Nakamura Norifumi, Mitsuyasu Takeshi, Mitsuyasu Yoshiko, Taketomi Takaharu, Higuchi Yoshinori, Ohishi Masamichi
Department of Oral and Maxillofacial Surgery, Kyushu University Dental Hospital, Fukuoka, Japan.
Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2002 Nov;94(5):543-53. doi: 10.1067/moe.2002.128022.
This study evaluated the effects of marsupialization on odontogenic keratocysts (OKCs) and its role in conjunction with enucleation and curettage.
Twenty-eight primary OKCs, treated by marsupialization before enucleation and curettage, were examined in this study. The effect of marsupialization and recurrence data after a follow-up period of at least 3 years were evaluated. The changes of growth characteristics during marsupialization were analyzed by means of histopathologic and immunohistochemical studies with monoclonal anti-Ki-67 antibody.
The effect of marsupialization was evaluated as extremely effective (64.3%), moderately effective (32.1%), and poorly effective (3.6%). In 5 lesions, the cysts disappeared macroscopically and further surgery was not done. Recurrence was observed in 6 lesions (21.4%), and there was no significant difference in recurrence rates between the lesions treated with or without marsupialization. There appeared to be a predilection for recurrence in the lesions in the mandibular ramus region and also for radiographically multilocular lesions. Microscopic examination showed substantial changes from a parakeratinized or orthokeratinized epithelium into a hyperplastic, stratified, nonkeratinizing squamous epithelium after marsupialization in many cases. There was no significant difference in labeling index between premarsupialization (20.2% +/- 12.0%) and postmarsupialization (15.3% +/- 10.3%).
Marsupialization was found to be effective as a preliminary treatment for large OKCs. This procedure does not appear to affect the recurrence tendency of OKCs, and the probable changes in growth characteristics become rather less aggressive.
本研究评估袋形术对牙源性角化囊肿（OKCs）的影响及其与摘除术和刮除术联合应用时的作用。
本研究对28例在摘除术和刮除术前接受袋形术治疗的原发性OKCs进行了检查。评估了袋形术的效果以及至少3年随访期后的复发数据。通过使用单克隆抗Ki-67抗体的组织病理学和免疫组织化学研究分析了袋形术期间生长特征的变化。
袋形术的效果评估为极其有效（64.3%）、中度有效（32.1%）和效果不佳（3.6%）。在5个病变中，囊肿肉眼消失，未进行进一步手术。6个病变（21.4%）观察到复发，接受或未接受袋形术治疗的病变之间复发率无显著差异。下颌支区域的病变以及影像学上的多房性病变似乎更容易复发。显微镜检查显示，在许多情况下，袋形术后从不全角化或正角化上皮到增生性、分层的、非角化鳞状上皮有实质性变化。袋形术前（20.2%±12.0%）和袋形术后（15.3%±10.3%）的标记指数无显著差异。
发现袋形术作为大型OKCs的初步治疗有效。该手术似乎不影响OKCs的复发倾向，并且生长特征的可能变化变得不那么侵袭性。
