运用唾液腺治疗重症干眼的应用解剖

背景唾液腺移植或导管转位可提供持续性分泌的、生理性的泪液替代物，为重症干眼的理想治疗方法，但其相关解剖学资料较少，且一些研究中的结论尚存在争议，限制了其在临床应用中的改良和推广。目的探讨三大唾液腺移植或其导管移位治疗重症干眼的解剖学基础、手术可行性及各自的优缺点，为进一步的临床应用提供依据。方法在手术显微镜辅助下对34侧颈动脉灌注红色乳胶的成人头颈部标本进行解剖，观察面神经腮腺外分支与腺体的关系，三大唾液腺的形态、大小，导管的长度和外径，追寻其血供来源及分支走行、血管外径、毗邻关系等，并对眼眶周围及额面部血管进行解剖，寻找可供吻合的受区动静脉。在人体标本上模拟腮腺导管转位、下颌下腺及舌下腺游离移植手术。结果腮腺导管位置较固定，导管长度为（4．20±1．10）cm，外径为（0．60±0．30）cm，腮腺导管转位术部分需用颊黏膜或静脉等做导管延长，术中应避免损伤面神经颊支、颧支和颞支；下颌下腺移植术，血管蒂为面血管，外径为（2．70±0．28）mm，移植血管蒂长（1．90±0．30）cm，受区血管为颞浅血管；舌下腺移植术，血管蒂为舌下血管（30侧，占88．2％）或颏下血管（4侧，占11．8％），其外径分别为（1．92±0．36）mm和（1．96±0．54）mm，移植血管蒂长分别为（2．60±1．10）cm和（3．50±0．40）cm，受区血管为颞浅血管额支，本组中3侧标本舌下腺阙如，占8．8％。结论基于解剖学研究，三大唾液腺移植或其导管移位治疗重症干眼是可行的，并各具优势。腮腺导管转位和下颌下腺移植已应用于临床，舌下腺移植尚需动物实验进一步证实其应用价值。

Clinical anatomy of three major salivary glands to treat xerophthalmia

Background Salivary transplantation or duct transposition can provide continuous physiological secretion of tear substitutes. This may be an ideal method in treatment of dry eye. But the relative anatomical literatures is few, and some of the conclusions in the literatures are still controversial, which limit its clinical application. Objective This study was to discuss the possibility and the advantage and disadvantage of applying three major salivary glands to treat xerophthalmia. Methods The relationship between the branches of the facial nerve out of the parotid gland and the salivary glands,the salivary glands size,origin of blood supply, out diameter of vessels and adjacent relation were observed in 34 sides pate specimens perfused with red latex under the operating microscope. To find the vessels in recipient site to anastomose, the vessels around fossa orbitalis and forehead were anatomized and observed. The parotid gland duct transfer operation, the submandibular gland free transplantation surgery and sublingual gland free transplantation surgery in the human anatomy specimens were simulated. Results The position of parotid duct was constant. The duct length was （4.20 ±1. 10 ） cm, duct diameter was （ 0.60 ±0.30 ） cm. The stensen＇ s duct was likely to be prolonged by the cheek mucous membrane or venous andthe damage of buccal branch, zygomatic branch and temporal branches of facial nerve should be avoided during the operation of transplanting stensen＇s duct. When submandibular gland was transplanted, facial vessel was taken as its pedicle, whose outside diameter was （2.70 ±0.28 ） mm, and the length of the transplant vascular pedicle was （ 1.90 ±0.30 ） cm. The anastomosed vessel was superficial temporal vessel in recipient site. When sublingual gland was transplanted, sublingual（88.2% ,30 sides）or submental vessel（ 11.8% ,4 sides）was taken as its pedicle,whose outside diameter was（1.92±0.36） mm and （1.96±0.54）mm, and the length of the transplant vascular pedicle was （2.60±1. 10）cm and（3.50±0. 40）era, and the anastomosed vessel was the frontal branch of superficial temporal vessel in recipient site. Three sides of specimens lacked sublingual glands. Conclusions It is feasible that treating severe xerophthalmia by the operation of grafting the major salivary glands or transplanting stensen＇ s duct on the point of anatomical view. Parotid duct inversion and the submandibular gland transplantation have been applied to clinic. However, sublingual transplantation remains to be further confirmed by the animal experiments.