下颌下腺导管大型结石的治疗及预后

中国口腔颌面外科杂志 ›› 2014, Vol. 12 ›› Issue (3): 228-232.

下颌下腺导管大型结石的治疗及预后

石欢,俞创奇,郑凌艳,浦益萍,谢李松,王知俊

上海交通大学医学院附属第九人民医院·口腔医学院口腔外科,上海市口腔医学重点实验室,上海 200011

收稿日期:2013-10-18 出版日期:2014-05-10 发布日期:2014-07-15
通讯作者: 俞创奇,E-mail:ycq616@hotmail.com E-mail:shihuan1312@163.com
作者简介:石欢(1987-),女,硕士研究生
基金资助:
国家自然科学基金(81100766);上海市卫生和计划生育委员会重点项目(2014035);上海高校创新团队发展计划;上海交通大学医学院校基金(YZ1024);上海市科学技术委员会医学引导类基金(08DZ2271100)

Treatment and prognosis of large submandibular calculi

SHI Huan, YU Chuang-qi, ZHENG Ling-yan, PU Yi-ping, XIE Li-song, WANG Zhi-jun

Department of Oral Surgery, Ninth People’s Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology. Shanghai 200011, China

Received:2013-10-18 Online:2014-05-10 Published:2014-07-15

摘要/Abstract

摘要： 目的:总结内镜辅助下经口内行下颌下腺导管大型结石取石术的经验。方法:收集近10年间下颌下腺导管结石病例,结石最长径均>1 cm。所有病例均进行肿胀症状VAS评分,选取病程较长(≥1年)者,应用99mTc放射性核素显像评估腺体功能。所有大型结石均在内镜辅助下经口内路径行取石术,未成功取出者则行患侧下颌下腺摘除术。利用VAS评分对取石术后患者进行疗效评估。结果:在642例取石术中,106例(16.5%)为下颌下腺导管大型结石病例。其中,19例患者在术前进行放射性核素检查,6例患侧腺体功能完全丧失,9例部分丧失,4例患侧与健侧相比无显著差异。经口内路径取石术成功率为95.3%(101/106)。内镜探查发现,29例患者导管远端残余结石,利用抓钳或套石篮成功取出23例残余结石。术后随访显示,所有患者术后腺体肿胀症状缓解。结论:下颌下腺大型结石可行口内路径取石术并保留腺体,大部分患者在术后腺体肿胀症状完全消失。

关键词: 涎石病, 大型结石, 放射性核素显像

Abstract: PURPOSE: Recently, different minimally invasive techniques have been developed for the management of submandibular calculi. This retrospective study summarized our experience in transoral management of large submandibular calculi with sialendoscopy. METHODS: During a period of 10 years from 2002, patients with swelling symptom in submandibular gland were confirmed with large calculi (≥10 mm) by routine methods. All cases were evaluated in regard to the degree of symptom by VAS, and patients with long history (more than 1 year) were further assessed with uptake and excretion function by 99mTc pertechnetate scintigraph. Large calculi were removed by transoral approach (with gland preservation) combined with sialendoscopic management. Failed cases underwent removal of the glands. Evaluation of the results included VAS assessment after large calculi removed successfully. RESULTS: One hundred and six cases had large calculi in the submandibular duct (anterior 33, posterior 73). 19 cases were evaluated by scintigraphic examination, 6 cases (31.6%) almost lost total function, and 9 cases lost partial function, 4 cases had normal function. Transoral sialolithectomy was successfully performed in 101 cases (101/106, 95.3%). Residual calculi were detected in distal duct in 29 cases under sialendoscopy, and 23 cases were removed successfully by forceps or basket simultaneously. Most cases after management had relieved symptom by VAS evaluation. CONCLUSIONS: Large submandibular calculi can be removed transorally by gland-preserving procedure and most cases were asymptomatic after joint management with sialendoscopy. Supported by National Natural Science Foundation of China (81100766), Key Project of Shanghai Municipal Health and Family Planning Bureau(2014035), Research Fund of Science and Technology Committee of Shanghai Municipality (08DZ2271100), Program for Innovative Research Team of Shanghai Municipal Education Commission, and Medical Guiding Foundation of Shanghai Jiao Tong University (YZ1024).

Key words: Sialolithiasis, Large submandibular sialolith, 99mTc scintigraphy

中图分类号:

R781.7.5

石欢,俞创奇,郑凌艳,浦益萍,谢李松,王知俊. 下颌下腺导管大型结石的治疗及预后[J]. 中国口腔颌面外科杂志, 2014, 12(3): 228-232.

SHI Huan, YU Chuang-qi, ZHENG Ling-yan, PU Yi-ping, XIE Li-song, WANG Zhi-jun. Treatment and prognosis of large submandibular calculi[J]. China J Oral Maxillofac Surg, 2014, 12(3): 228-232.

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