上唇静脉畸形治疗后并发肉芽肿性唇炎1例报道及文献回顾  

Granulomatous cheilitis after treatment of venous malformations of the upper lip:a case report and literature review

作　　者：杨扬 周海文[1] 葛姝云[1] YANG Yang;ZHOU Haiwen;GE Shuyun(Department of Oral Mucosal Diseases,Shanghai Ninth People’s Hospital,Shanghai Jiao Tong University School of Medicine&College of Stomatology,Shanghai Jiao Tong University&National Center for Stomatology&National Clinical Research Center for Oral Diseases&Shanghai Key Laboratory of Stomatology,Shanghai 200011,China;Department of Periodontal and Mucosal Diseases,Affiliated Stomatological Hospital of Xuzhou Medical University,Xuzhou 221000,China)

机构地区：[1]上海交通大学医学院附属第九人民医院口腔黏膜病科,上海交通大学口腔医学院,国家口腔医学中心,国家口腔疾病临床医学研究中心,上海市口腔医学重点实验室,上海200011 [2]徐州医科大学附属口腔医院牙周黏膜病科,江苏徐州221000

出　　处：《口腔疾病防治》2025年第3期230-236,共7页Journal of Prevention and Treatment for Stomatological Diseases

基　　金：上海市卫健委中医药科研项目计划(2020LP023)。

摘　　要：目的探讨上唇静脉畸形治疗后并发肉芽肿唇炎患者的临床表现、诊断、鉴别诊断和治疗,为临床诊疗提供参考。方法报道1例上唇静脉畸形治疗后并发肉芽肿性唇炎病例的临床表现、诊断、鉴别诊断和治疗,并结合相关文献对肉芽肿性唇炎进行分析。患者,30岁,男性,因唇部出现鲜红斑首诊于外院皮肤科,疑为过敏性皮炎,对症治疗,红斑症状未见改善。后于外院口腔科就诊,诊断为“海绵状血管瘤”,予“聚多卡醇”和“博来霉素”注射治疗后,唇部鲜红斑好转,但肿胀加重半年余,于本院口腔黏膜科就诊,接诊时上唇及唇周皮肤肿胀明显,右侧上唇有红色斑片残留,充血,上唇质韧,有硬结,边界不清,动度差,病理学检查示上唇黏膜上皮增生,表面过角化,上皮下纤维组织增生,黏膜及小唾液腺慢性炎症,黏膜下层见灶性组织细胞、淋巴细胞、浆细胞浸润,呈肉芽肿性炎表现。根据患者病史、临床表现、结合组织病理学表现,诊断为肉芽肿性唇炎。予患者左右两侧上唇黏膜深层分别注射曲安奈德混悬液0.3 mL(40 mg/mL,1 mL/瓶)行局部封闭治疗。口服醋酸泼尼松片(10 mg/Qd);1周后复诊症状好转、继续原方案治疗;2周后复诊,唇部肿胀状态明显改善;口服醋酸泼尼松片调整5 mg/Qd。患者4周后复诊,唇部外形基本恢复正常、双唇颜色及柔软度明显改善。停止局部封闭治疗及口服药物,嘱上唇局部涂抹曲安奈德软膏,Bid。结果患者治疗8周后复诊,唇部色、形、质保持正常状态,嘱患者停药随访。回顾相关文献表明,肉芽肿唇炎病因不明,与遗传易感性、牙源性感染、过敏因素,微生物感染及免疫因素有关。临床需与唇部静脉畸形、唇部血管神经性水肿、克罗恩病、结节病等疾病鉴别。目前肉芽肿性唇炎的临床治疗仍以局部糖皮质激素封闭治疗或联合口服糖皮质激素类药物为主。本例患者在�Objective To explore the clinical manifestations,diagnosis,differential diagnosis,and treatment of granulomatous cheilitis complications after treatment in patients with upper lip venous malformations,as well as to pro-vide a reference for their clinical diagnosis and treatment.Methods This report provides details on the clinical mani-festations,diagnosis,differential diagnosis,and treatment of a case of granulomatous cheilitis after the treatment of up-per lip venous malformation,and then analyzes granulomatous cheilitis alongside the related literature.The patient,a 30-year old male,was first seen in the dermatology department of another hospital with bright red spots on his lips,diag-nosed with allergic dermatitis and received symptomatic treatment,and the erythema did not improve.He was diagnosed with‘cavernous hemangioma’and was treated with polydocanol and bleomycin injections.The bright red spots on his lips improved,but the swelling worsened for more than half a year.He then sought treatment at the oral mucosal depart-ment of our hospital.At the time of consultation,the swelling of the upper lip and perilabial skin was obvious,and there was a red patch on the right side of the upper lip,that was congested with blood.The upper lip was tough,with hard nodules,unclear borders,and poor mobility.Pathological examination showed epithelial hyperplasia of the upper lip mu-cosa,surface hyperkeratosis,subepithelial fibrous tissue hyperplasia,and chronic inflammation of the mucosa and minor salivary glands.Focal histiocyte,lymphocyte,and plasma cell infiltration was seen in the submucosal layer,with granu-lomatous inflammatory manifestations.Based on the patient's medical history,clinical manifestations,and histopatholog-ical manifestations,the diagnosis of granulomatous cheilitis was made.Tretinoin 0.3 mL(40 mg/mL,1 mL/vial)was in-jected into the deep layer of the mucosa of the right and left upper lips for local block treatment.Prednisone acetate tab-lets(10 mg/Qd)were taken orally,and after 1 week of follow-u

关 键 词：肉芽肿性唇炎 药物因素 局部封闭 糖皮质激素 曲安奈德 硬化剂 聚多卡醇 博来霉素 并发症 

分 类 号：R78[医药卫生—口腔医学]