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
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,△()
Xiao LI1,Jia-zeng SU1,Yan-yan ZHANG1,Li-qi ZHANG2,Ya-qiong ZHANG2,Deng-gao LIU2,△(),Guang-yan YU1,△()
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。
中图分类号:
[1] | van Nostrand D. The benefits and risks of I-131 therapy in patients with well-differentiated thyroid cancer[J]. Thyroid, 2009,19(12):1381-1391. |
[2] | Lu L, Shan F, Li W, et al. Short-term side effects after radioiodine treatment in patients with differentiated thyroid cancer[J]. Biomed Res Int, 2016,2016(9):1-5. |
[3] | De Luca R, Vicidomini A, Trodella M, et al. Sialoendoscopy: A viable treatment for I131 induced sialoadenitis [J]. Br J Oral Maxillofac Surg, 2014,52(7):641-646. |
[4] | 柳登高, 郭玉娇, 姜岚, 等. 43例慢性阻塞性腮腺炎内镜治疗疗效观察[J]. 中华口腔医学杂志, 2012,47(9):81-84. |
[5] | Ish-Shalom S, Durleshter L, Segal E, et al. Sialochemical and oxidative analyses in radioactive131I-treated patients with thyroid carcinoma [J]. Eur J Endocrinol, 2008,158(5):677-681. |
[6] | Badam RK, Suram J, Babu DB, et al. Assessment of salivary gland function using salivary scintigraphy in pre and post radioactive iodine therapy in diagnosed thyroid carcinoma patients[J]. J Clin Diagn Res, 2016,10(1):60-62. |
[7] | Ali MJ. Iodine-131 therapy and nasolacrimal duct obstructions: What we know and what we need to know[J]. Ophthalmic Plast Reconstr Surg, 2016,32(4):243-248. |
[8] | Maruoka Y, Baba S, Isoda T, et al. A functional scoring system based on salivary gland scintigraphy for evaluating salivary gland dysfunction secondary to 131I therapy in patients with differentiated thyroid carcinoma [J]. J Clin Diagn Res, 2017, 11(8): TC23-TC28. |
[9] |
Jarzab B, Handkiewicz-Junak D, Wloch J. Juvenile differentiated thyroid carcinoma and the role of radioiodine in its treatment: a qualitative review[J]. Endocr Relat Cancer, 2005,12(4):773-803.
pmid: 16322322 |
[10] | Wu CB, Xi H, Zhou Q, et al. Sialendoscopy-assisted treatment for radioiodine-induced sialadenitis[J]. J Oral Maxillofac Surg, 2015,73(3):475-481. |
[11] |
Allweiss P, Braunstein GD, Katz A, et al. Sialadenitis following131I therapy for thyroid carcinoma: Concise communication [J]. J Nucl Med, 1984,25(7):755-758.
pmid: 6737074 |
[12] |
Silberstein EB. Reducing the incidence of131I-induced sialadenitis: the role of pilocarpine [J]. J Nucl Med, 2008,49(4):546-549.
doi: 10.2967/jnumed.107.049411 pmid: 18344428 |
[13] | Ko KY, Kao CH, Lin CL, et al. 131I treatment for thyroid cancer and the risk of developing salivary and lacrimal gland dysfunction and a second primary malignancy: A nationwide population-based cohort study [J]. Eur J Nucl Med Mol Imag, 2015,42(8):1172-1178. |
[14] | Chow S. Side effects of high-dose radioactive iodine for ablation or treatment of differentiated thyroid carcinoma[J]. J HK Coll Radiol, 2005(8):127-135. |
[15] |
Malpani BL, Samuel AM, Ray S. Quantification of salivary gland function in thyroid cancer patients treated with radioiodine[J]. Int J Radiat Oncol Biol Phys, 1996,35(3):535-540.
pmid: 8655377 |
[16] |
Geres AE, Mereshian PS, Fernández S, et al. Sialadenitis after radioiodine therapy: Analysis of factors that influence the response to medical treatment[J]. Endocrinol Nutr, 2015,62(10):493-498.
pmid: 26459118 |
[17] |
Wu JQ, Feng HJ, Ouyang W, et al. Systematic evaluation of salivary gland damage following I-131 therapy in differentiated thyroid cancer patients by quantitative scintigraphy and clinical follow-up[J]. Nucl Med Commun, 2015,36(8):819.
doi: 10.1097/MNM.0000000000000325 pmid: 25932534 |
[18] | Nahlieli O, Nazarian Y. Sialadenitis following radioiodine therapy a new diagnostic and treatment modality[J]. Oral Disease, 2006,12(5):476-479. |
[19] |
Gonzalez ME, Muttikkal TJ, Rehm PK. Sialadenitis following low dose I-131 diagnostic thyroid scan with Thyrogen® (recombinant human thyroid stimulating hormone-thyrotropin alfa) [J]. J Radiol Case Rep, 2015,9(6):44-49.
pmid: 26622936 |
[20] | Prendes BL, Orloff LA, Eisele DW. Therapeutic sialendoscopy for the management of radioiodine sialadenitis[J]. Arch Otolaryngol Head Neck Surg, 2012,138(1):15-19. |
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