口腔疾病防治 ›› 2020, Vol. 28 ›› Issue (2): 69-72.DOI: 10.12016/j.issn.2096-1456.2020.02.001

• 专家论坛 • 上一篇    下一篇

开窗治疗颌骨囊性病变的专家共识

陶谦1(),何悦2,刘冰3,侯劲松1,南欣荣4,张彬5,张磊涛6,乔彬7   

  1. 1. 中山大学附属口腔医院·光华口腔医学院口腔颌面外科,广东 广州(510055)
    2. 上海交通大学医学院附属第九人民医院口腔颌面—头颈肿瘤科,上海(200011)
    3. 武汉大学口腔医学院口腔颌面外科,湖北 武汉(430072)
    4. 山西医科大学第一医院口腔颌面外科,山西 太原(030001)
    5. 中山大学孙逸仙纪念医院口腔颌面外科,广东 广州(510120)
    6. 南方医科大学南方医院口腔颌面外科,广东 广州 (510515)
    7. 郑州大学第一附属医院口腔颌面外科,河南 郑州(450001)
  • 收稿日期:2019-07-21 修回日期:2019-11-30 出版日期:2020-02-20 发布日期:2020-02-25
  • 通讯作者: 陶谦
  • 作者简介:陶谦,医学博士,中山大学附属口腔医院·光华口腔医学院口腔颌面外科教授,博士生导师,主任医师。擅长口腔颌面部肿瘤、外伤和唾液腺相关疾病的诊断与治疗。主持和参加国家自然科学基金及省、市科研基金等多项研究工作。现任广东省口腔医学会口腔颌面外科专业委员会常委,《中华口腔医学研究杂志》(电子版)和《口腔疾病防治》编委。主编专著《颌骨肿瘤的诊断与治疗》,在 SCI 杂志和国内专业杂志发表论文40余篇。
  • 基金资助:
    广东省科技计划基金项目(2016A020220008);广东省科技计划基金项目(2017A020211025)

Expert consensus on marsupialization of cystic lesions of the jaw

TAO Qian1(),HE Yue2,LIU Bing3,HOU Jinsong1,NAN Xinrong4,ZHANG Bin5,ZHANG Leitao6,QIAO Bin7   

  1. 1. Department of Oral and Maxillofacial Surgery, Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-sen University, Guangzhou 510055, China
    2. Department of Oromaxillofacial Head and Neck Oncology, Shanghai Ninth People′s Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
    3. Department of Oral and Maxillofacial Surgery, School of Stomatology, Wuhan University. Wuhan 430072, China
    4. Department of Oral and Maxillofacial Surgery, The First Hospital, Shanxi Medical University, Taiyuan 030001, China
    5. Department of Oral and Maxillofacial surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510210, China
    6. Department of Oral and Maxillofacial Surgery, Nan Fang Hospital, Southern Medical University, Guangzhou 510515, China
    7. Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450001, China
  • Received:2019-07-21 Revised:2019-11-30 Online:2020-02-20 Published:2020-02-25
  • Contact: Qian TAO

摘要:

开窗治疗颌骨囊性病变行之有效,具有创伤小、操作简单、减少术后复发,能最大程度地保留周围组织结构和功能等优点;但临床上由于适应证把握不当、操作不规范等原因,开窗治疗存在一定的失败率,文献报道的最高失败率为32.6%。为进一步完善和规范开窗术临床应用,提高治疗成功率,本文总结国内外文献和汇集部分国内著名专家的诊治经验,形成“开窗治疗颌骨囊性病变的专家共识”。此共识提出开窗术的3个要素为开窗口的建立、囊肿塞维持开窗口以及定期冲洗;开窗术的适用范围包括颌骨囊肿和囊性成釉细胞瘤等;需要规范开窗位置、开窗口大小以及囊肿塞制作与放置等重要操作步骤;对疗效评判采用全景片或锥形束CT观察术前、术后囊腔的变化较为客观;二期手术宜在病灶显著缩小 > 50%,或远离累及的重要结构5 mm左右时实施;对于病灶牙,应根据病灶与牙的关系以及牙的类型,分别予以处理。

关键词: 颌骨, 囊性病变, 开窗术, 适应证, 禁忌证, 疗效判定, 二期手术, 专家共识

Abstract:

Marsupialization is effective in the treatment of cystic lesions of the jaw. It is a simple operation that can result in minimal trauma, the reduction of postoperative recurrence, and maximum preservation of the surrounding tissue structure and function. However, there is a certain failure rate in clinical treatment due to the improper grasp of indications and nonstandard operation. The highest failure rate reported in the literature is 32.6%. To further standardize the clinical application of marsupialization and improve the success rate of treatment, we put forward an expert consensus of marsupialization in the treatment of jaw cystic lesions by reviewing the domestic and foreign literature and summarizing the experience in marsupialization from some famous domestic experts. In this consensus, we propose three elements of marsupialization: the establishment of the opening, the maintenance of cyst plugs and regular washing. The scope of application of marsupialization includes jaw cysts and cystic ameloblastomas. It is necessary to standardize the position of the opening, the size of the opening and the manufacture of the cyst plug, and a panoramic film or cone beam computed tomography(CBCT) should be used to observe the changes in the cystic cavity before and after operation. A second-stage operation should be performed when the lesion is significantly reduced by more than 50% or at least 5 mm from important structures; furthermore, the teeth of focus should be treated according to the relationship between the lesion and tooth and the type of tooth.

Key words: jaw bone, cystic lesions, marsupialization, indication, contraindication, effect evaluation, second-stage surgery, expert consensus

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