阻塞性唾液腺炎病因与导管内微观结构关系的初步探讨  

Primary study of the relationship between obstructive sialadenitis and micro-structure by sialoendoscopy

作　　者：俞创奇[1] 郑凌艳[1] 别筝[1] 杨驰[1] 

机构地区：[1]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

出　　处：《中国口腔颌面外科杂志》2013年第1期56-60,共5页China Journal of Oral and Maxillofacial Surgery

基　　金：上海市科学技术委员会资助项目(10411964400)~~

摘　　要：目的:通过对阻塞性唾液腺炎导管内微观结构和病理表现的内镜观察,了解唾液腺导管阻塞和结石形成的相关因素,为临床预防和治疗提供理论依据。方法:对2002年10月—2012年2月间583例阻塞性唾液腺炎患者进行内镜探查,其中492例为阻塞性下颌下腺炎,91例为阻塞性腮腺炎,对其导管内微观表现进行观察,了解导管内各种不同的阻塞原因,以及微观解剖结构。结果:583例阻塞性唾液腺炎患者中,574例导管内发现不同的病理表现(574/583,98.5%),而导管内正常表现者仅9例(9/583,1.5%)。下颌下腺导管内阻塞性原因主要是结石(439例,89.2%),其中结石包裹鱼刺样异物12例。多发性结石(2个及以上)79例。内镜下非结石性原因是黏液栓子(18例),导管狭窄(28例)和非导管内因素(7例),几个因素可同时出现。91例阻塞性腮腺炎中,89例阻塞原因为导管不同部位和程度的狭窄(67例,73.6%)、结石(9例,9.9%)、黏液栓子(13例,14.3%),2例患者导管内未发现阻塞原因。内镜下,导管内可观察到一些微观结构,主要是舌下腺导管开口、管壁息肉样增生、Sphincter现象和腺门盆状结构。结论:下颌下腺导管阻塞的主要原因是结石,而阻塞性腮腺炎的主要原因是导管狭窄。内镜下发现的导管内各种不同微观结构和病理改变,可能导致唾液流动不畅,是诱发导管逆行性感染和结石形成的重要微观解剖因素。PURPOSE： Obstructive sialadenitis （OS） is a relatively common disease in clinic. This study aimed to explore the relationship between micro-structure and obstructive sialadenitis by sialoendoscopy. METHODS： Between October 2002 and February 2012, 583 patients with obstructive symptoms in submandibular gland （n=492 cases） and parotid gland （n=91eases） were diagnosed using sialoendoscopy and occlusal films, and the inner features and structure of duct of submandibular and parotid gland were observed and evaluated by sialoendoscopy. RESULTS： Pathological findings were noted in salivary duct in 574 cases （98.5%, 574 of 583）, and normal findings were in 9 cases （1.5%, 9 of 583）. In submandibular gland, the histological features of 485 cases were identified endoscopically and radiographically, and endoscopic findings were of three types： sialolith （n=439, 89.2%）, mucus plug （n=18, 3.7%）, and stenosis （n=28, 5.7%）. 12 cases were found to have foreign body （fish bone） wrapped by sialolith. Among 89 parotid cases： stenosls accounted for 67, 73.6%, sialolith accounted for 9, 9.9% ,mucus plug accounted for 13,14.3%. Opening of sublingual gland, basin-like structure in hilus region,sphincter phenomenon and polyps were found under sialoendoscopie observation. CONCLUSION： Sialoendoscopy is a new technique to detect the cause of obstruction in salivary gland and presume the possible mechanism of obstruction, especially stone formation. Supported by Research Fund of Science and Technology Commission of Shanghai Municipality（10411964400）.

关 键 词：下颌下腺 腮腺 结石 涎腺内镜 

分 类 号：R781.7[医药卫生—口腔医学]