口腔疣狀增生：病例之臨床治療與病理特性分析

Oral Mucosal Verrucous Hyperplasia: Clinical Analysis

背景：口腔黏膜疣狀增生為口腔的癌前病變的一種，在臨床上非常值得我們注意。本篇研究目的即在統計分析，並探討病灶之臨床表現、相關因子、病理特性、治療方式。方法：本篇收集自2003年1月至2006年1月間，口腔疣狀增生之病例共26例，以回溯性的方式統計患者年齡、性別、是否抽煙、喝酒、嚼食檳榔.；病灶發生部位、是否為多發性、是否併發其他口腔黏膜病變，以及診斷、治療和後續追蹤的情形並且比較相關之研究報告，據以分析其病理特性以及討論在臨床治療上的注意事項。結果：共26位患有口腔疣狀增生之患者，皆為男性，年齡平均約為55歲。發生位置在頰部的有18處，硬顎和下唇各3處，軟顎和牙齦各2處，舌部和臼齒後三角區各1處。其中，過去沒有其他口腔黏膜相關病史的有19例；有口腔黏膜病史且與此次診斷相同位置者共6例。有病史且與此次診斷不同位置者則有1例（鱗狀上皮細胞癌）。對於病灶的診斷，有3例的切片檢查報告與術後病理結果不符合。本科之治療方式為較小的疣狀增生病灶以雷射直接局部切除，較大的病灶則以廣泛切除並以頰咽部脂肪轉移的方式填覆傷口。術後追蹤時間平均為8個月，情形良好者11例，失聯者4例，其餘11例有復發現象，但追蹤至今尚未發現有惡性轉變之案例。結論：本科之研究即反應出口腔黏膜病變的複雜與多樣性。治療方式為多數病灶以雷射直接局部切除即可，少數範圍較大的病灶則施以廣泛切除。切片檢查時，大的病灶應多作不同位置切片，以和口腔疣狀癌與鱗狀上皮細胞癌區分。目前追蹤的結果顯示並未遺漏惡性上皮細胞癌的病例，但對於疣狀增生的預後則需要更長時間的追蹤。

Background: Verrucous hyperplasia is one of the pre-malignant lesions of oral cancer, thus it is worthy of considerable clinical attention. The aim of this study is to discuss the clinical presentation, related factors, pathologic features and therapeutic modalities of oral mucosal verrucous hyperplasia by statistical analysis. Methods: This is a retrospective study of 26 cases with oral mucosal verrucous hyperplasia in their pathologic report from Jan. 2003 to Jan. 2006. We apply statistical analysis of age, gender, history of smoking, drinking and betel nut chewing, lesion site, multi-centricity, and other complicated oral mucosal pathologic changes. Diagnosis, treatment and follow-up are also included. Results: The twenty-six patients included were all males with a mean age of 55 years. Lesion sites originated from 18 buccal areas, 3 hard palates, 3 lower lips, 2 soft palates, 2 gingivals, 1 oral tongue and 1 retromolar trigone area. There were 19 cases without any prior oral mucosa pathologic history. For those with previous oral mucosa pathologic lesions, 6 cases are in the same site of origin with newly diagnostic verrucous hyperplasia, except one case with prior squamous cell carcinoma. There were three cases with different preoperative histopathologic reports from final postoperative pathologic diagnoses. In general, our treatment strategy of laserexcision was used for smaller lesions and wide local excision with local buccinators fat pad flap reconstruction was applied for larger lesions with a high risk of coexisting malignancy. The average postoperative follow-up was 8 months. Among them, 11 cases healed without any new clinically detected lesion but we lost contact with 4 cases. The other 11 cases showed recurrence, but no malignant transformation was noted until now under our regular follow up. Conclusion: Our study reflects the complexity and variability of oral mucosal pathology. In our experience, most verrucous lesions can be excised by laser knife but a few lesions are large enough to undergo wide local excision. To establish a clinical diagnosis, multiple site biopsies are essential for larger lesions to distinguish verrucous carcinoma and squamous cell carcinoma. According to recent follow-up result, it is acceptable without missing or misdiagnosis of any epithelial malignancy, but the prognosis of verrucous hyperplasia still requires a longer regular follow-up.