下颌骨放射性骨坏死临床诊疗专家共识

doi:10.19438/j.cjoms.2017.05.015

中国口腔颌面外科杂志 ›› 2017, Vol. 15 ›› Issue (5): 445-456.doi: 10.19438/j.cjoms.2017.05.015

下颌骨放射性骨坏死临床诊疗专家共识

何悦^1*#，侯劲松^2*，李晓光^1#，马春跃¹，彭歆³，王慧明⁴，王松灵⁵，刘磊⁶，刘冰⁷，田磊⁸，刘忠龙¹，刘习强²，徐昕⁹，张东升¹⁰，蒋灿华¹¹，王军¹²，姚原¹³ ，朱国培¹³，白永瑞¹⁴，王胜资¹⁵，孙长伏¹⁶，李劲松¹⁷，何三纲⁷，王成²，Nabil Samman¹⁸，孙坚¹，张陈平¹，张志愿¹，邱蔚六¹

1.上海交通大学医学院附属第九人民医院·口腔医学院口腔颌面-头颈肿瘤科，上海 200011;
2.中山大学光华口腔医学院附属口腔医院口腔颌面外科，广东广州 510055;
3.北京大学口腔医学院口腔颌面外科，北京 100081;
4.浙江大学口腔医学院·浙江大学医学院附属第一医院口腔颌面外科，浙江杭州 310006;
5.首都医科大学附属北京口腔医院口腔颌面外科，北京 100050;
6.四川大学华西口腔医院口腔颌面外科，四川成都 610041;
7.武汉大学口腔医院口腔颌面外科，湖北武汉 430070;
8.第四军医大学口腔医院口腔颌面外科，陕西西安 710032;
9.浙江大学医学院附属第二医院口腔颌面外科，浙江杭州 310009;
10.山东大学附属省立医院口腔颌面外科，山东济南 250021;
11.中南大学湘雅医院口腔颌面外科，湖南长沙 410008;
12.甘肃省肿瘤医院头颈外科，甘肃兰州 730050;
13.上海交通大学医学院附属第九人民医院放疗科，上海 200011;
14.上海交通大学医学院附属仁济医院放疗科，上海 200127;
15.复旦大学附属眼耳鼻喉科医院放疗科，上海 200000;
16.中国医科大学附属口腔医院口腔颌面-头颈外科，辽宁沈阳 110002;
17.中山大学孙逸仙纪念医院口腔颌面外科，广东广州 510120;
18.香港大学牙医学院口腔颌面外科，香港 999077

收稿日期:2017-06-20 出版日期:2017-08-30 发布日期:2017-10-27
基金资助:
国家自然科学基金（81570949）；上海市申康临床创新三年行动计划（16CR2038B）；2017年上海市卫生计生系统优秀学科带头人计划（2017BR019）

Expert consensus statement on diagnosis and clinical management of osteoradionecrosis of mandible

HE Yue¹, HOU Jin-song², LI Xiao-guang¹, MA Chun-yue¹, PENG Xin³, WANG Hui-ming⁴, WANG Song-ling⁵, LIU Lei⁶, LIU Bing⁷, TIAN Lei⁸, LIU Zhong-long¹, LIU Xi-qiang², XU Xin⁹, ZHANG Dong-sheng¹0, JIANG Can-hua¹¹, WANG Jun¹², YAO Yuan¹³, ZHU Guo-pei¹³, BAI Yong-rui¹⁴, WANG Sheng-zi¹⁵, SUN Chang-fu¹⁶, LI Jin-song¹⁷, HE San-gang⁷, WANG Cheng², Nabil Samman¹⁸, SUN Jian¹, ZHANG Chen-ping¹, ZHANG Zhi-yuan¹, QIU Wei-liu¹.

1.Department of Oromaxillofacial Head and Neck Oncology, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai 200011;
2.Department of Oral ａｎｄ　Maxillofacial Surgery, Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat -sen University. Guangzhou 510055;
3.Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology. Beijing 100081;
4.Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Zhejiang University of Medicine, School of Stomatology, Zhejiang University. Hangzhou 310006, Zhejiang Province;
5. Department of Oral and Maxillofacial Surgery, Capital Medical University. Beijing 100050;
6.Department　of Oral and Maxillofacial Surgery, West China Hospital of Stomatology. Chengdu 610041, Sichuan Province;
7.Department of Oral and Maxillofacial Surgery, Hospital of Stomatology, Wuhan University. Wuhan 430070, Hubei Province;
8.Department of Oral and Maxillofacial Surgery, The Fourth Military Medical University Hospital of Stomatology. Xi'an 710032, Shaanxi Province;
9. Department of Oral and Maxillofacial Surgery, The Second Affiliated Hospital of Zhejiang University of Medicine. Hangzhou 310009, Zhejiang Province;
10.Department of Oral and Maxillofacial Surgery, Shangdong Provincial Hospital. Jinan 250021, Shandong Province;
11.Department of Oral and Maxillofacial Surgery, Xiangya Hospital Central South University. Changsha 410008, Huｎａｎ Province;
12.Department of Head and Neck Oncology, Gansu Provincial Cancer Hospital. Lanzhou 730050, Gansu Province;
13.Department of Radiotherapy, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine. Shanghai 200011;
14.Department of Radiotherapy, Renji Hospital, Shanghai Jiao Tong University School of Medicine. Shanghai 200127;
15.Department of Radiotherapy, Eye and ENT Hospital of Fudan University. Shanghai 200000;
16.Department of Oromaxillofacial Head and Neck Surgery, School and Hospital of Stomatology, China Medical University. Shenyang 110002, Liaoning Province;
17.Department of Oral and Maxillofacial Surgery, Sun Yat -sen Memorial Hospital, Sun Yat-sen University. Guangzhou 510120, Guangdong Province;
18.Discipline of Oral and Maxillofacial Surgery, Faculty of Dentistry, University of Hong Kong. Hong Kong 999077, China

Received:2017-06-20 Online:2017-08-30 Published:2017-10-27

摘要/Abstract

摘要： 下颌骨放射性骨坏死（osteoradionecrosis，ORN）是头颈部大剂量放疗后的一种严重并发症，常以慢性坏死及感染为主要特征，临床表现为局部红肿、疼痛、吞咽困难、开口受限、咀嚼及语言障碍、面部软组织瘘管经久不愈、死骨暴露，严重者甚至造成病理性骨折，给患者的身心带来巨大痛苦，已成为口腔颌面外科及头颈外科领域棘手的临床难题。迄今为止，国内外对于下颌骨ORN缺乏统一的分类、分期及相关治疗共识或指南，不同单位对于下颌骨ORN的诊治水平参差不齐，缺乏统一科学的诊疗标准与规范，对该疾病的处理仍以个人或单位经验作为治疗依据，同时也缺乏客观有效的下颌骨ORN治疗后评价体系。为进一步统一和规范下颌骨ORN的诊疗标准,减少医疗资源的浪费,提高治疗效果，中华口腔医学会口腔颌面外科专业委员会召集国内颌骨放射性骨坏死研究领域的专家进行反复讨论，汇集全国17家著名医学院校及附属医院专家的诊治意见，同时借鉴和参考国内外近年来对下颌骨ORN的研究成果与诊治经验，最终制订“下颌骨放射性骨坏死临床诊疗专家共识”，供临床医师参考。

关键词: 下颌骨, 放射性骨坏死, 专家共识

Abstract: Osteoradionecrosis (ORN) of mandible is one of the most devastating complications caused by radiation therapy in the head and neck region. It is characterized by infection and chronic necrosis of mandible as the main manifestation. Clinically, ORN of mandible related symptoms include swelling, pain, dysphagia, trismus, masticatory or speech disorder, refractory orocutaneous fistula, bone exposure, and even pathological fracture. ORN of mandible has become a challenging clinical problem for oral and maxillofacial surgeons to deal with. But so far, this problem has not been solved due to the lack of widely accepted treatment algorithms or guidelines. Since the nonexistence of standardized treatment criteria, most clinical treatment against ORN of mandible nowadays is largely based on controversial empirical understandings, while recommendations on post-therapeutic evaluations are scarce. Therefore, to further unify and standardize the standard of diagnosis and treatment of mandibular ORN, to decrease the huge waste of medical resources, and ultimately, to improve the wellbeing of the patients, the Chinese Society of Oral and Maxillofacial Surgery (CSOMS) convened an expert panel specialized in ORN of mandible from 17 famous domestic medical colleges and affiliated hospitals to discuss and formulate about the spectrum of diagnosis and treatment. In addition, consensus recommendations were also revised with a comprehensive literature review of the previous treatment experiences and research pearls. This "expert consensus statement on diagnosis and clinical management of osteoradionecrosis of mandible" is for clinical references.

Key words: Mandible, Osteoradionecrosis, Expert consensus

中图分类号:

R782

何悦，侯劲松，李晓光，马春跃，彭歆，王慧明，王松灵，刘磊，刘冰，田磊，刘忠龙，刘习强，徐昕，张东升，蒋灿华，王军，姚原，朱国培，白永瑞，王胜资，孙长伏，李劲松，何三纲，王成，Nabil Samman，孙坚，张陈平，张志愿，邱蔚六. 下颌骨放射性骨坏死临床诊疗专家共识[J]. 中国口腔颌面外科杂志, 2017, 15(5): 445-456.

HE Yue, HOU Jin-song, LI Xiao-guang, MA Chun-yue, PENG Xin, WANG Hui-ming, WANG Song-ling, LIU Lei, LIU Bing, TIAN Lei, LIU Zhong-long, LIU Xi-qiang, XU Xin, ZHANG Dong-sheng0, JIANG Can-hua, WANG Jun, YAO Yuan, ZHU Guo-pei, BAI Yong-rui, WANG Sheng-zi, SUN Chang-fu, LI Jin-song, HE San-gang, WANG Cheng, Nabil Samman, SUN Jian, ZHANG Chen-ping, ZHANG Zhi-yuan, QIU Wei-liu.. Expert consensus statement on diagnosis and clinical management of osteoradionecrosis of mandible[J]. China J Oral Maxillofac Surg, 2017, 15(5): 445-456.

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下颌骨放射性骨坏死临床诊疗专家共识

Expert consensus statement on diagnosis and clinical management of osteoradionecrosis of mandible

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