开窗减压术治疗颌骨囊肿的临床价值

金岚; 赵文妍; 阮妍; 钟林玲; 杨帆; 张国兴

doi:10.16766/j.cnki.issn.1674-4152.002183

开窗减压术治疗颌骨囊肿的临床价值

doi: 10.16766/j.cnki.issn.1674-4152.002183

金岚¹,
赵文妍²,
阮妍²,
钟林玲¹,
杨帆³,
张国兴^4, ,

1.
诸暨市人民医院眼口整形外科，浙江诸暨 311800
2.
蚌埠医学院口腔医学系，安徽蚌埠 233000
3.
浙江省人民医院口腔科，浙江杭州 310000
4.
绍兴市越城区张国兴口腔诊所口腔科，浙江绍兴 312000

基金项目:

浙江省医药卫生科技计划项目 2020KY010

详细信息

通讯作者:
张国兴，E-mail：pian12385@163.com

中图分类号: R782.2
计量
- 文章访问数: 154
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- 被引次数: 0
出版历程
- 收稿日期: 2020-10-26
- 网络出版日期: 2022-02-15

Clinical value of fenestration decompression in the treatment of jaw cysts

1.
Eye and Mouth Plastic Surgery, People's Hospital of Zhuji City, Zhuji, Zhejiang 311800, China

摘要

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。
- 颌骨囊肿 /
- 开窗减压术 /
- 邻近牙髓 /
- 并发症 /
- 囊腔
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.
- Jaw cyst /
- Fenestration decompression /
- Adjacent pulp /
- Complications /
- Sac cavity

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图 1 开窗手术前后研究组颌骨囊肿病变囊腔大小变化CBCT影像图

注：A示术前CBCT示囊腔范围广，下颌骨形态发生改变；B示术后6个月CBCT片示囊腔密度上升，病变内高密度影像形成，修复新骨生成，周围骨质增多，囊肿基本消失，下颌形态恢复良好。

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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)
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)	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		0.006^a	0.123^b	1.013^b	1.600^b	0.002^a
P值		0.938	0.903	0.314	0.113	0.963
注：^a为χ²值，^b为t值。

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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

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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)
组别	例数	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±1.22^a	18.71±4.72^ab	21.34±5.14^abc	3.89±1.06^a	6.95±1.38^ab	8.17±1.55^abc	0.42±0.11^a	0.52±0.13^ab	0.57±0.15^abc
对照组	40	6.19±1.72	9.57±2.56^b	15.78±3.58^bc	3.17±0.78	5.25±1.15^b	6.34±1.34^bc	0.33±0.06	0.43±0.05^b	0.45±0.07^bc
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。

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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		0.180^a	0.872^b	0.483^b	0.396^a	0.005
注：^a为采用Fisher精确检验，^b为校正χ²检验结果。

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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		0.039^a	0.180^a
注：^a为采用Fisher精确检验。

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