11)mL、(2.11±0.48)d,均显著少于对照组[(51.52±10.28)min、(52.34±2.99)mL、(4.72±0.52)d,t=-14.254、-73.191、-24.454,均P < 0.001]。研究组术后3、6、12个月囊腔体积减少量、囊腔面积减少量均多于对照组,骨密度值高于对照组(均P < 0.001)。研究组术后3个月并发症发生率(4.17%)低于对照组(25.00%,χ2=8.041,P=0.005)。研究组术后3个月邻近牙髓坏死率(0.00%)低于对照组(12.50%,P=0.039)。研究组随访复发率为0.00%,略低于对照组的7.50%,但组间差异无统计学意义(P=0.180)。 结论 开窗减压术治疗颌骨囊肿可减少术中出血量,缩小颌骨囊肿,促进囊腔修复,提高骨密度,减少术后并发症,降低邻近牙牙髓坏死发生率。 Abstract:Objective To explore the clinical value of fenestration decompression in the treatment of jaw cysts. Methods The clinical data of 88 patients with jaw cysts who were diagnosed and treated in the Oral and Maxillofacial Surgery of People's Hospital of Zhuji City from June 2015 to May 2019 were retrospectively collected and divided into the study group (fenestrated decompression, n=48) and the control group (traditional curettage of jaw cyst, n=40) according to different surgical methods. The operation status of both groups was recorded, and their cyst lesions were compared before and after the operation. The changes in the volume of the sac cavity, the volume of the sac cavity area and the bone density were recorded. The occurrence of surgical complications in both groups was counted, the status of adjacent pulp necrosis between both groups was followed up and observed, and the difference in recurrence rates at follow-up was compared. Results The operation time, intraoperative blood loss and postoperative hospitalisation time in the study group were (29.83±2.18) min, (12.43±2.11) mL and (2.11±0.48) days, respectively, which were significantly less than those in the control group [(51.52±10.28)min, (52.34±2.99)mL, (4.72±0.52)d, t=-14.254, -73.191, -24.454, all P < 0.001]. The volume of the cyst and the volume of the sac cavity area in the study group were less than those in the control group at 3, 6 and 12 months after the operation, and the bone density was higher than that of the control group (all P < 0.001). The complication rate in the study group was 4.17% at 3 months after the operation, which was lower than 25.00% in the control group (χ2=8.041, P=0.005). The necrosis rate of adjacent pulp in the study group was 0.00% at 3 months after the operation, which was significantly lower than 12.50% in the control group (P=0.039). The recurrence rate at follow-up was 0.00%, which was slightly lower than 7.50% in the control group, but the difference was not statistically significant (P=0.180). Conclusion Fenestration decompression in the treatment of jaw cysts can reduce intraoperative blood loss, minimise jaw cysts, promote cyst repair, increase bone density, reduce postoperative complications and reduce the incidence of necrosis of adjacent pulp. -
Key words:
- Jaw cyst /
- Fenestration decompression /
- Adjacent pulp /
- Complications /
- Sac cavity
-
表 1 2组颌骨囊肿患者一般资料对比
组别 例数 性别(男/
女,例)囊肿直径
(x±s,cm)年龄
(x±s,岁)体重指数
(x±s)颌骨囊肿部位(例) 上颌骨囊肿 下颌骨囊肿 研究组 48 26/22 6.63±2.19 45.68±2.28 22.87±2.19 11 37 对照组 40 22/18 6.58±1.48 45.10±3.11 22.18±1.78 9 31 统计量 0.006a 0.123b 1.013b 1.600b 0.002a P值 0.938 0.903 0.314 0.113 0.963 注:a为χ2值,b为t值。 表 2 2组颌骨囊肿患者围手术指标对比
(x±s) 组别 例数 手术时间
(min)术中出血量
(mL)术后住院
时间(d)研究组 48 29.83±2.18 12.43±2.11 2.11±0.48 对照组 40 51.52±10.28 52.34±2.99 4.72±0.52 t值 -14.254 -73.191 -24.454 P值 < 0.001 < 0.001 < 0.001 表 3 2组颌骨囊肿患者囊腔缩小体积、囊腔缩小面积和骨密度对比
(x±s) 组别 例数 囊腔体积减少量(cm3) 囊腔面积减少量(cm2) 骨密度值(g/cm2) 术后3个月 术后6个月 术后12个月 术后3个月 术后6个月 术后12个月 术后3个月 术后6个月 术后12个月 研究组 48 8.34±1.22a 18.71±4.72ab 21.34±5.14abc 3.89±1.06a 6.95±1.38ab 8.17±1.55abc 0.42±0.11a 0.52±0.13ab 0.57±0.15abc 对照组 40 6.19±1.72 9.57±2.56b 15.78±3.58bc 3.17±0.78 5.25±1.15b 6.34±1.34bc 0.33±0.06 0.43±0.05b 0.45±0.07bc 注:与对照组比较,aP < 0.05;与同组术后3个月比较,bP < 0.05;与同组术后6个月比较,cP < 0.05。 表 4 2组颌骨囊肿患者术后并发症发生情况对比
[例(%)] 组别 例数 感染 下唇麻木 疼痛 面形塌陷 合计 研究组 48 0(0.00) 1(2.08) 1(2.08) 0(0.00) 2(4.17) 对照组 40 3(7.50) 2(5.00) 3(7.50) 2(5.00) 10(25.00) χ2值 0.026 0.491 8.041 P值 0.180a 0.872b 0.483b 0.396a 0.005 注:a为采用Fisher精确检验,b为校正χ2检验结果。 表 5 2组邻近牙髓坏死及随访复发率对比
[例(%)] 组别 例数 牙髓坏死 随访复发 研究组 48 0(0.00) 0(0.00) 对照组 40 5(12.50) 3(7.50) P值 0.039a 0.180a 注:a为采用Fisher精确检验。 -
[1] 李勇, 程如玉, 彭学生, 等. 富自体浓缩生长因子联合Bio-Oss骨粉在颌骨囊肿中的疗效研究[J]. 中华全科医学, 2018, 16(7): 1113-1115. https://www.cnki.com.cn/Article/CJFDTOTAL-SYQY201807022.htm [2] 陈玥, 胡建. 囊肿塞在颌骨囊肿开窗减压术中的应用[J]. 口腔医学, 2020, 40(1): 92-96. https://www.cnki.com.cn/Article/CJFDTOTAL-KQYX202001024.htm [3] 李冬仙, 李琴琴. 大型颌骨囊肿开窗减压术与囊肿刮治术的疗效比较[J]. 中国药物与临床, 2018, 18(11): 2013-2015. https://www.cnki.com.cn/Article/CJFDTOTAL-YWLC201811069.htm [4] 熊依箐, 曹志云, 李罡, 等. 颌骨囊肿开窗减压术后戴塞治器疗效分析[J]. 口腔医学, 2018, 38(7): 630-633, 644. https://www.cnki.com.cn/Article/CJFDTOTAL-KQYX201807014.htm [5] 车银富, 杜洪亮, 陶峰, 等. 开窗减压术在不同颌骨囊性病变中的疗效观察[J]. 实用口腔医学杂志, 2018, 34(5): 636-639. doi: 10.3969/j.issn.1001-3733.2018.05.013 [6] 张兴安, 谭小尧, 张兰芳, 等. 开窗减压术联合负压吸引对牙源性颌骨囊性病变患者预后的影响[J]. 西部医学, 2017, 29(6): 843-846. doi: 10.3969/j.issn.1672-3511.2017.06.024 [7] 陶谦, 何悦, 刘冰, 等. 开窗治疗颌骨囊性病变的专家共识[J]. 口腔疾病防治, 2020, 28(2): 69-72. https://www.cnki.com.cn/Article/CJFDTOTAL-GDYB202002003.htm [8] 胡爽, 李春梅, 张帅源, 等. 口腔修复膜和β-磷酸三钙治疗颌骨囊肿术后骨缺损的临床价值[J]. 华西口腔医学杂志, 2020, 38(5): 541-545. https://www.cnki.com.cn/Article/CJFDTOTAL-HXKQ202005015.htm [9] 王彬, 徐镭, 孙秋望月, 等. 开窗减压术治疗下颌骨牙源性囊肿的临床和影像学研究[J]. 南京医科大学学报(自然科学版), 2018, 38(5): 653-657. https://www.cnki.com.cn/Article/CJFDTOTAL-NJYK201805019.htm [10] CHRCANOVIC B R, GOMEZ R S. Glandular odontogenic cyst: An updated analysis of 169 cases reported in the literature[J]. Oral Dis, 2018, 24(5): 717-724. doi: 10.1111/odi.12719 [11] JAMSHIDI S, ZARGARAN M, ROSHANAEI G, et al. Immunohistochemical comparison of the expression of CD34 and CD105 in odontogenic keratocyst and dentigerous cyst[J]. J Dent, 2017, 18(1): 43-46. http://pdfs.semanticscholar.org/3ac5/ce1c9354cf9cc52d60d5b078d2e17e6bac58.pdf [12] 刘一秀, 瞿杨, 李真华, 等. 开窗减压术联合二期刮治术及自体牙骨粉植入在治疗颌骨较大囊肿中的应用[J]. 华西口腔医学杂志, 2020, 38(4): 464-469. https://www.cnki.com.cn/Article/CJFDTOTAL-HXKQ202004028.htm [13] 于晓婧, 高聪, 付兆臣. 开窗减压术治疗颌骨囊性病变的研究进展[J]. 现代肿瘤医学, 2018, 26(5): 789-792. doi: 10.3969/j.issn.1672-4992.2018.05.035 [14] 李淑华, 曹发明, 许从平, 等. 开窗减压术与传统刮治术治疗颌骨囊肿的手术效果、生活质量和预后的对比研究[J]. 现代生物医学进展, 2020, 20(17): 3260-3263. https://www.cnki.com.cn/Article/CJFDTOTAL-SWCX202017013.htm [15] 许龙, 林卫, 李敏学, 等. 儿童混合牙列期颌骨囊肿开窗减压术与超声骨刀切除术疗效比较[J]. 牙体牙髓牙周病学杂志, 2018, 28(11): 663-666. https://www.cnki.com.cn/Article/CJFDTOTAL-YTYS201811010.htm [16] LIZIO G, FERRAIOLI L, MELINI M, et al. Long-term investigation of decompression as a definitive treatment for mandibular cysts associated with impacted third molars. [J]. J Am Dent Assoc, 2018, 149(11): 953-959. doi: 10.1016/j.adaj.2018.07.001 [17] 郭骏, 黄怡, 费伟, 等. 颌骨囊肿开窗减压术与刮治术临床疗效评价及应用分析[J]. 口腔颌面外科杂志, 2018, 28(4): 219-224. doi: 10.3969/j.issn.1005-4979.2018.04.008 [18] 徐芳, 郑刚. 大型颌骨囊肿开窗减压术联合囊肿塞治疗的临床应用[J]. 口腔颌面外科杂志, 2018, 27(3): 195-198. https://www.cnki.com.cn/Article/CJFDTOTAL-KQHM201703016.htm [19] 比力克孜·玉素甫, 达成利, 帕拉提·艾斯卡, 等. 开窗减压术治疗颌骨大型囊性肿瘤临床初步研究[J]. 中国美容医学, 2018, 27(10): 89-91. https://www.cnki.com.cn/Article/CJFDTOTAL-MRYX201810029.htm [20] 张同韩, 刘晓玲, 吴纪楠, 等. 大型颌骨囊性病变的开窗减压治疗[J]. 中华口腔医学研究杂志(电子版), 2018, 12(6): 354-359. doi: 10.3877/cma.j.issn.1674-1366.2018.06.005 [21] GÜLŞEN U, DERECI Ö, GÜLŞEN E A. Treatment of a calcifying epithelial odontogenic tumour with tube decompression: A case report[J]. Br J Oral Maxillofac Surg, 2018, 56(10): 979-981. doi: 10.1016/j.bjoms.2018.11.008