三氧化二砷治疗急性早幼粒细胞白血病致颌骨坏死1例及文献复习

Osteonecrosis of the jaw induced by arsenic trioxide therapy in acute promyelocytic leukemia patient:a case report and literature review

目的探讨三氧化二砷致颌骨坏死的病因、临床表现、治疗及预防,为临床诊疗提供参考。方法对1例三氧化二砷治疗急性早幼粒细胞白血病致颌骨坏死患者的临床资料及相关文献进行回顾。结果该病例因静脉注射三氧化二砷(每日1次,每次10 mg,治疗1个月)治疗急性早幼粒细胞白血病,治疗后约20 d,出现右上颌疼痛伴有牙龈红肿及黏膜溃疡,14-17牙颊侧和腭侧牙槽骨暴露,牙龈黏膜缺失,牙龈组织缺损至前庭沟底部,腭部软组织缺损至腭中缝5~8 mm;该患者因患急性早幼粒细胞白血病,病情不稳定,予以患者口服维生素及康复新液含漱,保持口腔卫生清洁等保守治疗。文献报道的药物性颌骨坏死可见于双膦酸盐类药物引起,三氧化二砷亦可引起局部颌骨坏死,临床上常表现为伤口长期不愈合、脓液、牙槽骨或颌骨外露、死骨形成,伴有疼痛、牙齿松动、面部红肿等症状。抗炎、清创、手术切除死骨是常用的治疗方法。结论临床上需要警惕药物性颌骨坏死并加强预防。

Objective To investigate the etiology,clinical manifestations,treatment and prevention of jaw necrosis caused by arsenic trioxide to provide a reference for clinical diagnosis and treatment.Methods To analyze the clinical data and related literature of patients with jaw necrosis caused by acute promyelocytic leukemia treated with arsenic tri⁃oxide.Results We report a case of jaw necrosis caused by the use of arsenic trioxide(10 mg once a day for one month)during the treatment of acute promyelocytic leukemia.About 20 days after treatment,the patient developed right maxillary pain accompanied by gingival redness and swelling and mucosal ulcer,14⁃17 teeth had buccal and palatal al⁃veolar bone exposed,gingival mucosa was missing,gingival tissue was damaged to the bottom of vestibular groove,and palatal soft tissue was damaged to 5⁃8 mm of palatal suture.Due to the unstable condition of acute promyelocytic leuke⁃mia,the patient was given conservative treatment such as oral vitamin and Kangfuxin liquid gargle to keep his mouth clean.Drug induced jaw necrosis reported in the literature can be caused by bisphosphonates.Arsenic trioxide can also cause local jaw necrosis.Clinically,it is often manifested as long⁃term wound nonunion,pus,alveolar bone or jaw bone exposure,dead bone formation,accompanied by pain,loose teeth,facial swelling and other symptoms.Anti inflamma⁃tion,debridement and surgical removal of dead bone are commonly used treatment methods.Conclusion In clinical practice,we should be alert to drug⁃induced jaw necrosis and strengthen prevention.