陈志方　赵兵

[摘要]目的：评价大型（病变长径≥3.5cm）颌骨囊性瘤（角化囊性瘤、囊性成釉细胞瘤）采用开窗减压治疗方法的临床效果。方法：对2009～2013年收治的8例大型颌骨囊性瘤，首次采用开窗减压治疗，对其临床效果进行回访和评价。结果：X线全景片或CBCT显示，开窗减压治疗后，囊性骨缺损影像逐渐缩小，直至消失，骨再生修复现象显著，部分患者被推移的下颌神经管恢复正常，无复发和并发症， 8例患者均获得满意的治疗效果。结论：开窗减压治疗是大型颌骨囊性瘤比较经济实用的方法之一。

[关键词]开窗减压；囊性；颌骨肿瘤

[中图分类号]R739.8 [文献标识码]A [文章编号]1008-6455（2014）18-1523-03

Abstract： Objective To prospectively investigate the effectiveness of marsupialization in the treatment of large jaw cystic tumors（the maximum diameter of the lesion ≥3.5cm）. Methods 8 patients with large jaw cystic tumors were received marsupialization from 2009 to 2013.All the patients were followed up after postoperation， and the clinical effects of these patients were evaluated by clinical symptoms，X-ray and pathological examinations. Results The results of X-ray examination or CBCT showed that， after the marsupialization， the diameter of the lesion reduced gradually until it disappeared.Bone regeneration were observed in all patients.The displaced mandibular canals of some patients retuned to their normal place.Recurrence and complications were not found after the postoperation. This phenomenon prompted that the satisfactory efficacy was obtained by marsupialization of all patients. Conclusion The marsupialization is one of the most useful methods in the treatment of the large jaw cystic tumor，which can completely cure the lesion and maximally preserve the anatomical structures and physiological function of jaw.

Key words：marsupialization； decompression；cystic；jaw tumor

角化囊性瘤和囊性成釉细胞瘤是口腔临床较为常见的颌骨囊性肿瘤，由于其具有相似的侵袭性和易复发的特点，手术刮治的方法一直颇受争议，一般主张在肿瘤边缘外0.5cm以上正常颌骨内切除。尽管这种治疗方法明显提高了治愈率，但是，手术造成的颌骨和牙列的缺损，严重影响了患者的功能及面形，后期需作更为复杂的修复手术，给患者生理心理、生活和经济等方面都带来诸多问题。近10多年来，对颌骨大型囊性病变（最大直径在3.5～10cm或以上[1]）采用开窗减压治疗取得了显著的临床疗效。但目前临床报道疗效显著的多是牙源性囊肿，而对于颌骨囊性瘤，尤其是成釉细胞瘤的开窗减压治疗，临床仍较为谨慎。笔者对我院9例囊性瘤的开窗减压治疗进行了较长时间的临床观察，近期均取得了满意的临床效果，并以1例大型囊性瘤为例，现报道如下。……