口腔扁平苔藓合并食道扁平苔藓的诊治及相关文献复习

Diagnosis and treatment on oral lichen planus combining with esophageal lichen planus and review the related literatures

目的总结分析口腔扁平苔藓(OLP)合并食道扁平苔藓(ELP)的临床发生率、诊出方法、治疗和恶变倾向。方法对236例OLP确诊患者,根据主诉及问诊有胸部不适、胸前灼痛、烧灼感、吞咽困难、食道狭窄、进食不畅等症状,获得知情同意后进一步进行食道胃镜检查及病理活检,筛选合并ELP,进行规范治疗和追踪。结果 18例出现了ELP病损,OLP合并出现ELP发生率为7.6%(18/236)。其中2例11.1%(2/18)早于OLP出现食道非典型增生,1例5.5%(1/18)已早于OLP出现恶变为食道鳞状细胞癌。结论扁平苔藓是全身性疾病,ELP和OLP均属于黏膜的慢性炎症性疾病,两者间存在关联性。口腔科医生接诊OLP患者时,应该关注其全身其他部位的病损,尽早发现其他部位早期而隐匿的恶变,以免造成误诊和漏诊。

Objective To explore and report the clinical oral lichen planus（OLP） cases combining with esophageal lichen planus（ELP）, including prevalence, clinical manifestations, diagnosis, treatment and prognosis. Methods Two hundred and thirty-six OLP patients with chief-compliances and symp- tomes such as chest discomfort, chest burning, dysphagia, poor food intake et al. were included in this study. Esophagogastroscopy and biosy were suggested and applied to find weather combining with esophageal lichen planus （ELP） after written informed consent were obtained. Standard therapy of OLP and case follow-up were applied. Results Eighteen OLP patients with combined ELP were found （7.6%, 18/236）. Dysplasia were detected in 2 cases 11.1%（2/18） and in 1 case, 5.5%（1/18）, esophageal squamous cell carcinoma was detected while the three OLP was not malignant-transformed. Conclusions Lichen planus is general condition and there is a correlation between ELP and OLP. Thus, oral medicine doctors should pay attention to the other site lichen planus lesion to detect early and hiding malignant- transformed, avoided misdiagnosis and missed diagnosis.