非结石性腮腺阻塞的成因分析

Analysis of causes for non-stone parotid obstructions

腮腺阻塞可引起腺体反复肿胀,以往多认为导管结石是引起阻塞的主要原因,但唾液腺内镜检查发现相当部分出现阻塞症状的腮腺的导管系统中并未存在结石或异物,表现出此类腮腺阻塞症状的疾病主要包括慢性复发性腮腺炎、非结石性慢性阻塞性腮腺炎、舍格伦综合征、IgG4相关性腮腺炎和放射性腮腺炎等,阻塞机理不明,病程迁延。本文在简析导管狭窄、扭曲和粘液栓子等可能导致腮腺阻塞因素的基础上,着重介绍一个新观点:“腮腺的导管系统+流动的唾液”构成一个微型流场。基于流体力学的原理,流场中的唾液流动可受导管汇流、变径和转折等影响,产生低速区、回流、逆流以及湍流等变化,影响唾液流动和正常排出,引发腮腺阻塞的症状。从导管解剖和唾液性状等两个变量分析引起腮腺阻塞的可能机制,有助于解释非结石性腮腺阻塞的成因。

Parotid obstructions can cause repeated swelling of the glands.Previously,duct stones were thought to be the main cause of obstructions,but salivary gland endoscopy examinations have revealed the absence of stones or foreign bodies in the duct system of the parotid glands with obstructive symptoms.Diseases of the parotid gland with obstructive symptoms include chronic recurrent parotitis,non-stone chronic obstructive parotitis,Sjogren's syndrome,IgG4related parotitis and radiation-induced parotitis.The mechanism of obstructions is unknown,and the disease course is prolonged.In this paper,based on a brief analysis of duct stenosis,distortion and mucus emboli,which may lead to parotid obstructions,a new perspective is emphasized:the duct system of the parotid and flowing saliva constitute a microflow field.Based on the principle of fluid mechanics,the flow of saliva in the flow field can be affected by the confluence,diameter changes,and twist of the ducts.This outcome results in changes in the low velocity zone,backflow,counterflow and turbulence;affects saliva flow and normal discharge;and causes symptoms of parotid obstruction.An analysis of the possible mechanisms of parotid obstruction using two variables,duct anatomy and saliva traits,helps explain the causes of nonstone parotid obstructions.