华西口腔医学杂志 ›› 2020, Vol. 38 ›› Issue (6): 718-725.doi: 10.7518/hxkq.2020.06.020
• 治疗经验 • 上一篇
程国平(
), 叶畅畅(), 唐兢, 孟姝, 吴亚菲, 丁一
收稿日期:2020-01-12
修回日期:2020-06-23
出版日期:2020-12-01
发布日期:2020-12-07
通讯作者:
叶畅畅
E-mail:1187514641@qq.com;yechang111@163.com
作者简介:程国平,住院医师,硕士,E-mail：基金资助:
Cheng Guoping(), Ye Changchang(), Tang Jing, Meng Shu, Wu Yafei, Ding Yi
Received:2020-01-12
Revised:2020-06-23
Online:2020-12-01
Published:2020-12-07
Contact:
Ye Changchang
E-mail:1187514641@qq.com;yechang111@163.com
Supported by:摘要：
妊娠期牙龈瘤在中国发病率高,口腔门诊和产科门诊均十分常见,口腔医生在接诊妊娠期牙龈瘤的患者时,不仅要根据局部病灶的严重程度制定治疗方案,更需要了解孕妇的全身情况和胎儿的发育情况,预判治疗过程的各种风险。本文通过3例具有代表性的病例,并结合国内外文献,对妊娠期牙龈瘤的病因、鉴别诊断、治疗与预防及并发症的处理进行归纳,总结专科医生治疗妊娠期牙龈瘤的体会, 以期为临床提供参考。
中图分类号:
程国平, 叶畅畅, 唐兢, 孟姝, 吴亚菲, 丁一. 不同特点妊娠期牙龈瘤的治疗体会[J]. 华西口腔医学杂志, 2020, 38(6): 718-725.
Cheng Guoping, Ye Changchang, Tang Jing, Meng Shu, Wu Yafei, Ding Yi. Treatment strategy for pregnancy epulis[J]. West China Journal of Stomatology, 2020, 38(6): 718-725.
图 1
病例1治疗过程 A：妊娠31周;B：牙周基础治疗后2周;C：术后即刻;D：术后17个月;E：苏木素伊红染色 × 40,红色箭头为毛细血管,蓝色箭头为炎症细胞。
图 2
病例2治疗过程 A、B：妊娠37周的唇面观、腭面观;C：术后即刻;D：术后12个月;E：苏木素伊红染色 × 40,红色箭头为毛细血管,蓝色箭头为炎症细胞。
图 3
病例3疾病发展过程 A：妊娠33周;B：妊娠34周;C：妊娠36周;D：妊娠37周。
图 4
病例3影像学检查（36周） A、B：33—43根尖片;C：CBCT冠状面。
图 5
病例3治疗过程 A：妊娠37周;B：术后即刻;C：术后1年;D：苏木素伊红染色 × 40,红色箭头为毛细血管,蓝色箭头为炎症细胞。
图 6
病例3免疫组化和雌激素受体检查 × 200 A：间变型淋巴瘤激酶（-）;B：分化簇31、血管内皮表达CD31（+）;C：分化簇34、间叶组织来源标记CD34（+）;D：DES结蛋白（个别+）;E：葡萄糖转运蛋白-1（-）;F：平滑肌肌动蛋白（+）;G：雌激素受体（-）;H：孕激素受体（-）。
图 7
牙龈癌影像学检查 A：冠状面;B：矢状面;C：横断面。
图 8
OSCC的病理图片 苏木精伊红染色 × 200 A：鳞状上皮异型增生,细胞排列拥挤,极向紊乱;B：肿瘤细胞核大,深染,具异型,于间质内浸润性生长,C：红色箭头所指为肿瘤细胞岛。
图 9
骨肉瘤的影像学检查 A：冠状面;B：矢状面;C：横断面。
图 10
治疗流程
| [1] | Newman MG, Takei HH, Klokkevold PR, et al. Carranza’s clinical periodontology[M]. 12th ed. St. Louis: Saunders, 2014. |
| [2] | 孟焕新. 牙周病学[M]. 4版. 北京: 人民卫生出版社, 2012: 154-162. |
| Meng HX. Periodontology[M]. 4th ed. Beijing: People’s Medical Publishing House, 2012: 154-162. | |
| [3] |
Stelmakh V, Slot DE, van der Weijden GA. Self-reported periodontal conditions among Dutch women during pregnancy[J]. Int J Dent Hyg, 2017,15(4):e9-e15.
doi: 10.1111/idh.12210 URL pmid: 26913579 |
| [4] |
Silva de Araujo Figueiredo C, Gonçalves Carvalho Rosalem C, Costa Cantanhede AL, et al. Systemic alterations and their oral manifestations in pregnant women[J]. J Obstet Gynaecol Res, 2017,43(1):16-22.
doi: 10.1111/jog.13150 URL pmid: 28074549 |
| [5] |
Wu M, Chen SW, Su WL, et al. Sex hormones enhance gingival inflammation without affecting IL-1β and TNF-α in periodontally healthy women during pregnancy[J]. Mediators Inflamm, 2016,2016:4897890.
doi: 10.1155/2016/4897890 URL pmid: 27034591 |
| [6] | Neville B, Damm DD, Allen C, et al. Oral and maxillofacial pathology[M]. 4th ed. St. Louis: Saunders, 2015. |
| [7] |
Truschnegg A, Acham S, Kiefer BA, et al. Epulis: a study of 92 cases with special emphasis on histopathological diagnosis and associated clinical data[J]. Clin Oral Investig, 2016,20(7):1757-1764.
doi: 10.1007/s00784-015-1665-3 URL pmid: 26578118 |
| [8] |
Jafarzadeh H, Sanatkhani M, Mohtasham N. Oral pyogenic granuloma: a review[J]. J Oral Sci, 2006,48(4):167-175.
doi: 10.2334/josnusd.48.167 URL pmid: 17220613 |
| [9] |
Jafri Z, Bhardwaj A, Sawai M, et al. Influence of female sex hormones on periodontium: a case series[J]. J Nat Sci Biol Med, 2015,6(Suppl 1):S146-S149.
doi: 10.4103/0976-9668.166124 URL pmid: 26604605 |
| [10] |
Yuan K, Wing LC, Lin MT. Pathogenetic roles of angiogenic factors in pyogenic granulornas in pregnancy are modulated by female sex hormones[J]. J Periodontol, 2002,73(7):701-708.
doi: 10.1902/jop.2002.73.7.701 URL pmid: 29539023 |
| [11] |
Wu M, Chen SW, Jiang SY. Relationship between gingival inflammation and pregnancy[J]. Mediators Inflamm, 2015,2015:623427.
doi: 10.1155/2015/623427 URL pmid: 25873767 |
| [12] |
Bragado R, Bello E, Requena L, et al. Increased expression of vascular endothelial growth factor in pyogenic granulomas[J]. Acta Derm Venereol, 1999,79(6):422-425.
URL pmid: 10598753 |
| [13] |
Yuan K, Jin YT, Lin MT. The detection and comparison of angiogenesis-associated factors in pyogenic granuloma by immunohistochemistry[J]. J Periodontol, 2000,71(5):701-709.
doi: 10.1902/jop.2000.71.5.701 URL pmid: 10872949 |
| [14] |
Figuero E, Carrillo-de-Albornoz A, Herrera D, et al. Gingival changes during pregnancy:Ⅰ. Influence of hormonal variations on clinical and immunological parameters[J]. J Clin Periodontol, 2010,37(3):220-229.
doi: 10.1111/j.1600-051X.2009.01516.x URL pmid: 20070862 |
| [15] |
Jensen J, Liljemark W, Bloomquist C. The effect of female sex hormones on subgingival plaque[J]. J Periodontol, 1981,52(10):599-602.
doi: 10.1902/jop.1981.52.10.599 URL pmid: 6946202 |
| [16] |
Aldulaimi S, Saenz A. A bleeding oral mass in a pregnant woman[J]. JAMA, 2017,318(3):293-294.
doi: 10.1001/jama.2017.6901 URL pmid: 28719673 |
| [17] |
Brooks JK, Kleinman JW, Lubek JE, et al. Gingival squamous cell carcinoma: an unexpected clincal presentation[J]. Quintessence Int, 2019,50(1):50-57.
doi: 10.3290/j.qi.a41334 URL pmid: 30411091 |
| [18] |
Bornstein MM, Andreoni C, Meier T, et al. Squamous cell carcinoma of the gingiva mimicking periodontal disease: a diagnostic challenge and therapeutic dilemma[J]. Int J Periodontics Restorative Dent, 2018,38(2):253-259.
URL pmid: 29447319 |
| [19] |
Peddana SK, Ramadas R, Cherian E, et al. Chondroblastic and fibroblastic osteosarcoma of the jaws: report of two cases and review of literature[J]. Indian J Dent Res, 2017,28(1):100-104.
URL pmid: 28393823 |
| [20] |
Brierley DJ, Crane H, Hunter KD. Lumps and bumps of the gingiva: a pathological miscellany[J]. Head Neck Pathol, 2019,13(1):103-113.
doi: 10.1007/s12105-019-01000-w URL pmid: 30693455 |
| [21] |
Zhu YQ, Wang YQ, Tang YC, et al. Initial periodontal therapy for the treatment of gingival pregnancy tumor[J]. Genet Mol Res, 2016, 15(2): 10.4238/gmr.15028119.
doi: 10.4238/gmr.15028258 URL pmid: 27421007 |
| [22] | 张春澍, 王文霞. 妊娠期多发性牙龈瘤1例[J]. 华西口腔医学杂志, 2018,36(4):461-463. |
| Zhang CS, Wang WX. Multiple pregnancy epulides: a case report[J]. West China J Stomatol, 2018,36(4):461-463. | |
| [23] | 杨如倩, 郭淑娟, 肖诗梦, 等. 激光在牙冠延长术中的临床应用[J]. 华西口腔医学杂志, 2019,37(5):551-555. |
| Yang RQ, Guo SJ, Xiao SM, et al. Clinical application of laser in crown lengthening[J]. West China J Stomatol, 2019,37(5):551-555. | |
| [24] |
Truschnegg A, Acham S, Kqiku L, et al. Minimally invasive excision of epulides with a CO2 laser: a retrospective study of 90 patients[J]. Photomed Laser Surg, 2017,35(9):472-478.
doi: 10.1089/pho.2016.4192 URL pmid: 28375684 |
| [25] |
Walsh LJ. The current status of laser applications in dentistry[J]. Aust Dent J, 2003,48(3):146-155.
doi: 10.1111/j.1834-7819.2003.tb00025.x URL pmid: 14640367 |
| [26] |
Cobb CM. Lasers and the treatment of periodontitis: the essence and the noise[J]. Periodontol 2000, 2017,75(1):205-295.
URL pmid: 28758295 |
| [27] |
Armitage GC. Bi-directional relationship between pregnancy and periodontal disease[J]. Periodontol 2000, 2013,61(1):160-176.
doi: 10.1111/j.1600-0757.2011.00396.x URL pmid: 23240948 |
| [28] | 叶畅畅, 赵蕾, 王冬青, 等. 妊娠期牙周疾病的防治策略[J]. 国际口腔医学杂志, 2018,45(5):501-508. |
| Ye CC, Zhao L, Wang DQ, et al. The treatment strategy of periodontal disease during pregnancy[J]. Int J Stomatol, 2018,45(5):501-508. | |
| [29] |
Ichimiya M, Yoshikawa Y, Hamamoto Y, et al. Successful treatment of pyogenic granuloma with injection of absolute ethanol[J]. J Dermatol, 2004,31(4):342-344.
doi: 10.1111/j.1346-8138.2004.tb00682.x URL pmid: 15187331 |
| [30] |
Moon SE, Hwang EJ, Cho KH. Treatment of pyogenic granuloma by sodium tetradecyl sulfate sclerotherapy[J]. Arch Dermatol, 2005,141(5):644-646.
URL pmid: 15897398 |
| [31] |
Matsumoto K, Nakanishi H, Seike T, et al. Treatment of pyogenic granuloma with a sclerosing agent[J]. Dermatol Surg, 2001,27(6):521-523.
doi: 10.1046/j.1524-4725.2001.01039.x URL pmid: 11442586 |
| [32] |
Tsai KY, Wang WH, Chang GH, et al. Treatment of pregnancy-associated oral pyogenic granuloma with life-threatening haemorrhage by transarterial embolisation[J]. J Laryngol Otol, 2015,129(6):607-610.
doi: 10.1017/S0022215115001176 URL pmid: 26074261 |
| [33] |
González-Jaranay M, Téllez L, Roa-López A, et al. Periodontal status during pregnancy and postpartum[J]. PLoS One, 2017,12(5):e0178234.
doi: 10.1371/journal.pone.0178234 URL pmid: 28538740 |
| [1] | 张春澍, 王文霞. 妊娠期多发性牙龈瘤1例[J]. 华西口腔医学杂志, 2018, 36(4): 461-463. |
| [2] | 王虎. 牙骨质结构不良的X线多样性表现与口腔临床相关性[J]. 华西口腔医学杂志, 2017, 35(6): 565-570. |
| [3] | 王凯利 郑广宁 刘莉 许来青 郭文豪. 牙源性钙化上皮瘤2例[J]. 华西口腔医学杂志, 2016, 34(1): 104-107. |
| [4] | 任东萍 汤亚玲 耿宁 秦丹青 申婷 陈宇. 下颌骨骨化性纤维黏液样瘤1例[J]. 华西口腔医学杂志, 2014, 32(2): 200-202. |
| [5] | 聂敏海,曾光明,李秉琦,何志秀,甘筱莉,罗刚. 龈组织活检鉴别诊断口腔大疱性疾病[J]. , 1999, 17(01): 0-. |
| [6] | 卢勇，吴兰雁，何志秀，贾问炬，刘臣恒. 腮腺包块688例术中快速冰冻切片诊断的评估[J]. , 1995, 13(03): 0-. |
| 阅读次数 | ||||||
|
全文 |
|
|||||
|
摘要 |
|
|||||
