※ 引述《meglin (天馬行空)》之銘言：
: 我的吉娃娃，年約六歲，體重約3.5公斤
: 左側上牙齦有一個明顯可見的牙齦瘤
: 目前已有點讓狗狗的嘴巴無法完全閉合....
: 想請問板上的朋友，關於狗狗要接受手術，有哪些需要注意的？
: 有沒有朋友有類似經驗，願意分享一點給我
: 或者，願意提供有關牙齦瘤的資訊>"<
: 捨不得狗狗挨刀，但也擔心會有其他變化....
: 也會害怕手術過程中的風險....
: 還懇請大家的幫忙了<(_ _)>
一般腫瘤需要經過細胞學和組織學檢查再配合一些試驗來確診。
請問你家犬的腫瘤已經確診了嗎?還是你自己猜測的呢?
齒齦瘤 (epulis)
口腔部位的腫瘤佔了犬隻腫瘤的6%。而其中包括了良性及惡性的腫瘤。齒齦瘤就發生及生長
的方式來看，是屬於良性的腫瘤。必須注意的是，有些腫瘤也會發生在齒齦部位，但是卻是
屬於惡性腫瘤，例如鱗狀上皮細胞瘤。齒齦瘤為口腔內常見的良性腫瘤，除棘皮瘤性齒齦瘤
外，還包括纖維瘤性齒齦瘤 (fibromatous epulis) 及骨化齒齦瘤 (ossifying epulis)，
後二者的發源也都在齒齦溝內的齒周膜韌帶中的馬賴塞氏細胞。而且組織學上也都由緻密的
纖維基質、豐富的膠原及血管組成，並覆蓋有非角化的複層扁平上皮。只是骨化齒齦瘤在纖
維基質中還可見到嗜酸性、均質的膠原物質，可能是類骨質 (osteoid)、擬齒質
(dentinoid) 或齒堊質 (cementum) 。此二者在人醫學將之統稱為末稍性牙胚性纖維瘤
(peripheral odontogenic fibroma)，該腫瘤不會侵犯骨頭。簡言之，纖維瘤性齒齦瘤和棘
皮瘤性齒齦瘤在組織學的差別只在於棘皮層上皮細胞的增生。
發生率
在口腔良性腫瘤中，齒齦瘤是最常發生的一種腫瘤。各年齡層犬隻皆可能發生，但好發於
7.5 至 10.5 歲之間，但是母犬發生機率是公犬的 17 倍
好發部位
通常齒齦瘤會從牙周基質部位(periodontal stroma)開始生長，並且通常發生在犬齒的齒齦
部位。且偏好於下顎的門齒處。
臨床特徵
通常臨床症狀的產生和腫瘤發生的大小有關。吞嚥困難、疼痛和流涎是比較常發生的症狀。
除此之外，口臭、血樣分泌物、體重減輕也可以見到。嚴重時，牙齒會鬆脫。
肉眼病變
齒齦瘤的外觀和牙齦增生的外觀相似，並且通常都是生長在牙床的部位。堅實且完整的被上
皮細胞覆蓋。
組織病理
根據組織病理，齒齦瘤通常可以分成三類:纖維化齒齦瘤(fibrous epulis)、骨化齒齦瘤
(ossifying epulis)以及麟狀上皮細胞或是棘狀細胞齒齦瘤(squamous or acanthomatous
epulis)。前兩種是非潰爛、非侵入型的齒齦瘤；而棘狀細胞齒齦瘤，雖然它是良性的，但
是其特徵通常都是具有惡性的徵狀，包括了局部的入侵以及骨骼的破壞。
治療
以外科手術為主，由於此腫瘤界限不明確，為求切除完全，必須切除相關的牙齒及團塊下方
的骨頭，還包括部分的正常組織，以確保不再復發。否則切除不完全時，復發機率非常高。
預後
如果移除完整，預後良好。
另外再附上一篇英文的Paper，不過內容差不多就是了。
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
一般腫瘤越快切除當然是越好，尤其如果它現在還小，所需切除的正常組織也就越少，當
然你外科手術的目的，就是改善動物的生活品質，這部分你可以和你的獸醫師做溝通，他
會幫你評估它的身體狀況，以及手術的可行性和必要性，當然手術上的風險性是一定有的
，但是它現在才六歲，如果身體健康狀況允許，而且腫瘤已經對它造成影響，我認為手術
的必要性還是很高。
這些獸醫師應該會和你說才是，再一次強調，
一般腫瘤需要經過細胞學和組織學檢查再配合一些試驗來確診。
請問你家犬的腫瘤已經確診了嗎?還是你自己猜測的呢?
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