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北京大学学报（医学版） ›› 2020, Vol. 52 ›› Issue (3): 586-590. doi: 10.19723/j.issn.1671-167X.2020.03.029

• 论著 • 上一篇    下一篇

131I相关唾液腺炎的炎症分级及内镜治疗

李潇1,苏家增1,张严妍1,张丽琪2,张亚琼2,柳登高2,△(),俞光岩1,△()   

  1. 1. 北京大学口腔医学院?口腔医院,口腔颌面外科,北京　100081
    2. 北京大学口腔医学院?口腔医院,放射科　国家口腔疾病临床医学研究中心　口腔数字化医疗技术和材料国家工程实验室　口腔数字医学北京市重点实验室,北京　100081
  • 收稿日期:2019-02-01 出版日期:2020-06-18 发布日期:2020-06-30
  • 通讯作者: 柳登高,俞光岩 E-mail:kqldg@bjmu.edu.cn;gyyu@263.net
  • 基金资助:
    国家自然科学基金(81974151)

Inflammation grading and sialoendoscopic treatment of131I radioiodine-induced sialadenitis

Xiao LI1,Jia-zeng SU1,Yan-yan ZHANG1,Li-qi ZHANG2,Ya-qiong ZHANG2,Deng-gao LIU2,△(),Guang-yan YU1,△()   

  1. 1. Department of Oral and Maxillofacial Surgery
    2. Department of Oral Radiology, Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China
  • Received:2019-02-01 Online:2020-06-18 Published:2020-06-30
  • Contact: Deng-gao LIU,Guang-yan YU E-mail:kqldg@bjmu.edu.cn;gyyu@263.net
  • Supported by:
    National Natural Science Foundation of China(81974151)

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摘要：

目的 结合唾液腺造影及内镜表现对131I相关唾液腺炎进行炎症分级,评估分析内镜治疗的疗效。 方法 收集2012年11月至2018年10月间在北京大学口腔医院进行唾液腺内镜检查与治疗的131I相关唾液腺炎患者的临床及影像学资料,分析唾液腺造影与内镜表现的特点并进行炎症分级。根据病变程度,采取内镜下生理盐水与地塞米松混合液灌洗、机械扩张等治疗,术后进行随访。 结果 42例131I相关唾液腺炎患者中,男性5例、女性37例,男女比例为1 ∶7.4,症状为唾液腺区反复肿胀、疼痛或口干等。腮腺造影主要表现为一处或多处导管狭窄,部分病例分支导管未显影。唾液腺内镜主要表现为导管不同程度狭窄,可见分支导管闭锁。根据腮腺造影及内镜所见分为3级:(1)轻度炎症:主导管存在狭窄和扩张,但0.9 mm内镜可通过;(2)中度炎症:主导管存在一处重度狭窄,内镜不能直接通过;(3)重度炎症:主导管存在2处以上重度狭窄、弥漫性狭窄或导管闭锁。33例(65侧)131I相关唾液腺炎患者的腮腺同时接受唾液腺造影与内镜检查,其中轻度炎症8侧,中度炎症23侧,重度炎症34侧。内镜治疗后经3~72个月随访,效果评价为显效22侧,缓解22侧,无效19侧,失访2侧,总有效率为69.8%。 结论131I相关唾液腺炎的临床、腮腺造影以及唾液腺内镜表现具有明确的特点,据此我们提出131I相关唾液腺炎炎症严重程度的分级标准。唾液腺内镜技术可以明显缓解131I相关唾液腺炎患者的主观临床症状,对于早期病变效果更佳。

关键词: 唾液腺内镜, 唾液腺炎, 碘放射性同位素, 诊断, 治疗结果

Abstract:

Objective: To investigate the inflammation grading of131I radioiodine-induced sialadenitis based upon sialoendoscopic and sialographic appearances, and to evaluate the results of sialoendoscopic intervention.Methods: The patients diagnosed with131I radioiodine-induced sialadenitis and underwent sialoendoscopic exploration and intervention procedures in Peking University Hospital of Stomatology from Nov. 2012 to Oct. 2018 were included in this study. The appearances of sialogaphy and sialoendoscopy were analyzed and classified. The treatment options included irrigation with saline and dexamethasone and mechanical dilatation by sialoendoscope. The patients were followed up after treatment.Results: Forty-two patients with131I radioiodine-induced sialadenitis were included. There were 5 males and 37 females, with a male-to-female ratio of 1 ∶7.4. Symptoms included recurrent swelling and pain in the parotid glands, and dry mouth. Sialography showed stenosis in the main duct,and in some cases nonvisua-lization of the branches. Sialoendoscopy showed narrowing of the main duct, and the branch duct atresia was seen. The appearances of sialogaphy and sialoendoscopy were analyzed and classified into 3 groups: (1) Mild inflammation: stenosis and ectasia occurred in the main duct, whereas the 0.9 mm sialoendoscope could pass through easily. (2) Moderate inflammation: one point of severe stricture could be seen in the main duct where 0.9 mm sialoendoscope could not be passed through. (3) Severe inflammation: two points or more of severe strictures or diffused strictures occurred in the main duct. Thirty-three patients with 65 affected glands were examined by both sialography and sialoendoscopy. Eight glands were classified as mild inflammation, 23 glands moderate inflammation, and 34 glands severe inflammation. The duration of follow-up ranged from 3-72 months. The clinical results were evaluated as good in 22 glands, fair in 22 glands, and poor in 19 glands, with an overall effective rate of 69.8% (44/63).Conclusion: The clinical, sialographic and sialoendoscopic appearances of131I radioiodine-induced sialadenitis showed their characteristics. We proposed an inflammation grading standard for the131I radioiodine-induced sialadenitis based on the appearances of sialography and sialoendoscopy. Sialoendoscopy can significantly alleviate the clinical symptoms, which is an effective therapy, and better for early lesions.

Key words: Sialoendoscopy, Sialadenitis, Iodine radioisotopes, Diagnosis, Treatment outcome

中图分类号: 

  • R781.7

图1

131I相关唾液腺炎内镜表现"

图2

131I相关唾液腺炎腮腺造影表现"

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ISSN 1671-167X
CN 11-4691/R
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