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研究生:林鈞盛
研究生(外文):Jiun-Sheng Lin
論文名稱:應用甲基藍作為疑似口腔癌及口腔癌前期病灶之臨床篩檢工具合併組織病理之研究
論文名稱(外文):Detection of oral cancer and precancerous lesion by Methylene blue
指導教授:高壽延高壽延引用關係張哲壽
指導教授(外文):Che-Shoa ChangShou-Yen Kao
學位類別:碩士
校院名稱:國立陽明大學
系所名稱:臨床牙醫學研究所
學門:醫藥衛生學門
學類:牙醫學類
論文種類:學術論文
論文出版年:2004
畢業學年度:92
語文別:中文
論文頁數:72
中文關鍵詞:口腔癌篩檢甲基藍
外文關鍵詞:Oral cancerPrecancerMethylene blueScreening
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  • 下載下載:73
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在口腔鱗狀細胞癌(以下均以口腔癌作為口腔鱗狀細胞癌之簡稱)的發生率與死亡率方面,1997年發生率為每十萬人14.7(男)及2.1(女),在頭頸癌中的比例高達42.9% (1988年為28.7%),已超越國人鼻咽癌發生率,躍居成為頭頸癌第一位。而口腔癌在所有癌症的個案比例,1995年衛生署的統計是5.17%,至今仍占男性十大癌症發生率的第五位,女性的第十七位。根據行政院衛生署2002年台灣地區十大死因統計資料顯示,惡性腫瘤(癌症)是國人死因第一位,其中口腔癌佔居國人癌症死因的第七位,而五年存活率平均低於百分之五十,在所有口腔癌病例中,百分之九十五以上為口腔鱗狀細胞癌。遺憾的是越來越多新診斷出的病例屬於第三期或第四期,這種現象讓我們體會到針對高危險群作早期預防篩檢與正確治療是同等重要的。本次實驗研究目的以甲基藍(Methylene blue)作一系列廣泛而有效的篩檢與推廣,以達到早期發現,早期治療的功效。在進行大規模口腔癌篩檢時,以甲基藍做為臨床發現懷疑病灶後,作切片檢查之前的簡易染劑測試。材料及方法甲基藍為組織之染色劑,利用漱口的方式來記錄著色區之部位、面積大小、顏色深淺、並隨即在染色所呈現的病症處進行切片檢查,以取得病理組織學診斷。本研究收集了58位疑似口腔癌患者和20位正常人施行甲基藍染色。其中男性 66位,女性12位。平均年齡為41±15歲。染色檢查結果與病理報告比對後,整體偽陰性則有9﹪,整體偽陽性有42.22﹪,整體敏感性則有89.66﹪,整體準確性則有71.8﹪,整體專一性則有61.22%,在臨床上甲基藍除了用於早期發現口腔癌病灶外,更有許多其他的應用,如已罹患口腔癌患者之追蹤檢查,確定懷疑之病灶與其範圍,決定切片手術之位置與增加切片之準確率等。在大篩臨床檢時不但迅速、便宜、安全、比甲苯胺藍(Toluidine bule)毒性低、無致癌性。加上其敏感性和準確性高,雖然專一性不高,仍可用來當做臨床診斷之外的輔助工具以減低及控制偽陽性與偽陰性的發生機率,不失為進行大規模口腔癌篩檢時,做為臨床發現懷疑病灶後,作切片檢查之前的簡易方便的染色測試。做大規模的口腔癌病灶及癌前期病灶篩檢,建議使用在高危險群之病人確有其可行性。
Oral cancer is a fatal disease which accounts for the 5th highest incidence of malignancy of male and 7th in general population. five years survival is also below 50% with no sign of recent improvement, survival is strongly influenced by the stage of the disease at initial presentation, oral cancer is common due to the prevalence of betel nut chewing and smoking in Taiwan. The five years survival rate of early treated oral cancer is significantly better than the late one. Therefore how to detect oral cancer in early stage is important. Methylene blue is a diagnostic agent for detection of oral cancer and easy to apply clinically. The purpose of this study was to assess the functionality of Methylene blue dye for patients with suspected oral lesions of precancerous or malignant by comparing microscopic diagnoses, with staining reactions. The study group comprised 58consecutive patients who had suspected oral squamous cell carcinomas or precancerous lesions and 20 normal mucosa , Methylene blue dye staining recorded by photographs was applied and biopsy was performed . The results of histopathologic diagnosis confirmed 16 malignancy, 13 precancerous, 29 benign lesions, and normal mucosa ,in malignancy precancerous and benign lesion normal mucosa the sensitivity (89.66%), specificity (61.22%), accuracy(71.8%) , the false negative were 9%, and there were 42.22% false positives ,It was concluded that vital staining is a useful adjunct to careful examination and Suggest restricting the use of vital staining to selective cases.
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