下颌下腺保存治疗新技术体系的建立与应用

The saliva secreted from submandibular gland (SMG) accounts for 60%-65%. It plays an important role in maintaining the human function of swallow, digestion, testing, speech, protection of oral mucosa, and prevention from dental carries. The SMG is frequently resected during the treatment for various kinds of oral and maxillofacial diseases, resulting in xerostomia and decreased quality of life. During the past 15 years, Research Center of Salivary Gland Diseases in Peking University School and Hospital of Stomatology conducted a series of studies on new techniques for preservation of SMG and achieved remarkable results. The clinicopathologic and imaging characteristics of IgG4-related sialadenitis (IgG4-RS) were clarified based on systematic studies. The results of studies on the pathogenesis of IgG4-RS showed that unbalance of inflammatory factors mediated the abnormality of secretion of SMG. IL-4 participates in occurring and development of glandular fibrosis of SMG. Regulation of tumor necrosis factor α (TNF-α) and cleaning of senescent cells might be taken as the targets for treatment of IgG4-RS. The combination of glucocorticoid and steroid-sparing agents showed effective results for treating IgG4-RS, clinical remission was achieved in all the patients, serum IgG4 levels decreased, and salivary gland secretion significantly increased. Sialoendoscopy-assisted sialolithectomy was applied in the treatment of about 1 000 cases with submandibular hilar calculi with a success rate of more than 90%. Transfer of SMG was used for prevention from radiation-induced xerostomia in the patients with head and neck carcinoma. SMG was transferred to the submental region before radiotherapy and was kept away from the ra-diation field. The results of prospective clinical controlled study showed this technique could effectively preserve the function of SMG and prevent from xerostomia. Based on the micro-anatomical study on the blood vessels and ducts of SMG, partial sialoadenectomy was applied for treatment of benign tumors in the SMG. A clinical controlled study confirmed its safety for control of the tumors and its advantage of preservation of SMG function. The studies on the involvement of SMG in oral squamous cell carcinoma (OSCC) provided the anatomical and histopathological basis for preservation of SMG during neck dissection for early cases with OSCC. A innovated surgical modality "four preservations including SMG" was used during the neck dissection for the early cases with OSCC. A prospective randomized clinical controlled study confirmed its safety, feasibility, effectiveness for control of the carcinoma, and advantages of preservation of SMG function.     

向口腔医学工作者推荐一部新的学术专著--<正颌外科手术学>

我国正颌外科学在学习引进国外先进经验的基础上 ,经历了几代人的艰辛探索与创业 ,已经成为我国口腔颌面外科领域中最具生气、发展迅速的新的分支学科。它不仅为众多牙颌面畸形患者带来了福音 ,而且也日益广泛地渗透到口腔颌面外科的其它分支学科 ,促进了口腔颌面外科的全面进步与发展。由北京医科大学口腔医学院王兴、张震康、张熙恩三位教授主编的《正颌外科手术学》是继他们 1994年编写的《正颌外科学》之后的又一力作。它不仅得到山东科技出版社泰山基金资助 ,而且也是我国口腔医学专著中第一次得到国家科学技术学术著作出版基金的资助…     

COMBINED IMAGING DIAGNOSIS OF PAROTID MASSES

Computed tomography (CT), ultrasonography, sialography, and 99mTc scintigraphy were applied before operation to 108 patients with parotid masses. The results of each technique and the combined study of them were compared with the pathological diagnosis. Ultrasonography was found to be a very effective diagnostic aid in determining the presence of space-occupying lesion in the parotid. CT was the best technique to provide adequately reliable informations regarding the location of the tumor and the relationship between tumor and surrounding tissues. For diagnosing the nature of tumors, ultrasonography combined with sialography was reliable. 99mTc scintigraphy was better than other techniques in diagnosis of adenolymphoma. The diagnostic accuracy of combined diagnosis (90.7%) was higher than those of ultrasonography (83%), CT (80.5%), sialography (79%), and 99mTc scintigraphy (13.9%) alone. The advantage of combined diagnosis was particularly obvious for the diagnosis of low-grade malignant tumors.     

下颌骨区段缺损术后骨性重建对生活质量的影响

目的分析口腔癌患者下颌骨区段缺损术后骨性重建对生活质量（quality of life,QOL）的影响。方法17例因口腔癌而致下颌骨区段切除的患者按重建术式的不同分为骨性重建组和非骨性重建组,同时采用SF-36、FACT-H＆N和UW-QOL三种量表分别在术前、术后3个月和术后12个月进行生活质量的测量,比较两组患者生活质量的差异及纵向变化趋势。结果两组患者术前生活质量的差异无显著性,而在术后3个月和术后12个月两个时点,骨性重建组均有较好的外貌、进食、功能状况和总体生活质量（P〈0.05）。术后12个月时,骨性重建组的生活质量恢复到了接近术前水平,而非骨性重建组仍遗留有较严重的口腔相关的特异性问题和较差的功能状况。结论下颌骨区段缺损后的骨性重建能改善患者的外形和功能,提高患者术后的QOL,值得在临床上推广使用。     

肩胛舌骨肌上颈清扫术在临床N0口腔癌治疗中的应用

目的探讨肩胛舌骨肌上颈清扫术在口腔癌治疗中的应用价值。方法对27例临床N0(T1~3)口腔鳞状细胞癌患者行肩胛舌骨肌上颈清扫,清扫范围为第Ⅰ、Ⅱ、Ⅲ区淋巴结。记录颈清扫手术时间、术后淋巴结病理检查结果、术后肩功能及随访结果。结果手术时间平均(x±s)为(16±02)h。术后病理检查证实5例出现颈淋巴转移(19%),转移发生于第Ⅰ区2例(7%)、第Ⅱ区4例(15%),其中1例同时存在第Ⅰ、Ⅱ区转移。肩功能在术后3个月内基本恢复。术后随访2~4年,随访率100%,未见原发灶复发及颈淋巴转移。结论肩胛舌骨肌上颈清扫术是临床颈部N0口腔癌的合适术式,它既能达到治疗目的,又能最大程度地保留肩颈部外形与功能。     

人类大涎腺CT值的增龄性改变

目的 观察大涎腺在不同年龄组ＣＴ值的正常范围及增龄性变化的规律。方法 测定１００例正常腮腺，颌下腺的ＣＴ值，并以嚼肌，胸锁乳突肌为对照。结果 腮腺和颌下腺的ＣＴ值随着年龄增加逐渐降低，而嚼肌，胸锁乳突肌的ＣＴ值的增龄性改变不显著。腮腺及颌下腺的ＣＴ值在不同年龄组差异很大；同一年龄组内不同个体的ＣＴ值差异明显缩小。结论确定正常大涎腺的ＣＴ值，必须按年龄分组。ＣＴ诊断时，以对侧腺体作为对照是可行的。     

腮腺区肿大的鉴别诊断和处理

腮腺位于颜面两侧,耳的前下方。平时不易触及,当可触及而又可度量时,则可认为是腮腺肿大。腮腺区肿大是临床上常见的一种症状,原因复杂,种类繁多。为叙述方便,可将其分为3类:腮腺肿大而无自觉症状者称为肿大;腮腺肿大伴有胀或疼痛感觉者称为肿胀;腮腺区扪及肿块者归为肿块。有时三者之间不能严格区分。现将常见疾病的诊断要点及处理原则作一简述。     

国家口腔公共卫生项目对促进我国口腔卫生事业发展的作用及思考

公共卫生的概念最早由美国学者Winslow提出, 核心是保障和促进公众健康。口腔疾病被公认为公共卫生问题, 龋病是最常见、多发的口腔疾病, 因其可防可治, 一直被世界卫生组织列为可由公共卫生有效干预的疾病。我国政府也将其纳入重点防治的主要慢性病。2008年, 由原卫生部启动的"中西部地区儿童口腔疾病综合干预试点项目", 主要针对学龄儿童的第一恒磨牙施行窝沟封闭和口腔健康教育。覆盖国务院划归的中西部22个省、自治区、直辖市以及新疆生产建设兵团。这是我国首个以中央财政专项经费设置的口腔公共卫生项目, 委托中华口腔医学会管理并组织实施。经过6年的探索和经验积累, 原国家卫生计生委将该项目推广至全国31个省(区、市)和新疆生产建设兵团, 更名为"全国儿童口腔疾病综合干预项目"。项目运行10余年来, 对我国口腔公共卫生事业的发展和全国儿童口腔健康促进产生了重要影响。本文通过回顾项目设立的背景, 梳理项目涵盖内容、实施情况和取得的成效, 总结项目管理的经验, 分析我国口腔公共卫生工作在政策保障、经费保障、防治体系、人员能力、技术措施等方面面临的挑战, 提出未来口腔公共卫生事业发展的对策。     

整合素Ⅱb/Ⅲa抑制剂抗涎腺腺样囊性癌转移的实验研究

目的 :探讨涎腺腺样囊性癌 (salivaryadenoidcysticcarcinoma ,SACC)转移与SACC细胞 血小板粘附的关系 ,观察整合素Ⅱb/Ⅲa抑制剂抗SACC转移的作用。方法 :体外实验观察高转移潜能的SACC LM细胞、非高转移潜能的SACC 83细胞与血小板的粘附 ,阿斯匹林、阿斯匹林镁、精氨酸 天冬氨酸 (arginina aspartate ,RD)对SACC LM细胞与血小板粘附的影响 ;动物实验观察阿斯匹林、阿斯匹林镁、RD对SACC LM细胞实验性肺转移的作用。结果 :SACC LM细胞与SACC 83细胞相比和血小板的粘附增高 ,阿斯匹林、阿斯匹林镁、RD在 1,5 ,2 5 μg/ml时抑制血小板与SACC LM细胞的粘附 ,RD能抑制SACC LM实验性肺转移的形成。结论 :SACC的转移与血小板 肿瘤细胞的粘附有关 ,RD能明显抑制SACC的转移。     

不同疗程直流电治疗创伤性面神经损伤的实验研究

考察不同疗程直流电治疗创伤性神经损伤的效果。方法４０只家兔随机分为常规治疗组，电刺激一疗程组、电刺激二疗程组、电刺激三疗程，分别给予不同程序电刺激治疗，进行组织学观察，神经电图测定、计量病理学研究。结果①电刺激各组对神经恢复均有促进作用，电刺激二疗程、三疗程作用效果明显优于电刺激一疗程。②对于中度神经损伤，电刺激作用时间与神经恢复并不呈线性关系。电刺激三疗与二疗程治疗效果相近。结论地神经中度损伤，