北京大学学报(医学版) ›› 2014, Vol. 46 ›› Issue (1): 39-42.

• 论著 • 上一篇    下一篇

涎腺内镜辅助手术取石治疗腮腺涎石症

赵坚1,3,张雷1△,柳登高2,张祖燕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,北京100081; 3. 河北省唐山市开滦(集团)有限责任公司总医院头颈外科,河北唐山063000)
  • 出版日期:2014-02-18 发布日期:2014-02-18

Sialoendoscopy-assisted sialolithectomy for large parotid stones

ZHAO Jian 1, 3 , ZHANG Lei1△, LIU Deng-gao2, ZHANG Zu-yan2, YU Guang-yan1   

  1. (1.Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing 100081, China; 2. Department of Radiology, Peking University School and Hospital of Stomatology, Beijing 100081, China; 3. Department of Head and Neck Surgery, Kai Luan General Hospital, Hebei Tangshan 063000, China)
  • Online:2014-02-18 Published:2014-02-18

摘要: 目的:探讨涎腺内镜辅助手术取石治疗腮腺涎石症的临床应用价值。方法:选择自2010年1月至2013年4月,因腮腺反复肿胀于北京大学口腔医院就诊,确诊为腮腺结石,并接受涎腺内镜辅助手术取石治疗的患者6例(其中男性5例,女性1例,年龄30~62岁,中位年龄49.5岁)。术前通过B超和锥形束CT(cone-beam CT)检查明确结石数目、位置和大小。局部麻醉下采用内镜下套篮或抓钳取石失败后,行全身麻醉下内镜辅助手术取石,术中利用涎腺内镜引导精确定位,腮腺区翻瓣,准确暴露导管及结石,切开导管壁取石。术后记录并发症发生情况,随访了解患者症状缓解情况。结果:术前影像学检查显示,6例患者结石直径在5~9 mm,均位于导管后段近腺门部。在涎腺内镜辅助下手术翻瓣取石,全部取石成功。所有患者术后伤口均Ⅰ期愈合,术后均未出现面瘫、涎瘘、感染等并发症。术后随访6~36个月(中位随访时间19月),患者腮腺区肿痛症状明显缓解(5例完全缓解,1例部分缓解),疗效满意。结论:对于其他治疗失败且症状顽固的腮腺结石患者,采用涎腺内镜辅助腮腺翻瓣手术取石成功率高,并发症少,值得推广。

关键词: 腮腺疾病, 结石, 内窥镜检查, 涎腺, 外科手术

Abstract: Objective: To explore the clinical application of endoscope-assisted operative retrieval of large parotid stones as a minimally invasive alternative.Methods: From January 2010 to April 2013, 6 patients (male: 5, female: 1, age from 30-62 years, and median age: 49.5 years)suffering from recurred swelling of parotid gland due to sialoliths were treated by endoscope-assisted parotid surgery in Peking University School and Hospital of Stomatology. All of the patients underwent clinical, ultrasonographic and cone-beam CT (CBCT) examinations to get the detailed information of the number, location and size of stones, which was recorded in the medical records. Endoscope-assisted parotid surgery was performed under general anesthesia in all the 6 cases after the failure of basket or forcep retrieval firstly. During the operation, sialoendoscope was used to locate the stone exactly and then the calculus was exposed through a pre-auricular approach and released by incising the duct. The postoperative complications were recorded and observed during the follow-up periods.Results: Preoperative radiological examinations showed that all of the sialoliths were near the hilum of parotid gland ducts in the 6 cases, which were 5-9 mm in diameter. All of the stones were removed successfully by endoscope-assisted operative retrieval. The incisions healed smoothly in all the 6 cases. There were no cases of facial nerve weakness, infection or salivary fistula. After a mean follow-up of 19 months (ranging from 6-36 months), 5 patients remained asymptomatic and 1 patient had mild obstructed or infective symptoms. The final results were satisfied.Conclusion: It is suggested that endoscope-assisted operative retrieval is a viable minimally invasive alternative to remove the large or recalcitrant parotid stones with a high successful rate and low complications.

Key words: Parotid diseases, Calculi, Endoscopy, Salivary glands, Surgical procedures, operative

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