内镜辅助慢性阻塞性腮腺炎的病因观察与药物灌注治疗

The Etiology and D rug Perfusion Treatment of Chronic Obstructive Parotitis under Sialoendoscopy

目的通过内镜技术了解慢性阻塞性腮腺炎导管内在表现和阻塞病因,并根据病变情况进行导管扩张术和相应的药物灌洗和灌注治疗。方法应用涎腺镜对16例慢性阻塞性腮腺炎患者的导管进行观察,了解其导管壁和导管内变化,以明确发病原因。根据内镜下的不同表现进行导管扩张、氯霉素灌洗和碘化油灌注,观察疗效。结果16例慢性阻塞性腮腺炎患者的内镜下导管内壁变化显示,引起腮腺导管阻塞的内在表现主要有以下几种,导管炎(表现为导管内壁充血)11例;导管炎伴脓栓(或粘液栓子)形成7例;导管炎伴炎性增生9例;导管炎伴结石(结石常粘附在导管壁)2例。16例患者均行导管冲洗扩张术,9例患者同时行药物灌注术。近期随访显示优良率分别为87.5%(2周)和81.3%(4周);应用碘化油灌注的患者,疗效更明显。结论内镜能直接了解慢性阻塞性腮腺炎的内在病因,并可同时进行相应的治疗。碘化油行腮腺导管灌注,能起暂时性的导管扩张、栓塞作用,使灌洗抗生素液停留更长时间,以提高疗效。

Objective The purpose of this st udy was to describe the use of sialoendoscopy for diagnosis and treatment of chr onic obstructive parotitis,to detect the etiology of chronic obstructive siaload enitis,and to evaluate the effectiveness of perfusion of Iodized oil(lipiodol).M ethods16patients with obstructive symptoms were detected under sialoendoscopy,an d the inner lesions of the obstructive duct were explored.Treatment was performe d by dilatation,lavage and drug perfusion according to the obstructive degree.Re sults Under endoscope,the obstructive etiology was classified into sialodochitis ,pus(mucus)embolism,polyps,and sialolith.11patients had a diagnosis of sialodoch itis,9polyps,2sialolith(the small stone was found affiliated duct wall).The sial odochitis was treated by ductal dilatation and lavage,and drug perfusion was use d to pus(mucus)embolism and polyps.The success rate was more than80%(87.5%at2wee ks a nd81.3%at4weeks).Conclusion This study demonstrates the sialoendoscopy as a dire ct and minimal invasive method in the diagnosis of COP,and the Iodized oil used as drug perfusion for treatment of COP is efficient and safe.