844例牙源性角化囊肿的临床病理学分析

doi:10.19723/j.issn.1671-167X.2020.01.006

摘要/Abstract

摘要：

目的:分析牙源性角化囊肿(odontogenic keratocyst, OKC)的临床病理特点及预后相关因素,为临床诊治及预后判断提供依据。方法:收集2000—2018年北京大学口腔医院病理诊断为OKC或与其相关疾病的病例844例,分析其临床资料、影像学及病理特点,分别归类为散发型OKC[发生于颌骨内,不伴痣样基底细胞癌综合征(nevoid basal cell carcinoma syndrome, NBCCS)]、综合征相关OKC、实性型OKC以及外周型OKC四组,并分析患者的治疗及随访资料。结果:844例患者中,散发型OKC患者805例(95.4%),综合征相关OKC患者32例(3.8%),实性型OKC患者3例,外周型OKC患者4例。散发型OKC患者平均年龄36.03岁(11~30岁为发病高峰),男女性别比1.27 ∶1,好发于下颌磨牙升支部(56.2%),经影像学检查,其中428例(71.2%)为单房性病损,多房性病损占28.8%。588例散发型OKC患者行刮治术后有随访资料,其中118例复发(20.1%),复发高峰发生于术后1~3年,影像学呈多房表现者易复发(39.0%),开窗术后刮治术(43例)和单纯刮治术(545例)这两种保守治疗的复发率差异无统计学意义(P>0.05)。综合征相关OKC患者的发病年龄(平均20.97岁)小于散发型OKC,易多发(30/32,93.7%), 好发于下颌磨牙升支部(41.7%),综合征相关OKC组织学上囊壁中含子囊者较散发型OKC多见(分别为56.3%和17.9%),且更易复发(13/29,44.9%)。实性型和外周型OKC患者的年龄较大(平均年龄分别为45.00岁和65.75岁),4例外周型OKC摘除后无复发。结论:散发型OKC行刮治术后的复发率为20.1%,影像学表现多房者更易复发,开窗术后刮治术或单纯刮治术的复发率无明显差异,临床上应注意适应证;综合征相关OKC的发病年龄小、更易多发、刮治后易复发;实性型OKC和外周型OKC少见,患者年龄较大。

关键词: 牙源性囊肿, 临床病理, 预后

Abstract:

Objective: To investigate the clinicopathologic features and prognostic factors in odontoge-nic keratocyst (OKC), and to provide new reference for clinic treatment and management of these patients. Methods: Clinicopathological data of 844 cases initially diagnosed as or associated with OKC at Department of Oral Pathology, Peking University Hospital of Stomatology from 2000 to 2018 were collec-ted. The cases were divided into 4 groups: sporadic OKCs (intraosseous, cystic lesion irrelevant to nevoid basal cell carcinoma syndrome), syndromic OKCs, solid OKCs and peripheral OKCs. The patients were follow-up for 6 to 216 months and the factors that might relate to recurrence were analyzed. Results: There were 805 cases (95.4%) of sporadic OKCs, 32 cases (3.8%) of syndromic OKCs, 3 cases of solid OKCs and 4 cases of peripheral OKCs. The main age of sporadic OKCs was 36.03 years with the peak at the second and third decades. Ratio of male and female was 1.27 ∶1. The predilection site was the molar and ramus area of mandibular (56.2%). In the study, 428 cases (71.2%) were unilocular in radiography while 28.8% were multilocular. The recurrent rate of enucleation with the follow-up was 20.1% (118/588) while most of them occurred in 1-3 years after surgery. The recurrent rate of multilocular patients (39.0%) was significantly higher than that of the unilocular. Enucleation after marsu-pialization (43 cases) or enucleation only (545 cases) showed no difference in recurrence (P>0.05). The syndromic OKCs was younger (main 20.97) and preferred to be multiple compared with sporadic OKCs (30/32, 93.7%). The predilection site was also molar and ramus area of mandibular (41.7%). Age and gender distribution of multiple cases had no significant difference with those in sporadic OKCs. More daughter cysts and epithelial islands were seen (56.3% and 17.9%). Furthermore, the recurrent rate was significantly higher than that of the sporadic OKCs (13/29, 44.9%). But there was no evidence of recurrent-related factors. The age of solid and peripheral OKCs, averaged at 45.00 and 65.75 years, were older than others. Four of peripheral OKCs showed no recurrence after enucleation. Conclusion: The recurrence rate of sporadic OKCs after enucleation is 20.1%. The multilocular lesions prefer to be recurrent. There is no significant difference of recurrence with enucleation only or enucleation after marsupialization. Compared with sporadic OKCs, the syndromic patients are younger and easier to be multiple. It tends to be recurrent frequently and rapidly. There are no related factors about recurrence of syndromic patients. The clinicians should considerate comprehensively and make an individual management of therapy and follow-up. Solid and peripheral OKCs are rare and older.

Key words: Odontogenic cysts, Clinicopathology, Prognosis

中图分类号:

R739.8

王彦瑾,谢晓艳,洪瑛瑛,白嘉英,张建运,李铁军. 844例牙源性角化囊肿的临床病理学分析[J]. 北京大学学报（医学版）, 2020, 52(1): 35-42.

Yan-jin WANG,Xiao-yan XIE,Ying-ying HONG,Jia-ying BAI,Jian-yun ZHANG,Tie-jun LI. Clinicopathological analysis of 844 cases of odontogenic keratocysts[J]. Journal of Peking University(Health Sciences), 2020, 52(1): 35-42.

图/表 7

图1

表1

OKC的临床病理及随访资料"

Characteristics	Syndromic (n=32)	Sporadic (n=805)	Solid (n=3)	Peripheral (n=4)	Total (n=844)
Age/years, n (%)
≤10	6 (18.8)	10 (1.3)	0	0	16 (1.9)
11-20	14 (43.8)	146 (18.1)	0	0	160 (19.0)
21-30	7 (21.8)	213 (26.5)	0	0	220 (26.1)
31-40	0	161 (20.0)	1 (33.3)	0	162 (19.2)
41-50	3 (9.4)	113 (14.0)	2 (67.7)	0	118 (14.0)
51-60	2 (6.2)	70 (8.7)	0	1 (25.0)	73 (8.6)
61-70	0	66 (8.2)	0	1 (25.0)	67 (7.9)
71-80	0	21 (2.6)	0	2 (50.0)	23 (2.7)
>80	0	5 (0.6)	0	0	5 (0.6)
Gender, n (%)
Male	20 (62.5)	450 (55.9)	2 (67.7)	3 (75.0)	475 (56.3)
Female	12 (37.5)	355 (44.1)	1 (33.3)	1 (25.0)	369 (43.7)
Quantity, n (%)
Single	2 (6.3)	791 (98.3)	3 (100)	4 (100.0)	800 (94.8)
Multiple	30 (93.7)	14 (1.7)	0	0	44 (5.2)
Location^*, n (%)	n=103	n=824			n=930
Maxillary anterior	7 (6.8)	32 (3.9)	0	NA	39 (4.2)
Maxillary premolar	4 (3.9)	48 (5.8)	1 (33.3)	NA	53 (5.7)
Maxillary molar	27 (26.2)	127 (15.4)	0	NA	154 (16.6)
Mandibular anterior	7 (6.8)	37 (4.5)	0	NA	44 (4.7)
Mandibular premolar	8 (7.8)	99 (12.0)	0	NA	107 (11.5)
Mandibular molar-ramus	43 (41.7)	463 (56.2)	2 (67.7)	NA	508 (54.6)
Cross midline	7 (6.8)	18 (2.2)	0	NA	25 (2.7)
Histological features, n (%)
Inflammation	26 (81.3)	681 (84.6)	2 (67.7)	4 (100.0)	713 (84.5)
Daughter cyst & epithelium island	18 (56.3)	144 (17.9)	1 (33.3)	0	163 (19.4)
Active proliferation	0	19 (2.4)	1 (33.3)	0	19 (2.2)
Orthokeratinized area	0	17 (2.1)	0	0	17 (2.0)
Budding	1 (0.3)	35 (4.3)	0	0	36 (4.3)
Radiographic features, n (%)	n=80	n=601	n=2		n=684
Root absorption	40 (50.0)	331 (55.1)	2 (100.0)	NA	373 (54.5)
Impacted teeth	31 (38.8)	232 (38.6)	0	NA	263 (38.5)
Unilocular	68 (85.0)	428 (71.2)	0	NA	496 (72.5)
Multilocular	12 (15.0)	173 (28.8)	2 (100.0)	NA	188 (27.5)
Treatment, n (%)	n=103	n=824			n=934
Enucleation	99 (96.1)	725 (88.0)	2 (67.7)	4 (100.0)	830 (88.8)
Marsupialization	4 (3.8)	63 (7.6)	0	0	67 (7.2)
Osteotomy	0	36 (4.4)	1 (33.3)	0	37 (4.0)
Recurrence^#, n (%)	n=29	n=613	n=2	n=4	n=663
<1 year	0	0	0	0	0
1-3 years	11 (37.9)	71 (11.5)	1 (50.0)	0	83 (12.7)
4-6 years	2 (6.9)	30 (4.9)	0	0	32 (4.8)
7-9 years	0	13 (2.1)	0	0	13 (2.0)
Over 10 years	0	4 (0.6)	0	0	4 (0.6)

表1

图2

图3

图4

图5

表2

参考文献 18

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Items	B	P	Exp (B)	95%CI for Exp (B)
Items	B	P	Exp (B)	Lower	Upper
Step 1
Treatment	0.241	0.608	1.273	0.506	3.205
Unilocular/multilocular	1.099	<0.001	3.001	1.952	4.613
Age	-0.038	0.580	0.962	0.840	1.102
Step 2
Unilocular/multilocular	1.100	<0.001	3.005	1.955	4.619
Age	-0.044	0.523	0.957	0.837	1.095
Step 3
Unilocular/multilocular	1.103	<0.001	3.015	1.961	4.633