下颌牙龈转移性肝癌的病例.doc

下颌牙龈转移性肝癌1例 周及仁　 陈玉山 患者，男，74岁。因左下颌牙龈肿物2个月人院。患者2个月前发现左下颌磨牙区长一肿物约黄豆大小，疼痛不明显，肿物生长较快，人院时达鸡蛋大小并出现下唇麻木、左下颌后牙松动并脱落1牙。患者既往体健，否认有肝炎及结核病史。??? 人院检查：全身一般情况好，心肺脾肾未发现异常，肝右肋下5cm剑突下6cm，质硬，表面不光滑，轻压痛，腹水征(—)。口腔情况：左下颌后牙区肿物主要位于舌侧约4cmx4cmx3cm,颜色暗红，形态不规则表面尚光滑，无蒂，触质中等，活动度较差。「8松动Ⅲ度，「67残根，「5缺如。左颌下可触及4个黄豆大小淋巴结，较硬，相互粘连，固定.??? 实验室检查：肝功能正常，HBsAg阳性，AFP阴性。X线片：下颌骨左侧体部可见不规质骨质破坏区，约4．5cmx 2．5cm，其上缘骨质消失，侧缘及下缘边界不规则，硬化边缘。B超及CT均显示肝脏弥漫性占位性病变，以右叶为主。??? 初步诊断：①左下颌牙龈癌；②左下颌牙龈转移癌。??? 人院后患者左下颌肿瘤反复出血，每次100—200mI且不易止血，为彻底止血以延长患者生命，于1994年3月9日全麻下行左侧下颌骨及肿瘤切除术，左舌骨上淋巴清扫术，术中结扎左侧颈外动脉，手术过程顺利。??? 标本病理报告：左下颌牙龈转移性肝细胞肝癌。??? 患者术后经过顺利，伤口I期愈合。由于患者家属拒绝继续治疗，于术后16d自动出院。患者于1年后病亡。 下颌骨转移性肝癌（附2例报告及文献分析） HYPERLINK /qikan/guokanll_zzxq.php?id=25 《青岛大学医学院学报》 HYPERLINK /qikan/qkarticle_list.php?e=7041 2008年2月44卷1期 HYPERLINK /qikan/qkarticle_list.php?e=7041c=1190 论著 刘洪伟，冯元勇，李宁毅，贾暮云，袁荣涛，尚伟? 【摘要】? 目的 探讨下颌骨转移性肝癌的发病规律、临床特点和诊断要点。方法 结合有关文献报道，对2例经病理确诊的下颌骨转移性肝癌病人临床资料进行总结。结果 下颌骨转移性肝癌多见于中年人，男性多发，表现为下颌骨膨隆伴下唇麻木，多数病人HBsAg阳性。局部手术切除肿瘤后转肿瘤科继续治疗。结论 下颌骨转移性肝癌比较罕见，临床症状不典型，诊断困难，需要行B超、CT、AFP等检查进一步明确诊断。 【关键词】? 肝肿瘤；肿瘤转移；下颌骨 　　METASTATIC HEPATIC CARCINOMA TO MANDIBLE: REPORT OF TWO CASES AND REVIEW OF LITERATURE 　　LIU HONGWEI, FENG YUANYONG, LI NINGYI, et al 　　(Department of Oral and Maxillofacial Surgery, The Affiliated Hospital of Qingdao University Medical College, Qingdao 266003, China); 　　［ABSTRACT］ObjectiveTo study the clinical features and diagnosis of metastatic hepatic carcinoma to mandible.MethodsClinical data of two patients with metastatic liver cancer to mandible were reviewed and summarized in references to literatures.ResultsThe metastasis was mostly seen in middleaged male, manifesting as swelling of mandible, numbness in lower lip. Some showed positive HBsAg. The patients were transferred to department of oncology for further treatment after the metastaic tumors had been resected.ConclusionMetastatic hepatic carcinoma to mandible is rare. It is difficult to diagnose due to lack of typical manifestations. For confirmation, ultrasonogra