开窗减压术治疗大型上颌窦牙源性囊性病变疗效评价

doi:10.19438/j.cjoms.2023.01.008

摘要/Abstract

摘要： 目的： 评价开窗减压术治疗大型上颌窦牙源性囊性病变的疗效,为临床治疗提供参考。方法： 回顾2011年1月—2020年12月于上海交通大学医学院附属第九人民医院口腔外科就诊的大型牙源性上颌窦囊性病变病例,采用开窗减压后二期刮治手术治疗,开窗后配戴塞治器,分为负压及非负压引流2种。应用Mimics定量测量病变体积变化,观察新骨改建、上颌窦炎症情况。采用SPSS 17.0软件包,通过配对t检验比较术前囊性病变和最终二期手术前囊性病变体积是否存在差异,通过成组t检验和卡方检验比较不同塞治器治疗效果。结果： 20例患者纳入研究,负压及非负压引流各10例。开窗前囊性病变体积为(25 993.81±13 611.78)mm³,减压后最终体积为(5 386.30±3 546.30)mm³,体积缩小率为(77.54±13.01)%,缩小显著(P<0.001)。11例病变体积缩小>80%,9例介于50%~80%之间。非负压吸引组体积缩小率为(72.75±14.16)%,疗效优秀率40%;负压吸引组体积缩小率为(82.33±10.29)%,疗效优秀率70%,两组无显著差异。2例角化囊肿二期刮除后复发,16例患者开窗后窦壁有新骨形成。结论： 开窗减压术治疗大型上颌窦牙源性囊性病变疗效好,保护了窦黏膜、邻近牙、眶底等重要组织,推荐作为该类疾病的首选治疗方法。

关键词: 上颌窦, 牙源性囊肿, 开窗减压

Abstract: PURPOSE: To evaluate the effect of decompression for large odontogenic maxillary cysts, and to provide reference for clinical treatment. METHODS: The cases of large odontogenic maxillary cysts in the Department of Oral Surgery, Shanghai Jiao Tong University School of Medicine from January 2011 to December 2020 were reviewed. The patients were treated with decompression and secondary curettage. The patients were divided into non-negative pressure drainage group and negative pressure drainage group according to the type of cyst plug used. Mimics was used to quantitatively measure the change of cyst volume. New bone remodeling and maxillary sinus inflammation were evaluated. The volume change of the cysts was compared by paired t test. The therapeutic effects of different cyst plugs were compared by group t test and chi-square test with SPSS 17.0 software package. RESULTS: A total of 20 patients were included in the study. Ten patients were treated with non-negative pressure drainage and 10 with negative pressure drainage respectively. The volume of the lesions before decompression was (25 993.81±13 611.78) mm³,and significantly reduced to (5 386.30±3 546.30) mm³ after surgery(P<0.001), with a reduction rate of (77.54±13.01)%. The reduction rate of 11 patients was more than 80%, 9 patients between 50% and 80%. The volume reduction rate of non-negative pressure suction group was (72.75±14.16)%, with a superiority rate of 40%. The volume reduction rate of the negative pressure suction group was (82.33±10.29)%, and the superiority rate was 70%, but there was no significant difference between the two groups. Two cases of keratocyst recurred after secondary curettage, and 16 patients had new bone formation in sinus wall after decompression. CONCLUSIONS: Decompression is effective for large maxillary sinus odontogenic cystic lesions, and it can protect important anatomical tissues, which is recommended to be the first treatment for such diseases.

Key words: Maxillary sinus, Odontogenic cyst, Decompression

中图分类号:

R739.8

胡颖恺, 徐光宙, 马志贵, 谢千阳, 张永亚, 杨驰. 开窗减压术治疗大型上颌窦牙源性囊性病变疗效评价[J]. 中国口腔颌面外科杂志, 2023, 21(1): 49-54.

HU Ying-kai, XU Guang-zhou, MA Zhi-gui, XIE Qian-yang, ZHANG Yong-ya, YANG Chi. Efficacy of decompression for large odontogenic maxillary sinus cysts[J]. China J Oral Maxillofac Surg, 2023, 21(1): 49-54.

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