※ 引述《meglin (天马行空)》之铭言： : 我的吉娃娃，年约六岁，体重约3.5公斤 : 左侧上牙龈有一个明显可见的牙龈瘤 : 目前已有点让狗狗的嘴巴无法完全闭合.... : 想请问板上的朋友，关於狗狗要接受手术，有哪些需要注意的？ : 有没有朋友有类似经验，愿意分享一点给我 : 或者，愿意提供有关牙龈瘤的资讯>"< : 舍不得狗狗挨刀，但也担心会有其他变化.... : 也会害怕手术过程中的风险.... : 还恳请大家的帮忙了<(_ _)> 一般肿瘤需要经过细胞学和组织学检查再配合一些试验来确诊。 请问你家犬的肿瘤已经确诊了吗?还是你自己猜测的呢? 齿龈瘤 (epulis) 口腔部位的肿瘤占了犬只肿瘤的6%。而其中包括了良性及恶性的肿瘤。齿龈瘤就发生及生长 的方式来看，是属於良性的肿瘤。必须注意的是，有些肿瘤也会发生在齿龈部位，但是却是 属於恶性肿瘤，例如鳞状上皮细胞瘤。齿龈瘤为口腔内常见的良性肿瘤，除棘皮瘤性齿龈瘤 外，还包括纤维瘤性齿龈瘤 (fibromatous epulis) 及骨化齿龈瘤 (ossifying epulis)， 後二者的发源也都在齿龈沟内的齿周膜韧带中的马赖塞氏细胞。而且组织学上也都由致密的 纤维基质、丰富的胶原及血管组成，并覆盖有非角化的复层扁平上皮。只是骨化齿龈瘤在纤 维基质中还可见到嗜酸性、均质的胶原物质，可能是类骨质 (osteoid)、拟齿质 (dentinoid) 或齿垩质 (cementum) 。此二者在人医学将之统称为末稍性牙胚性纤维瘤 (peripheral odontogenic fibroma)，该肿瘤不会侵犯骨头。简言之，纤维瘤性齿龈瘤和棘 皮瘤性齿龈瘤在组织学的差别只在於棘皮层上皮细胞的增生。 发生率 在口腔良性肿瘤中，齿龈瘤是最常发生的一种肿瘤。各年龄层犬只皆可能发生，但好发於 7.5 至 10.5 岁之间，但是母犬发生机率是公犬的 17 倍 好发部位 通常齿龈瘤会从牙周基质部位(periodontal stroma)开始生长，并且通常发生在犬齿的齿龈 部位。且偏好於下颚的门齿处。 临床特徵 通常临床症状的产生和肿瘤发生的大小有关。吞咽困难、疼痛和流涎是比较常发生的症状。 除此之外，口臭、血样分泌物、体重减轻也可以见到。严重时，牙齿会松脱。 肉眼病变 齿龈瘤的外观和牙龈增生的外观相似，并且通常都是生长在牙床的部位。坚实且完整的被上 皮细胞覆盖。 组织病理 根据组织病理，齿龈瘤通常可以分成三类:纤维化齿龈瘤(fibrous epulis)、骨化齿龈瘤 (ossifying epulis)以及麟状上皮细胞或是棘状细胞齿龈瘤(squamous or acanthomatous epulis)。前两种是非溃烂、非侵入型的齿龈瘤；而棘状细胞齿龈瘤，虽然它是良性的，但 是其特徵通常都是具有恶性的徵状，包括了局部的入侵以及骨骼的破坏。 治疗 以外科手术为主，由於此肿瘤界限不明确，为求切除完全，必须切除相关的牙齿及团块下方 的骨头，还包括部分的正常组织，以确保不再复发。否则切除不完全时，复发机率非常高。 预後 如果移除完整，预後良好。 另外再附上一篇英文的Paper，不过内容差不多就是了。 Epulis: A Common Oral Tumor Holly Nash, DVM, MS Veterinary Services Department, Drs. Foster & Smith, Inc. What is an epulis? An epulis is the most common benign tumor of the mouth in dogs. It is usually located in the gum tissue near the incisors or canine teeth. It originates in the connective tissue that holds the teeth to the bone of the jaw. The literal translation of "epulis" is "gum boil." There are three types of epulides (the plural for epulis): Fibromatous: Consists of tough, fibrous tissue. Ossifying: In addition to fibrous tissue, also contains bone cells. These may transform into cancerous tumors. Acanthomatous: More invasive, growing into the normal bone around it and destroying it, but not metastasizing. What causes an epulis? The cause of epulides is unknown, but they do occur more commonly in older dogs and Boxers. They occur equally in both sexes. What signs are associated with an epulis? Usually, the owner simply notices a firm growth between the teeth. The tumor is usually the same color as the gum tissue, has a smooth surface, and may be attached to the gum via a peduncle (a stalk-like structure). As the epulis enlarges a dog may drool, have difficulty eating or lose his appetite, have bad breath, bleed from the area of the tumor, or even have trouble breathing depending upon the size and location of the tumor. It may push apart and misalign the adjacent teeth. There is often more than one epulis present. How is an epulis diagnosed? An epulis may be suspected by its location and appearance, but it is necessary to biopsy the tumor to distinguish if from other oral tumors. A pathologist will examine the tissue microscopically to determine if it is an epulis, and of what type. Other oral tumors include squamous cell carcinoma (malignant), and other benign tumors such as fibromas, lipomas, and histiocytomas. How is an epulis treated? Surgery is necessary to remove the epulis. A wide margin (large portion of healthy tissue around the tumor, possible including some bone) needs to be taken to assure all of the epulis is removed. If a portion remains, it will often regrow. The teeth next to the epulis usually need to be removed, as well. Large epulides may also be treated with radiation. What is the prognosis for a dog with an epulis? If the epulis is small and all of the tumor is removed, the prognosis is good. The larger the tumor, the more likely a recurrence or complications. Acanthomatous epulides have a more guarded prognosis since they are much more difficult to completely remove. On rare instances, radiation therapy has resulted in the tumor becoming cancerous. Reference:http://www.peteducation.com/article.cfm?cls=2&cat=1631&articleid=3057 一般肿瘤越快切除当然是越好，尤其如果它现在还小，所需切除的正常组织也就越少，当 然你外科手术的目的，就是改善动物的生活品质，这部分你可以和你的兽医师做沟通，他 会帮你评估它的身体状况，以及手术的可行性和必要性，当然手术上的风险性是一定有的 ，但是它现在才六岁，如果身体健康状况允许，而且肿瘤已经对它造成影响，我认为手术 的必要性还是很高。 这些兽医师应该会和你说才是，再一次强调， 一般肿瘤需要经过细胞学和组织学检查再配合一些试验来确诊。 请问你家犬的肿瘤已经确诊了吗?还是你自己猜测的呢? --

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