2020年全球口腔癌新发病例377,713(2.0％),死亡病例177,757(1.8％),位居36种癌症中第18位,是严重危害人类生命健康的恶性疾病之一.在2017年美国癌症联合委员会所发布的第8版TNM分期手册(AJCC8))中,肿瘤大小不再是判断口腔癌T分期的唯一标准,新的分期系统中加入了浸润深度(depth of invasion,DOI)等新的指标,在诸多研究中肿瘤浸润深度被认为是预测口腔癌淋巴结转移的良好预测因子,也是预测隐匿性淋巴结转移和患者临床预后的指标之一,受到了人们的广泛关注.笔者通过查阅有关口腔癌浸润深度的国内外文献,熟悉掌握了浸润深度定义,测量方法以及临床应用.本文分别从浸润深度测量方法、浸润深度与淋巴结转移关系、浸润深度对口腔癌预后影响等三个方面阐述诸多学者的研究结果.文献复习结果表明,浸润深度的加入使患者原有TNM分期发生了改变,提高了不同TNM分期的预测价值和分层,能够识别生存率降低的高风险患者,对于口腔癌患者治疗方案以及预后评估有着深远意义.

Regenerative medicine is a new popular subject in the field of medicine. With its affluent growth factors,concentrated platelets have been proved to have strong regenerative potential, and have been widely used in oral therapy fields such as site preservation after tooth extraction, alveolar bone defect, periodontal tissue regeneration, apical surgery and implantation. The third generation of Concentrated platelets-Concentrated growth factors（CGF） is a new oral biomaterial containing advantages of convenient source, strong biocompatibility and high safety. Currently, CGF has been sought its fortune in oral clinical application,and its effect on tissue defects and bone regeneration has attracted more attention. By reviewing the domestic and foreign literatures on concentrated growth factors, the author is familiar with the production method, mechanism of action,scope and conditions of application of CGF, and better highlight the prospect of CGF in clinical application by comparing the content of growth factors and clinical application effects with the second generation of Concentrated platelets-Platelet-rich fibrin（PRF）. This paper make the further statement of the bone defects in oral clinical application of CGF progress, and the research results of many scholars were described from three aspects:jaw defect, guided bone regeneration,（GBR）, and post-tooth extraction,.The final conclusion in oral clinical CGF osteogenesis effect has a very positive, confirmed the CGF oral alveolar surgery applica tions in the field of significance.

目的:应用CBCT分析多生牙构成及临床特征.方法:收集2019～2020年多生牙患者160例,通过CBCT分析其特征.结果:多生牙发病率男性高于女性,多为4～12岁;未萌出者多于萌出者,多为圆锥形;以上颌切牙区为主,多为单侧生长;与邻牙成0～60°角的多生牙以正向生长为主;差异均有统计学意义(P<0.05).单发及双发性多生牙男性多于女性;除牙瘤形外,各形态均男性多于女性;但差异均无统计学意义(P>0.05).结论:CBCT对判断多生牙特征有显著优势,可为其诊治提供支持.

目的:应用锥形束CT(CBCT)分析多生牙相关特征,为临床诊疗提供参考.方法:选择2019年1月—2020年12月内蒙古医科大学附属医院口腔科经CBCT确诊的234颗多生牙作为研究对象,分析其生长发育特征及继发影响.采用SPSS 25.0软件包对数据进行统计学处理.结果:患者平均年龄11.16±7.61岁,以7～12岁最多.男女比例为1.6∶1.汉族占85.0％.多数单侧生长,数量多为1颗.多生牙生长区域多数为上颌骨切牙区,下颌骨前磨牙区.切牙区多生牙多见于7～12岁,尖牙区和前磨牙区多见于13～18岁,磨牙区多见于≥19岁.切牙区多生牙好发于男性,以圆锥形为主;其余区域多生牙好发于女性,以结节形为主,差异均有统计学意义(P＜0.05).发育情况为≥19岁年龄组高于其他3组,磨牙区高于其他区域,上颌骨高于下颌骨,差异均有统计学意义(P＜0.05);位于两恒牙牙根之间的多生牙高于其他3组,差异无统计学意义(P＞0.05).萌出情况为部分牙根形成和完全形成高于牙冠形成,正向高于其他方向;位于两恒牙牙根之间的多生牙高于其他3组,差异均有统计学意义(P＜0.05).继发影响为各生长区域及位于恒牙唇侧、根尖部和两恒牙牙根之间的多生牙主要影响邻近恒牙,位于恒牙腭侧的多生牙多数无继发影响,差异均有统计学意义(P＜0.05).结论:CBCT可精确分析多生牙相关特征,利于临床制定完善诊疗方案,提高治疗效果.

Objective Lymph node metastasis is the most important factor influencing the prognosis of oral squamous cell carcinoma (OSCC) patients. However, there is no proper method for predicting lymph node metastasis. This study aimed to construct and validate a preoperative prediction model for lymph node metastasis and guide personalized neck management based on the gene expression profile and clinicopathological parameters of OSCC. Methods Based on a previous study of related genes in OSCC, the mRNA expression of candidate genes was evaluated by real-time PCR in OSCC specimens. In this retrospective study, the gene expression profile and clinicopathological parameters of 112 OSCC patients were combined to construct the best prediction model for lymph node metastasis of OSCC. The model was validated with 95 OSCC samples in this study. Logistic regression analysis was used. The area under the curve (AUC) ultimately determined the diagnostic value of the prediction model. Results The two genes CDKN2A + PLAU were closely related to lymph node metastasis of oral squamous cell carcinoma. The model with the combination of CDKN2A, PLAU, T stage and pathological grade was the best in predicting lymph node metastasis (AUC = 0.807, 95% CI: 0.713-0.881, P=0.0001). The prediction model had a specificity of 96% and sensitivity of 72.73% for stage T1 and T2 OSCC (AUC = 0.855, 95% CI: 0.697-0.949, P=0.0001). Conclusions High expression of CDKN2A and PLAU was associated with lymph node metastasis in OSCC. The prediction model including CDKN2A, PLAU, T stage and pathological grade can be used as the best diagnostic model for lymph node metastasis in OSCC.

目的:建立一个能够稳定传代且生物学特性稳定的兔舌癌细胞系并对其生物学特性进行检测.方法:取对数生长期的第55代RSCC-1,注射于新西兰白兔舌缘,2周后成瘤,取瘤体组织Transwell Permeable Supports(TPS)法原代培养、纯化,获得新的兔舌癌细胞系RSCC-1a.连续传代培养,并对RSCC-1a进行生物学特性检测:1.形态学检测,包括HE染色、免疫组化染色、倒置相差显微镜、透射电镜观察兔舌癌细胞形态;2.细胞生长动力学检测,包括生长曲线绘制、细胞生长周期分析、计算细胞倍增时间;3.成瘤性检测,包括同种异体(兔)成瘤率、异种(裸鼠)成瘤率;4.核型分析.结果:RSCC-1接种后2周,形成兔舌癌模型,病理检查证实为鳞状细胞癌,瘤体组织进行原代培养,获得RSCC-1a细胞系,已稳定传至73代,形态学观察见细胞呈多边形,免疫组化角蛋白阳性.生长曲线呈停滞期、对数生长期及平台期3个典型时相;细胞周期测GⅠ期为71.55％,G2期为6.59％,S期为20.84％;染色体为亚四倍体核型,染色体数为93 ～ 212条,众数为139;裸鼠成瘤率100％,同种异体成瘤率100％,部分兔还发生颈部淋巴结转移.结论:通过RSCC-1成瘤后的瘤体组织进行原代培养,获得兔舌癌细胞系RSCC-1a,对其生物学特性检测,证明其为上皮来源的恶性肿瘤细胞系.

目的 通过体外研究明确GPD1L(甘油三磷酸脱氢酶-1类基因)基因对口腔鳞癌细胞系增殖、迁移及侵袭等生物学表型的影响.方法 构建GPD1L过表达稳定转染细胞系,采用CCK8生长曲线、细胞划痕实验、重建基底膜侵袭实验和蛋白免疫印迹实验,明确GPD1L过表达前后口腔鳞癌细胞系增殖、迁移、侵袭能力及相关蛋白表达的变化趋势.结果 口腔鳞癌细胞系WSU-HN6、Cal27和Tca83在GPD1L基因过表达后4～5天,出现明显增殖抑制及细胞周期S期阻滞.细胞划痕实验和重组基底膜侵袭实验发现,GPD1L基因过表达明显抑制口腔鳞癌细胞系Cal27和Tca83的迁移和侵袭能力.Western blotting实验证实GPD1L在口腔鳞癌细胞系中过表达可上调PHD2表达,并下调HIF–1α和Cyclin A2蛋白表达.结论 GPD1L过表达可以抑制肿瘤细胞增殖、迁移、侵袭及细胞周期阻滞,从而影响口腔鳞癌细胞系体外生物学表型.

随着显微外科的发展,肿瘤切除及外伤造成的大面积组织缺损可以采用游离皮瓣进行修复,但是游离皮瓣移植术后皮瓣组织血运障碍、水肿及坏死等并发症时常发生,其主要原因是缺血再灌注损伤.目前治疗此类损伤的主要方法是以减少氧自由基和炎性因子的产生为出发点,但治疗效果不明显.细胞外囊泡是细胞分泌的双层脂质膜结构的微小囊泡,主要存在于血液、淋巴液、唾液、尿液、乳汁等各种体液.几乎所有的细胞都可自发产生或在一定刺激下释放细胞外囊泡.细胞外囊泡参与细胞存活与凋亡、血管新生、血栓形成、炎症免疫反应等.近年,研究发现胚胎干细胞、骨髓间充质干细胞等多种细胞可以分泌细胞外囊泡,而细胞外囊泡在干细胞发挥促修复功能中起到重要作用.外泌体和微囊泡对缺血再灌注损伤保护作用的相关研究成为热点,了解其机制具有重要意义.本文将细胞外囊泡对缺血再灌注损伤保护作用的相关研究做一综述,以期为治疗游离皮瓣移植术后血管危象提供新思路.

目的:观察发育完全的自体智齿移植修复下颌第一磨牙的临床效果,探讨对自体牙移植成功的影响因素.方法:对16例下颌第一磨牙残冠或缺失、智齿发育完全且已萌出的患者行自体智齿牙移植修复下颌第一磨牙,术后1、3、6、12个月复诊时进行临床和影像学检查,观察智齿移植的成活率.结果:自体智齿移植1年后,成活率达100％.结论:自体牙移植临床效果满意,可成为牙列缺损的修复方式.

旨在了解导师制对住院医师规范化培训的影响.对照组采用传统教学模式,实验组采用导师制进行培养,运用SPSS 20.0软件对临床培训结果进行统计分析.结果显示,实验组技能考核成绩高于对照组,差异有统计学意义.问卷调查结果提示,实验组分析和解决临床问题能力、临床思维能力明显提高.

骨母细胞瘤是一种少见的骨肿瘤,约占骨肿瘤的1％[1],好发于脊柱和长骨,发生于颌骨者很少见[2-5].现将我科收治的1例左侧髁突侵袭性软骨母细胞瘤病例报道如下: 1.临床资料 患者男性,71岁,因“左侧颧弓部肿瘤术后11年伴局部疼痛2年”入院.患者11年前在我院行左侧颧弓部软骨母细胞瘤切除术,术后恢复好.2年前自觉左侧颞颌关节区咀嚼痛,张口受限,夜间偶有针刺样痛,口服布洛芬疼痛缓解.1周前左侧颞颌关节区疼痛加剧.查体见患者左侧髁突部可触及一大小约4cm×2.5cm肿物,质硬,无活动度,无触压痛,张口型基本正常,张口度约3cm,口内未见异常,颏下、颌下、颈部未触及肿大淋巴结.CT示左侧髁突周围不规则结节状高密度影(见图1).

The finite element method is an important tool for mechanical research.Compared with the experimental stress analysis,the finite element method has many advantages.It is widely used in oral biomechanical research.The finite element method is used to not only study the influence of different implant bone binding sites on the stress analysis of bone interface under functional loads,but also simulate the mechanical loading of real chewing actions under the defined mechanical parameters and loading conditions of the oral tissues.This article summarizes the current situation and progress of the application of finite element method in dental implants.

STAT3在头颈部肿瘤如鼻咽癌中异常表达,参与细胞的增殖、凋亡等生理过程,并与肿瘤放射敏感性密切相关[1],然而,其在口腔舌鳞癌中作用机制及对细胞放射的影响研究较少.本研究旨在探讨沉默STAT3表达对口腔舌鳞癌细胞生长和放射的影响及其机制.

目的 对比后牙区自体牙移植后3种不同固定方法的临床效果,为临床自体牙移植固定方法的选择提供参考.方法 选取10例后牙区自体牙移植为研究样本,分为3组,分别采用正畸弓丝法、树脂钢丝固定法和牙弓夹板固定法进行固定.对比3组固定后牙周状况、移植牙稳定性、1年内牙根吸收等情况.结果 3种固定方法均可对移植牙起到固定作用,1个月拆除固定装置后,10例移植牙均未脱落.但使用树脂钢丝固定法时,固定装置易脱落.牙弓夹板固定时,牙周卫生维护较困难.正畸弓丝法,操作较复杂且成本较高.结论 3种固定方法均可取得良好的固定效果,短期内在牙周膜形成和牙根吸收等方面无明显差别.

Supernumerary teeth is one of the teeth dysplasia that the number of teeth exceeded normal.Most of supernumerary teeth reported were located in anterior teeth region,while rare cases were reported in molar region.Supernumerary teeth can cause many complications,affecting the appearance and function of patients.Most of supernumerary teeth were pulled out.There were very few essays reporting that supernumerary teeth repair the missing teeth by autotransplantation.This article reported a case that supernumerary teeth in the mandibular molar region repaired the second premolar successfully by autotransplantation,and the clinical results were satisfactory after one year.

Objective:To investigate the effects of PTEN on proliferation and apoptosis of periodontal ligament cells induced by hydrogen peroxide.Methods:Human periodontal ligament cells were isolated and cultured in vitro,and then transfected with PTEN small interfering RNA or small interfering RNA negative control.After H2O2 treatment,PTEN expression was detected in cells by Western blot.Results:PTEN expression was inhibited in hu man periodontal ligament cells transfected with PTEN small interfering RNA.Conclusion:Interference of PTEN expression could inhibit the apoptosis and the proliferation of human periodontal ligament cells induced by H2O2.

目的 了解蒙古族人群第三磨牙萌出情况.方法 调查316例蒙古族患者(指三代内无与其他民族婚配者)智齿萌出受阻的情况,每位患者检查口腔内智齿萌出情况并拍数字全景片.结果 上颌智齿缺失发生率高于下颌智齿缺失,男性发生率较女性高;下颌阻生明显高于上颌阻生,且男女无明显差异.上颌阻生类型以垂直最多,下颌阻生类型以近中最多.结论 蒙古族人群智齿先天缺失率及阻生率都很高,是人类咀嚼器官退化的结果.

目的 通过对下颌骨正中联合骨折患者的回顾性研究,探讨下颌骨正中联合骨折的手术入路和感染发生的关系,并对原因进行分析.为临床治疗下颌骨正中联合骨折合并髁突骨折提供理论依据.方法 对内蒙古医科大学附属医院口腔颌面外科近3年住院治疗下颌骨正中联合骨折的病例106例进行回顾性分组对照研究.结果 坚固内固定术后伴有35例髁突骨折的患者无论采用手术治疗或保守治疗术后张口度基本恢复正常.开放伤口手术入路的感染率最高.结论 下颌骨正中联合骨折合并髁突骨折的术后愈合与手术入路的选择有关.

Dental autotransplantation is a relatively simple,cheap,high success rate of repairing of missing teeth treatment.In this paper,the concept and indications of wisdom tooth autotransplantation and the factors that influence the prognosis of wisdom teeth autotransplantation were reviwed.

目的 探讨聚桂醇治疗口腔颌面部血管瘤的临床疗效.方法 98例口腔和目标血管瘤患者随机分组,49例对照组患者给予平阳霉素、地塞米松及利多卡因癯体内注射,49例研究组患者在上述治疗的基础上增加聚桂醇注射液,比较两组患者治愈率及不良反应发生率.结果 研究组患者的临床治疗有效率为98％,不良发应发生率仅为6.1％.均优于对照组,差异有统计学意义(P＜0.05).结论 聚桂醇治疗口腔颌面部血管瘤可提高临床治疗效果,并且该药不良反应小,疗效确切.