多发性唾液腺肿大的鉴别诊断及处理

唾液腺是口腔颌面部的重要功能器官,其分泌的唾液对于维护口腔及全身健康发挥重要作用。多种疾病可以引起唾液腺肿大,有的是单个腺体肿大,有的则为多个腺体肿大,并可伴有同属外分泌腺的泪腺肿大。唾液腺肿大的病因可以是局部病变所致,也可以是系统性疾病在口腔颌面部的表现,疾病性质不同,治疗原则各异,因此,多发性唾液腺肿大的鉴别诊断非...     

糖尿病颌下腺功能和细胞因子表达的研究进展

颌下腺为三大唾液腺之一 ,70 %的唾液是由颌下腺分泌的 ,传统的观点认为 :颌下腺是典型的外分泌腺。但是 ,到目前为止的研究表明 ;颌下腺也是产生生物活性物质种类最多的器官之一 ,因此 ,颌下腺既是外分泌腺也是内分泌腺。糖尿病是一种以胰岛素绝对或相对不足为主要病理生理的疾病 ,其发生发展过程中存在着多种胰岛素以外的内分泌紊乱 ,本文对于颌下腺在糖尿病时功能及细胞因子表达变化的研究情况给予综述。1　颌下腺的正常形态结构及分泌功能光镜下 ,颌下腺实质由分泌部和导管组成 ,分泌部以浆液性腺泡为主 ,少数为混合性腺泡或粘液性腺泡 …     

激活辣椒素受体是调控下颌下腺分泌的新途径

唾液对于维持摄食、消化、味觉、语言和保护口腔黏膜等口腔及消化道正常功能具有非常重要的作用。在静息状态下,下颌下腺的分泌量占全唾液量的60％～65％。全身性疾病如舍格伦综合征（ Sj?gren’ s syndrome ）或局部疾病,如慢性下颌下腺炎症和下颌下腺失神经损伤,以及某些治疗后的并发症如头颈部肿瘤行放射治疗等,可导致腺体的分泌功能受损,唾液的分泌量降低,影响进食和吞咽等功能,严重者继发猖獗龋和念珠菌感染等并发症,严重影响患者的生活质量,因此,寻找有效的干预下颌下腺分泌的靶点,对防治下颌下腺功能低下具有重要的理论意义和临床应用价值。     

要珍惜自己的唾液

在日常生活中,有人自觉不自觉的把自己口中的唾液随便吐掉。这种习惯不好。因为这样做不仅不文明,时间长了还会影响身体健康,甚至引起疾病。为什么呢？因为唾液来自唾液腺,人有三大唾液腺,即腮腺、颌下腺和舌下腺。它们分布在口腔壁及舌下,每对唾液腺还有导管与口腔通连。此外,在口腔的黏膜和舌头的表面,还生有无数的小唾液腺。     

功能性外科手术治疗下颌下腺良性肿瘤的疗效

目的 探讨功能性外科手术治疗下颌下腺良性肿瘤的临床疗效。方法 选择安徽医科大学附属合肥医院口腔颌面外科2017年1月至2019年12月收治的60例下颌下腺良性肿瘤患者作为研究对象,按就诊顺序依次预先给予编码,并采用随机数字表法分为功能保存组和对照组,每组30例。功能保存组采用肿瘤及瘤周腺体切除术,对照组采用腺体完整摘除术。比较两组患者手术效果、预后效果、生存质量、腺体功能恢复效果及复发率的差异。结果 功能保存组手术时间(34.0±6.0)min,较对照组缩短,差异有统计学意义(P＜0.05);功能保存组手术切口长(3.8±0.7)cm,较对照组术后疤痕小,差异有统计学意义(P＜0.05);功能保存组中1例出现口干症状,对照组中10例出现口干症状,差异有统计学意义(P＜0.05);生存质量评分中,功能保存组术后外貌、唾液及情绪得分高于对照组,差异有统计学意义(P＜0.05);手术前后健侧和患侧下颌下腺唾液腺核素动态显像结果存在时间效应(P＜0.05),功能保存组下颌下腺分泌功能于术后3个月达到最低,术后6个月逐步恢复,术后1年患侧下颌下腺分泌功能基本恢复到术前水平,组间差异无统计学意义(P>0.05),不存在交互效应(P＞0.05)。术后随访2～5年,两组患者均无复发。结论 功能性外科手术治疗下颌下腺良性肿瘤效果较好。     

酸刺激对腮腺和下颌下腺唾液流率及成分的影响

目的: 探讨酸刺激对腮腺和下颌下腺唾液流率及成分的影响,为全面评估健康和疾病状态时的唾液腺功能提供依据。方法: 采用自然留取法收集210名健康志愿者在静息状态下的全唾液,负压吸引法收集腮腺、下颌下腺分泌液; 2%柠檬酸每间隔1 min滴于舌尖进行酸刺激,共5次,收集酸刺激状态下全唾液、腮腺及下颌下腺分泌液,称量计算各项唾液流率。生化分析仪检测唾液样本的K⁺、Na⁺、Cl^-、Ca²⁺、总蛋白、总磷浓度及α-淀粉酶水平,对比分析不同类别唾液流率及成分的变化特点。结果: 与静息状态检测结果相比较,酸刺激后腮腺唾液流率增加的倍数(10.7倍)大于下颌下腺(2.9倍);腮腺唾液中的Na⁺、Cl^-、Ca²⁺、总蛋白和α-淀粉酶浓度明显升高(P<0.05), 总磷、K⁺差异无统计学意义(P=0.89,P=0.34);下颌下腺唾液中的Na⁺和Ca²⁺浓度显著升高(P<0.05), 总磷浓度显著降低(P<0.05), Cl^-浓度升高,但差异无统计学意义(P=0.068), 总蛋白、K⁺和α-淀粉酶差异无统计学意义(P=0.85,P=0.07,P=0.95)。下颌下腺唾液中总磷的复合分泌速率不变(P=0.066), K⁺、Na⁺、Cl^-、Ca²⁺、总蛋白、α-淀粉酶分泌速率升高(P<0.01)。腮腺唾液中K⁺、Na⁺、Cl^-、Ca²⁺、总蛋白、总磷及α-淀粉酶的复合分泌速率均升高(P<0.01)。腮腺唾液中Na⁺、Cl^-、K⁺、总磷、总蛋白、α-淀粉酶浓度高于下颌下腺(P<0.01),下颌下腺唾液中Ca²⁺浓度显著高于腮腺(P<0.001)。结论: 腮腺对酸刺激的反应更为强烈,下颌下腺分泌较为稳定; 酸刺激明显影响唾液中电解质的浓度,复合分泌速率是同时反映唾液流率和成分浓度的评价指标; 腮腺在唾液总蛋白、总磷和α-淀粉酶的分泌过程中起重要作用,而下颌下腺是唾液中Ca²⁺的主要来源。     

下颌下腺放射性损伤及干细胞治疗的研究进展

放射治疗是头颈部恶性肿瘤的主要治疗方法之一,由于头颈部解剖关系复杂,使恶性肿瘤细胞被杀伤的同时,邻近涎腺组织也受到损伤,超过一定剂量时往往会引起放射性涎腺炎的发生,导致涎液分泌减少,继而使患者口腔黏膜及牙齿等组织器官发生一系列并发症,影响咀嚼、吞咽和语言等各项功能,严重影响患者生活质量。因此,对涎腺放射损伤机制的研究一直是国内外学者关注的热点,而干细胞治疗方式具有有效减轻及潜在治疗涎腺放射损伤的临床应用价值。 Coppes等[1-2]报道无论啮齿类还是人类的下颌下腺都较腮腺对辐射更敏感,因此研究下颌下腺放射损伤及干细胞修复更有意义。现就下颌下腺放射性损伤机制及干细胞治疗的研究进展综述如下。     

舌燥口干为哪般

日常生活中,不少人有舌燥口干的感觉,由于程度比较轻,没有引起的重视。但有的人口干程度比较重,持续时间长,饮水不解渴,甚至进食干硬食品时出现咀嚼、吞咽困难,这意味着体内可能隐藏着某种疾病,需要仔细检查,及时确诊。人的口腔是由多个组织器官组成的,有多种功能,要保障这些功能,维持口腔健康,唾液发挥着至关重要的作用,成人涎腺每天可分泌1000～1500毫升唾液到口腔,以润湿口腔黏膜,清洁口腔,抑制细菌,湿润食物,促进咀嚼和吞咽,并具有消化食物的功能。口腔的唾液来自口腔颌面部的大小涎腺,主要是3对大涎腺,即腮腺、颌下腺及舌下腺。当唾液…     

甲状腺与下颌下腺结节同期微波消融治疗的初步尝试

目的 尝试进行甲状腺和下颌下腺结节的同期微波消融治疗,总结临床经验。方法 57岁男性患者超声诊断右侧下颌下腺区、右侧甲状腺无痛性结节,大小分别为10 mm×10 mm×9 mm、13 mm×11 mm×10 mm,采用超声引导下穿刺活检及超声引导下同期一次性微波消融治疗,观察近期疗效。结果 手术顺利完成,右侧下颌下腺结节消融时间约185 s,右侧甲状腺结节消融时间约72 s,总手术时间约20 min。术中无出血、水肿、神经损伤等并发症。术后2个月随访,患者未出现面神经、舌神经、喉返神经受损的相关临床表现,无口腔干燥现象。超声检查见消融区均缩小,超声造影时保持无增强状态。结论 微波消融治疗适用于颈部多器官结节性疾病的联合治疗,符合微创、节约、高效的治疗原则,值得进一步临床尝试。     

颌下腺结石临床病理分析

目的探讨颌下腺结石发生的临床和病理相关性及其发病机制。方法光镜下观察颌下腺腺体的病理变化，对颌下腺结石患者进行临床、X线片及病理资料复习，对其临床资料进行分析。结果证实颌下腺结石发生与性别、病程、细菌感染、口腔环境密切相关。结论注意保持口腔清洁卫生预防颌下腺结石的关键。     

IgG4相关唾液腺炎的临床病理特点及诊断

SUMMARY Immunoglobulin G4-related sialadenitis (IgG4-RS) is a newly recognized immune-mediated disease and one of immunoglobulin G4-related diseases (IgG4-RD). Our multidisciplinary research group investigated the clinicopathological characteristics and diagnosis of IgG4-RS during the past 10 years. Clinically, it showed multiple bilateral enlargement of major salivary glands (including sublingual and accessory parotid glands) and lacrimal glands. The comorbid diseases of head and neck region including rhinosinusitis, allergic rhinitis, and lymphadenopathy were commonly seen, which could occur more early than enlargement of major salivary glands. Internal organ involvements, such as autoimmune pancreatitis, sclerosing cholangitis, and interstitial pneumonia could also be seen. Thirty-five (38.5%)patients had the symptom of xerostomia. Saliva flow at rest was lower than normal. Secretory function was reduced more severely in the submandibular glands than in the parotid glands. Serum levels of IgG4 were elevated in almost all the cases and the majority of the patients had increased IgE levels. CT, ultrasonography, and sialography showed their imaging characteristics. Histologically it showed marked lymphoplasmacytic inflammation, large irregular lymphoid follicles with expanded germinal centers, prominent cellular interlobular fibrosis, eosinophil infiltration, and obliterative phlebitis. Their immunohistological examination showed marked IgG-positive and IgG4-positive plasma cell infiltration and high IgG4/IgG ratio. The disease could be divided into three stages according to severity of glandular fibrosis. The serum IgG4 level was higher and the saliva secretion lower as glandular fibrosis increased. IgG4-RS should be differentiated from other diseases with enlargement of major salivary gland and lacrimal gland, such as primary Sjögren syndrome, chronic obstructive submandibular sialadenitis, and eosinophilic hyperplastic lymphogranuloma.     

3类新型慢性唾液腺炎的诊断和治疗

慢性唾液腺炎是组织病理学以唾液腺慢性炎症为主要表现的一类疾病,有传统的已经熟知的慢性唾液腺炎,也有新近才被认识或者受到重视的慢性唾液腺炎,即新型慢性唾液腺炎;有唾液腺本身局部病变为主的疾病,也有唾液腺作为靶器官受损的全身性疾病.传统的已经熟知的慢性唾液腺炎有慢性复发性腮腺炎、唾液腺结石伴发的唾液腺炎等.唾液腺内镜的引入使其治疗发生根本变化,尽可能保留唾液腺功能器官的理念正在进一步深化[1-3].     

3类新型慢性唾液腺炎的诊断和治疗

Some kinds of chronic sialadenitis were recognized during the recent years. They have specific pathogenesis, clinical and histopathologic appearances, and require specific treatment. IgG4-related sialadenitis (IgG4-RS) is one of the immune-mediated diseases, characterized by tumefactive lesions. The incidence of IgG4-RS obviously increased during the past 30 years. The study on the potential relationship between occupational exposure to chemical substances and the incidence of IgG4-RS showed that subjects with occupational exposure to agents known to cause IgG4-RD had an increased risk for IgG4-RS. Surgical excision of involved SMG could not control the disease progression, which is not recommended for treatment of IgG4-RS. The combination of glucocorticoid and steroid-sparing agents is effective for treating IgG4-RS, and restores salivary gland function. Radioiodine induced sialadenitis (RAIS) is one of the common complications of postoperative adjuvant treatment of differentiated thyroid cancer by ¹³¹I. The incidence of the disease is related to radiation dosage. Clinically, the patients suffered from swelling and tenderness in the buccal or submandibular regions, especially during the mealtime. Imaging appearances are similar to those of chronic obstructive sialadenitis. Conservative managements, such as gland massage, sialagogues, are the mainstream methods in the treatment of RAIS. Sialendoscopy is feasible for RAIS, but not as effective as conventional obstructive sialadenitis (COS). Therefore the prevention of RAIS is crucial. Eosinophilic sialodochitis (ES) is a new type of chronic inflammatory disease of the salivary gland related to allergy. It has characteristics of swelling of multiple major salivary glands, strip-like gelatinous plugs discharged from the duct orifice of the gland, elevated level of serum IgE and eosinophils in peripheral blood, infiltration of eosinophils and IgE positive plasma cells in the tissues, allergic history, increased expression of allergy-related cytokines, such as IL-4, IL-5, IL-13, and eotaxin, which suggest allergic reactions as a potential pathogenesis of the disease. The clinical, laboratory, histological, and immunohistochemical characteristics of ES are significantly different from conventional obstructive sialadenitis (COS). Therefore, it is suitable to separate ES from COS. Conservative managements, such as self-maintenance therapy and anti- allergic modality are the choices of treatment for ES. Based on the results of our comprehensive studies a new classification of chronic sialadenitis is suggested.     

正常和移植颌下腺分泌功能的研究

角结膜干燥症（干眼）是眼科常见病,严重影响患者的生活质量。对于重症患者,传统治疗方法效果不佳。1999年以来,北京大学口腔医院与北京同仁医院眼科合作,采用血管化自体颌下腺移植治疗重症角结膜干燥症105例（108侧）。其中95侧（88％）移植腺体成活,导管通畅,手术治疗成功。患者畏光怕风症状缓解,眼干症状消失或明显减轻,可停用人工泪液,泪膜破裂时间延长,角膜荧光着色减少,部分患者视力有不同程度提高。血管化自体颌下腺移植已成为目前治疗重症角结膜干燥症行之有效的方法。     

下颌下腺质量和体积的实体体外检测

目的: 采用腺体实体体外检测法测量正常下颌下腺的质量和体积,探讨影响下颌下腺质量和体积可能的相关因素,并与CT容积重建法测量值做比较,评估两种检测方法的一致性。方法: 选择2019年5月至2020年1月在北京大学口腔医院因口腔癌接受选择性颈淋巴结清扫术且术后组织病理学证实下颌下腺正常的患者,术前CT扫描图像通过CT容积...     

血管化自体下颌下腺移植治疗重症干眼20年研究

干眼是泪膜异常导致的以角结膜干燥为主的眼表疾病,重症患者因眼干、视力减退甚至失明而严重影响生活质量。1998年以来,北京大学口腔医学院、基础医学院和首都医科大学北京同仁医院组成联合项目组,开展血管化自体下颌下腺移植治疗重症干眼的基础与临床紧密结合的系列研究,将患者自体下颌下腺游离后移植到颞部,相应血管进行吻合,分泌导管转移到眼眶,用下颌下腺分泌的唾液替代泪液,术后采用多种措施,人工调控移植腺体的分泌,取得了良好的治疗效果。     

激活毒蕈碱乙酰胆碱受体调控下颌下腺分泌的机制研究

SUMMARY Muscarinic acetylcholine receptors (mAChRs), including M1-M5 subtypes, are classic receptors in regulating water, ion, and solute transport in salivary gland. Our work focuses on the studies on the expression pattern and function of mAChR in the submandibular gland (SMG), and the under-lying mechanism involved in the mAChR-regulated secretion, together with the effect of parasympathectomy on the salivary secretion. Microvascular autotransplantation of SMG into the temporal fossa provides a continuous and endogenous source of fluids, and is currently an effective method for treating severe keratoconjunctivitis sicca. By using RT-PCR, Western blotting, and immunofluorescence, our data demonstrated that the expression of M1 and M3 subtypes were decreased in latent period in rabbit SMG autotransplantation model, whereas carbachol stimulation promoted the salivary secretion, as well as M1 and M3 expressions. By contrast, mAChRs were hypersensitive in epiphora SMGs, whereas atropine gel and botulinum toxin A application significantly inhibited the hypersecretion in both animal models and patients. Furthermore, the possible intracellular signal molecules involved in the mAChR-modulated saliva-ry secretion were explored. Activation of mAChR upregulated the expression of aquaporin 5 (AQP5), the main transporter that mediated water secretion through transcellular pathway, and led to AQP5 trafficking from lipid rafts to non-lipid microdomain. Extracellular signal-regulated kinase 1/2 (ERK1/2) was involved in the mAChR-regulated AQP5 content. mAChR activation also modulated the expression, distribution, and function of tight junction proteins, and increased paracellular permeability. ERK1/2/β-arrestin2/clathrin/ubiquitin signaling pathway was responsible for the mAChR-regulated downregulation of tight junction molecule claudin-4. Cytoskeleton filamentous actin (F-actin) was also involved in the distribution and barrier function of epithelial tight junctions. Besides, endothelial tight junctions were opened by mAChR agonist-evoked salivation in the mice. Furthermore, parasympathetic denervation increased resting salivary secretion in the long terminrats and minipigs. Taken together, our work demonstrated that mAChR regulated saliva secretion via transcellular and paracellular pathways in SMG epithe-lium as well as tight junction opening in SMG endothelium. Modulation of mAChR might be a promising strategy to ameliorate SMG dysfunction.     

疑难唾液腺结石病的治疗研究

Sialolithiasis occurs in approximately 0.45% to 1.20% of the general population. The typical clinical symptom manifests as a painful swelling of the affected glands after a meal or upon salivary stimulation, which extremely affects the life quality of the patients. With the development of sialendoscopy and lithotripsy, most sialoliths can be successfully removed with preservation of the gland. However, sialoliths in the deep hilar-parenchymal submandibular ducts and impacted parotid stones located in the proximal ducts continue to pose great challenges. Our research center for salivary gland diseases (in Peking University School and Hospital of Stomatology) has used sialendoscopy for 17 years and treated >2 000 patients with salivary gland calculi. The success rate was approximately 92% for submandibular gland calculi and 95% for parotid calculi. A variety of minimally invasive surgical techniques have been applied and developed, which add substantial improvements in the treatment of refractory sialolithiasis. Further, the radiographic positioning criteria and treatment strategy are proposed for these intractable stones. Most of the hilar-parenchymal submandibular stones are successfully removed by a transoral approach, including transoral duct slitting and intraductal basket grasping, while a small portion of superficial stones can be removed by a mini-incision in submandibular area. Impacted stones located in the distal third of parotid gland ducts are removed via "peri-ostium incision", which is applied to avoid a cicatricial stenosis from a direct ostium incision. Impacted parotid stones located in the middle and proximal third of the Stensen's duct are removed via a direct mini-incision or a peri-auricular flap. A direct transcutaneous mini-incision is commonly performed under local anesthesia with an imperceptible scar, and is indicated for most of impacted stones located in the middle third, hilum and intraglandular ducts. By contrast, a peri-auricular flap is performed under general anesthesia with relatively larger operational injury of the gland parenchyma, and should be best reserved for deeper intraglandular stones. Laser lithotripsy has been applied in the treatment of sialolithiasis in the past decade, and holmium ∶YAG laser is reported to have the best therapeutic effects. During the past 3 years, our research group has performed laser lithotripsy for a few cases with intractable salivary stones. From our experiences, withdrawal of the endoscopic tip 0.5-1.0 cm away from the extremity of the laser fiber, consistent saline irrigation, and careful monitoring of gland swelling are of vital importance for avoidance of injuries of the ductal wall and the vulnerable endoscope lens during lithotripsy. Larger calculi require multiple treatment procedures. The risk of ductal stenosis can be alleviated by endoscopic dilation. In summary, appropriate use of various endoscopy-assisted lithotomy helps preserve the gland function in most of the patients with refractory sialolithiasis. Further studies are needed in the following aspects: Transcervical removal of intraglandular submandibular stones, intraductal laser lithotripsy of impacted parotid stones and deep submandibular stones, evaluation of long-term postoperative function of the affected gland, et al.     

分化型甲状腺癌首次131Ⅰ治疗前唾液腺显像分析

目的应用放射性核素显像对分化型甲状腺癌(DTC)患者首次131Ⅰ治疗前唾液腺功能进行观察和半定量分析。方法对75例DTC首次131Ⅰ治疗前患者和12例健康者(对照组)行唾液腺显像,利用计算机感兴趣区技术(ROI)获得唾液腺摄取功能参数:摄取分数(UR);排泄功能参数:酸刺激后唾液腺排泌分数(ER)。将75例DTC患者按唾液腺功能正常、轻度异常、重度异常分为3组,各组功能参数行单因素方差分析。68例DTC功能正常组患者和12例对照组定量参数行成组设计t检验。结果 12例对照组及68例(68/75,91%)DTC患者腮腺和颌下腺动态显像图及TAC均正常,4例(4/75,5%)DTC患者呈轻度异常,3例(3/75,4%)DTC患者呈重度异常。68例DTC功能正常组和12例对照组的左、右腮腺及颌下腺的UR、ER比较,差异均无统计学意义(t值分别为3.266、4.182、2.173和3.512,P均>0.05)。DTC各组间腮腺及颌下腺的UR、ER比较,组间差异均有统计学意义(F:4.532-23.106,P均<0.05)。组间两两比较:与DTC功能正常组比较,DTC轻度异常组及DTC重度异常组差异均有统计学意义(P<0.05,P<0.01)。结论 DTC首次131Ⅰ治疗前部分患者即可能存在唾液腺功能损伤,应常规行唾液腺显像,建立唾液腺摄取和排泄功能基线值。     

内窥镜辅助经颌下小切口入路颌下腺切除术

目的:为了改善传统开放颌下腺切除术后的美观效果,探讨内窥镜辅助颌下小切口颌下腺切除术的有效性、安全性和可行性。方法:回顾性分析30例内窥镜辅助经颌下小切口行颌下腺切除术患者的临床资料,术前诊断慢性颌下腺炎7例(4例含涎石),多形性腺瘤16例,颌下腺囊肿7例,所有病例术前经影像学、三维超声学评估。结果:所有患者均于内镜辅助下完全切除颌下腺和肿瘤,无一例中转开放手术,无手术并发症,术后美观效果好,患者满意度较高,多形性腺瘤患者术后随访时间4～36个月,未见复发。结论:内镜辅助经颌下小切口入路行颌下腺切除术安全可行,与传统开放手术相比,美容效果好,颌部切口瘢痕小,无面神经下颌缘支损伤风险。