- 學位論文
口腔黏膜下纖維化症之超微結構研究
Ultrastructural Findings of Oral Submucous Fibrosis
摘要
口腔黏膜下纖維化症（Oral submucous fibrosis，簡稱OSF）之病人有口腔黏膜灼燒感、張口困難以及對冷熱和辛辣食物特別敏感的現象；本實驗針對口腔黏膜下纖維化症病人之口腔黏膜組織（包括上皮、結締組織、肌肉、血管和神經組織）在超微結構下，做一研究探討。20例取自口腔黏膜下纖維化症病人的頰黏膜組織，做電子顯微鏡觀察。發現上皮組織大多呈現退化的現象，細胞間隙水腫，基底膜變得不規則，可見缺損、變多層；上皮的分層變得不規則，細胞核變多型。在結締組織上可見透明均質化的顆粒，OSF的膠原纖維是細且多（不成熟的）；OSF病人張口困難，不只是因為黏膜下纖維化，連肌肉組織都有受影響。肌細胞呈現不等程度的退化，細胞膜的破損。肌肉中的血管可見內皮細胞損壞的現象。在神經的變化上，以往的文獻沒有提到。末稍神經呈現退化現象。神經周圍細胞（perineural cell） 兩側的基底板增厚且不完整；微纖維散亂地分佈在神經的周圍且呈被壓縮的狀態。神經內的膠原纖維緊密的集中在神經纖維旁邊。許旺細胞鞘被明顯增厚的基底板所包圍住。軸突呈現退化的狀態，粒線體腫脹而且細胞質透明化。透明化的軸突常可在神經細胞的遠心端看到。此神經變化可能和病人感覺改變有關。
並列摘要
Oral submucous fibrosis（OSF）is characterized by symptoms such as intolerance to spicy food, burning seasation, altered salivation, progressive difficulty in opening the mouth. The purpose of the present investigation is to describe the ultrastructural findings（TEM ＆ SEM）of the oral epithelium , subepithelial connective tissue, muscle, vessels and nerve of OSF. Biopsies were taken from the buccal mucosa of 20 cases of typical OSF. Routine EM procedures were done and sections were examined by TEM and SEM.The epithelium showed degeneration. The intercellular spaces of cells were edematous. The basal lamina appeared branched, thickened and duplicated in almost all the lesions. The cells showed pleomorphism. There were hylinized homogenous granules in the connective tissue. The collagen fibers of OSF tissue were excessive and fine (immature).The muscle was involved as well as submucous layer in OSF. Muscle fibers underwent degeneration and plasma membrane was vacuolization and hyalinization. The endothelial cells of vessels in muscle showed degeneration. Peripheral nerve also showed degeneration. The basal laminae on each side of perineural cells were thickened and incomplete. Microfibrils were compressed and scattered at the periphery of the nerve. Endoneural collagen fibrils were also compacted and concentrated around nerve fibers. The Schwann cell sheaths were invested with remarkably thickened basal lamina. The axons appeared degenerated with swollen mitochondria and hyalinized cytoplasm. The hyalinized axons were frequently observed at the distal portion of nerves. The disorganized changes of neural tissues in OSF were not previously reported and might be one of the factors resulting in the intolerance to spicy food and the burning sensation of the mouth.
參考文獻
延伸閱讀
- 楊順發（2005）。口腔黏膜下纖維化症的致病機轉〔博士論文，中山醫學大學〕。華藝線上圖書館。https://doi.org/10.6834/CSMU.2005.00028
- Huang, Y. L., Jin, Y. T., Yan, Y. H., Lin, C. C., & Lin, L. M. (1987). 口腔X型組織細胞增多症之超微構造組織病理學及免疫組織生化學的探討. The Kaohsiung Journal of Medical Sciences, 3(3), 155-165. https://doi.org/10.6452/KJMS.198703.0155
- 高文斌、謝耀東、謝天渝（2008）。口腔黏膜下纖維化症之致病基因微陣列分析及蛋白質確認。臺灣口腔顎面外科學會雜誌，19(4)，249-259。https://doi.org/10.7104/TJOMS.200812.0249
- 張燕清、郭進賢、陳振漢（2003）。應用基因微陣列技術探討口腔黏膜下纖維化症之基因表現。中華民國口腔顎面外科學會雜誌，14(2)，158-168。https://doi.org/10.7104/CJOMS.200309.0158
- 蘇昶瑋、林怡伶、陳俊明（2019）。Artificial Dermis in the Treatment of Oral Submucous Fibrosis。臺灣口腔顎面外科學會雜誌，30(3)，155-160。https://www.airitilibrary.com/Article/Detail?DocID=a0000494-201909-201910180005-201910180005-155-160