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目的评价复发性牙源性角化囊肿外科治疗效果。方法对1998年1月至2008年3月于第四军医大学口腔医院颌面外科手术的、病历资料完整且术后经病理证实为下颌骨牙源性角化囊肿复发病例79例的临床资料进行整理,分析不同治疗方式相应治疗效果。结果79例复发性牙源性角化囊肿患者,采用保守性治疗和根治性治疗手术方式。(1)保守外科治疗后复发率为29.7%(11/37);其中单纯刮治术治疗后复发率为80.0%(8/10);刮治加微波热凝或射频消融、刮治加冷冻治疗后复发率为11.1%(3/27)。根治性治疗后复发率为2.3%(1/42)。(2)单纯刮治术治疗的复发病例平均复发时间为21.8个月;刮治加冷冻、刮治加微波热凝或射频消融术后平均复发时间为47.6个月;1例根治性治疗患者于术后4年复发。(3)保守外科治疗后病例无明显外形及功能障碍,根治性治疗有不同程度面部畸形、咬合障碍。结论复发性牙源性角化囊肿治疗首选仍为根治性治疗,但对部分病例,采用积极保守性手术治疗,可减少截骨所造成并发症,降低复发率,达到与根治性治疗相近的治疗效果。

Analysis of surgical treatment for 79 eases of recurrent odontogenie keratocyst.

Objective To evaluate the result of the surgical treatment for recurrent odontogenic keratocyst. Methods The clinical data of 79 cases of recurrent odontogenic keratocyst, who had received operation in Department of Oral and Maxillofacial Surgery, School of Stomatology, Fourth Military Medical University and were conformed by pathologi-cal evidence, from January 1998 to March 2008, were collected and the different treatment effect analyzed. Results The methods of operation included conservative and radical treatment. (1)The recurrence rate of patients with conserva-tive treatment was 29.7% (11 /37), in which the recurrence rates were 80.0% (8/10) and 11.1% (3/27) in the pa-tients treated with curettage and curettage combined with cryotherapy, microwave or radiofrequency ablation respective-ly. The recurrence rate of those with radical treatment was 2.3%(1/42).(2)The mean recurrent time was 21.8 months and 47.6 months in the patients treated with curettage and curettage combined with cryotherapy , microwave or radiofre-quency ablation respectively. Postoperative recurrent time in 1 ease with radical treatment was 4 years. (3)The patients with conservative treatment had no obvious defects. The patients with radical treatment had different degree of maxillofa-cial deformities and occlusal obstacles. Conclusion The radical treatment is the primary therapy for recurrent odonti-genic keratocysts. For part of the cases, the application of positive conservative treatment can reduce complications as a result of ostectomy, reduce the recurrence, and achieve treatment effect similar to radical treatment.