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淋巴管畸形是常见于头颈部的一种先天性发育畸形。临床上常用的治疗方法主要有手术切除、硬化治疗、激光治疗等,可根据病变类型和病变范围选择其中一种方法或几种方法联合应用。口腔黏膜的微囊型淋巴管畸形适用激光治疗、平阳霉素注射或几种方法联合治疗。累及口腔和面颈部的淋巴管畸形的治疗困难较多,弥漫性病变手术切除后易复发,并发症发生率高。病变内注射平阳霉素、溶血性链球菌制剂(OK-432)可用于淋巴管畸形的治疗,大囊型病变的疗效明显优于微囊型。围手术期硬化治疗可提高微囊型病变的治愈率。     

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目的评价不同浓度平阳霉素局部注射治疗口腔颌面部淋巴管畸形的临床疗效。方法回顾分析2006年1月至2013月5月在中国医科大学附属口腔医院口腔颌面外科采用平阳霉素局部注射治疗的82例淋巴管畸形患者的临床资料。对不同类型、同一类型不同大小的淋巴管畸形采用不同浓度的平阳霉素治疗,具体如下：微囊型淋巴管畸形为8 mg/8 mL;病损直径〈5 cm的大囊型及混合型淋巴管畸形为8 mg/5 mL;病损直径〉5 cm的大囊型淋巴管畸形为8 mg/3 mL。随访时间为6个月至3年。结果微囊型淋巴管畸形治愈率为43.3%;病损直径〈5 cm的大囊型淋巴管畸形治愈率为93.3%;病损直径〉5 cm的大囊型淋巴管畸形治愈率为88.9%;混合型淋巴管畸形的治愈率为60.0%。所有患者术后均出现局部肿胀、疼痛,出现全身发热4例,出现局部溃疡1例,均未见肺纤维化及严重不良反应发生。结论对不同类型、同一类型不同大小的淋巴管畸形采用适宜浓度的平阳霉素进行治疗,不仅可以提高疗效、缩短疗程,而且可以减少不必要的并发症发生,治疗相对安全。     

平阳霉素局部注射治疗口腔颌面颈部淋巴管瘤

目的:探讨平阳霉素治疗口腔颌面颈部淋巴管瘤的疗效和适应症。方法:195例口腔颌面颈部淋巴管瘤患者的200个瘤体采用平阳霉素瘤内局部注射治疗。毛细管型和海绵型淋巴管瘤在瘤体内作分点注射;囊肿型淋巴管瘤则抽出部分囊液后,再注射药液。治疗周期及用药量根据淋巴管瘤的部位、大小、类型和患者年龄而定。评价其治疗效果。结果:总有效率为5415%(109/200),其中囊肿型淋巴管瘤疗效最好,有效率为100%(51/51),而海绵型和毛细管型及其混合型的有效率分别为46136%(51/110),16166%(3/18),19105%(4/21)。结论:平阳霉素局部注射疗法可作为口腔颌面颈部淋巴管瘤,尤其是囊肿型淋巴管瘤的首选治疗方法。     

A群链球菌制剂、平阳霉素联合强的松龙注射治疗体表血管瘤和脉管畸形的研究

目的:前瞻性观察并评价A群链球菌制剂和平阳霉素注射治疗颌面部血管瘤、静脉畸形和淋巴管畸形的治疗效果。方法:选取门诊及住院颌面部脉管瘤120例,随机分组采用A族链球菌制剂和平阳霉素注射治疗,对所有病例进行随访,并记录其疗效及毒副作用。结果:血管瘤36例,A群链球菌制剂组15例,治愈8例(53.33%);平阳霉素组21例,治愈12例(57.14%)。静脉畸形40例,A族链球菌制剂治疗组19例,治愈13例(68.42%);平阳霉素组21例,治愈14例(66.67%)。淋巴管畸形44例,A族链球菌制剂治疗21例,治愈14例(66.67%);平阳霉素治疗23例,治愈6例(26.09%)。结论:A族链球菌制剂注射治疗淋巴管畸形效果更为明显,A族链球菌制剂和平阳霉素注射治疗血管瘤和静脉畸形均有效。     

口腔颌面部淋巴管畸形的治疗

根据ISSVA、Waner和Suen的分类,过去所称的淋巴管瘤现统称为淋巴管畸形,包括微囊型和大囊型2类,以头颈部最多见。其发病原因不清,治疗方法多样。本文复习新近文献,论述了淋巴管畸形的手术治疗、硬化治疗、激光治疗的适应证、优缺点等,并介绍了其分子生物学研究和治疗前景。认为淋巴管畸形虽属良性病损。但极少自然消退,常与头颈部重要结构毗邻且具有局部浸润性而引起严重并发症和高复发率,给临床治疗带来了很大困难。虽然目前可用的治疗方法很多,但均有优点与不足,应根据患者病情和技术条件,制定个体化治疗方案。采用综合治疗．以期获得最佳疗效。对黏膜表面的微囊型淋巴管畸形、面颈部大囊型淋巴管畸形,平阳霉素、OK-432等病变内注射可获得良好的效果。黏膜表面的微囊型淋巴管畸形,也适于激光治疗。组织深部的微囊型淋巴管畸形的治疗。仍然是临床上面临的难题。目前不主张毫无指征地对任何类型的淋巴管畸形进行手术切除,手术适用于局限的、黏膜表面的微囊型淋巴管畸形和面颈部大囊型淋巴管畸形的治疗。手术中应注意重要结构的辨别和保护。对于复杂病例,提倡采用综合序列治疗。     

口腔颌面部淋巴管畸形的VEGF-C和VEGFR-3表达

目的 :观察接受和未接受平阳霉素治疗的淋巴管畸形中VEGF -C和VEGFR - 3表达 ,探讨平阳霉素治疗淋巴管畸形机制。方法 :收集 2 0例接受平阳霉素治疗的淋巴管畸形标本及 10例未接受治疗的标本做组织学观察以及免疫组织化学研究 ,评价形态学变化并分析VEGF -C和VEGFR - 3表达是否存在差异。结果 :两组病变VEGF -C和VEGFR - 3表达有显著性差异 (P <0 .0 5 ) ,并且VEGF -C和VEGFR - 3表达有相关性。结论 :平阳霉素注射治疗淋巴管畸形的分子机制可能是通过抑制VEGF -C -VEGFR - 3系统的信号传导从而达到治疗淋巴管畸形的目的     

2种病变内平阳霉素注射方法治疗68例儿童唇面部微囊型淋巴管畸形疗效分析

目的: 总结儿童唇面部微囊型淋巴管畸形（lymphatic malformation,LM）2种病变内平阳霉素注射方法治疗的远期疗效和安全性。方法: 回顾分析1990年1月—2013年1月临沂市肿瘤医院收治的68例儿童唇面部弥漫性微囊型LM病例。32例患儿（A组）采用同期、全层病变内平阳霉素注射治疗,即经黏膜、黏膜下层病变内注射平阳霉素并同期行唇面部全层病变内平阳霉素注射治疗;36例患儿（B组）行分期、分层次病变内平阳霉素注射治疗,即先期行经黏膜、黏膜下层病变内平阳霉素注射治疗,黏膜面病变基本消失后再行经皮、面颊部浅层病变内平阳霉素注射治疗。疗效评价采用Achauer 4级标准。记录疗程,平阳霉素总剂量,观察远期局部凹陷萎缩并发症。采用SPSS 18.0软件包对数据进行统计学分析。结果: 随访5~25年,A组病灶评价疗效Ⅰ级0例,Ⅱ级0例,Ⅲ级4例,Ⅳ级28例;B组病灶评价疗效Ⅰ级0例,Ⅱ级0例,Ⅲ级5例,Ⅳ级31例。2组Ⅳ级疗效比较无统计学差异（P>0.05）。A组疗程（5.9±1.4）次,B组疗程（6.4±1.3）次,2组比较无统计学差异（P>0.05）。A组注射平阳霉素总剂量（44.1±8.5）mg,B组注射平阳霉素总剂量（48.2±10.6）mg,2组比较无统计学差异（P>0.05）。A组20例（62.5%）出现局部凹陷萎缩,B组1例（2.8%）出现萎缩凹陷,2组差异有显著性（P<0.05）。结论: 采用分期、分层病变内平阳霉素注射治疗,与同期、全层病变内平阳霉素注射治疗儿童唇面部微囊型淋巴管畸形相比,其疗效、疗程和平阳霉素总剂量相当,但远期局部组织萎缩凹陷并发症发生率显著降低,治疗后面部外形好,患者满意度高。     

超声引导下应用平阳霉素治疗面颈部静脉畸形75例疗效分析

目的:评价超声引导下应用平阳霉素病变内注射治疗面颈部静脉畸形的疗效。方法:75例面颈部静脉畸形患者,其中面部54例,颏下区8例,下颌下区10例,颈部3例。病变最大32mm×39mm,最小6mm×9mm。观察在超声引导下采用平阳霉素病变内注射法的治疗效果及并发症。结果:平均每例患者接受1.64次治疗,其中1次42例,2次21例,3次9例,4次3例。按疗效标准进行疗效判定,治愈63例(84%),基本治愈10例(13.33%),好转2例(2.67%),无效0例(0%),治愈和基本治愈率为97.33%,治疗有效率达100%。治疗后71例(占94.67%)患者出现肿胀,2例(占2.67%)出现一过性头晕,未发现其他并发症。结论:超声引导下病变内注射平阳霉素治疗面颈部静脉畸形安全有效。     

合并呼吸道梗阻的血管瘤和脉管畸形32例治疗分析

目的：总结合并呼吸道梗阻的血管瘤和脉管畸形的临床特点和治疗经验。方法：1985年6月～2003年6月间．收治32例合并不同程度的呼吸道梗阻和呼吸困难的血管瘤和脉管畸形病例，男20例，女12例，年龄2个月～46岁。平均年龄9．31岁。其中血管瘤3例，静脉畸形12例，淋巴管畸形17例。病变原发于咽喉部4例，面颈部病变压迫或侵犯咽喉26例，上纵隔病变压迫气管2例。合并Ⅰ度、Ⅱ度、Ⅲ度呼吸困难分别为22例、7例、3例。采用口服糖皮质激素治疗3例．平阳霉素等硬化剂病变内注射治疗14例，手术治疗3例，手术 硬化剂病变内注射治疗12例。32例中，紧急气管切开4例，预防性气管切开11例。结果：3例血管瘤、16例淋巴管畸形和10例静脉畸形治愈；1例淋巴管畸形和2例静脉畸形好转；无效病例0例。结论：对合并呼吸道梗阻的血管瘤和压迫咽喉或气管的淋巴管畸形，分别采用激素疗法和单纯平阳霉素病变内注射治疗，治愈率高，一般不需气管切开；原发于咽喉部的局限性静脉畸形和淋巴管畸形手术容易治愈：侵犯咽喉部的静脉畸形和淋巴管畸形多合并面颈部广泛性病变，需采取手术 硬化剂注射 气管切开的综合治疗．方能治愈或控制病变发展。     

平阳霉素局部注射治疗小儿颈部囊性水瘤

目的 探讨平阳霉素局部注射治疗颈部囊性水瘤的疗效。方法 27例颈部囊性水瘤患儿采用平阳霉素瘤内局部注射治疗，先抽出部分囊内液体，再注射药液。用药量根据囊性水瘤的大小和患儿年龄而定。评价其治疗效果。结果 有效率达100％。结论 平阳霉素局部注射疗法可作为小儿颈部囊性水瘤的首选治疗方法。     

Variation in periodontal referral in 2 regions in theUK

This study investigated the periodontal referral patterns of general dental practitioners (GDPs) in Northern Ireland (NI) and North West England (NWE). A questionnaire dealing with periodontal referral was sent to all 520 GDPs registered in NI and to 274 GDPs in NWE. A usable return was made by 355 (68%) in NI and 189 (70%) in NWE. The NI dentists made significantly more periodontal referrals (median 5, range 0-80) in the year preceding the survey than those in NWE (median 2, range 0-50), p<0.001. Distance was the only factor significantly related to the referral rate in both regions with those who practised more than 25 miles from a specialist referring significantly fewer patients in both regions. In NI, there was a trend towards increased periodontal referral by GDPs who had attended more postgraduate courses; however, in NWE, this was not the case. The GDPs in NWE were significantly less likely than those in NI to refer patients with medical conditions. It is concluded that there is considerable variation in periodontal referral both within and between the 2 regions studied. It is further concluded that in many cases, non-disease factors, such as the accessibility of the specialist service, have powerful effects on the decisions made by dentists and patients in these regions (NI and NWE) in relation to periodontal referral. Much of the variance in referral in North West England, as in Northern Ireland, remains unexplained.     

云南省五岁儿童乳牙龋病调查分析

目的：了解云南省５岁儿童乳牙龋齿患病情况。方法：随机抽取云南省三个城市三个农村的２１３２名５岁常住儿童,采用第二次全国口腔健康流行病学调查标准调查龋齿患病情况。结果：云南省５岁儿童乳牙患龋率为７５．７５％,龋均为４．４４,充填率仅为６．５７％,仅占构成比的４．３９％。结论：云南省５岁儿童乳牙龋齿患病率高,充填率低。儿童龋病防治应注重两个方面：１．加强对家长和教师的幼儿口腔卫生保健知识及方法的宣传。     

Changes in cyclooxygenase metabolities in experimental periodontitis in Macaca mulatta

The four principal metabolites of cyclooxygenase (CO) were examined during the progression of experimental periodontitis in the rhesus monkey Macaca mulatta. Thirty-two monkeys were divided in four disease-matched groups. Three groups were treated with flurbiprofen, a potent CO inhibitor, at either 0.027, 0.27 or 7.1 mg/kg/day delivered systemically by a subcutaneously-implanted osmotic mini-pump. We have previously described the findings indicating that flurbiprofen treatment significantly retarded clinical attachment loss (ALOSS), redness and radiographic bone loss (BLOSS). This investigation focuses on the changes in CO metabolites which occur during disease progression of ligature-induced periodontitis and on the dose-response relationship of flurbiprofen, as it relates to disease inhibition and the suppression of ARA metabolites within the crevicular fluid (CF). In untreated animals there was a statistically significant 3-fold increase in CF levels of prostaglandin E2 (PGE2) and thromboxane B2 (TxB2) at 3 months, as compared to baseline, which positively correlated with increases in redness, bleeding, ALOSS and BLOSS. CF-PGE2 and TxB2 levels reached a 6-fold peak at 6 months and returned to baseline by 12 months. Flurbiprofen (Fb) prevented the 3-month rise in TxB2, but did not affect the increase in PGE2. At 6 months, Fb administration caused a dose-dependent inhibition of both PGE2 and TxB2. Probit analysis of the dose-response data revealed that the concentration of Fb which caused a 50% inhibition of CF-TxB2 level (the IC50 value for TxB2 synthesis) was approximately two logs lower than the IC50 value for PGE2 synthesis, i.e. TxA2-IC50 = 0.013 vs. PGE2-IC50 = 1.35 mg flurbiprofen/kg/d. The slopes of the PGE2 and TxB2 inhibition curves were identical, consistent with a similar mechanism or singular enzyme for the site of action of Fb inhibition of CO activity. However, the kinetics and sensitivity of Fb inhibition were significantly different for the CO activity responsible for TxB2 and PGE2 synthesis, perhaps due to different compartmentalization of CO within different cell types.     

Mast cells in masseter muscle in experimental bruxism in man

Three human subjects performed tooth grinding for 25 min, and after 20 h biopsies of the right and left masseter muscles were examined for their contents of mast cells. In comparison with specimens from a control group of three subjects, there was an increase of degranulating mast cells in muscles that had performed bruxism.