口腔粘膜白斑和扁平苔癣癌变后的诊治探讨

CLINICAL STUDY OF ORAL CARCINOMA DERIVED FROM LEUKOPLAKIA OR LICHEN PLANUS

一些口腔粘膜的慢性疾病,诸如口腔粘膜白斑(Oral Leukoplakia简称LK)和口腔粘膜扁平苔癣(Oral Lichen planus简称LP)已被人们普遍认为是癌前病变。但对由LK和LP恶变而来的口腔鳞癌,在临床上有何特征?在治疗中应注意什么?则还未见报道。本文对1978～1988年间我院口腔颌面外科收治的61例在LP和LP基础上癌变的口腔粘膜鳞状上皮癌的临床诊治作一探讨。

From 1978—1988, we had dealt with 61 cases of oral squamous carcinoma.All of them developed their cancers from Leukoplakia or Lichen Planus, with histories for 2 months to 29 years.The mean duration for malignancy changing is 5 months. 10 cases had lesions involved more than 2 areas.4 cases had been confirmed carcinoma at 2 areas separately.We had performed neck dissection in 34 cases.The positive rate of neck lymph node metastasis was 34.88%. We found that the age, the type of precancerous lesion and patient's immunological condition may be concerned with the cause of carcinoma.Aslo we think that a negative result of biopsy can't be regard as no malignancy at other site or at other time. Although carcinoma is to be seen usually at high differentiated lesions pathologically, but it occurs more often at the third or fourth clinical stage.This may be the result of the delay of the pathological confirmation or improper treatment.Recurrence rate was 37.84% in our fellow-up. Buccal malignancy rate is higher in 61 cases and the lympy node meatstasis rate is higher too.It suggested that we should remove the whole white lesion, avoid any harmful stimulation.Pay attention to every white lesion, to regulate patient's immunological function.