CAJ | 학술논문

目的探讨上颌窦癌上颌骨全切除后即刻中空充填式赝复体修复缺损的可行性和临床效果.方法 13例T3-4aNOMO 上颌窦癌患者,术前根据鼻窦三维计算机断层摄影术(three dimention-CT,3D-CT)重建,形成三维市体实物模型;应用Surgieare 5.0软件模拟外科手术切除边界,形成计算机三维立体赝复体模型.依据计算机三维立体模型及患者术前印模,使用甲基丙烯酸树脂快速精确制作中空充填式赝复体,底部附带牙齿.上颌骨全切除术毕即刻完成置入.术后1、3、6个月定期门诊复查,人工测量面容、语音清晰度测定及调查问卷评估临床效果,差异比较采用配对t检验.术后6个月更换为甲基丙烯酸树脂材料的永久性中空充填式赝复体.结果 13例赝复体均在上颌骨全切除术毕顺利置入,完成即刻修复.患者术后能咀嚼、吞咽和发音,不必鼻饲.术后1、3、6个月戴与不戴赝复体眼球下坠、面部凹陷度和语音清晰度差异均有统计学意义(t值分别为4.67、5.67和16.38,P值均<0.05).问卷调查显示患者对赝复体同位、饮水呛咳及面容的改善均较满意.术后6个月11例患者均顺利更换永久性赝复体,2例患者不要求更换.结论上颌窦癌上颌骨全切除后中空充填式赝复体的精确制作及即刻修复,可提高患者的生活质量.
목적 탐토상합두암상합골전절제후즉각중공충전식안복체수복결손적가행성화림상효과.방법 13례T3-4aNOMO 상합두암환자,술전근거비두삼유계산궤단층섭영술(three dimention-CT,3D-CT)중건,형성삼유시체실물모형;응용Surgieare 5.0연건모의외과수술절제변계,형성계산궤삼유입체안복체모형.의거계산궤삼유입체모형급환자술전인모,사용갑기병희산수지쾌속정학제작중공충전식안복체,저부부대아치.상합골전절제술필즉각완성치입.술후1、3、6개월정기문진복사,인공측량면용、어음청석도측정급조사문권평고림상효과,차이비교채용배대t검험.술후6개월경환위갑기병희산수지재료적영구성중공충전식안복체.결과 13례안복체균재상합골전절제술필순리치입,완성즉각수복.환자술후능저작、탄인화발음,불필비사.술후1、3、6개월대여불대안복체안구하추、면부요함도화어음청석도차이균유통계학의의(t치분별위4.67、5.67화16.38,P치균<0.05).문권조사현시환자대안복체동위、음수창해급면용적개선균교만의.술후6개월11례환자균순리경환영구성안복체,2례환자불요구경환.결론 상합두암상합골전절제후중공충전식안복체적정학제작급즉각수복,가제고환자적생활질량.
Objective The feasibility and clinical effects of hollow obturator prosthesis for the repair of maxillofacial defect immediately after maxillectomy for cancer were assessed. Methods Thirteen patients with T3-4aN0M0 maxillary neoplasm were treated by the prostheses immediately after maxillectomy. According to the 3D-CT reconstruction of nasal sinus, the 3D stereoscopic prototype was constructed before the surgery. Simulating surgery with Surgicare 5. 0 software and then the prosthesis 3D stereoscopic model was shaped. The prosthesis was made quickly and precisely with methacrylate resins according to the model and the print mold before surgery, with supplementary tooth at the bottom of prosthesis. In the surgery, the prosthesis was installed instantly after maxillectomy. The patients were followed up at 1 , 3 and 6 month after the surgery, respectively. The facial features and the pronunciation clarity were examined and the questionnaires were carried out in the patients, with compareation by paired t-test. The hollow obturator prosthesis would be replaced by permanent prosthesis made of methacrylate resins at 6 month after the surgery. ResultsThe hollow obturator prostheses were installed accurately and maxillofacial defects were repaired immediately after maxillectomy in the 13 patients. Postoperative follow-up showed there were significant differences in eyeball sagging (t = 4. 67, P <0. 05 ) , mid-facial region collapse ( t = 5. 67, P < 0.05) , and pronunciation clarity (t = 16. 38, P <0. 05) between patients with and without prostheses. Questionnaires showed that all the patients were satisfied with the retention of prostheses, the improvement of appearance, the improvement of the symptom of water choking and speech definition. Six months after the surgery, the hollow obturator prostheses were replaced smoothly by permanent prostheses in 11 of the 13patients. Conclusion The precise and instant repair of maxillofacial defect by prosthesis after maxillectomy can improve survival quality of patient.