- 期刊
Clinicopathological Study on Submucosal Injection of Collagenase in the Treatment of Submucous Fibrosis in the Oral Cavity
利用膠原酶經黏膜下注射以治療口腔黏膜下纖維化症之臨床病理研究
摘要
病人由於咀嚼檳榔而罹患黏膜下纖維化症，引起張口困難，黏膜敏感度異常 (如對辣、酸、冷與熱)，甚至轉變成類上皮癌。此種患者確實不少，佔本院口腔黏膜疾病患者12.0%。 本研究發現先以4%酚溶液注射於5隻紐西蘭種之白兔 (平均體重為1.5-2.0 kgs)的黏膜下層組織，能誘發很典型的黏膜下纖維化症，之後用膠原酶連續性注射病灶，以溶化過剩之纖維組織。作者以膠原酶應用於臨床病人，將病人之病灶經注射後之臨床表徵有顯著改善 (如黏膜色澤變紅、病灶顯著軟化、張口增加)等。如病人能由此戒除咀嚼檳榔，我們相信誘發成類上皮癌之機會將相對減低。 目前對於此症之治療包括有下列兩種，然各有其缺點，(1)口腔內科方面：如注射類固醇，它只能減少發炎性反應而已，但我們所採用之方法是直接溶化纖維性組織；(2)口腔外科方面：切除纖維化之病灶需再植皮，但是植皮往往有排斥反應，或是植皮邊緣傷口癒合不良，如再長期慢性發炎將引能纖維化，甚至引起瘢痕性收縮；此外，植皮過程比黏膜下局部注射膠原酶溶液來得困難、複雜。我們藉由動物實驗研究成功，進而對罹患黏膜下纖維化之病人施以膠原酶溶液之注射，獲得令人滿意之治療效果；其效果單以張口度變化比傳統性類固醇注射相比有5-8倍的增加。同時注射後病灶區血液循環增加，使病灶口腔黏膜變粉紅，同時更使患者對辣、酸、冷、熱等食物的刺激極度敏感不快的症狀也因使用本法獲得未曾預料的改善。本論文所提採用此類膠原酶溶液之注射病灶以治療黏膜下纖維化症之病人，以目前而言我們認為是最有效的治療方法。
關鍵字
無資料並列摘要
Sufferers of submucous fibrosis (often a condition thought to have resulted from the frequent chewing of betel nut) in its later stages may have difficulty opening their mouths, may experience alterations in mucosal sensations, such as sensitivity to spices, sour, cold, and heat, and can even develop malignant squamous cell carcinoma. In performing this study, we first injected a 4% phenol solution into the submucosa of 5 New Zealand rabbits (weights ranging from 1.5－2.0 kgs), a method that we found would successfully induce beautiful submucous fibrosis, and then utilized collagenase to lyse this dense fibrous tissue. The collagenase injections resulted in significant clinical improvements of the submucous fibrosis and also decreased significantly the incidence of malignancy. The current treatments of submucous fibrosis have several disadvantages: 1) medical method: injection of steroids. This can only decrease the inflammatory reaction, whereas collagenase can directly lyse the persisting submucous fibrous tissue. 2) surgical method: by the usage of tissue graft. This involves the possibility of rejection, or a fibrotic change in the suture edge that will eventually result in the contraction of the repair portion and sometimes even a keloid formation. In addition to this, the graft procedure is more difficult than our submucosal collagenase injection. In an experimental study on animals, followed by a clinical application, we obtained exciting therapeutic results with the injection of a 1.0 ml solution of collagenase (SIGMA) into the submucous fibrosis patients. As far as we know, this may be the most convenient and readily available treatment in the submucous fibrosis patients.