为期6个月的随访,随机,对照和单盲研究摘要:目的:评估舍格伦综合征(SS)患者主要唾液腺的唾液镜检查对唾液流量和口腔干燥的影响。方法: 将49例SS患者随机分为对照组(n = 15)和两个干预组:用生理盐水(n = 16)冲洗,以及先用生理盐水然后用曲安奈德冲洗(盐水/ tA)(n= 18)。在接受治疗前一周(T0), 以及在治疗后1(t1),8(t8),16(t16)和24(t24)周检测下列指标。未受刺激的全唾液流量(UWS),咀嚼刺激的全唾液流量(SWS),柠檬酸刺激的腮腺血流量(SpF),临床口腔干燥度评分(CodS),口干症存量(xI)评分和欧洲抗风湿病联盟SS患者报告指数(ESSprI)。结果: UWS,SWS和SpF评分的中位基线分别为0.14,0.46和0.22 mL / min。干预后,在生理盐水组(t8(p = 0.013)和t24(p = 0.004))和生理盐水/ tA组(t24(p = 0.03)和t = 16(p = 0.035))观察到UWS和WSW显着增加。 SpF显着增加。在t24的盐水/ tA组中(p = 0.03)。两个干预组的肛门镜检查后xI评分均下降。与对照组相比,干预组的CodS,xI和ESSprI均有所改善。 UWS,SWS和与对照组相比,干预组的SpF较高,但这些差异在t24时盐水/ tA组的SpF除外(p = 0.005)。结论:在唾液腺内镜下灌注患有SS患者的大唾液腺,均增强了唾液流量,并减少了口腔干燥症的症状,最长缓解时间可达6个月。原文刊载于Ann Rheum Dis 2018;0:1–7. doi:10.1136/annrheumdis-2017-212672 作者: K Hakki Karagozoglu,1 Arjan Vissink,2 tim Forouzanfar,1 Henk S Brand,3 Floor Maarse,1 derk Hendrik Jan Jager1,4 作者单位:1department of oral and Maxillofacial Surgery and oral pathology, VU University Medical Center, Amsterdam Movement Sciences, Amsterdam, the netherlands 2department of oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, the netherlands 3department of oral Biochemistry, Academic Centre for dentistry Amsterdam (ACtA), Amsterdam, netherlands 4department of oral Health Sciences, KU Leuven & University Hospitals Leuven, Leuven, Belgium
儿科唾液腺内镜治疗复发性唾液腺肿胀:诊断检查,发现和结果介绍:复发性涎腺肿大常导致儿科患者的腮腺和颌下腺的疼痛肿胀。对于该类疾病的处理和治疗没有规范的步骤和方法,导致诊疗缺乏统一性,并且在一些情况下CT被过度使用。 唾液腺内镜是可以用于腮腺和颌下腺反复肿胀诊疗的介入性方法;然而,它在儿科人群中的有效性仍在确定。目标:评估术前影像利用率和复发性小儿涎腺炎,术中唾液腺内镜的发现以及唾液腺内镜应用后的治疗结果。方法:对接受唾液腺内镜治疗的复发性唾液腺炎的儿童进行了为期5年的回顾性图表研究。结果显示:本研究总共对29名儿童的38个腮腺和11个下颌下腺进行了49次唾液腺内镜治疗。45.5%的下颌下腺和2.6%的腮腺病例中CT图像可发现结石或狭窄并有指导手术治疗的信息(P <.001)。在45.5%的下颌下腺中发现了一块结石而腮腺中没有结石(P <.001)。54.6%的下颌下腺和5.3%的腮腺患者接受了唾液腺内镜治疗干预,如球囊扩张或结石清除(P <.001)。接受唾液腺内镜治疗的腮腺患者中有74%的患者因1次干预治疗而停止复发性腺体肿胀,26%需要额外干预治疗。全部的下颌下腺患者对首次唾液腺内镜治疗干预有反应。无论使用何种类固醇或是否使用类固醇注射的唾液腺内镜治疗的有益效果均无显著改善(P = .897)(P = .082)。结论:在复发性腮腺肿胀的病人中CT检查的图像收获较少,超声是腮腺疾病诊断的首推检查步骤。 唾液腺内镜是下颌下腺和腮腺涎腺炎的推荐一线干预措施,首次唾液腺内镜治疗有效率分别为100%(下颌下腺)和74%(腮腺)。Ann Otol Rhinol Laryngol.2019 Apr;128(4):338-344. PediatricSialendoscopyforRecurrentSalivary Gland Swelling: Workup, Findings, and Outcomes.作者:Nation J1,2,Panuganti B1,Manteghi A3,Pransky S2.作者单位1 Division of Otolaryngology, University of California San Diego, San Diego, CA, USA.2 Division of Pediatric Otolaryngology, Rady Children's Hospital San Diego, San Diego, CA, USA.3 Division of Pediatric Otolaryngology, St. Christopher's Hospital for Children, Philadelphia, PA, USA.摘要INTRODUCTION::Recurrentsalivary gland swelling of the parotid and submandibular glands results in painful swelling in the pediatric population. There is no defined algorithm for workup and treatment of these disorders, resulting in wide heterogeneity and in some cases overuse of computed tomography (CT) imaging.Sialendoscopy(SE) is an interventional option forrecurrentswelling of both glands; however, its effectiveness in the pediatric population is still being determined.OBJECTIVES::To assess preoperative imaging utilization and benefit in the workup ofrecurrentpediatric sialadenitis, intraoperative SE findings, and postoperative outcomes after intervention with SE.METHODS::Case-series with a 5-year retrospective chart review on children undergoing SE forrecurrentsialadenitis.RESULTS:Forty-nine SE procedures were performed on 38 parotid glands (PG) and 11 submandibular glands (SMGs) in 29 children. CT imaging findings were useful for identifying a stone or stricture and guiding surgical management in 45.5% of SMGs versus 2.6% of PGs (P< .001). A stone was found in 45.5% of SMGs and none in PG (P < .001). SE intervention such as balloon dilation or stone removal was performed in 54.6% of SMGs and 5.3% of PGs (P< .001). 74% of parotid patients undergoing SE responded to 1 intervention with a cessation ofrecurrentgland swelling, while 26% required additional interventions. One hundred percent of SMG patients responded to first intervention. There was no improvement in the beneficial effect of SE with steroid injection ( P = .897) regardless of steroid used ( P = .082).CONCLUSION::CT findings were found to be low yield forrecurrentparotid swelling, and ultrasound is a recommended first-line step for PG pathology. SE is a recommended first-line intervention for SMG and parotid sialadenitis as demonstrated by 100% and 74% response rate to initial SE, respectively.
涎石病是指发生在涎腺腺体及其导管中的钙化性团块而引起的一系列病变。该病最常见于下颌下腺,其次为腮腺。涎石常使唾液排出受阻,并继发感染,造成腺体急性或反复发作的炎症。针对于很小的结石可保守治疗。酸性刺激促使唾液大量分泌,促进涎石排出。如果无法自行排出的结石则需要手术治疗。位于颌下腺导管前段结石,可用推挤法将结石从导管口取出。导管中段结石,在口内切开导管取出。发生于颌下腺及腮腺导管后份以及腺体内结石,则常需同时摘除腺体。唾液腺内镜导管取石是一种无创或者微创的新疗法,通过内镜无需切开或者小切口下微创取石。唾液腺内镜对于导管后部结石的取出,无需摘除腺体,保存了腺体功能。能够使用唾液腺内镜微创取出的结石,需要同时满足以下三个条件:1. 位于唾液腺导管内的结石2. 结石悬浮于导管内,与导管壁无粘连,亦不嵌入导管内;3. 结石直径小于3mm
唾液腺疾病是口腔临床医疗常见病和多发病,包括唾液腺导管结石、唾液腺炎症和干燥综合征等。唾液腺内镜为唾液腺疾病的诊疗提供了高效、微创的技术手段。目前已在国内部分医院应用。与传统的唾液腺疾病治疗方法相比,内镜诊疗技术具有创伤小、并发症较少、恢复快等优点;是一种微创的唾液腺疾病治疗手段,能够保存腺体,保存功能。 那什么样的唾液腺疾病适合内镜诊疗,就要介绍一下唾液腺内镜的适应证:1.唾液腺结石病或唾液腺导管异物2.慢性阻塞性唾液腺炎3.慢性儿童及成人复发性腮腺炎4.唾液腺良性肥大继发感染(非急性期)5.舍格伦综合征(干燥综合征)继发感染,导致反复肿胀者6.唾液腺导管畸形 7.唾液腺功能障碍(包括唾液少或多者)8.全身疾病导致的唾液腺炎 9.各类放射治疗导致的唾液腺炎(例如碘131及头颈癌放疗)10.涎瘘11.其他唾液腺相关疾病 但也不是所有的患者都适合内镜治疗,以下情况的患者就不适合内镜治疗:1.炎症急性发作期2.患者合并严重全身疾病,无法耐受治疗3.唾液腺恶性肿瘤4.传染病活动期5. 有精神心理问题患者
唾液腺造影检查是唾液腺疾病诊断和治疗的重要手段之一。该检查可以对大唾液腺导的管系统拥有较好的显示效果,能够显示主导管及各级分支导管。是一种较为简便并且检查费用低廉的检查方法。对如唾液腺导管阴性结石、导管狭窄、导管损伤、慢性炎症或自身免疫病等具有重要的诊断学意义。 由于造影剂中的碘具有抗菌消炎的作用,故该检查还对有细菌感染的慢性炎症患者具有治疗作用。唾液腺造影检查可以适用于下列患者:(1)怀疑X线检查阴性的涎石患者、(2)导管狭窄等引起的唾液腺阻塞性炎症;(3)明确涎瘘的诊断和位置(4)唾液腺反复肿胀和唾液腺炎症(5)干燥综合征等自身免疫病。 下列情况应视为唾液腺造影的禁忌:(1)碘过敏者;(2)急性炎症期;(3)已显示有阳性唾液腺结石者。 唾液腺造影检查作为一种无创检查手段,大体过程如下:(1)用粘膜消毒剂在导管口局部消毒。(2)用圆头探针扩张导管口(3)将导管插入腮腺导管口,缓慢注射造影剂。(4)造影剂注射完毕后,立即拍片。分别拍摄侧位片和分泌功能片。唾液腺造影检查可能会引起造影腺体短时间的不适合轻微疼痛,一般2-3天后会逐渐缓解。
放射碘性涎腺炎的涎腺内镜检查和治疗Prendes BL,Orloff LA,Eisele DW.加利福尼亚大学耳鼻咽喉头颈外科,旧金山,94118,USA.摘要目的:描述我们对放射性碘(碘131)涎腺炎的治疗性涎腺镜检查的经验。设计:回顾性医学图表回顾。设置:学术三级推荐中心。患者:这项研究包括11名患者,他们在其他涎腺治疗方法治疗失败后接受了治疗性涎腺镜检查以治疗碘(131)引起的涎腺炎。治疗措施:所有患者都进行了扩张和冲洗导管系统的治疗性涎腺内镜检查。主要结果指标:患者报告症状的严重程度和频率。结果:我们的研究包括9名女性和2名男性(平均年龄51岁;年龄范围35-65岁)。共治疗腮腺23个,颌下腺5个。除了一例不能插管的狭窄导管,其余所有患者都可以进行涎腺镜检查。典型的唾液腺内镜表现包括苍白的导管粘膜、厚的粘液塞、导管碎片和导管狭窄。大多数患者(91%)报告单次治疗后症状有所改善。6名患者(54%)在平均18个月的随访中症状完全缓解。4名患者(36%)报告症状得到部分改善,仍然伴有持续性间歇性疼痛或肿胀。一名患者在两次治疗后没有主观性症状改善,随后接受了腮腺切除术。结论:对于保守药物治疗难治的患者,使用唾液镜检查有助于改善放射性碘引起的唾液腺炎的症状。根据我们的经验,治疗性涎腺镜检查似乎能有效且持续地改善大多数患者的症状。Arch Otolaryngol Head Neck Surg.2012 Jan;138(1):15-9. doi: 10.1001/archoto.2011.215.Therapeuticsialendoscopyfor the management of radioiodine sialadenitis.Prendes BL1,Orloff LA,Eisele DW.Author informationDepartment of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, 94118, USA. AbstractOBJECTIVE:To describe our experience with therapeuticsialendoscopyfor radioiodine (iodine 131 [(131)I]) sialadenitis.DESIGN:Retrospective medical chart review.SETTING:Academic tertiary referral center.PATIENTS:The study included 11 patients who underwent therapeuticsialendoscopyfor the treatment of (131)I sialadenitis after failing medical management.INTERVENTIONS:Therapeuticsialendoscopywith dilation and irrigation of the ductal system was performed in all patients.MAIN OUTCOME MEASURES:Patient-reported frequency and severity of symptoms.RESULTS:Our series included 9 women and 2 men (mean age, 51 years; age range, 35-65 years). A total of 23 parotidglandsand 5 submandibularglandswere treated.Sialendoscopywas possible in all patients, except one in whom the Stensen duct could not be cannulated. Typical endoscopic findings included pale ductal mucosa, thick mucous plugs, ductal debris, and stenosis of the duct. Most patients (91%) reported improvement of symptoms after a single procedure. Complete resolution of symptoms, with sustained benefit, was reported by 6 patients (54%) at a mean follow-up of 18 months. Partial improvement of symptoms, with some persistent intermittent episodes of pain or swelling, was reported by 4 patients (36%). One patient reported no subjective symptomatic improvement after 2 procedures and subsequently underwent a parotidectomy.CONCLUSIONS:Sialendoscopyis useful for the improvement of symptoms due to radioiodine-induced sialadenitis in patients who are refractory to conservative medical therapy. Therapeuticsialendoscopyappears to provide effective and sustained symptom improvement in most patients in our experience.
介入性涎腺内镜治疗放射性碘引起的涎腺炎作者:Bomeli SR、Schaitkin B、Carrau RL、Walvekar RR作者信息:美国宾夕法尼亚州匹兹堡大学耳鼻喉科和头颈外科摘要目标/假设:本研究的目的是回顾我们使用唾液镜治疗放射性碘引起的涎腺炎的经验。方法:回顾性图表分析介入性涎腺内镜治疗放射性碘诱导性涎腺炎的所有患者。结果:12名平均年龄46.5岁(25-77岁)的女性患者接受了介入性涎腺内镜检查,以治疗由放射性碘引起的大唾液腺损伤引起的顽固性涎腺炎。其中75%的患者出现腮腺症状,50%的患者出现颌下腺症状。三名患者(25%)同时出现腮腺和颌下腺症状。患者接受放射性碘的平均剂量是143 mci(范围,101.9-185.7 mci)。从接受放射性碘治疗到唾液腺内镜检查的平均时间间隔为10.4个月(5-16个月)。32个腺体(20个腮腺,12个下颌下腺)选择采用唾液腺内镜治疗,其中27个腺体(84.4%)完成内镜检查。术中可以看到导管狭窄(30%)和粘液塞(44%)是最常见的导管病理类型。唾液腺内镜改善了75%(9/12)患者的症状,随访2周至33个月(中位数,6个月)无严重并发症。结论: 介入性涎腺镜检查是治疗对医疗管理无反应的放射性碘引起的涎腺炎的有效工具。Laryngoscope.2009 May;119(5):864-7. doi: 10.1002/lary.20140.Interventionalsialendoscopyfor treatment of radioiodine-induced sialadenitis.Bomeli SR1,Schaitkin B,Carrau RL,Walvekar RR.Author informationDepartment of Otolaryngology and Head Neck Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.AbstractOBJECTIVES/HYPOTHESIS:The purpose of this study is to review our experience withsialendoscopyfor the management of radioiodine-induced sialadenitis.METHODS:Retrospective chart review of all patients with radioiodine-induced sialadenitis treated with interventionalsialendoscopy.RESULTS:Twelve female patients with a mean age of 46.5 years (range, 25-77 years) underwent interventionalsialendoscopyfor the treatment of recalcitrant sialadenitis from radioiodine-induced damage to the majorsalivary glands. Symptoms arising from the parotidglandwere seen in 75% of patients, whereas symptoms arising from the submandibularglandwere seen in 50%. Three patients (25%) presented symptoms in both the parotids and the submandibularglands. The mean dose of radioiodine was 143 mCi (range, 101.9-185.7 mCi) received as a single dose prior to their referral. The mean duration from radioiodine ablation therapy tosialendoscopywas 10.4 months (range, 5-16 months). Thirty-twoglands(20 parotid, 12 submandibular) were taken to the operating room, with complete endoscopy successful in 27glands(84.4%). Ductal stenosis (30%) and mucus plugs (44%) were the most common types of ductal pathology.Sialendoscopyimproved the symptoms in 75% (9/12) of patients, with no serious complications reported in follow-up ranging from 2 weeks to 33 months (median, 6 months).CONCLUSIONS:Interventionalsialendoscopyis an effective tool for the management of patients with radioiodine-induced sialadenitis that is unresponsive to medical management.
1. 内镜治疗后两小时内,避免进食及饮水。2. 术后5天内患者可能会有腺体区域的肿胀疼痛及其他不适感觉,一般会自行恢复,无需特别处理。3. 患者治疗或检查后应行对腺体进行自我维护治疗, 主要为按摩腺体(每日2次,每次2-3分钟,由后向前轻压腺体),可局部热敷(每日2次,每次8-10分钟),温盐水或漱口液漱口(每餐后)。4. 口内外有切口并缝合者,应在术后1周左右就诊拆除缝线。5. 导管狭窄留置人工导管者,请于术后10日左右就诊拆除人工导管。6. 按医嘱正确服用医生开具药物。7. 治疗后7-10天戒除烟酒。8. 如发生术后感染等情况,请及时复诊。
1. 为避免发生术后感染,患者治疗前应保持口腔清洁。请于治疗前清洁口腔(刷牙并漱口),口内卫生情况较差者应于术前行洁牙治疗。2. 为防止术中出血,治疗前应停用抗凝血药物,例如阿司匹林,氯吡格雷,华法林等。如病情特殊,患者可于就诊开予上述类型抗凝药物的专科门诊就诊咨询,明确能否停用上述药物。3. 为防止术中及术后口腔分泌物过多影响治疗,请于治疗前后戒除烟酒。4. 为保证术区清洁,请患者保持口周皮肤清洁(男性患者请剃须,女性患者请勿化妆)。5. 本操作因在局麻下进行,无需禁食禁饮。为防止部分局麻并发症的发生,请患者务必于检查及治疗前进食。6. 因术前需预防性使用抗菌药物,请患者自备饮用水。
治疗前术后拆除腮腺导管内防止导管狭窄的支撑物。并使用药物对腮腺导管进行冲洗,防止术后瘢痕形成导致导管狭窄。面部皮肤切口注射抗瘢痕形成药物,减少瘢痕形成,促进美观。现术后导管未见狭窄,患者无明显主观不适症状,瘢痕也逐渐淡化。治疗后治疗后47天术后拆除腮腺导管内防止导管狭窄的支撑物。并使用药物对腮腺导管进行冲洗,防止术后瘢痕形成导致导管狭窄。面部皮肤切口注射抗瘢痕形成药物,减少瘢痕形成,促进美观。现术后导管未见狭窄,患者无明显主观不适症状,瘢痕也逐渐淡化。治疗后0天患者因左侧唾液腺反复肿胀就诊,外院诊断为慢性阻塞性涎腺炎,超声检查未见结石存在。后于我门诊就诊,行导管检查时发现左腮腺导管结石存在可能,结石与导管壁黏连;拍摄ct后证实结石存在。于2018.4.3于门诊局麻下行唾液腺内镜辅助下腮腺导管结石取出术,并行腮腺导管成形术。避免了手术摘除腺体。