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目的探讨口腔疣状癌的病因、临床表现、鉴别诊断、组织病理学特点及治疗。方法回顾分析中国医科大学附属口腔医院1990—2012年收治的86例经组织病理确诊的口腔疣状癌患者的临床资料,总结其临床症状、病灶区影像学表现、病理学表现、治疗方案及术后随访情况。结果 86例患者中44例于肿物边缘外1.0~1.5 cm单纯行病灶扩大切除,21例除行病灶扩大切除外均同期行临近瓣转移修复术,11例行病灶扩大切除及功能性颈淋巴结清扫术,9例行病灶扩大切除及颌骨部分切除术,1例行病灶扩大切除+右侧颌下腺摘除+颌下腺导管改道术。对术后患者随访调查,单纯行手术切除的患者术后5年内复发3例(其中包括同期行临近瓣修复患者1例),余未见复发。对复发病例再次行肿物扩大切除,未见复发。结论疣状癌的诊断需靠临床表现、镜下形态以及生物学行为判断,外科根治性手术为首选治疗方案,术后应定期复查、随访。
Objective To investigate the etiology, clinical manifestations, differential diagnosis, histopathological features and treatment of oral verrucous carcinoma. Methods The clinical data of 86 patients with oral verrucous carcinoma diagnosed by histopathology from 1990 to 2012 at Stomatological Hospital Affiliated to China Medical University were retrospectively analyzed. The clinical symptoms, imaging features, pathological findings, treatment and operation of the lesion were summarized Follow-up situation. Results Of the 86 patients, 44 patients were enlarged and resected with simple lesions of 1.0-1.5 cm outside the margins of the tumor. In 21 cases, all the lesions were expanded and resected, and adjacent flap transfer and repair were performed in 21 cases. Enlarged resection and functional cervical lymph node dissection were performed in 11 cases. Dissection, 9 cases of focal enlargement and resection and partial resection of the jaw, 1 case of expansion of the lesion + right submandibular gland extirpation + submandibular gland duct diversion. Follow-up survey of patients after surgery, simple surgical resection of patients within 5 years after the recurrence of 3 patients (including the same period near the flap repair patients in 1 case), I did not see recurrence. On the recurrence of cases again tumor expansion and removal, no recurrence. Conclusion The diagnosis of verrucous carcinoma depends on clinical manifestations, microscopic morphology and biological behavior judgment. Surgical radical surgery is the first choice of treatment, and should be reviewed and followed up regularly.