下颌骨成釉细胞瘤个体化手术的临床研究

Clinical study of individualized surgery for mandibular ameloblastoma.

目的:探讨下颌骨成釉细胞瘤个体化手术治疗方法及适应症。方法:选取2010年~2018年收治下颌骨成釉细胞瘤患者38例,根据临床表现、影像学检查及病理学检查情况进行临床分型并采用不同的手术方法。单囊型采取开窗减压术,术后缩小停止给予彻底刮治术;实性、多囊型采取彻底刮治开窗术;外周型采取扩大切除术;多囊大型骨质破坏、颌骨畸形,累及软组织、反复复发者、局部恶性变者采用节段性下颌骨切除术。结果:术后随访2~3年,单囊型采取开窗术,缩小后二次彻底刮治术,术后失败2例。实性、多囊型采取彻底刮治开窗术术后1例复发。外周型采取扩大切除术术后无复发,多囊大型骨质破坏、颌骨畸形、累及软组织、反复复发、恶性变者采用节段性下颌骨切除术后无复发。结论:根据下颌骨成釉细胞瘤临床分型采用个体化手术治疗,能最大限度地保存下颌骨连续性及功能,外形美观,减少复发。

Objective:To explore the individualized surgical treatment and indications of mandibular ameloblastoma.Methods:A total of 38 patients with mandibular ameloblastoma were gathered from 2010 to 2018.The patients were clinically classified according to their clinical manifestations,imaging examinations and pathological examinations.Different surgical methods were used that the single-capsule type adopted window decompression,and after surgery,it was stopped and given a complete curettage.For solid and multi-capsule type was used a thorough curettage and then fenestration and decompression.Peripheral type adopted enlarged resection.Segmental mandibular resection was used for polycystic large bone destruction,jaw deformity,involving soft tissue,repeated recurrence and malignant changes.Results:After follow-up for 2 to 3 years,singlecapsule fenestration was performed,and complete curettage were performed after reduction.Two cases failed after operation.One case of solid and polycystic recurrence was recurred after radical curettage.There was no recurrence after enlarging resection in the peripheral type,and there was no recurrence after segmental mandibular resection in patients with polycystic bone destruction,jaw deformity,involving soft tissue,repeated recurrence and malignant changes.Conclusion:According to the clinical classification of mandibular ameloblastoma,individualized surgery can be used to maximize the continuity,function of the mandible and nice appearance.