摘要目的 分析颌骨囊性病变的发病原因、治疗方式、复发及预后.方法 回顾2013年2月至2017年6月医院治疗的600例颌骨囊性病变患者,对患者病变构成比例、年龄分布情况、病变部位、病程、术前主要症状、临床治疗方式进行分析,随访复发情况,评价临床治疗效果.结果 600例颌骨囊性患者中,男339例,女261例;年龄1～81岁,多发年龄为20～29岁,其次为30～39岁;根端囊肿、牙源性角化囊性瘤、成釉细胞瘤的多发年龄均为20～29岁.好发部位:左侧311例,右侧365例;上颌217例,下颌392例;颌骨囊性病变好发部位为下颌骨后牙区.临床表现:132例(22.0％)为口腔门诊就诊时拍摄X片意外发现病灶,因肿胀就诊276例(46.0％),瘘道形成78例(13.0％),其他因张口受限、口唇麻木等就诊114例(19.0％).治疗方式及复发率:311例根端囊肿中,295例首诊采用刮治术,其中12例术后复发,复发率为4.1％;14例采用开窗减压术,其中13例首诊开窗术后经过6～15个月持续冲洗后,经过二期根治术后均治愈,另一例经开窗后冲洗15个月效果不佳,病变范围无明显变化,后采取刮治术治疗.44例含牙囊肿中,均采用"埋伏牙拔除术+刮治术",术后无一例复发.105例牙源性角化囊性瘤病例中,83例首诊采用刮治术,其中16例术后复发,复发率为19.3％;21例首诊采用开窗减压术,未见复发;1例采用截骨术+肋骨移植修复术,术后12个月后复发.108例囊性成釉细胞瘤中,87例首诊采用刮除术,其中46例术后复发,复发率为52.9％;16例囊性成釉细胞瘤首诊采用开窗减压术,11例开窗效果良好,第二次术后均无再复发,5例开窗效果差,均择期行成釉细胞瘤刮除术;5例首诊采用截骨术,其中联合腓骨移植修复术3例,术后随访至今无复发,联合髂骨移植修复术2例,均术后12个月后复发.结论 颌骨囊性病变包含病种多,且各病种间生物学行为、治疗方式及预后等存在较大差异,术前准确的诊断对于采取合适的治疗方式、获得良好的治疗效果有重要意义.进一步探讨颌骨囊性病变合适的治疗方案,才能在临床实践中正确地选择治疗方案,防止治疗不足或过度治疗.

abstractsObjective To analyze the causes, treatment, recurrence and prognosis of jaw bone cystoid disease .Methods From February 2013 to June 2017 , 600 cases of jaw bone cystoid disease were treated in the hospital .The proportion of the lesions , the distribution of age , the location of the disease , the course of the disease , the main symptoms before the operation , the clinical treatment methods were analyzed , and the recurrence of the patients was followed up and the effect of the clinical treatment was evaluated . Results Among the 600 patients with jaw bone cystoid disease , gender composition:339 males and 261 females.Age distribution: the distribution was 1 -81 years, the multiple age was 20-29 years, and the second was 30-39 years.The multiple age of the root cysts , odontogenic keratoma and ameloblastoma was 20-29 years old.Predilection site:311 cases on the left side, 365 cases on the right side , 217 cases in the upper jaw , and 392 cases in the mandible;the most common site of jaw cystic lesions was mandibular posterior teeth .Clinical manifestations: 132 patients (22.0％) were photographed with X in an oral clinic , 276 cases (46.0％) were diagnosed as swelling , 78 cases (13.0％) with fistula formation, other 114 cases (19.0％) were due to limited mouth opening and numbness of lips .Treatment methods and recurrence rate: among the 311 cases of root cyst , 295 cases were curettage first , of which 12 cases had recurrence , the recurrence rate was 4.1％.Treatment methods and recurrence rate:of 311 cases of root cyst , 295 cases were curettage first , of which 12 cases had recurrence , the recurrence rate was 4.1％; 14 patients were treated with fenestration and decompression;13 cases of them were cured after 6 -15 months of continuous flushing after the first fenestration , another case was treated with irrigation for 15 months after opening the window , but the lesion area did not change significantly , and then took the treatment of curettage .Forty-four cases of dental cyst were treated with "extraction of impacted teeth and curettage", no recurrence occurred after operation.Among 105 cases of odontogenic keratoma , 83 cases were treated by curettage , of which 16 cases recurred after operation , and the recurrence rate was 19.3％; 21 cases of first diagnosis were reduced by window decompression and no recurrence was found;Osteotomy and rib graft were used in 1 case, and relapsed after 12 months postoperatively .Among the 108 cases of cystic ameloblastoma , 87 cases were initially treated by curettage , of which 46 cases recurred after operation , and the recurrence rate was 52.9％;the first diagnosis of 6 cases of cystic ameloblastoma was open window decompression , 11 cases had good effect on open window , no recurrence after second operation and 5 cases of ameloblastoma curettage , all were operated by elective ameloblastoma curettage;osteotomy was used in 5 cases of first diagnosis , among them , 3 cases were repaired with fibular graft , no recurrence was found after the postoperative follow-up,2 cases were repaired with iliac bone graft , all of which recurred 12 months after operation .Conclusions There are many kinds of diseases in the jaw bone cystoid disease , and there are great differences in biological behavior , treatment and prognosis among the various diseases .Accurate preoperative diagnosis is of great significance for the proper treatment and good treatment effect.Further exploration of the appropriate treatment of jaw bone cystoid disease , in order to correctly choose the treatment program in clinical practice , to prevent inadequate or excessive treatment .