三维标记技术在上颌骨恶性肿瘤外科治疗中的应用

Application of three-dimensional tumor mapping technique in diagnosis and treatment of malignant maxillary cancer

目的 探讨三维标记技术在上颌骨恶性肿瘤外科治疗中的可行性和临床效果.方法 采用回顾性队列研究方法,选取2012年12月至2014年10月就诊于北京大学口腔颌面外科的17例上颌骨恶性肿瘤患者为试验组,以同期18例传统方法行上颌骨切除的恶性肿瘤患者为对照组.将试验组患者术前CT扫描数据导入数字化软件中,对肿瘤进行三维标记,设计截骨范围,术中采用导航技术按照术前设计精确切除肿瘤.评估术中肿瘤实际位置、范围与术前标记的符合程度,术中以冰冻切片检测切缘.对两组患者进行术后随访,评估预后.结果 试验组17例上颌骨恶性肿瘤患者平均年龄44.2岁（9～ 74岁）,其中原发肿瘤13例,复发肿瘤4例.术中肿瘤范围与术前设计符合,1例术中冰冻切缘阳性.对照组18例患者中,2例术中冰冻切缘阳性.两组患者术后平均随访时间14.8个月（2.0 ～22.0个月）,试验组中4例出现术后复发,对照组中6例出现术后复发,均为晚期高度恶性肿瘤.结论 三维标记技术在上颌骨恶性肿瘤的外科治疗中具有较好的可行性与可靠性,可提高上颌骨恶性肿瘤手术治疗的精确性以及临床治疗效果。

Objective To investigate the application efficacy of three-dimensional tumor mapping technique for diagnosis and treatment of maxillary cancer.Methods Seventeen patients （aged from 9 to 74 years with an average age of 44.2 years） diagnosed with maxillary malignant tumors （13 for primary cancer and 4 for recurrent cancer） in Peking University School of Stomatology from December 2012 to October 2014 were reviewed as experimental group,in whom three-dimensional tumor mapping was performed before surgery,and 18 patients underwent traditional surgery in the same period as control group.Three dimensional tumor imaging was generated with conversion of CT data into DICOM format by a software.Virtual plan of tumor resection and osteotomy was also manipulated according to the three-dimensional position of the tumor.Surgical navigation was used in the operation to confirm the virtual plan.The real position and situation of tumor was evaluated in the operation and compared with the pre-operative design.The frozen section was applied to confirm the margin after tumor resection.All the patients were followed up and the prognosis was evaluated.Results The real situation of the tumor in the operation matched well with the result of pre-operative tumor mapping and positive margin was detected only in one case.While in the control group,2 of 18 patients presented with positive margin in the operation.The mean follow-up time was 14.8 months （range from 2.0 to 22.0 months）.Local recurrence occurred in 4 cases of experimental group and in 6 cases of controlled group,and all of them were with advanced malignant tumors.Conclusion The three-dimensional tumor mapping technique is a feasible and reliable method for the diagnosis and treatment of maxillary malignant tumor,and use of this technique can significantly improve the clinical outcome.