口腔扁平苔藓合并食道扁平苔藓的诊治及相关文献复习

doi:10.3877/cma.j.issn.1674-1366.2015.02.009

中华口腔医学研究杂志(电子版) ›› 2015, Vol. 09 ›› Issue (02) : 134 -139. doi: 10.3877/cma.j.issn.1674-1366.2015.02.009

所属专题：文献；

临床研究

口腔扁平苔藓合并食道扁平苔藓的诊治及相关文献复习

何健慧¹, 黄丰², 李容林³, 赖人旭⁴, 易先平⁵, 李春阳¹^,^†(

)

^1. 519000　珠海，中山大学附属第五医院口腔科
^2. 519000　珠海市口腔医院
^3. 510055　广州，中山大学光华口腔医学院·附属口腔医院，广东省口腔医学重点实验室
^4. 519000　珠海，中山大学附属第五医院消化内科
^5. 519000　珠海，中山大学附属第五医院病理科

收稿日期:2015-01-14 出版日期:2015-04-01
通信作者: 李春阳
基金资助:
广东省科技计划(2011B061300002、2012B061700103)

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

Jianhui He¹, Feng Huang², Ronglin Li³, Renxu Lai⁴, Xianping Yi⁵, Chunyang Li¹^,^†()

^1. Department of Stomatology, The fifth affiliated hospital of Sun Yat-sen University, Zhuhai 519000, China
^2. Zhuhai Hospital of Stomatology, Zhuhai 519000, China
^3. Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Stomatology, Guangzhou 510055, China
^4. Department of Gastroenterology, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai 519000, China
^5. Department of Pathology, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai 519000, China

Received:2015-01-14 Published:2015-04-01
Corresponding author: Chunyang Li
About author:
Corresponding author: Li Chunyang, Email: lichyang@mail.sysu.edu.cn, Tel: 0756-2528274

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引用本文：

何健慧, 黄丰, 李容林, 赖人旭, 易先平, 李春阳. 口腔扁平苔藓合并食道扁平苔藓的诊治及相关文献复习[J]. 中华口腔医学研究杂志(电子版), 2015, 09(02): 134-139.

Jianhui He, Feng Huang, Ronglin Li, Renxu Lai, Xianping Yi, Chunyang Li. Diagnosis and treatment on oral lichen planus combining with esophageal lichen planus and review the related literatures[J]. Chinese Journal of Stomatological Research(Electronic Edition), 2015, 09(02): 134-139.

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。

关键词: 扁平苔藓，口腔, 扁平苔藓，食道

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 symptomes 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.

Key words: Oral lichen planus, Esophageal lichen planus

表1 18例口腔合并食道扁平苔藓患者的病理检查情况

部位	上皮过角化或不全角化	基底细胞液化变性	固有层淋巴细胞浸润	上皮异常增生	鳞状上皮癌
口腔	18	18	18	0	0
食道	15	18	18	2(11.1%)	1(5.5%)

表1 18例口腔合并食道扁平苔藓患者的病理检查情况

部位	上皮过角化或不全角化	基底细胞液化变性	固有层淋巴细胞浸润	上皮异常增生	鳞状上皮癌
口腔	18	18	18	0	0
食道	15	18	18	2(11.1%)	1(5.5%)

图1 ELP典型病例1食道胃镜图像

图2 ELP典型病例1食道病变部位病理活检镜下观（苏木精-伊红× 100）

图3 ELP典型病例1治疗后复诊食道胃镜图像

图4 ELP典型病例2食道胃镜图像

图5 ELP典型病例2食道病变部位病理活检镜下观（苏木精-伊红）

图6 ELP典型病例2治疗后复诊食道胃镜图像

图7 ELP典型病例3初诊食道胃镜图像

图8 ELP典型病例3初诊食道病变部位病理活检镜下观（苏木精-伊红× 200）

图9 ELP典型病例3复诊恶变为食道鳞状细胞癌食道胃镜图像

图10 ELP典型病例3复诊恶变为食道鳞状细胞癌病理活检镜下观（苏木精-伊红× 200）

图11 ELP典型病例3恶变为食道鳞状细胞癌放疗后复诊食道胃镜图像

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