CAJ | 학술논문

目的：观察下颌骨大型牙源性角化囊性瘤（KCOT）摘除术后开放愈合的长期预后。方法于2003年9月—2011年4月通过手术治疗41例下颌骨大型KCOT（瘤腔最大径大于5?cm），采用口内切口摘除肿瘤，碘仿纱条填塞骨腔开放愈合，定期换药（每月2~3次）的治疗方式，观察术后并发症及骨再生修复情况，同时定期复查，观察肿瘤治疗远期预后。结果所有病例术中均发现下牙槽神经暴露于囊腔，部分与肿瘤囊壁粘连较紧密。摘除肿瘤术后开放愈合时间平均为8.9个月（3~15个月），无术后出血、感染、永久性下颌神经损伤等并发症，病变骨腔逐渐缩小消失，骨再生良好；病变累及区域牙齿的牙髓可保持活性，牙齿也逐渐稳固；患者面型及咬合功能恢复满意。平均随访时间为81.5个月（36~127个月），术后复发2例，复发率4.9%（2/41）。结论口内摘除肿瘤开放愈合的治疗方法显示出较为可靠的近远期治疗效果，可以为临床医师选择KCOT治疗方案提供参考。
목적：관찰하합골대형아원성각화낭성류（KCOT）적제술후개방유합적장기예후。방법우2003년9월—2011년4월통과수술치료41례하합골대형KCOT（류강최대경대우5?cm），채용구내절구적제종류，전방사조전새골강개방유합，정기환약（매월2~3차）적치료방식，관찰술후병발증급골재생수복정황，동시정기복사，관찰종류치료원기예후。결과소유병례술중균발현하아조신경폭로우낭강，부분여종류낭벽점련교긴밀。적제종류술후개방유합시간평균위8.9개월（3~15개월），무술후출혈、감염、영구성하합신경손상등병발증，병변골강축점축소소실，골재생량호；병변루급구역아치적아수가보지활성，아치야축점은고；환자면형급교합공능회복만의。평균수방시간위81.5개월（36~127개월），술후복발2례，복발솔4.9%（2/41）。결론구내적제종류개방유합적치료방법현시출교위가고적근원기치료효과，가이위림상의사선택KCOT치료방안제공삼고。
Objective The aim of this retrospective study is to present the long-term effects of open healing of keratocystic odontogenic tumors (KCOTs) in the mandible. Methods A retrospective case series study was conducted on 41 patients with large KCOTs (the maximum diameter of the tumors exceeded 5 cm) treated at our institution between September 2003 and April 2011. A conservative surgical treatment was applied. The treatment involved enucleation of the primary lesion through narrow unroofing and open packing of the residual osseous defect with iodoform gauze for secondary healing. Bone regeneration and surgical complications were observed. The long-term effects of the treatment were followed up. Results The inferior alveolar nerve was exposed in the KCOT bone cavity in all cases, and some nerves adhered to the tumor tightly. The postoperative follow-up time was 81.5 months on the average (36 to 127 months). The packing gauze was changed every two weeks after enucleation, and the total duration time for packing was 8.9 months on the average (3 to 15 months). Notable bone regeneration and satisfactory secondary healing were observed clinically and radiographically. The KCOT-affected teeth were reserved, and their chewing functions were restored. Two cases presented recurrences after the initial treatment. The recurrence rate was 4.9% (2/41). No serious complications were observed. Conclusion Enucleation associated with subsequent open packing is a reliable treatment for patients with large KCOTs in the mandible.