北京大学学报(医学版) ›› 2023, Vol. 55 ›› Issue (1): 8-12. doi: 10.19723/j.issn.1671-167X.2023.01.002

• 工作综述 • 上一篇    下一篇

疑难唾液腺结石病的治疗研究

柳登高*(),郑丹妮,赵雅宁,张亚琼,叶欣,张丽琪,谢晓艳,张雷,张祖燕,俞光岩   

  1. 北京大学口腔医学院·口腔医院影像科,国家口腔医学中心,国家口腔疾病临床医学研究中心,口腔生物材料和数字诊疗装备国家工程研究中心,口腔数字医学北京市重点实验室,国家卫生健康委员会口腔医学计算机应用工程技术研究中心,国家药品监督管理局口腔生物材料重点实验室,北京 100081
  • 收稿日期:2022-09-08 出版日期:2023-02-18 发布日期:2023-01-31
  • 通讯作者: 柳登高 E-mail:kqldg@bjmu.edu.cn

Recent progress in the treatment of intractable sialolithiasis

Deng-gao LIU*(),Dan-ni ZHENG,Ya-ning ZHAO,Ya-qiong ZHANG,Xin YE,Li-qi ZHANG,Xiao-yan XIE,Lei ZHANG,Zu-yan ZHANG,Guang-yan YU   

  1. Department of Oral and Maxillofacial Radiology, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomatology & NHC Research Center of Engineering and Technology for Computerized Dentistry & NMPA Key Laboratory for Dental Materials, Beijing 100081, China
  • Received:2022-09-08 Online:2023-02-18 Published:2023-01-31
  • Contact: Deng-gao LIU E-mail:kqldg@bjmu.edu.cn

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关键词: 唾液腺结石病, 腮腺, 下颌下腺, 取石术, 激光碎石术

Abstract:

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.

Key words: Sialolithiasis, Parotid gland, Submandibular gland, Lithotomy, Laser lithotripsy

中图分类号: 

  • R781.75

图1

下颌下腺腺门部与腺内段结石分型示意图"

图2

腮腺结石定位的螺旋CT轴位图"

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