涎腺内镜辅助颌下腺腺门结石取出术疗效分析

目的 分析涎腺内镜辅助颌下腺导管腺门段结石取出术的疗效.方法 2005年12月至2011年3月在北京大学口腔医学院·口腔医院经影像检查发现的颌下腺腺门结石患者80例,采用涎腺内镜探查颌下腺导管,观察结石及导管炎症情况,并在内镜辅助下取石.术后随访3～6个月,分析内镜辅助下取石的效果及术后并发症.结果 80例颌下腺腺门结石患者中,71例结石被完全取出,5例结石大部分取出,4例结石未取出,取石成功率为95％ (76/80).76例结石成功取出者中 8例由网篮套索取出;59例采用了涎腺内镜辅助下口内切开取石术;9例经网篮套索及口内切开法取出结石.术后并发症主要为暂时性舌神经麻痹(1例)及舌下腺囊肿(2例).结论 涎腺内镜技术对于颌下腺腺门结石是一种安全有效的诊疗手段,可减少并发症的发生,并可避免结石残留.     

经口内入路治疗下颌下腺腺门区合并腺内多发结石的临床总结

目的:介绍一种经口内黏膜切口治疗下颌下腺腺门区合并腺内多发结石的手术方法,并对其临床应用进行评价.方法:全麻下对20例下颌下腺腺门区合并腺内多发结石的患者行口底黏膜切开取石术.术前超声、CT定位,术中首先口底定位腺门区结石,切开黏膜导管壁取出结石,保持上述切口敞开通畅,按压颌下区,使腺内结石自切口排出,冲洗导管,放置导管支架,观察术后并发症及治疗效果.结果:20例患者均成功取出腺门区及所有腺内结石,共取出结石56枚.腺门区结石直径为4.5～15.0 mm,腺内结石直径为0.5～4.5 mm,腺门区结石与腺内结石之间的直线距离为3.58～28.28 mm.术后5例患者出现舌麻木,4例患者出现颌下区轻度肿痛,均逐渐恢复.结论:下颌下腺腺门区结石合并腺内直径小于5 mm的结石可通过口内入路取石术全部取出,且治疗效果良好.     

涎腺内镜治疗涎石病的回顾分析

目的 分析涎腺内镜在涎石病的诊断与治疗中的临床价值.方法 对52例(43例颌下腺、9例腮腺)涎石病行内镜探查及取石术.结果 34例颌下腺导管前段和(或)后段结石中,24例在内镜下直接取石;2例经手术及内镜取石;8例手术取石.8例颌下腺导管腺门处结石在内镜辅助下手术取石.9例腮腺结石中3例以抓篮取石;3例直接切开导管口取石;1例以抓篮套锁后于颊部切开取石.取石成功的49例随访1个月～2年无复发.结论 涎腺内镜可提高涎石病的诊断敏感性,且多数结石可在内镜辅助下取出.     

涎腺内镜在慢性颌下腺炎病因诊断中的价值--78例临床报告

目的：评价涎腺内镜在慢性颌下腺炎病因诊断中的价值。方法：对78例因颌下腺反复肿胀就诊的患者行颌下腺涎腺内镜检查,明确导管系统的病变。结果：7例因导管重度狭窄放弃检查,71例完成涎腺内镜检查（91．0％）。59例通过涎腺内镜可发现明确的导管系统病变,其中结石31例,23例存在导管增生扩张、粘液栓及纤维素样渗出形成;导管息肉2例,导管畸形2例。多数病例导管内壁可见不同程度的充血、糜烂性炎症。此外,12例患者通过内镜未发现可观察到的明确的病变。结论：涎腺内镜可直观、有效地观察颌下腺导管系统的病变,具有较高的诊断价值。     

涎腺内镜在颌下腺导管及导管内病变中的临床应用

目的:评价涎腺内镜在颌下腺导管及导管内病变中的临床应用.方法:选择自2006年9月至2007年2月因颌下区反复肿胀而在我科就诊的21例患者,行涎腺内镜诊治,其中男12例,女9例,年龄12～42岁,左侧14例,右侧7例.16例行颌下腺造影检查,5例行下颌横断咬合片检查.结果:X线片显示颌下腺导管阳性结石5例,其他原因致颌下腺导管阻塞16例.涎腺内镜检查显示:1)颌下腺导管病变:导管狭窄3例,扭曲2例,导管息肉2例,憩室2例.2)颌下腺导管内病变:阳性结石5例,阴性结石7例,粘液栓及脓栓在所有病例中均有不同程度的表现.涎腺内镜术后,阻塞症状基本消失,无明显并发症发生.结论:涎腺内镜是一种有前途的新技术,在颌下腺导管及导管内病变的诊断和治疗中是一种安全、有效、微创的方法.     

阻塞性唾液腺炎病因与导管内微观结构关系的初步探讨

目的:通过对阻塞性唾液腺炎导管内微观结构和病理表现的内镜观察,了解唾液腺导管阻塞和结石形成的相关因素,为临床预防和治疗提供理论依据。方法:对2002年10月—2012年2月间583例阻塞性唾液腺炎患者进行内镜探查,其中492例为阻塞性下颌下腺炎,91例为阻塞性腮腺炎,对其导管内微观表现进行观察,了解导管内各种不同的阻塞原因,以及微观解剖结构。结果:583例阻塞性唾液腺炎患者中,574例导管内发现不同的病理表现(574/583,98.5%),而导管内正常表现者仅9例(9/583,1.5%)。下颌下腺导管内阻塞性原因主要是结石(439例,89.2%),其中结石包裹鱼刺样异物12例。多发性结石(2个及以上)79例。内镜下非结石性原因是黏液栓子(18例),导管狭窄(28例)和非导管内因素(7例),几个因素可同时出现。91例阻塞性腮腺炎中,89例阻塞原因为导管不同部位和程度的狭窄(67例,73.6%)、结石(9例,9.9%)、黏液栓子(13例,14.3%),2例患者导管内未发现阻塞原因。内镜下,导管内可观察到一些微观结构,主要是舌下腺导管开口、管壁息肉样增生、Sphincter现象和腺门盆状结构。结论:下颌下腺导管阻塞的主要原因是结石,而阻塞性腮腺炎的主要原因是导管狭窄。内镜下发现的导管内各种不同微观结构和病理改变,可能导致唾液流动不畅,是诱发导管逆行性感染和结石形成的重要微观解剖因素。     

精囊内镜用于诊断和治疗11例阻塞性唾液腺疾病的效果评价

目的: 探讨精囊内镜用于阻塞性唾液腺疾病诊断和治疗的可行性及疗效。方法: 选取2018年10月—2019年7月青岛大学附属青岛市市立医院口腔颌面外科收治的11例阻塞性唾液腺疾病患者,其中腮腺3例,下颌下腺8例。术前通过CT检查判断有无结石及其数目、位置和大小。全麻下应用精囊内镜在直视下观察导管壁及导管内的变化,明确发病原因,并进行相应治疗和评价疗效。结果: 术前CT检查3例腮腺和1例下颌下腺未见明显结石影像;7例下颌下腺可见导管内单发或多发性高密度结石影。10例患者成功应用精囊内镜取出结石,或利用导管扩张、灌洗,去除黏液栓子后,阻塞症状消失;1例因导管口狭窄明显,附加口底小切口,引入腔镜进行取石。术后6~12个月随访均无阻塞症状复发。结论: 精囊内镜可用于阻塞性唾液腺疾病的诊断和治疗,可部分替代涎腺镜的功能,属于一种创新性微创治疗方案。     

CBCT定位结合涎腺镜指导颌下腺后段导管结石的处理策略

目的:探讨CBCT定位结合涎腺镜指导颌下腺后段导管结石的处理策略。方法:回顾分析颌下腺后段导管结石初治的患者共77例的CBCT和临床资料，以CBCT矢状位三维成像，磨牙后纵线为解剖标志线，并根据结石横径和位置将患者分为4组，Ⅰ组：线后结石(n=22);Ⅱ组：线前直径>4 mm结石(n=33);Ⅲ组：线前直径<3 mm结石(n=17);Ⅳ组：线前直径3～4 mm结石(n=5)。对Ⅰ组患者手术从口外入路摘除腺体同时去除结石，对Ⅱ组30例在内镜辅助下口内旁路切口取出结石保留腺体(预定方案), 3例切除腺体(改行方案)。Ⅲ组16例均通过涎腺内镜从导管内直接取出(预定方案), 1例通过口内旁路取出(改行方案)。Ⅳ组3例通过涎腺内镜从导管内直接取出(预定方案), 2例改为口内旁路方案。结果:预定方案手术成功率Ⅰ组100%,Ⅱ组90.9%,Ⅲ组94.1%,Ⅳ组60%。并发面神经损Ⅰ组2例(9.0%),舌神经损伤Ⅰ组4例(18.1%),Ⅱ组12例(40.0%)。术后结石复发Ⅱ组2例(6.7%),Ⅲ组1例(6.7%)。结论:CBCT定位结合涎腺镜指导颌下腺后段导管结石清除术能够在尽量保留腺体...     

下颌下腺导管内结石位置分布及形态研究：附65例临床分析

目的：分析下颌下腺导管内结石的位置和形态,研究结石的分布规律。方法：对连续就诊的65例下颌下腺导管结石患者通过口底双合诊和下颌横断片判断结石的位置,手术取石,其中57例经口内直接切开导管取石或内镜辅助下取石,8例行下颌下腺切除术后取石,观察、测量术后所取结石的形状和大小。结果：下颌下腺导管结石在导管中发生的位置由前向后依次升高,62.5%患者结石位于导管的后段,结石以圆形和椭圆形为多,位于后段者体积多较大。结论：下颌下腺导管结石好发于导管后段,原因可能与导管后段的某些特殊解剖形态有关。     

口内取石后内镜导管探查治疗下颌下腺导管后部结石

目的:探讨下颌下腺导管后部结石的治疗方法。方法:对40例下颌下腺导管后部结石口底黏膜切口,导管切开取石,应用涎腺内镜探查导管,使其通畅,随访术后腺体恢复和导管分泌情况。结果:36例局麻下取石,4例因肥胖手术视野较差和局麻下手术患者配合困难而采用全身麻醉,40例患者均成功取石。随访35例术后6月～1年没有再出现进食后下颌下肿胀,下颌下腺质地逐渐变软,舌下肉阜处导管口有清亮液分泌28例。结论:口内取石简便了取石方法,联合内镜导管探查有助于下颌下腺导管通畅,有利于取石后恢复和保存腺体功能。     

A retrospective case series illustrating a possible association between a widened hilum and sialolith formation in the submandibular gland

ObjectiveThe purpose of this study was to explore any association between anatomical variances in the ductal system and sialolith formation using sialoendoscopy and acrylic resin replication of the ductal system.MethodsA retrospective study of 372 submandibular gland sialoendoscopies was performed to review the findings of the submandibular gland duct anatomy. Using sialoendoscopy and replicated casts, a high rate of hilar widening was noted in patients with submandibular sialolithiasis.ResultsSialolithiasis was detected in 326 of the patients who presented with obstructive symptoms. Around 67% (285/426) of the stones were located in the distal third of the ducts or at the hilum of the submandibular gland. During the sialoendoscopic procedure, the anatomy of the ductal system was examined and 285/326 (87.4%) of the hilums were noted to be widened like a basin. The anatomy of the duct from the replicated casts demonstrated a treelike structure and the basin-like widening of the hilum was found in all the excised submandibular glands.ConclusionUsing sialoendoscopy, a high number of patients presenting with sialolithiasis in the submandibular gland seem to have an anatomical variance in the hilar region. The reproduced ductal system from excised glands also demonstrated this abnormal widening of the hilum. Although further studies need to be performed, we try and explain why there is such a high prevalence of hilar widening in patients with submandibular sialolithiasis.     

涎腺内镜诊治慢性阻塞性下颌下腺炎14例报道

目的：评价涎腺镜在诊断和治疗慢性阻塞性下颌下腺炎中的价值。方法：对14例临床诊断为慢性阻塞性下颌下腺炎的患者进行涎腺镜检查．了解导管壁和导管内的表现，并同时通过涎腺镜进行相应的治疗，包括液电碎石术、钳取术和套石篮取石术、导管清扫扩张术．将结石或黏液栓子取出。结果：14例患者涎腺镜诊断的阻塞原因分别是：阳性结石10例、阴性结石1例，黏液栓子1例，管壁严重增生2例(其中1例结石嵌入)。11例患者成功应用治疗性涎腺镜取出结石或去除黏液栓子，导管扩张灌洗后阻塞症状消失；3例治疗失败，原因主要为导管增生、结石嵌入。术后无明显并发症发生。结论：涎腺镜能直观地了解涎腺导管内的病变表现，明确导管阻塞原因，并可同时进行相应的治疗，为慢性阻塞性下颌下腺炎的诊断和治疗提供了新的有效方法。     

涎腺内镜对慢性阻塞性涎腺炎的诊治价值

目的 评价涎腺内镜对慢性阻塞性涎腺炎的诊治价值。方法选择自2003年1月至6月到武汉大学口腔医学院涎腺专科门诊因涎腺区反复肿胀就诊的患者25例(34侧)行涎腺内镜术。其中腮腺19例27侧，颌下腺6例7侧；女性16例，男性9例；年龄17～77岁，平均年龄43．72岁。22例术前拍摄涎腺造影片，3例颌下腺结石病例术前加拍下颌横断咬合片。结果常规X线检查显示：颌下腺导管阳性结石3例；慢性阻塞性涎腺炎22例。x线片显示：腮腺、颌下腺主导管及部分分支导管不均匀增粗。涎腺内镜检查显示：①导管内有不同程度的纤维样物质，呈絮状、片状附着管壁；②导管存在程度不一的狭窄；③导管壁片状充血，部分可见点状、斑点状出血；④黏液栓、脓栓；⑤导管内腔变形呈不规则状，管壁向外突起形成憩室；⑥阳性、阴性结石。涎腺内镜术后，涎腺区肿胀、不适、疼痛感明显减轻，未发现明显并发症。结论涎腺内镜技术是一种安全、有效、微创的介入学方法。对慢性阻塞性涎腺炎的诊治具有重要价值。     

Anatomical recovery of the duct of the submandibular gland after transoral removal of a hilar stone without sialodochoplasty: evaluation of a phase II clinical trial

Transoral removal of stones for the treatment of submandibular sialolithiasis has been popularised, even for stones in the hilum. Without sialodochoplasty after surgical retrieval, the affected glands seem to recover well functionally, even without sialodochoplasty. However, the anatomical changes of structural recovery have not been fully studied. We investigated the outcomes and the changes to the salivary duct system after transoral removal of hilar stones using postoperative sialography. We enrolled 28 patients (29 sides) who had transoral removal of stones for submandibular hilar sialolithiasis without sialodochoplasty, and prospectively analysed the structural outcomes 3 months and 12 months postoperatively using sialography. We found 23 ducts (79%) recovered with a normal size, while 4 ducts (14%) developed saccular dilatation and one duct (3%) partially stenosed. Saccular dilatation developed after removal of stones larger than 10 mm in diameter, but patients had no recurrent symptoms. By the 12 months’ follow up, one stone had formed severe adhesions to the salivary duct that caused stenosis, and this patient had recurrent symptoms. Transoral removal of submandibular hilar stones without sialodochoplasty is an effective treatment with good anatomical restoration of the salivary duct and flow.     

Diagnosis and treatment of strictures and kinks in salivary gland ducts.

PURPOSE: This article describes the use of sialoendoscopy for diagnosis and treatment of strictures and kinks in the major salivary glands ducts. PATIENTS AND METHODS: Thirty-four salivary glands with obstruction were diagnosed as having ductal kinks or strictures. Strictures were diagnosed by sialography and sialoendoscopy, kinks were diagnosed mainly by sialography, whereas endoscopy was used to rule out other pathology and to locate the kink. There were strictures in 25 salivary glands (14 male and 11 females; aged 25 to 60 years), 14 in the parotid and 11 in the submandibular gland, and kinks in 9 salivary glands (5 males 4 females; aged 40 to 55 years). Seven kinks were found in the submandibular gland and 2 in the parotid. Treatment of strictures was performed by dilatation procedures with saline under pressure, balloon techniques, and forced manipulation. After these procedures, a polyethylene stent was inserted for 2 weeks. Kinks were treated by advancement ductoplasty and balloon contouring to overcome the acute angle. RESULTS: Twenty of 25 cases of stricture became completely asymptomatic in a follow-up of 8 to 36 months after treatment. In 4 cases, further revisional dilatation was needed, and in 1 case treatment failed and the gland had to be removed. All 9 cases of kinks became completely asymptomatic in a follow-up of 6 to 24 months after treatment. CONCLUSION: Strictures and kinks should be considered when salivary gland obstruction is present without sialolithiasis.     

Sialoendoscopy as a diagnostic and therapeutic option for obstructive diseases of the large salivary glands—a retrospective analysis

Objectives

The diagnosis and therapy of obstructive inflammatory disorders of the salivary glands have changed in the past decades following the introduction of sialoendoscopy. The aims of the present study were to analyze the relevance of sialoendoscopy using our own data and to compare the results to those of other studies.

Patients and methods

A retrospective analysis of 70 patients was performed, who were treated for obstructive disorders of the parotid and/or submandibular gland in whom sialoendoscopy was indicated. Two categories of interventions were considered: diagnostic interventional sialoendoscopy and endoscope-assisted interventions. Interventional sialoendoscopy procedures requiring extirpation of the gland were included in the analysis, as were abnormal intraductal processes that were detected during endoscopy.

Results

Treatment was successful in 58 of 67 (86.6 %) procedures (sialoendoscopy without surgical intervention n?=?59; endoscope-assisted surgical intervention n?=?8). Based on the underlying disease, the success rate was 88.6 % (n?=?39) in patients with obstructive sialadenitis without sialolithiasis and 86.6 % (n?=?19) in patients with sialolithiasis. It was not possible to draw definitive conclusions on the underlying disease from the observed pathological intraductal changes.

Conclusions

Sialoendoscopy is an effective and safe diagnostic and therapeutic option with low complication rate. However, limiting factors such as the size or the position of potentially removable obstacles must be taken into consideration.

Clinical relevance

The rate of gland extirpations can be reduced using sialoendoscopy.

     

Sialoendoscopy with and without holmium:YAG laser-assisted lithotripsy in the management of obstructive sialadenitis of major salivary glands

Obstructive sialadenitis is a major cause of dysfunction of the salivary glands, and increasingly sialoendoscopy is used in both diagnosis and treatment. At present the limit of the endoscopic approach is the size of the stone as only stones of less than 4 mm can be removed. Endoscopic laser lithotripsy has the potential to treat many stones larger than this with minimal complications and preservation of a functional salivary gland. The holmium:YAG laser has been widely and safely used in urology, and its use has been recently proposed in salivary lithotripsy for the removal of bigger stones. We describe our experience with sialoendoscopy for stones in the parotid and submandibular glands and assess the feasibility and the efficacy of holmium:YAG laser lithotripsy. We have used the procedure 50 times for 43 patients with obstructive sialadenitis; 31 patients had sialolithiasis, 15 of whom (48%) had stones with diameters between 4 and 15 mm (mean 7). Total extraction after fragmentation was possible in 14 of the 15 patients without complications. Intraductal holmium:YAG laser lithotripsy is effective and safe, and allows the treatment of large stones in Stensen's and Wharton's ducts.     

内镜在慢性阻塞性涎腺炎诊断中的初步研究

目的　应用内镜技术了解涎腺的内在表现和慢性阻塞性涎腺炎的病因。方法　根据唾液腺解剖特点 ,设计唾液腺内镜 ,应用其对 1 9例慢性阻塞性涎腺炎进行诊断 ,了解导管壁和导管内变化 ,明确发病原因。结果　内镜下可见颌下腺导管阻塞原因以结石多见 ,占 9/ 1 2 ;而腮腺导管内以内壁增生为主 ,占 5/ 7;少数患者可见分支导管部分阻塞。结论　内镜能直接了解涎腺的内在表现 ,明确慢性阻塞性涎腺炎的发病原因 ,可同时进行治疗 ,具有较广阔应用范围及前景