本文關(guān)鍵詞：減壓成形術(shù)治療頜骨牙源性囊性病變的療效分析　出處：《浙江大學》2016年碩士論文　論文類型：學位論文

  更多相關(guān)文章： 減壓成形術(shù) 頜骨牙源性囊性病變 病損面積 二期手術(shù)

【摘要】：目的：通過分析不同頜骨牙源性囊性病變減壓成形術(shù)后病損面積的變化情況,探究該術(shù)式在治療不同囊性病變的效果差異,為臨床應用提供參考。方法：選取2012年6月-2015年12月就診于浙江大學附醫(yī)學院屬口腔醫(yī)院口腔頜面外科經(jīng)臨床及攝片檢查后被臨床診斷為頜骨牙源性囊性病變、先前未曾接受相關(guān)治療,并于本院病房住院行減壓成形術(shù)治療,有較完善術(shù)前及術(shù)后復診記錄的患者32例,應用Photoshop CS5對病損面積進行測量,統(tǒng)計并分析各類囊性病變的病損變化情況及差異。結(jié)果：(1)減壓成形術(shù)能使病灶范圍即有明顯的縮小,具有統(tǒng)計學意義(P0.01),術(shù)后6個月,有效比例(AS50%)達84.4%(27/32),8個月可達92.3%(24/26),而效果良好比例(AS80%)隨著開窗時長逐漸上升；對根尖囊腫(5例)及含牙囊腫(4例)的治療效果明顯,且均無需二期手術(shù)；對牙源性角化囊性瘤(20例)的治療效果較好,6個月即有90%的病例顯示有效,8個月后僅1例無效,除1例痊愈外均需二期手術(shù)；對成釉細胞瘤的治療效果欠佳,3例成釉細胞瘤中1例無效,2例效果一般。(2)減壓成形術(shù)后3個月、3-6個月、6個月以上的病變面積均有顯著的差異(P0.05)。不同種類囊性病變在不同時期的表現(xiàn)也有差異。根尖囊腫的病變范圍在前3個月內(nèi)就出現(xiàn)較明顯的縮小(79.98±34.67%)；含牙囊腫、牙源性角化囊性瘤在3個月內(nèi)病變縮小程度分別為35.58±27.38%和41.56±23.63%,3-6個月內(nèi)逐漸增至71.60±5.07%和60.56±18.14%；而成釉細胞瘤的病變面積縮小較緩慢,6-14個月平均縮小51.01±20.83%。(3)隨著囊腔的開放,根尖囊腫、含牙囊腫、牙源性角化囊瘤的病變面積縮小速率均逐漸減小,以最初2個月速率最大；而成釉細胞瘤的病變縮小速率的特征不明顯,整個開放的過程中病變的縮小速率整體比較緩慢。結(jié)論：減壓成形術(shù)對根尖囊腫、含牙囊腫的治療效果較好且穩(wěn)定；作為牙源性角化囊性瘤的一期治療,減壓成形術(shù)能明顯改善患者面部的膨隆畸形,縮小病變范圍,促進骨的修復,有利于二期手術(shù)的實施,是一種有效可行的治療方法。而對于成釉細胞瘤,該術(shù)式僅可作為嘗試性一期保守治療,術(shù)后應密切觀察,病變范圍無明顯縮小或出現(xiàn)擴大時應停止開放狀態(tài),并及時行手術(shù)切除。減壓成形術(shù)后病變縮小的效果在6-8個月就較為顯著,且之后的縮小速率緩慢,因此二期手術(shù)可在術(shù)后6-8個月就可進行,縮短治療時長,利于該術(shù)式在臨床的普及和實施。
[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.
【學位授予單位】：浙江大學
【學位級別】：碩士
【學位授予年份】：2016
【分類號】：R782

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