涎石症误诊1例报告

患者,男,23岁。因左侧颁下肿痛5年就诊,始发以进食时为重,进食后不久肿痛减轻,并向耳颞部放射,肿块逐渐增大,以慢性颁下腺炎于2006年8月10日收入住院。入院体查,一般情况良好,左颌下隆起饱满,舌下黏膜充血、水肿,颁下腺管扩张。双合诊有明显的结节感,坚硬、压痛。经CT检杏,见左侧颌下腺肿大、增生,有多个钙化灶。临床诊断为慢性颌下腺炎。于2006年8月14日在局部麻醉下行左侧颌下腺切除术,术中见颌下腺及舌下腺充血,纤维变性,无正常腺体组织,并包裹有10多枚如同珍珠样,类似圆形的结石,质硬光滑。病检为涎腺结石合并炎性增生。术后7天拆线,痊愈出院,随访1年无复发。     

腺样囊性癌的临床诊治进展

腺样囊性癌(ACC)是一种来源于腺体导管的低度恶性肿瘤,最常发生于涎腺组织[1],ACC以其独特的嗜神经侵袭性和肺高度转移性两大生物学特性吸引着众多肿瘤学研究者的关注,是涎腺肿瘤研究的热点. 一、ACC的流行病学 腺样囊性癌病因不明.虽然可以发生于任何年龄,但以40 ～ 60岁占绝大多数,女性稍多于男性,约1.2∶1.好发于涎腺,以小涎腺为多见.所有头颈部腺样囊性癌中,28％～ 42％发生在大涎腺,58％～72％发生在小涎腺[2].大涎腺中最常见发生于颌下腺,小涎腺最多见于腭腺.国内外有关ACC在不同腺体发生的构成比各不相同,但却在颌下腺及舌下腺中是居首位的恶性肿瘤[3].     

涎腺异物症诊治体会

涎腺异物症较为少见。我科自1974年以来,收治各种涎腺异物症11例,其临床资料及诊治体会如下。1临床资料本组11例,男9例,女2例。年龄最小4岁,最大28岁。异物部位为右腿腺导管4例,左腮腺导管2例,左腮腺腺体1例,左颌下腺导管3例,左颌下腺腺体1例。发病表现有面颊部便结2例,腮腺炎性肿块5例,额下腺导管炎2例,须下腺炎性肿块2例。病程最短4天,最长2年余。有自觉异物进入史仅2例。诊断正确3例,术前未确诊8例。治疗方法为导管按摩2例,异物硬结切除加导管吻合1例,导管切开去除异物1例,腺体摘除同时上除异物7例。异物种类是甜瓜子、…     

孕期表皮生长因子缺乏引起小鼠流产

鼠的下颌下腺产生大量表皮生长因子并可出现在循环中。表皮生长因子可以刺激培养的各类哺乳动物的细胞增殖,但其生理功能不十分清楚。孕期下颌下腺及血浆中的表皮生长因子浓度增加。作者通过评价表皮生长因子缺乏对于妊娠后果的影响,检查了孕期表皮生长因子可能的生理作用。未交配过的C_3H/HeN雌鼠行下颌下腺切除术后与成熟的同种雄鼠交配。对照组雌鼠也在同时交配。如有囊胚植入,检查不同妊娠时期种植部位的数量。放免测定未交配过的和妊娠的小鼠下颌下腺及血浆中表皮生长因子的浓度。涎腺切除的小鼠以及正常对照组的小鼠在妊娠第5～10天时,每日皮下给予兔制备的抗鼠表皮生长因子抗体50～100μl。同法注射正常兔血。妊娠第7～19天的涎腺切除的小鼠每日皮下给予表皮生长因子。     

中医辨证疗法应用于慢性阻塞性涎腺炎治疗的临床研究

目的：研究中西医结合治疗慢性阻塞性涎腺炎的临床效果。方法：选择笔者所在医院2004-2010年间收治的52例慢性阻塞性涎腺炎患者为研究对象,将所有患者随机分为西医组与中西医结合组各26例,西医组采用基础保守治疗,中西医组在上述基础上采用中医辨证治疗,两组治疗30d后比较成功率、复发率、全身局部炎症情况、唾液总流率、B超腺体检查结果。结果：52例患者中腮腺结石15例,腮腺分支导管阻塞者2例;下颌下腺结石34例,下颌下腺分支导管阻塞1例,其治疗结果为西医组中首次治疗成功者21例（80.8%）,复发者3例（11.5%）,1例行腺体摘除;中西医结合组首次治疗成功24例（92.3%）,1例治疗效果不佳后行直接切开导管取石,患者无复发现象;患者于治疗后肿胀,疼痛症状有明显缓解,术后均无严重并发症。治疗前后两组VAS评分组内比较差异显著。结论：中西医结合治疗慢性阻塞性涎腺炎具有明显效果,患者疼痛减轻显著,复发率低,提高了慢性阻塞性涎腺患者治愈水平,值得临床推广。     

奇怪的结石病

人体处处可罹患结石病，常见的有胆结石、肾结石、尿路结石等，偶可见眼睛内结石、鼻腔内结石、牙结石、唾涎腺结石、喉部结石、肺泡内结石、胃结石、支气管结石、乳房中结石、胰腺结石、阑尾结石、精囊结石，以及痛风所致耳壳皮下，手、足膝关节处的结石。     

涎腺腺泡细胞癌的超声特征及分型

目的:探讨涎腺腺泡细胞癌的超声图像特点及超声分型。方法:分析经手术病理证实的18例涎腺腺泡细胞癌的彩色多普勒超声表现,依据声像图特征进行简略分型。结果:18例涎腺腺泡细胞癌均为单发,发现低回声型12例、中等回声型2例、混合回声型4例;其中形态类圆或浅分叶13例(72.2%),边界清晰14例(83.3%),内部回声不均匀12例(66.7%),后方回声增强10例(55.6%),CDFI:0~I级14例(77.8%)。结论:涎腺腺泡细胞癌具有较明显的良性肿瘤声像图特征,常规超声对其定性诊断符合率较低。     

地塞米松对Wistar大鼠涎腺基因表达的影响

目的：观察腺病毒介导荧光素酶基因转导至大鼠颌下腺后地塞米松对基因表达的影响及IgG的变化.方法：将40只Wistar大鼠随机分为5组,经颌下腺导管转导腺病毒荧光素酶基因重组体即AdCMVLuc,3 d、1周、2周、4周、8周后观察肌注地塞米松对基因表达的影响.结果颌下腺转基因表达3 d最高,在注射地塞米松组明显大于未注射地塞米松组;以后逐渐下降,至4周、8周时仍可测到基因表达,但两组无明显差异.结论：肌注地塞米松能有效地减轻腺体的急性炎症反应,增加腺病毒介导涎腺短期基因表达,说明免疫及炎症反应直接影响转导基因的表达.     

颌下腺导管结石术后复发原因分析

颌下腺导管结石是口腔外科常见病、多发病。因手术方法简单，多数患者在门诊行取石术（多为导管前段结石）。但笔者从临床发现，有些患者术后再次出现梗阻症状，最后导致颌下腺分泌功能丧失。为此，笔者结合近10年来我科收治的17例患者情况，对颌下腺导管结石，尤其是前段导管结石术后易复发的原因分析如下：     

奇怪的结石病

人体处处可罹息结石病,常见的有胆结石、肾结石、尿路结石等,偶可见眼睛内结石、鼻腔内结石、牙结石、唾涎腺结石、喉部结石、肺泡内结石、胃结石、支气管结石、乳房中结石、胰腺结石、阑尾结石、精囊结石,以及痛风所致耳壳皮下,手、足膝关节处的结石。眼睛内结石长在眼结膜表面上的结石,由脱落的上皮细胞、变性白细胞和泪水中少量钙盐堆积组成,其质地坚硬,引起患者眼部不适。这种结石常见于中老年人,尤其是长期患沙眼及慢性结膜炎的病人。     

Response of submandibular gland of the rat to nutritional zinc deficiency.

Studies in several laboratories have shown that nutritional Zn deficiency in the rat causes a reduction in the activity of certain Zn-dependent enzymes in kidney, intestine, pancreas, etc. The present report deals with the effects of Zn-deficiency on submandibular gland of the rat. For the sake of comparison with previous studies, some assays on pancreas were included. Protein content, DNA, acid phosphatase, and acid protease activities were not affected in submandibular gland. Lactate dehydrogenase was unaffected in submandibular gland and showed increased activity in pancreas. Malate dehydrogenase was significantly decreased in both organs, the decrease being more marked in submandibular gland. Alkaline phosphatase activity in submandibular glands of control rats was about 10-fold higher than in pancreas. In the zinc-deficient rats, alkaline phosphatase was reduced to 59% of controls in the submandibular glands and to about 75% in pancreas. It is known from histochemical studies that in the submandibular gland this enzyme is confined to the myoepithelial cells. Recent studies attribute to salivary glands a role in the etiology of taste disturbances seen in clinical states of zinc deficiency. It is proposed that functional impairment of the myoepithelial cells might contribute to the disturbance of taste.     

A submandibular swelling: the salivary gland?

Four patients, three men aged 32, 51 and 74 years, respectively, and a woman aged 34 years, presented with a submandibular swelling. In all four patients, the swelling was caused by submandibular salivary-gland disease. The first patient appeared to have chronic sialoadenitis due to sialolithiasis, in the second patient the diagnosis was sialoadenosis due to anorexia-boulimia, the third patient had a pleomorphic adenoma and the fourth had a malignant neoplasm of the floor of the mouth causing obstruction of the submandibular gland. A submandibular swelling may have many different causes. It is sometimes difficult to differentiate between enlargement of the submandibular gland and an enlarged lymph node. Intra-oral inspection and palpation may give valuable information about the origin of some submandibular swellings. Using a combination of history, examination and, when necessary, fine-needle aspiration and r?ntgenological examination, the diagnosis of submandibular lumps is usually straightforward.     

Decreased expression of carbonic anhydrase isozyme II, rather than of isozyme VI, in submandibular glands in long-term zinc-deficient rats

We previously reported that in rats, long-term Zn deficiency significantly reduced taste sensitivity and total carbonic anhydrase (CA) activity in the submandibular gland. We therefore investigated the effects of Zn deficiency on salivary secretion and the expressions of CA isozymes (II and VI) in the rat submandibular gland, since those isozymes are thought to be related to taste sensation and salivary secretion. Male Sprague-Dawley rats, age 4 weeks, were divided into three groups (Zn-def, low-Zn and pair-fed, that were fed a diet containing 2.2, 4.1 or 33.7 mg Zn/kg, respectively, for 42 d). Northern blot analysis indicated that Zn deficiency reduced CA II mRNA expression in the submandibular gland without reducing CA VI mRNA expression. In Western blot analysis, Zn deficiency significantly reduced CA II (erythrocyte CA) protein expression in the submandibular gland without reducing CA VI protein expression. Salivary secretion was lower in the Zn-def group than in the pair-fed group. These results suggest that decreased CA isozyme II expression underlies the decreased CA activity previously reported in the submandibular gland in Zn-def rats, and this may reduce regular salivary secretion.     

内镜辅助下小切口颌下腺切除术的疗效观察

目的：探讨内镜辅助下小切口的颌下腺切除术的可行性。方法：选取2008年5月-2012年5月就诊于本院的颌下腺良性病变患者12例。设计下颌下区切口，内镜辅助下行颌下腺切除术。先切开颌下腺下缘的包膜，包膜下观察镜下面动脉、颏动脉颌下腺体分支和面前静脉属支的走行特点，采用高频超声刀凝断血管分支和下颌下神经节的腺体分支，结扎颌下腺导管，完整切除腺体。橡皮胶条负压引流，皮内缝合切口。结果：切口长度2．0～2．5cm，平均（2.3±0.3）cm；手术时间41—87min，平均（64±20）min；术中出血5-10mL；术中术后无面瘫、无感染，切口均一期愈合。随访4个月．4年，无复发。与传统切口相比，切口长度明显缩短，出血量明显减少，手术时间稍长。结论：采取小切口的内镜颌下腺切除损伤小，术后能获得良好的美容效果。     

Different responses of the submandibular salivary glands and liver of rats subjected to excess vitamin A: study on glycogen metabolism

The effect of excess vitamin A on glycogen metabolism in the submandibular salivary gland, as compared to that in liver was studied. Contrary to what has been previously reported for the liver, either using from 1 to 6 X 15 000 or 2 X 30 000 U.I. vitamin A, the glycogen content in the submandibular salivary gland was lower in the hypervitaminotic rats. The total phosphorylase activity was reduced in the groups receiving lower vitamin A doses.     

Enzymes of the carbohydrate metabolism in salivary glands from rats submitted to excess of vitamin A.

Male albino rats of the Wistar strain were submitted to daily doses of 15 000 I.U. of vitamin A. Enzymes of the carbohydrate metabolism were assayed in the salivary glands after 1,2, 3 and 4 doses. Phosphofructokinase showed decreased activity in the submandibular gland while it was not affected in the parotid. Glucose-6-phosphate dehydrogenase activity was higher in the submandibular glands of all experimental groups and only in the group of 1 dose for the parotid gland. Hexokinase activity did not alter in the submandibular gland while for parotid it showed higher activity only in the group of 1 dose. Pyruvate kinase activity was different only in the group of 3 doses for both glands.     

铅中毒对小鼠颌下腺神经生长因子基因表达的影响

目的探讨铅中毒对小鼠颌下腺的毒性作用及对神经生长因子基因（NGFmRNA）表达的影响。方法采用小鼠实验性铅中毒模型,通过光镜与电镜观察颌下腺的病理组织学变化。应用地高辛标记的人NGFDNA探针,采用原位杂交的方法,定量分析铅对小鼠颌下腺NGFmRNA表达的影响。结果实验性铅中毒小鼠体重下降,血铅浓度升高,颌下腺铅含量增加。光镜和电镜结果呈现铅中毒小鼠颌下腺腺叶萎缩,纤维增生,腺间质血管扩张,腺间隙增加。粗面内质网扩张,线粒体肿胀。图像分析结果表明,铅中毒小鼠颌下腺纹状管和颗粒曲管直径减小。原位杂交的结果显示,铅中毒小鼠颌下腺颗粒曲管和纹状管的杂交信号显著减弱,颌下腺组织中NGFmRNA表达减少。结论铅对小鼠颌下腺具有毒性作用,影响颌下腺NGF的基因表达。     

共刺激分子B7-H4对干燥综合征模型NOD鼠T细胞亚群的作用

目的 探讨共刺激分子B7-H4对干燥综合征（SjÖgren's syndrome,SS）模型非肥胖型糖尿病（non-obese diabetic,NOD）鼠T细胞亚群的调节作用。方法 将雌性NOD鼠随机分为基线组5只、生理盐水（normal saline,NS）组5只、B7-H4-Fc蛋白组8只、IgG2a-Fc组6只。在0 d和30 d时,将小鼠麻醉后处死,并取脾脏和颌下腺;流式细胞术检测脾脏单细胞悬液中淋巴细胞亚群的变化,颌下腺组织做苏木精和伊红染色和免疫组织化学染色。结果 共刺激分子B7-H4蛋白主要表达于NOD鼠颌下腺导管内皮细胞胞浆,组织病理显示颌下腺中有大量淋巴细胞浸润时B7-H4蛋白低表达。腹腔注射B7-H4-Fc融合蛋白30 d后NOD鼠颌下腺炎症浸润程度减轻。B7-H4-Fc组分别与IgG2a-Fc组、NS组、基线组比较时,脾脏中的CD4+Foxp3+T细胞/CD4+T细胞百分比升高,差异均有统计学意义（均有P<0.05）;而B7-H4-Fc组较IgG2a-Fc组、NS组、基线组CD4+IFN-γ+T细胞/CD4+T细胞百分比均降低（均有P<0.05）;三组间脾脏中CD4+IL-17+T细胞/CD4+T细胞百分比差异无统计学意义（均有P>0.05）。结论 B7-H4蛋白可延缓NOD小鼠颌下腺淋巴细胞浸润,减轻体内炎症细胞因子水平,抑制自身免疫炎症的进展。     

40例不同类型舌下腺囊肿的临床分析

目的：探讨不同类型舌下腺囊肿的临床特征、诊治方法、临床疗效及手术并发症的处理。方法：对某医院口腔颌面外科收治的40例不同类型舌下腺囊肿进行回顾性分析，其中单纯型30例，潜突型4例，哑铃型6例。结果：在40例不同类型舌下腺囊肿中。单纯型及哑铃型因其临床特征明显，易于诊断，对于潜突型舌下腺囊肿，则通过颌下区穿刺及彩色超声检查辅助诊断。手术方法均采用口内入路切除患侧舌下腺囊肿邻近囊壁及腺体。其中1例发生术后出血。通过紧急手术探查予以结扎止血处理，其余病例均未发生手术并发症。结论：局部穿刺及超声检查是值得推荐的用于舌下腺囊肿鉴别诊断的有效手段，完整摘除患侧舌下腺腺体是治疗不同类型舌下腺囊肿并预防其复发的关键。     

Histopathological changes in parotid and submandibular glands of patients treated with preoperative chemoradiation therapy for oral cancer

We retrospectively evaluated the relationship between computed tomography (CT)- and histopathological findings of parotid and submandibular glands in six patients treated for advanced oral cancer. Eligibility criteria were a pathologic diagnosis of oral squamous cell carcinoma, preoperative chemoradiation therapy (CRT) with a total dose of 30 Gy and oral S-1 (80 mg/m²/day), the availability of morphological assessments by CT and of functional assessments with the Saxon test before- and 2 weeks after CRT, and the availability of histopathological slides of irradiated parotid and submandibular glands. In the histopathological interpretation, gland structures were divided into acinar-, duct-, and adipose cells and other tissues. The Mann-Whitney test and the Spearman rank correlation test were used to determine histopathological changes. After 30-Gy irradiation, saliva production and parotid and submandibular volumes were significantly decreased (P < 0.05 each). Histopathological analysis demonstrated that 30-Gy irradiation resulted in a loss of acinar cells although acinar cells in the submandibular gland were relatively retained; the median acinar rate in the parotid and submandibular glands was 1.1% and 19.0%, respectively. The CT values after CRT were inversely correlated with adipose ratios (r = -0.98, P < 0.01) and there was a strong correlation between CT values before and after CRT (r = 0.97, P < 0.01). Our results suggested that acinar cell loss is a main contributor to changes in the volume and function of irradiated human parotid and submandibular glands. The CT value may reflect the adipose ratio rather than salivary function.