上海口腔医学

上海口腔医学 ›› 2022, Vol. 31 ›› Issue (1): 71-74.doi: 10.19439/j.sjos.2022.01.015

• 论著 • 上一篇    下一篇

92例上颌骨成釉细胞瘤不同手术方式的效果评价

罗号1,2, 袁壮1,2, 吴开柳3, 贺捷3,*, 孟箭1,2,*   

  1. 1.徐州医科大学口腔医学院,江苏 徐州 221000;
    2.徐州医科大学徐州临床学院 口腔科,江苏 徐州 221004;
    3.上海交通大学医学院附属第九人民医院 口腔颌面-头颈肿瘤科,上海交通大学口腔医学院,国家口腔医学中心,国家口腔疾病临床医学研究中心,上海市口腔医学重点实验室,上海 200011
  • 收稿日期:2020-09-29 修回日期:2020-11-26 出版日期:2022-02-25 发布日期:2022-03-10
  • 通讯作者: 孟箭, E-mail: mrocket@126.com;贺捷,E-mail: hejie2310@126.com。*共同通信作者
  • 作者简介:罗号（1993-）,男,在读硕士研究生,E-mail:714356298@qq.com
  • 基金资助:
    国家自然科学基金（31400859）; 上海市自然科学基金（19ZR1429900）; 上海市卫生与计划生育委员会基金面上项目（201840021）; 国家口腔疾病临床医学研究中心项目（NCRCO-202101）; 江苏省卫生计生委科研课题（H2017080）

Treatment of maxillary ameloblastoma with different modalities: a retrospective analysis of 92 cases

LUO Hao1,2, YUAN Zhuang1,2, WU Kai-liu3, HE Jie3, MENG Jian1,2   

  1. 1. School of Stomatology, Xuzhou Medical University. Xuzhou 221000, Jiangsu Province;
    2. Department of Stomatology, Xuzhou Clinical College, Xuzhou Medical University. Xuzhou 221004, Jiangsu Province;
    3. Department of Oromaxillofacial Head and Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; College of Stomatology, Shanghai Jiao Tong University; National Center for Stomatology; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology. Shanghai 200011, China
  • Received:2020-09-29 Revised:2020-11-26 Online:2022-02-25 Published:2022-03-10

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摘要： 目的: 探讨上颌骨各型成釉细胞瘤合适的手术治疗方法。方法: 回顾分析92例上颌骨成釉细胞瘤患者的临床资料,所有患者病理诊断明确,术后随访3~8年,定期拍摄颌面部CT、全景片,观察手术治疗效果。采用SPSS 22.0软件包对数据进行统计学分析。结果: 上颌骨成釉细胞瘤男女比例为3∶1,男性较多,平均年龄为45.77岁。92例患者总复发率为21.74%,其中单囊型成釉细胞瘤经不同术式手术后未见复发;38例经典型患者中,14例行刮治术,3例行一期开窗术,16例行部分切除术,3例行上颌骨次全切除术,1例行上颌骨次全切除后髂骨移植,1例行上颌骨次全切除后股前外侧皮瓣修复。经典型患者中18例术后复发, 5例发生癌变。骨外、外周型成釉细胞瘤患者,3例行部分切除术,2例行刮治术,术后均无复发。1例转移型成釉细胞瘤患者行部分切除,术后复发。结论: 上颌骨单囊型成釉细胞瘤应采用创伤最小的术式,完整摘除肿瘤。经典型成釉细胞瘤单纯刮治或部分切除手术复发率仍然较高,可能原因是肿瘤累及范围较大,刮治术无法完整去除肿瘤。骨外、外周型及转移型成釉细胞瘤,应尽可能切除受累颌骨,防止复发。成釉细胞瘤恶变者,术中需要切除肿瘤及颌骨,降低复发率。术后密切随访原发部位及颈部淋巴结、肺部,警惕和早期发现转移。

关键词: 上颌骨, 成釉细胞瘤, 开窗减压术, 刮治术, 复发

Abstract: PURPOSE: To explore the appropriate surgical approach for each type of maxillary ameloblastoma. METHODS: The clinical data of 92 patients with maxillary ameloblastoma were retrospectively analyzed. All patients were pathologically diagnosed, followed up for 3-8 years after surgery, maxillofacial CT and panoramic images were taken regularly to observe the surgical outcomes. SPSS 22.0 software package was used for data analysis. RESULTS: The proportion of maxillary ameloblastoma in male and female patients was 3 to 1,with more male patients and the mean age was 45.77 years old. The total recurrence rate of 92 patients was 21.74%, among which unicystic ameloblastoma had no recurrence after different surgical procedures. Among 38 patients with typical maxillary ameloblastoma, 14 underwent curettage, 3 underwent decompression,16 underwent extended resection, 3 underwent subtotal maxillary resection, 1 underwent iliac bone transplantation after subtotal maxillary resection, and 1 underwent reconstruction with anterolateral thigh flap after subtotal maxillary resection. Among them, 18 had recurrence and 5 had canceration. Three patients with extrasseous/peripheral type underwent expanded resection and two underwent curettage,none of them had recurrence. One patient with metastasizing ameloblastoma recurred after extended resection. CONCLUSIONS: Maxillary ameloblastoma with unicystic type should be completely removed with minimal trauma. The recurrence rate of maxillary ameloblastoma via simple curettage or extended resection is still relatively high, which may be due to the large tumor involvement scope of these patients and the failure of complete tumor removal by curettage. For external/peripheral ameloblastoma and metastatic ameloblastoma, the involved jaw bone should be removed as much as possible to prevent recurrence. For malignant transformation of ameloblastoma, the tumor and jaw bone should be dissected during the operation to reduce recurrence rate. The primary site, cervical lymph nodes and lungs should be closely followed after operation to detect early metastasis.

Key words: Maxilla, Ameloblastoma, Decompression, Curettage, Recurrence

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