根尖造釉細胞瘤—回顧性研究及三病例報告

造釉細胞為一良性齒源性腫瘤，約佔所有顎骨腫瘤的百分之一及齒源性腫瘤的百分之十。平均好發年齡約四十歲，無特別性別傾向，以下顎後牙區為最常見。此類腫瘤生長緩慢，通常於常規撿查或患者主訴顎骨腫脹，才會於放射影像學檢查中發現病灶。察覺時多半已非小型病灶，且局部侵犯性及高度復發率令臨床醫師不敢等閒視之。極少數之病例在早期發現時，於影像上僅呈現小型根尖病灶，極易混淆視聽，不易和常見之根尖病灶區分，臨床鑑別診斷困難，文獻上曾有案例報告，因未確診導致疾病未獲適當治療，復發擴大造成更嚴重之結構破壞。回溯本院五年內經切片及病理組織學檢查之550例根尖病址，其中造釉細胞瘤共計3例，約佔齒源性腫瘤11％及所有根尖病灶的0.5％。臨床外觀皆可見齒槽骨膨脹，牙髓保有正常健康的活性。此三例於術後門診追蹤至少一年半以上，目前無復發跡象，皆持續回診中。根尖病灶主要多為根管性來源，單憑放射線影像檢查仍不足以確診，一般建議施行常規切片檢查，籍病理組織學分析確診以避免誤判，造成不當醫療處置。在確診為造釉細胞瘤之後，倘若在切片檢查時有手術安全範圍不足之疑慮時，需和患者解釋病情並溝通討論再次手術，確立安全範圍之必要性，並且需長期規律定期回診追蹤，以利儘早發現復發跡象，避免病症對正常組織造成更大破壞。

關鍵字

造釉細胞瘤；根尖病性；鑑別診斷

並列摘要

Ameloblastoma is a benign but locally aggressive odontogenic tumor. It compromises 1% of all jaw tumors and 10% of all odontogenic tumors. It occurs in patients of around 40 years of age and the male to female ratio is about 1 : 1 and usually appears in the vicinity of the mandibular molars up to ramus region. The lesion maybe discovered during routine radiographic examination and the patient may complain of swelling in jaw bone area. Such small incipient lesions may be mistaken for common periapical lesions. During the past 5 years, we have reviewed 550 cases of periapical lesions and were sent for histo-pathologic examination at our hospital. 3 cases of ameloblastoma were noted (0.5%). All cases revealed bony swelling and the affected teeth were vital. Patients were kept in routine follow-up for more than 1.5 year and no sign of recurrence was noted until now. Most periapical lesions are endodontic origin and the radiographic examination are not sufficiently accurate to diagnose Routine histopathological examination should be completed to avoid misdiagnosis and inappropriate treatment. Definitive treatment and long-term periodic follow-up of the patient are mandatory after the diagnosis of ameloblastoma.

並列關鍵字

ameloblastoma ； periapical lesions ； differential diagnosis

國際替代計量

根尖造釉細胞瘤—回顧性研究及三病例報告

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