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北京大学学报（医学版） ›› 2022, Vol. 54 ›› Issue (5): 842-845. doi: 10.19723/j.issn.1671-167X.2022.05.011

• 工作综述 • 上一篇    下一篇

下颌下腺保存治疗新技术体系的建立与应用

俞光岩1,2,*(),苏家增1,2,柳登高1,3,吴立玲1,4,丛馨1,4   

  1. 1. 北京大学口腔医学院· 口腔医院唾液腺疾病研究中心，国家口腔医学中心，国家口腔疾病临床医学研究中心，口腔数字医学北京市重点实验室，北京 100081
    2. 北京大学口腔医学院· 口腔医院口腔颌面外科，国家口腔医学中心，国家口腔疾病临床医学研究中心，口腔数字医学北京市重点实验室，北京 100081
    3. 北京大学口腔医学院· 口腔医院口腔放射科，国家口腔医学中心，国家口腔疾病临床医学研究中心，口腔数字医学北京市重点实验室，北京 100081
    4. 北京大学基础医学院生理学与病理生理学系，北京 100191
  • 收稿日期:2022-04-07 出版日期:2022-10-18 发布日期:2022-10-14
  • 通讯作者: 俞光岩 E-mail:gyyu@263.net
  • 作者简介:俞光岩，北京大学口腔医学院·口腔医院口腔颌面外科教授、博士生导师，中华口腔医学会名誉会长。主要研究方向为唾液腺疾病、口腔颌面部肿瘤以及唾液腺移植治疗重症干眼症。先后承担国家及省部级科研基金项目40余项，培养研究生及博士后80余名。率先开展腮腺功能性外科，明显减少手术并发症; 提出唾液腺肿瘤临床病理新特点，牵头制定《唾液腺肿瘤诊断和治疗指南》。利用多学科交叉优势，创建了下颌下腺移植治疗重症干眼的关键技术体系并推广应用; 完成了全世界病例数最多的下颌下腺移植治疗重症干眼的临床和基础研究; 提出激活辣椒素受体调控下颌下腺分泌的新机制以及以受体为靶点人工调控移植下颌下腺分泌的新策略，创立了部分下颌下腺移植预防术后泪溢的新术式和诊治慢性阻塞性移植下颌下腺炎的新技术; 主持制定了《血管化自体下颌下腺移植治疗重症干眼症的指南》。建立了下颌下腺功能保存治疗的新技术体系，在国内率先开展下颌下腺转位预防放射性口干新术式; 建立IgG4相关唾液腺炎的诊治体系; 率先开展多项下颌下腺功能保存外科新术式，既根治肿瘤又保存了下颌下腺功能。先后发表SCI论文200余篇，以第一完成人获国家科学技术进步奖二等奖1项、省部级科技进步奖一等奖3项，获“全国五一劳动奖章获得者”“全国卫生系统先进工作者”“全国优秀科技工作者”等称号，被英国爱丁堡和英格兰两家皇家外科医师学院授予“Honorary Fellowship”
  • 基金资助:
    国家自然科学基金(81974151);国家自然科学基金(81671005);国家自然科学基金(81470756);国家自然科学基金(81271161);国家自然科学基金(81070847)

Establishment and application of new techniques for submandibular gland preservation

Guang-yan YU1,2,*(),Jia-zeng SU1,2,Deng-gao LIU1,3,Li-ling WU1,4,Xin CONG1,4   

  1. 1. Research Center of Salivary Gland Diseases, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China
    2. Department of Oral & Maxillofacial Surgery, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China
    3. Department of Oral Radiology, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China
    4. Department of Physiology and Pathophysiology, Peking University School of Basic Medical Sciences, Beijing 100191, China
  • Received:2022-04-07 Online:2022-10-18 Published:2022-10-14
  • Contact: Guang-yan YU E-mail:gyyu@263.net
  • Supported by:
    the National Natural Science Foundation of China(81974151);the National Natural Science Foundation of China(81671005);the National Natural Science Foundation of China(81470756);the National Natural Science Foundation of China(81271161);the National Natural Science Foundation of China(81070847)

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关键词: 免疫球蛋白G4相关唾液腺炎, 下颌下腺结石, 下颌下腺转位, 部分下颌下腺切除术, 颈淋巴清扫术

Abstract:

The saliva secreted from submandibular gland (SMG) accounts for 60%-65%. It plays an important role in maintaining the human function of swallow, digestion, testing, speech, protection of oral mucosa, and prevention from dental carries. The SMG is frequently resected during the treatment for various kinds of oral and maxillofacial diseases, resulting in xerostomia and decreased quality of life. During the past 15 years, Research Center of Salivary Gland Diseases in Peking University School and Hospital of Stomatology conducted a series of studies on new techniques for preservation of SMG and achieved remarkable results. The clinicopathologic and imaging characteristics of IgG4-related sialadenitis (IgG4-RS) were clarified based on systematic studies. The results of studies on the pathogenesis of IgG4-RS showed that unbalance of inflammatory factors mediated the abnormality of secretion of SMG. IL-4 participates in occurring and development of glandular fibrosis of SMG. Regulation of tumor necrosis factor α (TNF-α) and cleaning of senescent cells might be taken as the targets for treatment of IgG4-RS. The combination of glucocorticoid and steroid-sparing agents showed effective results for treating IgG4-RS, clinical remission was achieved in all the patients, serum IgG4 levels decreased, and salivary gland secretion significantly increased. Sialoendoscopy-assisted sialolithectomy was applied in the treatment of about 1 000 cases with submandibular hilar calculi with a success rate of more than 90%. Transfer of SMG was used for prevention from radiation-induced xerostomia in the patients with head and neck carcinoma. SMG was transferred to the submental region before radiotherapy and was kept away from the ra-diation field. The results of prospective clinical controlled study showed this technique could effectively preserve the function of SMG and prevent from xerostomia. Based on the micro-anatomical study on the blood vessels and ducts of SMG, partial sialoadenectomy was applied for treatment of benign tumors in the SMG. A clinical controlled study confirmed its safety for control of the tumors and its advantage of preservation of SMG function. The studies on the involvement of SMG in oral squamous cell carcinoma (OSCC) provided the anatomical and histopathological basis for preservation of SMG during neck dissection for early cases with OSCC. A innovated surgical modality "four preservations including SMG" was used during the neck dissection for the early cases with OSCC. A prospective randomized clinical controlled study confirmed its safety, feasibility, effectiveness for control of the carcinoma, and advantages of preservation of SMG function.

Key words: Immunoglobulin G4-related sialadenitis, Submandibular gland calculi, Submandibular gland transfer, Partial submandibular gland resection, Neck dissection

中图分类号: 

  • R782.7
1 Stone JH , Zen Y , Deshpande V . IgG4-related disease[J]. N Engl J Med, 2012, 366 (6): 539- 551.
doi: 10.1056/NEJMra1104650
2 Zhang KF , Hong X , Li W , et al. Natural developing process of immunoglobulin G4-related sialadenitis after submandibular gland excision: A retrospective cohort study[J]. Clinic Rheumatol, 2021, 40 (12): 4969- 4976.
doi: 10.1007/s10067-021-05859-5
3 俞光岩, 洪霞, 李巍, 等. IgG4相关唾液腺炎的临床病理特点及诊断[J]. 北京大学学报(医学版), 2018, 50 (6): 6- 8.
4 Li W , Chen Y , Sun ZP , et al. Clinicopathological characteristics of immunoglobulin G4-related sialadenitis[J]. Arthritis Res Ther, 2015, 17 (1): 186.
doi: 10.1186/s13075-015-0698-y
5 Witte T , Schulze-Koops H . IgG4-related sialadenitis: IgG4 is helpful, but biopsies are still crucial[J]. Arthritis Res Ther, 2015, 17, 368.
doi: 10.1186/s13075-015-0888-7
6 李巍, 孙志鹏, 刘筱菁, 等. 腮腺和下颌下腺体积的测量[J]. 北京大学学报(医学版), 2014, 46 (2): 288- 293.
doi: 10.3969/j.issn.1671-167X.2014.02.022
7 Hong X , Zhang YY , Li W , et al. Treatment of immunoglobulin G4-related sialadenitis: Outcomes of glucocorticoid therapy combined with steroid-sparing agents[J]. Arthritis Res Ther, 2018, 20 (1): 12.
doi: 10.1186/s13075-017-1507-6
8 Hong X , Min SN , Zhang YY , et al. TNF-α suppresses autophagic flux in acinar cell in IgG4-related sialadenitis[J]. J Dent Res, 2019, 98 (12): 1386- 1396.
doi: 10.1177/0022034519871890
9 Min SN , Wu LL , Zhang YY , et al. Disruption of tight junction structure contributes to secretory dysfunction in IgG4-related sialadenitis[J]. J Mol Histol, 2020, 51 (1): 33- 46.
doi: 10.1007/s10735-019-09854-8
10 Min SN , Zhu MQ , Mao XD , et al. The contribution of the interleukin-4-induced epithelial cell senescence to glandular fibrosis in IgG4-related sialadenitis[J]. Arthritis Rheumatol, 2022, 74 (6): 1070- 1082.
doi: 10.1002/art.42052
11 Zhang YY , Hong X , Wang Z , et al. Diagnostic utility of submandibular and labial salivary gland biopsy in IgG4-related sialadenitis[J]. Clin Rheumatol, 2020, 39 (12): 3715- 3721.
doi: 10.1007/s10067-020-05097-1
12 Hong X , Li W , Xie XY , et al. Differential diagnosis of IgG4-related sialadenitis, primary Sjögren syndrome, and chronic obstructive submandibular sialadenitis[J]. Br J Oral Maxillofac Surg, 2017, 55 (2): 179- 184.
doi: 10.1016/j.bjoms.2016.10.021
13 Zhu WX , Zhang YY , Sun ZP , et al. Differential diagnosis of immunoglobulin G4-related sialadenitis and Kimura's disease of the salivary gland: A comparative case series[J]. Int J Oral Maxillofac Surg, 2021, 50 (7): 895- 905.
doi: 10.1016/j.ijom.2020.05.023
14 Liu DG , Jiang L , Xie XY , et al. Sialoendoscopy-assisted sialolithectomy for submandibular hilar calculi[J]. J Oral Maxillofac Surg, 2013, 71 (2): 295- 301.
doi: 10.1016/j.joms.2012.02.016
15 赵雅宁, 张亚琼, 柳登高, 等. 内镜辅助下颌下腺腺门和腺内结石不同取石方法的探讨[J]. 中华口腔医学杂志, 2018, 53 (12): 826- 831.
doi: 10.3760/cma.j.issn.1002-0098.2018.12.007
16 Zhao YN , Zhang YQ , Zhang LQ , et al. Treatment strategy of hilar and intraglandular stones in Wharton' s duct: A 12-year expe-rience[J]. Laryngoscope, 2020, 130 (10): 2360- 2365.
doi: 10.1002/lary.28361
17 张晔, 俞光岩, 张雷, 等. 颌下腺转位预防放射性口干的初步研究[J]. 现代口腔医学杂志, 2004, 18 (5): 422- 423.
doi: 10.3969/j.issn.1003-7632.2004.05.012
18 Zhang Y , Guo CB , Zhang L , et al. Prevention of radiation-induced xerostomia by submandibular gland transfer[J]. Head Neck, 2012, 34 (7): 937- 942.
doi: 10.1002/hed.21859
19 Xu H , Mao C , Liu JM , et al. Microanatomic study of the vascular and duct system of the submandibular gland[J]. J Oral Maxillofac Surg, 2011, 69 (4): 1103- 1107.
doi: 10.1016/j.joms.2010.03.006
20 Ge N , Peng X , Zhang L , et al. Partial sialoadenectomy for treatment of benign tumors in the submandibular gland[J]. Int J Oral Maxillofac Surg, 2016, 45 (6): 750- 755.
doi: 10.1016/j.ijom.2015.12.013
21 Yang S , Su JZ , Gao Y , et al. The clinicopathologic study on involvement of submandibular gland in oral squamous cell carcinoma[J]. Brit J Oral Maxillofac Surg, 2020, 58 (2): 203- 207.
doi: 10.1016/j.bjoms.2019.11.016
22 Yang S , Su JZ , Gao Y , et al. Involvement of the submandibular gland in oral squamous cell carcinoma patients with positive lymph nodes[J]. J Stomatol Oral Maxillofac Surg, 2020, 121 (4): 373- 376.
doi: 10.1016/j.jormas.2019.12.004
23 Yang S , Wang X , Su JZ , et al. Rate of submandibular gland involvement in oral squamous cell carcinoma[J]. J Oral Maxillofac Surg, 2019, 77 (5): 1000- 1008.
doi: 10.1016/j.joms.2018.12.011
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ISSN 1671-167X
CN 11-4691/R
主管单位：中华人民共和国教育部
主办单位：北京大学
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