涎腺内镜诊治慢性阻塞性下颌下腺炎14例报道

Treatment of chronic obstructive sialoadenitis in submandibular gland under sialoendoscopy: Report of 14 cases

目的:评价涎腺镜在诊断和治疗慢性阻塞性下颌下腺炎中的价值。方法:对14例临床诊断为慢性阻塞性下颌下腺炎的患者进行涎腺镜检查,了解导管壁和导管内的表现,并同时通过涎腺镜进行相应的治疗,包括液电碎石术、钳取术和套石篮取石术、导管清扫扩张术,将结石或黏液栓子取出。结果:14例患者涎腺镜诊断的阻塞原因分别是:阳性结石10例、阴性结石1例,黏液栓子1例,管壁严重增生2例(其中1例结石嵌入)。11例患者成功应用治疗性涎腺镜取出结石或去除黏液栓子,导管扩张灌洗后阻塞症状消失;3例治疗失败,原因主要为导管增生、结石嵌入。术后无明显并发症发生。结论:涎腺镜能直观地了解涎腺导管内的病变表现,明确导管阻塞原因,并可同时进行相应的治疗,为慢性阻塞性下颌下腺炎的诊断和治疗提供了新的有效方法。

PURPOSE: To evaluate the sialoendoscopic technique for diagnosis and treatment of the chronic obstructive sialoadenitis in submandibular gland. METHODS: 14 patients presenting obstructive symptoms in the submandibular gland were detected and treated under sialoendoscopy. First, the intraductal features of the Wharton's duct were observed by diagnostic sialoendoscopy, then, the obstructive factors were removed by interventional sialoendoscopy. RESULTS: The obstructive reasons of 14 patients were explored. There were three main types, positive and negative sialolith (11 cases), mucus plug (1 case) and wall proliferation(1 case). Stones in the secondary branch of Wharton's duct were shown in a few patients.14 patients were treated by interventional sialoendoscopy immediately.The obstructive factors were successfully removed in 11 cases by different methods, including electrohydraulic calcutript, stone extractor , and lavage. 3 cases immediately failed because of wall proliferation, which leads to embedded stone and intraductal stricture. No severe complications were noted. CONCLUSION: This paper describes a new method to detect the causes of chronic obstructive disease in submandibular gland. This technique enables the direct observation of the intraductal features in submandibular gland and simultaneous removal of the obstructive factors.