涎腺内镜辅助手术取石治疗腮腺涎石症

Sialoendoscopy-assisted sialolithectomy for large parotid stones

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.

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.