口腔黏膜疣狀增生之臨床分析

Clinical Analysis Verrucous Hyperplasia in Oral Cavity

賴信宏(Shinn-Horng Lai) ； 游進益(Ching-Yi Yiu) ； 許振益(Chen-Yi Hsu) ； 劉嘉頤(Chia-Yee Liu)

《中華民國耳鼻喉科醫學雜誌》 35卷6期 (2000/12) Pp. 365-369

https://doi.org/10.6286/2000.35.6.365

摘要

背景: 疣狀增生是口腔中相當常見的一種病灶，大部分皆為良性，不過少數的病灶可能會演變為口腔鱗狀細胞癌；此種病灶常常一開始是以疣狀增生的形態表現，然而追蹤一段時間卻轉變成鱗狀細胞癌。本篇研究的目的主要在探討疣狀增生與惡性轉變關係。
方法:收集自1995年1月至1999年5月間在本院因口腔內病灶經病理切片診斷油狀增生患者共548例，針對隨後發生口腔鱗狀細胞癌的頻率及其危險因子間的差異，作一統計分析，並回溯性探討疣狀增生患者的臨床表現。
結果：在這548例疣狀增生的病患中，扣除在求診初即發現有惡性病灶並存的128例患者，其餘約有52.6%患者在發現有疣狀增生病灶，經過切片或治療後，病灶消失或改善；另外有41.0%患者病灶持續存在或反覆發作：有6.4%患者有惡性轉變的現象。在相關因子方面，年齡，性別，抽菸，喝酒與惡性轉變並沒有統計上明顯的差異存在。在病灶大小方面，只有在病灶大於4.5 cm 時，才有顯著的差異。嚼食檳榔在統計上確實會增加惡性轉變的機會(p=0.0137)。至於抽菸的患者，雖然得到惡性轉變的機會較高，但仍未達統計學上顯著差異的程度(p=0.0614)。大部份病患在診斷為疣狀增生之後，多數患者接受局部性切除；而部分患者證實有惡性變化後，在接受更大範圍的手術。
結論：疣狀增生合續發口腔鱗狀細胞癌間，確實有很密切的關係；當在患者口腔中發現疣狀增生時，必需重複切片或局部性切除送病理檢驗確認，若報告皆為良性，則需長期追蹤數年直到病灶完全消失；若為惡性則須及早施以積極治療。

關鍵字

疣狀增生 ； 鳞狀細胞 ； 增生性疣狀白斑

並列摘要

BACKGROUND: Verrucous hyperplasia (VH) is a very common and mostly benign lesion of the oral cavity. Nevertheless, a minority of lesionns subsequently develop into oral squa-mous cell carcinoma (SCC). Such lesions often present first as VH, with malignant change only after a period of time. This study attempted to investigate the relationship between VH and malignant transformation.
METHODS: We identified 548 patients seen between January 1995 toMay 1999 in whom biopsies of oral lesions identified VH. We examined the rate of subsequent development of oral SCC, and attempted to identify its association with various risk factors. The clini-cal course of VH was also reviewed.
RESULTS: Of the 548 VH patients, 128 were excluded due to the co-existence of malig-nancy at the time of diagnosis. Of the remaining 420 patients, the lesnon disappeared or improved after treatment in 52.6%. Persistence or recurrence of the lesion was found in 41.0%, and maliganant transformation was found in 6.4% With regard to risk factors, no significant differences were attributable to age, sex, smoking or alcohol consumption. A lesion larger than 4.5 cm size was found to be statistically significant. Betel nut chew-ing increased the risk of malignant transformation (p=0.0137). Smoking increased the risk of malignant transformation, but the increase did not satisfy our criteria for statisti-cal significance (p=0.0614). Most patients underwent local excision after VH was diag-nosed, with patients advised to undergo a more extensive resection when malignant trans-formation had been identified.
CONCLSIONS: There is a close relationship between Vhand subsequent malignant transformation to SCC. Whenever VH is found within the oral cavity, repeated biopsies or local excision for tissue pathology be performed. If results indicate that the lesion is still benign, then, follow up is suggested until the lesion disappears completely. If malignancy is identified, an early aggerssive treament is advisable.

並列關鍵字

Verrucous hyperplasia ； squamous cell carcinoma ； proliferative verrucous leukoplakia