开窗减压术与颌骨囊肿刮治术治疗颌骨囊肿的疗效比较及对术后血清疼痛介质的影响

摘要 目的：对比开窗减压术与颌骨囊肿刮治术治疗颌骨囊肿的疗效及术后血清疼痛介质变化。方法：回顾性分析2016年1月-2019年8月期间我院收治的60例颌骨囊肿患者的临床资料。按治疗方式的区别分为A组（颌骨囊肿刮治术,28例）和B组（开窗减压术,32例）,观察两组手术指标情况、术后恢复指标、并发症及术后血清疼痛介质变化。结果：与A组相比,B组的术中出血量更少,手术时间更短,术后疼痛评分更低,组间对比差异有统计学意义（P<0.05）。与A组相比,B组的骨密度水平更高,骨质增生厚度更厚,囊腔体积缩小率更大,囊肿愈合时间更短,组间对比差异有统计学意义（P<0.05）。B组术后2 h、术后12 h血清神经肽Y（NPY）、P物质（SP）、神经生长因子（NGF）水平低于A组,β内啡肽（β-EP）水平高于A组（P<0.05）。两组并发症发生率组间对比无统计学差异（P>0.05）。结论：与颌骨囊肿刮治术治疗颌骨囊肿相比,开窗减压术在减少术中出血量、缩短手术时间、降低患者术后疼痛、促进患者术后恢复方面优势更为显著。     

开窗减压对颔骨牙源性囊性病变治疗作用研究

目的:探讨开窗减压对颌骨牙源性囊性病变的治疗作用.方法:102例牙源性颌骨囊性病变按囊肿大小分成两组,直径大于3.5cm且颌面部畸形明显的37例为甲组,全部采用开窗减压术;直径小于3.5cm的65例为乙组,其中27例(乙组A)采用开窗减压或开髓引流术,38例(乙组B)采用一次性手术切除.定期复查观察囊肿及颌骨变化情况,记录曲面断层片上囊腔影像面积变化,术后6月视情况采取Ⅱ期手术治疗.结果:甲组开窗减压术后囊肿逐步缩小,骨质再生情况良好,颌面部外形改善,未出现神经及周围重要结构损伤症状,6月后囊肿面积平均缩小75.03%,与术前囊腔面积比较有显著差异(P＜0.01),有效率100%,Ⅱ期手术完成治疗;乙组A开窗减压或开髓引流组6月后有效率70.37%,大多采用二次手术治疗;乙组B一次手术切除治疗组囊腔愈合良好,6月后颌骨形态结构基本恢复正常,有效率100%,与乙组A有显著差异(P＜0.05).全部病例观察3至6年未见复发.结论:开窗减压术对大型颌骨囊性病变有很好的治疗作用;小型牙源性囊性病变最好选择一次性手术治疗.     

同期与分期鼻内镜手术治疗慢性泪囊炎合并慢性鼻-鼻窦炎的疗效对比研究

摘要 目的：探讨同期与分期鼻内镜手术治疗慢性泪囊炎合并慢性鼻-鼻窦炎的临床疗效。方法：回顾性分析本院2017年1月至2019年10月期间收治的76例慢性泪囊炎合并慢性鼻-鼻窦炎患者的临床资料,根据手术方式分为A组和B组,各38例。A组行分期手术（鼻腔鼻窦病变处理控制鼻腔鼻窦炎症后再行鼻内镜下泪囊鼻腔造孔术）。B组行同期手术（处理鼻腔鼻窦病变后立即行鼻内镜下泪囊鼻腔造孔术）,比较两组围术期指标、临床疗效、术后并发症发生情况,采用慢性泪囊炎生活质量量表（DQOLS）评价患者术前和术后6个月时的生活质量。结果：B组总有效率为94.74 %（36/38）,A组总有效率为92.11 %（35/38）,两组总有效率比较无明显差异（P>0.05）;B组术后并发症总发生率为13.16 %（5/38）,与A组的10.53 %（4/38）比较无明显差异（P>0.05）。两组患者术后6个月时的DQOLS各维度评分和总分均较术前升高（P<0.05）,但组间比较差异均无统计学意义（P>0.05）。B组患者住院总费用少于A组,住院时间、手术时间均短于A组（P<0.05）,两组术中出血量比较无明显差异（P>0.05）。结论：同期手术与分期手术治疗慢性泪囊炎合并慢性鼻-鼻窦炎患者具有相当的临床疗效和安全性,且对患者生活质量的改善程度亦无明显差异,但前者能够缩短手术时间、住院时间及减少住院费用。     

三种复合填塞方式在鼻内镜术后填塞中的临床比较

摘要 目的：探讨鼻内镜术后使用3种不同复合填塞方式时的临床应用效果。方法：选取2016年1月至2019年1月我科实施鼻内镜手术的77例慢性鼻-鼻窦炎患者作为研究对象,根据填塞方式的不同将患者分为3组,分别为膨胀海绵+凡士林纱条组（28例）、纳吸绵+凡士林纱条组（25例）及纳吸绵+膨胀海绵组（24例）。对患者术后填塞期间鼻腔疼痛程度、抽取填塞物时鼻腔疼痛程度及出血量进行比较。结果：根据各项观察结果,纳吸绵+膨胀海绵组均明显优于其他两组（P<0.05）,纳吸绵+凡士林纱条组优于膨胀海绵+凡士林纱条组(P<0.05)。结论：纳吸绵+膨胀海绵的复合填塞方式可明显降低慢性鼻-鼻窦炎患者鼻内镜术后填塞期及取出填塞物时的疼痛程度,明显减少取出填塞物时术腔的出血量。     

比较CSPO和ISR治疗超低位直肠癌的保肛效果

摘要 目的：比较适形切除保肛术（CSPO）和经内外括约肌间切除术（ISR）治疗超低位直肠癌的保肛效果。方法：选择2020年6月至2022年3月选择在本院诊治的超低位直肠癌患者63例作为研究对象,根据随机分配原则把患者分为ISR组31例与CSPO组32例,ISR组予经内外括约肌间切除术治疗,CSPO组予适形切除保肛术治疗,记录与随访患者的近期与远期预后。结果：所有患者都顺利完成保肛,两组的术中出血量、淋巴结清扫数目对比无差异（P>0.05）,CSPO组的手术时间、术后肠道功能恢复时间、术后住院时间明显少于ISR组（P<0.05）。CSPO组的术后7 d的切口感染、泌尿系感染、吻合口狭窄、吻合口瘘等并发症发生率为6.3 %,明显低于ISR组的29.0 %（P<0.05）。CSPO组术后1 d、3 d、7 d的血清降钙素原（PCT）、超敏C-反应蛋白（hs-CRP）含量都明显少于ISR组（P<0.05）。ISR组术后3个月的满意度为80.6 %,明显低于CSPO组100.0 %（P<0.05）。结论：相对经内外括约肌间切除术,适形切除保肛术治疗超低位直肠癌能有效抑制血清PCT与hs-CRP的表达,具有很好的保肛效果,能减少并发症的发生,还可促进患者康复,从而持续提高患者的随访生存率。     

超声下腔内激光消融联合点式剥脱治疗大隐静脉曲张的效果和安全性观察

摘要 目的：探讨超声下腔内激光消融联合点式剥脱治疗大隐静脉曲张的效果和安全性观察。方法：选取我院血管外科在2019年1月到2021年12月收治的140例大隐静脉曲张患者作为研究对象。将所有患者依照住院号单双号进行分组,分为联合组与对照组,每组70例。对照组采用常规高位结扎联合抽剥术进行治疗,联合组采用超声下腔内激光消融联合点式剥脱进行治疗。对比两组手术指标、临床疗效、术前术后下肢深静脉瓣膜功能变化以及术后并发症的发生率。结果：联合组的手术耗时较对照组高,术中出血量、切口个数及住院时间均较对照组低（P<0.05）;两组临床疗效分布对比有明显差异,且联合组显效率高于对照组（P<0.05）;术后3个月两组VCT均有缩短,Vmax均有提升,且联合组术后3个月VCT较对照组短,Vmax较对照组高（P<0.05）;联合组术后并发症较对照组低（P<0.05）。结论：对大隐静脉曲张患者采用超声下腔内激光消融联合点式剥脱方法治疗,与常规手术相比疗效更佳,且能够明显改善患者下肢静脉瓣膜功能,安全性高。     

经鼻高流量湿化氧疗对肺癌放射性肺炎合并呼吸衰竭患者的临床疗效观察

摘要 目的：探究经鼻高流量湿化氧疗对肺癌放射性肺炎合并呼吸衰竭患者的临床疗效,以期为临床治疗提供参考。方法：选取2020年9月至2022年8月在我院呼吸内科住院的因肺癌放射治疗出现放射性肺炎合并呼吸衰竭患者86例为研究对象,根据氧疗方法的不同分为HFNC组和COT组,每组各43例, COT组患者在此基础上给予鼻导管供氧治疗。HFNC组患者给予HFNC氧疗方式。比较两组患者治疗前后血气分析指标、呼吸频率及舒适度、疲劳程度评分的差异及对比两组的预后情况。结果：治疗后12 h、24 h、48 h两组PaO₂//FiO₂/指标均较治疗前明显升高（P<0.05）,且治疗后各个时间点HFNC组对PaO₂/FiO₂/指标改善明显优于COT组,差异具有统计学意义（P<0.01）。治疗后12 h、24 h、48 h两组呼吸频率均较治疗前明显降低（P<0.05）,且治疗后各个时间点HFNC组对呼吸频率改善明显优于COT组,差异具有统计学意义（P<0.01）。治疗后两组患者舒适度评分均较治疗前明显升高、疲劳程度评分较治疗前明显降低（P<0.05）,HFNC组对舒适度、疲劳程度评分改善程度明显优于COT组（P<0.01）。HFNC组患者气管插管占比、非机械通气天数明显少于COT组（P<0.01）,死亡人数占比两组患者差异无统计学意义（P>0.05）。结论：经鼻高流量湿化氧疗可以改善肺癌放射性肺炎合并呼吸衰竭患者氧合指数,降低患者呼吸频率,改善患者舒适度和促进患者预后。     

改良Bacon术联合腹腔镜下括约肌间切除术在低位直肠癌保肛术中的应用效果和安全性

摘要 目的：探讨改良Bacon术联合腹腔镜下括约肌间切除术（Lap-ISR）在低位直肠癌保肛术中的应用效果和安全性。方法：选择2019年10月到2021年5月在本院诊治的低位直肠癌患者78例作为研究对象,根据1:1随机分配原则把患者分为改良组与对照组各39例,对照组给予腹腔镜下括约肌间切除术,改良组在对照组治疗的基础上给予改良Bacon术,记录两组的治疗效果与安全性状况。结果：改良组的手术时间与对照组对比无差异（P>0.05）,改良组的术中出血量、术后正常饮食时间、术后肛门排气时间、术后住院时间少于对照组（P<0.05）。改良组术后14 d的吻合口瘘、盆腔脓肿、切口出血、尿潴留、静脉血栓等并发症发生率为5.1 %,低于对照组的30.8 %（P<0.05）。改良组术后3个月的肛门功能Williams分级好于对照组（P<0.05）。改良组术后1个月与3个月的肛门排便Wexner评分少于对照组（P<0.05）。改良组术后3个月的躯体功能、情绪机能、社会职能、症状体征等生活质量评分高于对照组（P<0.05）。结论：改良Bacon术联合腹腔镜下括约肌间切除术在低位直肠癌保肛术中的应用能促进恢复患者的肛门功能,能减少对患者的创伤,促进患者康复,降低术后并发症,从而持续提高患者的生活质量。     

充气与免充气经腋窝入路腔镜甲状腺癌根治术治疗单侧甲状腺乳头状癌临床疗效的对比分析

摘要 目的：比较充气与免充气经腋窝入路腔镜甲状腺癌根治术治疗单侧甲状腺乳头状癌的疗效。方法：回顾性分析2019年1月至2021年7月于南宁市第二人民医院住院手术治疗的126例单侧甲状腺乳头状癌患者的临床资料,根据手术方式的不同将其分为对照组60例和观察组66例,对照组行充气经腋窝入路腔镜甲状腺癌根治术,观察组行免充气经腋窝入路腔镜甲状腺癌根治术,对比分析两组患者围手术期指标、术后视觉模拟量表（VAS）评分及术后3个月并发症发生率。结果：两组围手术期指标、术后VAS评分及术后3个月并发症发生率均无显著性差异（P＞0.05）;与对照组相比,观察组患者手术时间显著缩短（P＜0.05）。结论：单侧甲状腺乳头状癌经充气与免充气经腋窝入路腔镜甲状腺癌根治术治疗,均安全可靠,免充气术式略显优势。     

鼻内镜下低温等离子刀鼻后神经切断术与鼻内镜下鼻后神经切断术对中重度变应性鼻炎的近远期疗效及安全性分析

摘要 目的：探讨鼻内镜下低温等离子刀鼻后神经切断术与鼻内镜下鼻后神经切断术对中重度变应性鼻炎的近远期疗效及安全性。方法：选择2019年3月到2021年3月来我院诊治的变应性鼻炎患者90例,将其随机分为对照组与观察组,对照组中48例,观察组42例,对照组给予鼻内镜下鼻后神经切断术治疗,观察组给予鼻内镜下低温等离子刀鼻后神经切断术治疗。对比两组患者术前、术后3个月及术后1年的喷嚏、鼻塞、鼻痒、流涕临床症状评分、临床疗效、生活质量评分、血清血管活性肠肽5水平,对比两组并发症发生率。结果：术后3个月及术后1年,两组临床症状评分降低,且观察组较对照组低（P<0.05）;术后3个月,两组的临床症状评分低于同组间术后1年,但对比无差异（P>0.05）。术后3个月及术后1年,观察组的治疗有效率均较高（P<0.05）。术后3个月及术后1年,两组生活质量评分降低,且观察组较对照组低（P<0.05）;术后3个月,两组的生活质量评分高于同组间术后1年,但对比无差异（P>0.05）。术后3个月及术后1年,两组血清血管活性肠肽5水平降低,且观察组较对照组低（P<0.05）;术后3个月,两组的血清血管活性肠肽5水平低于同组间术后1年,但对比无差异（P>0.05）。观察组的并发症发生率较对照组低（P<0.05）。结论：与鼻内镜下鼻后神经切断术相比,鼻内镜下低温等离子刀鼻后神经切断术可提高中重度变应性鼻炎的近远期疗效,且安全性较好。     

开窗减压术与传统刮治术治疗颌骨囊肿的手术效果、生活质量和预后的对比研究

目的:对比颌骨囊肿经传统刮治术与开窗减压术治疗后的手术效果、生活质量和预后。方法:回顾性选取2016年1月～2018年7月期间我院收治的90例颌骨囊肿患者的临床资料,上述患者根据手术方式的不同分为A组(n=45,传统刮治术)和B组(n=45,开窗减压术),比较两组患者疗效、临床指标、生活质量和预后。结果:B组患者临床总有效率为97.78%(44/45),高于A组的84.44%(38/45)(P0.05)。B组患者伤口愈合时间、手术时间、均短于A组,术中出血量少于A组(P0.05)。两组患者末次随访时情绪、外貌、味觉、疼痛、唾液、咀嚼等项目评分均升高,且B组高于A组(P0.05)。B组并发症发生率、复发率均低于A组(P0.05)。结论:与传统刮治术治疗相比,开窗减压术治疗颌骨囊肿,在手术效果、生活质量和预后方面效果显著,具有较高的临床应用价值。     

人工骨表面覆盖口腔修复膜对颌骨囊性缺损人工骨植入术患者植入腔感染的预防作用

目的:探讨人工骨表面覆盖口腔修复膜对颌骨囊性缺损人工骨植入术患者植入腔感染的预防作用。方法:将我院2012年4月～2016年2月收治的78例颌骨囊性缺损患者按治疗时间分为对照组38例与观察组40例,均行开窗人工骨植入术,其中对照组采取常规抗感染,观察组采取人工骨表面覆盖口腔修复膜。比较两组的囊腔体积、面积缩减率、人工骨植入量、骨厚度及植入腔感染率。结果:两组的囊腔体积、面积缩减率及人工骨植入量比较差异无统计学意义(P0.05)。但观察组的骨厚度明显大于对照组(P0.05),植入腔感染率明显低于对照组(P0.05)。结论:在开窗人工骨植入术的基础上使用口腔修复膜不仅能引导骨组织再生,而且能够显著降低植入腔的感染率。     

Free Radicals and Sod Activity of Jaw Cyst. Direct Measurement and Spin Trapping Studies by Esr

Free radicals produced in the fluid of jaw cysts were directly measured at room temperature using ESR. With these samples, SOD activity of the cyst fluid was measured by the ESR spin trapping method with DMPO as a trapping agent. Freeze-dried samples of cyst fluid showed a broad ESR signal at g = 2.005. Relative signal intensity of samples from jaw cysts with inflammation was higher than jaw cysts without inflammation. SOD activity of cyst fluid with high viscosity showed higher values than that of cyst fluid with low viscosity. We suggest that free radicals produced in jaw cyst damage tissues while higher SOD activity of cyst fluid play a role in a self-defense mechanism against free radicals.     

Age and wisdom teeth in Nigeria

An attempt has been made to estimate the eruption age of wisdom teeth in the North Nigerian population. The present study was carried out on 654 boys and 584 girls of age groups ranging from 11-23 years. From the data collected estimates have been provided for the eruption age of the third molar. In general, teeth of the lower jaw erupt before those of the upper jaw. The teeth on the left side erupt earlier than those on the right side. The wisdom teeth erupt little earlier amongst boys (18 years) as compared with girls (18.5 years). In general, the wisdom teeth erupt in Nigerians with some constancy between the age of 15 and 21. The wisdom teeth fail to erupt in 5% of the individuals.     

Tooth development and replacement in the Atlantic Cutlassfish,Trichiurus lepturus,with comparisons to other Scombroidei

Atlantic Cutlassfish, Trichiurus lepturus, have large, barbed, premaxillary and dentary fangs, and sharp dagger-shaped teeth in their oral jaws. Functional teeth firmly ankylose to the dentigerous bones. We used dry skeletons, histology, SEM, and micro-CT scanning to study 92 specimens of T. lepturus from the western North Atlantic to describe its dentition and tooth replacement. We identified three modes of intraosseous tooth replacement in T. lepturus depending on the location of the tooth in the jaw. Mode 1 relates to replacement of premaxillary fangs, in which new tooth germs enter the lingual surface of the premaxilla, develop horizontally, and rotate into position. We suggest that growth of large fangs in the premaxilla is accommodated by this horizontal development. Mode 2 occurs for dentary fangs: new tooth germs enter the labial surface of the dentary, develop vertically, and erupt into position. Mode 3 describes replacement of lateral teeth, in which new tooth germs enter a trench along the crest of the dentigerous bone, develop vertically, and erupt into position. Such distinct modes of tooth replacement in a teleostean species are unknown. We compared modes of replacement in T. lepturus to 20 species of scombroids to explore the phylogenetic distribution of these three replacement modes. Alternate tooth replacement (in which new teeth erupt between two functional teeth), ankylosis, and intraosseous tooth development are plesiomorphic to Bluefish + other Scombroidei. Our study highlights the complexity and variability of intraosseous tooth replacement. Within tooth replacement systems, key variables include sites of formation of tooth germs, points of entry of tooth germs into dentigerous bones, coupling of tooth germ migration and bone erosion, whether teeth develop horizontally or immediately beneath the tooth to be replaced, and how tooth eruption and ankylosis occur. Developmentally different tooth replacement processes can yield remarkably similar dentitions.     

联合方法测量工作长度应用于颌骨囊肿受累牙根管治疗的研究

目的：研究颌骨囊肿受累牙根管治疗中采用联合方法测量根管工作长度的效果。方法：选取36 例颌骨囊肿受累患牙需术前 根管治疗的患者,共135 颗患牙,186 个根管,随机分为两组,实验组（93 个根管）采用电测法联合纸尖法测量根管工作长度,对照 组（93 个根管）则采用电测法联合X 线法测量根管工作长度。对比两组根管充填后的充填效果。结果：实验组的根管恰填率为 90.32%,高于对照组的79.57%（P＜0.05）。结论：采用电测法联合纸尖法测量颌骨囊肿受累牙根管工作长度,准确率高,根管充填 效果好且安全。     

Mast cells in human odontogenic cysts

Abstract

Mast cells are granule-containing cells in mucosal and connective tissues that are known to play a central role in allergic and inflammatory responses owing to pro-inflammatory mediators. Cysts in jaws are among the most common expansive, benign and destructive bone lesions; at some stage they are associated with chronic inflammation. Earlier studies have identified mast cells in odontogenic cysts (OC). We investigated the presence and distribution of mast cells and compared their number in different types of radicular cysts (RC), dentigerous cysts (DC) and odontogenic keratocysts (OKC). Ten cases each of RC, DC and OKC diagnosed clinically and histopathologically were selected and stained with 1% toluidine blue. The greatest number of mast cells/mm² was found in RC. The fewest mast cells/mm² were found in OKC. The subepithelial zones of all cysts contained more mast cells than the deeper zones.     

Rat wct mutation induces a hypo-mineralization form of amelogenesis imperfecta and cyst formation in molar teeth

Our previous findings have demonstrated that the rat autosomal-recessive mutation, whitish chalk-like teeth (wct), induces enamel defects resembling those of human amelogenesis imperfecta (AI) in continuously growing incisor teeth. The present study clarifies the effect of the wct mutation on the morphogenesis and calcification of rat molar teeth. Formalin-fixed maxillae obtained from animals aged 4-30 days were examined by electron probe micro-analysis (EPMA) and by immunocytochemistry for amelogenin, ameloblastin, and enamelin. There were no distinct differences in the calcium and phosphorous contents and the amount of enamel between homozygous mutant and wild-type teeth during postnatal days 4–11. Although the mineral density in the enamel matrix considerably increased in the wild-type teeth until day 15, no changes occurred in mutant teeth during days 11–30. The immunoreactivity for enamel proteins in the secretory-stage ameloblasts in mutant teeth was similar to that in the wild-type teeth, and subsequently mutant maturation-stage ameloblasts became detached from the enamel surface, resulting in odontogenic cyst formation between the enamel organ and matrix until day 7 and the expansion of the cyst around the whole tooth crown on day 15. On day 30, the erupted mutant teeth presented morphological changes such as enamel destruction and tertiary dentin formation in addition to low mineral density in the enamel. Thus, the wct mutation prevents mineral transport without disturbing the synthesis of enamel proteins in molar teeth because of the absence of maturation-stage ameloblasts, in addition to the occurrence of odontogenic cysts. Electronic supplementary material The online version of this article (doi:) contains supplementary material, which is available to authorized users. This work was supported in part by KAKENHI (B) (no. 16390523 to H.O.) and KAKENHI (C) (no. 18592002 to T.U.) from MEXT, Japan.     

Fresh-frozen human bone graft to repair defect after mandibular giant follicular cyst removal: a case report

The purpose of this article is to report the clinical, radiographical and histological findings about a case of a young woman affected by a mandibular giant follicular cyst. Conservative tumor resection was followed by immediate reconstructive treatment using fresh frozen human bone graft, instead of autologous bone graft, as material for bone regeneration. Follicular cyst is a benign, non invasive lesion with slow but progressive growth. Radiological and histological examination of the lesion confirmed the presence of a follicular cyst which underwent biopsy evaluation before enucleation. According to literature, conservative treatment was performed with optimal prognosis. At 24?months post surgery no evidence of recurrency was objective; the CT scan revealed optimal bone formation inside the reconstructed site. The use of fresh frozen bone allograft, thanks to its osteoinductive and osteoconductive properties, can be a safe choice for reconstruction of bone defects after jaw cysts removal.