内镜辅助刮除术联合GBR技术治疗下颌骨大型牙源性角化囊肿的临床研究

Clinical efficacy of endoscope-assisted curettage combined with guided bone regeneration for large mandibular odontogenic keratocysts

摘要:

目的 探讨内镜辅助刮除术联合引导骨再生（GBR）技术在下颌骨大型牙源性角化囊肿（OKC）中的临床疗效。方法 回顾性选取中国人民解放军联勤保障部队天津康复疗养中心2021年1月—2023年12月收治的50例OKC患者，根据治疗方法分为两组，对照组（27例）给予内镜辅助刮除术治疗，观察组（23例）给予内镜辅助刮除术联合GBR技术治疗。比较两组的围手术期指标、骨腔体积缩小量及面积缩小量、骨再生相关因子［胰岛素样生长因子-1（IGF-1）、骨形态发生蛋白（BMP）、血管内皮生长因子（VEGF）］及并发症，比较观察组术后3、6个月骨密度及新生骨组织厚度。结果 与对照组比较，观察组手术时间较长，术中出血量较多（P <0.05）。术后6个月两组的骨腔体积缩小量及面积缩小量均高于术后3个月，且观察组高于对照组（P <0.05）。术后6个月观察组的骨密度、新生骨组织厚度高于术后3个月（P <0.05）。两组术后的IGF-1、BMP、VEGF水平均高于术前，且观察组高于对照组（P <0.05）。结论 内镜辅助刮除术联合GBR技术用于下颌骨大型OKC患者的临床治疗，可有效缩小骨腔，促进骨再生，且不会增加术后并发症，安全有效。

Abstract:

Objective To investigate the clinical efficacy of endoscope-assisted curettage combined with guided bone regeneration (GBR) for large mandibular odontogenic keratocysts (OKCs).Methods A total of 50 patients with OKC treated at the Tianjin Rehabilitation and Recuperation Center of the Chinese People's Liberation Army Joint Logistics Support Force between January 2021 and December 2023 were retrospectively enrolled and divided into two groups according to treatment. The control group (n = 27) underwent endoscope-assisted curettage, whereas the observation group (n = 23) underwent endoscope-assisted curettage combined with GBR. Perioperative indicators, reductions in bone cavity volume and area, bone regeneration-related factors [insulin-like growth factor-1 (IGF-1), bone morphogenetic protein (BMP), and vascular endothelial growth factor (VEGF) ], and complications were compared between the groups. Bone mineral density and new bone tissue thickness at 3 and 6 months postoperatively were compared in the observation group.Results The operative time was longer and intraoperative blood loss was greater in the observation group than in the control group (P < 0.05). At 6 months postoperatively, the reductions in bone cavity volume and area were greater than those at 3 months postoperatively in both groups and were greater in the observation group than in the control group (P < 0.05). In the observation group, bone mineral density and new bone tissue thickness were greater at 6 months than at 3 months postoperatively (P < 0.05). Postoperative IGF-1, BMP, and VEGF levels were higher than preoperative levels in both groups and were higher in the observation group than in the control group (P < 0.05).Conclusion Endoscope-assisted curettage combined with GBR is safe and effective for large mandibular OKCs. It reduces the bone cavity and promotes bone regeneration without increasing postoperative complications.