治疗角结膜干燥症自体颌下腺移植的血管处理

目的总结血管化自体颌下腺游离移植治疗角结膜干燥症的血管处理方法。方法对1999年8月至2004年4月完成的68例血管化自体颌下腺游离移植的血管处理作回顾性研究，分析受区和供区的血管、术后血管危象的发生和处理以及腺体的成活情况。结果68例游离颌下腺移植的供区和受区动脉均为颌外动脉与颞浅动脉，所用供区静脉中，面前静脉55例，颌外动脉伴行静脉12例，腺门静脉1例；所用受区静脉中，62例为颞浅静脉，1例为颢深静脉，5例经头静脉桥接后，回流至颈外静脉或颈内静脉的属支。术后10例出现血管危象，其中9例静脉危象，1例动脉危象，1例静脉危象经抢救腺体获得成活，本组移植腺体的成活率为86．8％（59／68）。结论血管化自体颌下腺移植的静脉变异较大，应根据每一病例的具体特点作出相应的处理，其中以颌外动脉伴行动脉与颞浅静脉的吻合最为可靠，显微镜下的血管吻合有助于降低术后血管危象的发生率，提高移植腺体的成活率。     

自体颌下腺移植治疗角结膜干燥症实验研究

目的 通过兔自体颌下腺移植试验,研究自体颌下腺移植治疗角结膜干燥症的可行性,移植术中、术后可能发生的问题及解决方法。方法 健康大耳白家兔20只,分成2组。试验组功除泪腺,通过血管吻合移植自体颌下腺至左颞部,导管植入外下穹隆结膜;对照组仅切除泪腺,不移植颌下腺。术后观察2个月,于术后1、2、3、4及8周分别进行施墨试验、移植眼泪液唾液淀粉酶测定、移植颌下腺造影、移植腺体及角膜组织病理学检查。结果 对照组兔术后施墨试验滤纸条长度低于术前,移植组施墨试验滤纸条长度高于术前。移植眼唾液淀粉酶浓度高于术前。移植腺体造影可清楚显示移植颌下腺完好的导管及腺泡结构,组织病理学观察,移植成功腺体结构正常,移植侧角膜无受破坏现象。结论 自体颌腺移植可适当增加角结膜干燥症兔泪液量,移植腺体分泌的唾液不会对眼部结构造成破坏,是治疗角治膜干燥症的有效方法。施墨试验及唾液淀粉酶浓度测定对壑移植腺体是否成活及移植腺体功能具有重要意义。移植颌下腺造影是检查移植腺体结构及功能的一种较好方法。     

血管化自体下颌下腺移植治疗重症角结膜干燥症的初步研究

目的:应用血管化自体下颌下腺移植的方法治疗重症角结膜干燥症,并评价其疗效.方法:纳入重症角结膜干燥症患者4例,将患者下颌下腺移植至颞部,完成血管吻合,并将移植腺体导管重新开口于患眼.术后监测移植腺体血运并调控其分泌功能,对患眼治疗效果进行评估.结果:2017—2019年共治疗了4例患者的5只眼,其中1例接受双侧眼部手术...     

颌下腺移植治疗角结膜干燥症的手术要点及并发症处理

目的 总结血管化自体颌下腺移植治疗重症角结膜干燥症的手术要点及并发症预防与处理的经验。方法 用该技术治疗23例重症角结膜干燥症，术后行^99m锝核素显像，随诊及并发症相应处理。结果 19例腺体移植成功，眼干症状消失，停用人工泪液；4例腺体未成活；5例出现泪溢，经切除部分移植腺体后症状消失；1例颌下腺导管闭锁，行导管重建术后症状减轻。结论 静脉桥接可解决腺体静脉与颞浅静脉管径不匹配问题；断离腺体前，保留颌外动脉，观察3条静脉渗血情况及游离颌一腺行颌外动脉肝素生理盐水灌注，观察3条静脉渗出情况，有助于选择合适的供体静脉。恰当处理与颌下腺移植治疗重症角结膜干燥症手术相关的各个环节，可提高手术成功率。     

第二期血管化下颌下腺移植治疗角结膜干燥症学习班及中德研讨会会议纪要

由中华口腔医学会口腔颌面外科专业委员会涎腺疾病学组主办、北京大学口腔医学院承办的国家级继续教育项目———血管化下颌下腺移植治疗角结膜干燥症学习班及中德研讨会于2004年10月25日至27日在北京召开,来自德国、新加坡和国内的代表近30余人参加了会议。在国际上较早开展血管化下颌下腺移植治疗研究的德国吕贝克大学Sieg教授带领其研究小组参加了本次研讨会。本次学习班是第二期血管化下颌下腺移植治疗角结膜干燥症学习班,来自北京大学口腔医学院以及北京市同仁医院的7名专家作了专题讲座,全面介绍了眼干症的综合治疗、血管化自体下颌…     

血管化自体颌下腺移植治疗重症角结膜干燥症指南

角结膜干燥症是全身或局部因素引起泪膜功能障碍导致的以角结膜干燥症状为主的疾病,是眼科的常见病,其发病率呈上升趋势.严重者视力减退,甚至可致失明.现有治疗方法以对症治疗为主,如应用人工泪液等,治疗方法对轻症者有一定疗效,重症者基本无效.以颌下腺分泌液代替泪液的血管化自体颌下腺移植已成为治疗重症角结膜干燥症的有效方法[1-3].然而,血管化自体颌下腺移植的技术要求较高,影响手术成功的因素和环节较多[4].     

正常人泪液与唾液成份的比较

目的：比较正常人泪液、颌下腺及腮腺分泌液各种成份之间的差异，探讨用自身唾液代替泪液的可行性、可能发生的问题及解决方法。方法：常规生化检查方法测定30例正常人颌下腺分泌液、腮腺分泌液及泪液成份并进行比较。结果：正常人唾液和泪液成份比较显示，泪液中各项成份，唾液中均可检出，虽然颌下腺分泌液、腮腺分泌液及泪液某些成份上存在差异。但除钠含量及渗透压的值差异较大外，其余各项值的均值偏离不大。正常人泪液中也含有很高浓度的淀粉酶。结论：可以用自身颌下腺分泌的唾液代替泪液。     

婴儿颌下腺淋巴结组织学观察

对围产期３２例胎龄为４１／２￣７个月的男女死婴的６４例颌下腺组织进行光镜观察。结果提示：①１３例颌下腺囊外边缘见淋巴结构样组织，占２０．３１％，其形态改变一种周围有明显的纤维组织包绕，内有淋巴窦，淋巴索，血管及散在淋巴细胞：另一种周围只有１￣２层纤维组织包绕，内有淋巴窦及丰富的血管，散在淋巴细胞；②２例２侧颌下腺边缘的血管，淋巴管内充满淋巴细胞及其周围见淋巴细胞聚集，占３．１３％。４例８例颌下腺小     

Endothelin expression in salivary gland

The present paper reviews the roles of endothelin (ET) in the rat submandibular gland (SMG). ET and its mRNA are expressed in the granular convoluted tubule (GCT) segment by immunostaining and in situ hybridization, respectively. ET is synthesized in granular cells of the GCT segment, stored in secretory granules, and secreted into the oral cavity. It is well known that granular cells in the GCT segment of the SMG in mice and rats express many kinds of growth factor such as epidermal growth factor and nerve growth factor. These growth factors are discharged into saliva and thought to regulate oral-esophageal and gastrointestinal mucosa. ET acts as a potent vasoconstrictor with mitogenic property and is excreted from Weibel-Palade bodies in vascular endothelial cells. ET in the salivary origin may regulate its own functions as noted in the endothelial origin. This review deals with comparative discussion of ET and other growth factors, which originate from GCT segments in rodents.     

腮腺非肿瘤性疾病混合唾液和腮腺液的细菌学研究

目的 探讨涎腺非肿瘤性疾病所引起的口腔微生态的变化。方法 ２０例患者,包括１１例舒格伦综合征（ＳＳ）、１０例腮腺良性肥大及８例慢性腮腺炎和１０名正常对照者。收集其混合唾液和腮腺液并进行口腔内５种常见致病菌的鉴定及细菌总量的测定。结果 ＳＳ、腮腺慢性炎症患者混合唾液中需氧菌、厌氧菌、兼性链球菌及放线菌总数较对照组明显升高,ＳＳ患者混合唾液中的变链菌、乳酸菌总数较对照组明显升高;２例患者腮腺导管内有不     

负压引流在腮腺手术中的应用

目的探讨负压引流在腮腺手术中的应用价值,分析与腮腺术后涎瘘等相关的临床因素。方法需手术治疗的腮腺疾病患者396例,随机分为负压引流组（200例）与正压引流组（196例）,记录术后创口积液、涎瘘、血肿以及皮瓣坏死等并发症发生的情况,同时分析不同的引流方式与术后处理的关系。结果负压引流组的积液、涎瘘、血肿以及皮瓣坏死等并发症发生率（4.0%）低于正压引流组（15.3%）,两组之间的差异有统计意义（P〈0.01）,负压引流组术后不必加压包扎而不影响I期愈合。结论腮腺切除术后应用负压引流优于传统的正压引流,具有临床应用价值,值得推广。     

腮腺区良性肿瘤术后并发症发生的相关因素分析

目的： 探讨腮腺良性肿瘤术后各类并发症发生的相关因素。方法：搜集并整理我院2010—2015年手术治疗的215例腮腺良性肿瘤患者的病例资料,回顾分析一般资料、手术治疗中不同因素及术后并发症的发生情况。采用SPSS17.0软件包对资料进行χ2检验。结果：术后积涎或涎瘘、面神经功能障碍及Frey综合征的发生与手术治疗中不同因素（手术切口、术中是否缝扎腺体残端、面神经解剖方式、手术切除范围及是否行胸锁乳突肌瓣转移修复等）之间具有显著相关性（P＜0.05）。结论：“N”形切口在解剖形态上不利于术后常规引流渗出液,需配合负压引流管,以减少术后积涎的发生。缝扎腺体残端能有效避免术后积涎及涎瘘的发生。顺行法解剖面神经及腮腺肿瘤区域性切除能加快手术速度,减少面神经的解剖量及暴露时间,从而减轻术后面神经功能障碍的发生。胸锁乳突肌瓣的转移修复能很好避免术后Frey综合征的发生。     

Suppression of reflex saliva from rat parotid gland following intracerebroventricular injection of hypertonic NaCl and sucrose.

These effects were studied in conscious rats. Salivary volume and flow rate induced by eating solid diet were decreased by both the hypertonic solutions, compared with the effects of normal saline. This finding suggests that central osmotic perception affects parotid salivary secretion in rats.     

少汗型外胚层发育不良症患者全唾液分析

目的研究少汗型外胚层发育不良症患者唾液流速和成分变化。方法测量HED男性患者、女性携带者、以及男性、女性正常对照组唾液流速和成分,对结果进行统计学分析。结果HED男性患者（18例）、女性携带者（15例）较正常对照组（男性30例、女性30例）唾液流速低,唾液无机成分和蛋白含量升高,淀粉酶活性降低。结论唾液流速减低,使HED患者更容易患口腔疾病,如龋病、念珠菌感染等;同时,唾液成分的改变也有助于HED的临床诊断。     

Immunohistochemical demonstration of acidic mammalian chitinase in the mouse salivary gland and gastric mucosa

Acidic mammalian chitinase (AMCase) is the sole chitinolytic enzyme that has been identified thus far in the gastrointestinal tract of mammals. AMCase mRNA expression has been demonstrated in the salivary gland and stomach of mice and in the stomach of humans, while a bovine homologue of AMCase is produced in the liver and secreted into the blood. The present study using antibody raised against bovine AMCase demonstrates the cellular distribution of AMCase in salivary and gastric secretions at the protein level. Immunostaining using mouse tissues detected intense immunoreactivity for AMCase in serous-type secretory cells of the parotid gland and von Ebner's gland. Gastric chief cells, localized at the bottom of gastric glands, were also immunoreactive for AMCase. Electron-microscopically, the immunoreactivity was localized in granules in the apical cytoplasm of these secretory cells, and not in other structures. Western blot analysis confirmed the existence of AMCase in the parotid gland and stomach, and in their secretions in mice. However, no immunoreactive band was clearly detectable in immunoblots of the human parotid saliva and gastric juice. At least in the mouse, AMCase is secreted into the saliva and gastric juice, and may function as a digestive enzyme or play a defensive role against chitinous pathogens.     

Analysis of residual saliva and minor salivary gland secretions in patients with dry mouth

The importance of oral mucosal wetness in the condition of dry mouth and the role of salivary proteins in proper oral function are acknowledged. A negative correlation between mucosal wetness and the protein concentration of residual saliva has been reported in normosalivators. Here, to examine the suggestion that a reduction in residual salivary volume leads to a concomitant elevation of its protein concentration, the amount of residual saliva and minor salivary gland secretions, and their protein concentrations, were measured in hyposalivators and normosalivator controls. A Periotron 8000 micro-moisture meter was used to measure the thickness of the mucosal film at six selected mucosal surfaces and the minor salivary gland secretion rate at two mucosal surfaces. The unstimulated whole salivary flow rate was measured by the spitting method. The total protein concentration of all salivary samples was measured by bicinchoninic acid assay. The hyposalivators had significantly lower amounts of residual saliva and minor salivary gland secretions than the normosalivators at all selected mucosal sites except the soft palate. In both groups, the site with the thinnest coat of residual saliva was the anterior hard palate and the wettest site was the anterior dorsal mucosa of the tongue. The protein concentration of residual saliva was significantly higher in hyposalivators than normosalivators. In the minor salivary gland secretions there was no significant difference in protein concentration between the normo- and hyposalivators. When the hyposalivators were divided into two subgroups according to their severity of dryness, the reduction of residual salivary volume and the elevation of protein concentration were more apparent in the group with the more severe dry mouth. Collectively, these results indicate that oral mucosal wetness is associated with the flow rate of unstimulated whole saliva. The function of the minor salivary glands was less affected and relatively well preserved in patients with dry mouth. The increased protein concentration of residual saliva in the hyposalivators appeared to be the result of decreased salivary volume.