内镜在慢性阻塞性唾液腺炎诊治中的应用研究

Clinical research of endoscopic technique for the diagnosis and treatment of the chronic obstructive sialoadenitis

目的评价内镜技术应用于慢性阻塞性唾液腺炎诊断和治疗的临床应用价值。方法应用涎腺镜对106例慢性阻塞性唾液腺炎进行诊断,其中腮腺57例,下颌下腺49例,探查其导管壁和导管内变化和发病原因。同时根据病因进行相应的治疗,如涎腺镜辅助下的套石篮取石术、钳夹取石术和导管扩张灌洗术。结果内镜下表现可见下颌下腺导管阻塞原因以结石多见,占41例(83.7%),异物3例;而腮腺导管内以内壁增生为主,占37例(64.9%),分支导管部分阻塞。对于下颌下腺导管内结石病例,涎腺镜辅助下取石成功率为84.1%;对于腮腺导管内增生及黏液栓子病例,涎腺镜辅助下导管扩张和灌洗的有效率为87.5%。结论涎腺镜能直接了解唾液腺导管的内在表现,明确慢性阻塞性唾液腺炎的发病原因,并可同时进行相应的取石术和导管扩张灌洗治疗,具有较好的临床应用前景。

[Objective] To evaluate the clinical effect of the new designed salivary gland endoscope to detect the etiology of chronic obstructive sialoadenitis and take the treatment in duct directly. [Methods] 106 patients presented with obstructive symptoms were detected under endoscopy in parotid and submandibular gland, and according to the size, shape and position of the sialolith, the obstructive problems were treated by interventional sialoendoscopy with wire basket and forceps. Non-sialolith obstructive cases, the lavage and dilation were used to solve the obstruction. [Results] Under endoscope, the inner manifestations of the obstructive duct were classified into two main types： sialolith and wall proliferation. 41 patients had a diagnosis of sialolith in submandibular gland （83.7%）. However, in parotid gland, the main features is the abnormal in duct wall, mainly is proliferation （64.9%） produced by infectious and other unknown factors nowadays. Among sialolith （including foreign body） cases in submandibular gland, 37 cases were removed the sialolith or foreign body by interventional sialendoscopy, 7 cases were failure, successful rate is 84.1%; As for non-sialolith （including proliferation and mucus.plug） cases in parotid gland, 36 cases were treated effectively by lavage and dilation under sialendoscopy, successful rate is 87.5%. Failure cases were due to sialolith embedded in the ductal wall and unsuccessful dilation of ductal stenosis. [Conclusion] The use of sialendoscopy allows us detect the obstruction reason in duct directly, and take the treatment to remove the obstruction problem, especially the sialolith simultaneously.