疑难唾液腺结石病的治疗研究  

Recent progress in the treatment of intractable sialolithiasis

作　　者：柳登高[1] 郑丹妮 赵雅宁 张亚琼 叶欣 张丽琪 谢晓艳[1] 张雷[1] 张祖燕[1] 俞光岩[1] LIU Deng-gao;ZHENG Dan-ni;ZHAO Ya-ning;ZHANG Ya-qiong;YE Xin;ZHANG Li-qi;XIE Xiao-yan;ZHANG Lei;ZHANG Zu-yan;YU Guang-yan(Department of Oral and Maxillofacial Radiology,Peking University School and Hospital of Stomatology&National Center of Stomatology&National Clinical Research Center for Oral Diseases&National Engineering Research Center of Oral Biomaterials and Digital Medical Devices&Beijing Key Laboratory of Digital Stomatology&NHC Research Center of Engineering and Technology for Computerized Dentistry&NMPA Key Laboratory for Dental Materials,Beijing 100081,China)

机构地区：[1]北京大学口腔医学院·口腔医院影像科,国家口腔医学中心,国家口腔疾病临床医学研究中心,口腔生物材料和数字诊疗装备国家工程研究中心,口腔数字医学北京市重点实验室,国家卫生健康委员会口腔医学计算机应用工程技术研究中心,国家药品监督管理局口腔生物材料重点实验室,北京100081

出　　处：《北京大学学报（医学版）》2023年第1期8-12,共5页Journal of Peking University:Health Sciences

摘　　要：唾液腺结石病在人群中的发病率为0.45%~1.20%,主要表现为受累腺体反复肿胀、疼痛,进食时加重,扪压腺体可见脓性分泌物溢出^([1-3])。随着唾液腺内镜及碎石技术的应用与发展,多数唾液腺结石病的治疗已不再是难题,但对于位置深在的下颌下腺腺门部与腺内段结石及位置靠后的腮腺嵌顿性结石等复杂病例的治疗仍存在挑战,需要进一步突破^([4-6])。北京大学口腔医院唾液腺疾病研究中心开展唾液腺内镜诊疗工作17年来.Sialolithiasis occurs in approximately 0.45% to 1.20% of the general population. The typical clinical symptom manifests as a painful swelling of the affected glands after a meal or upon salivary stimulation, which extremely affects the life quality of the patients. With the development of sialendoscopy and lithotripsy, most sialoliths can be successfully removed with preservation of the gland. However, sialoliths in the deep hilar-parenchymal submandibular ducts and impacted parotid stones located in the proximal ducts continue to pose great challenges. Our research center for salivary gland diseases(in Peking University School and Hospital of Stomatology) has used sialendoscopy for 17 years and treated >2 000 patients with salivary gland calculi. The success rate was approximately 92% for submandibular gland calculi and 95% for parotid calculi. A variety of minimally invasive surgical techniques have been applied and developed, which add substantial improvements in the treatment of refractory sialolithiasis. Further, the radiographic positioning criteria and treatment strategy are proposed for these intractable stones. Most of the hilar-parenchymal submandibular stones are successfully removed by a transoral approach, including transoral duct slitting and intraductal basket grasping, while a small portion of superficial stones can be removed by a mini-incision in submandibular area. Impacted stones located in the distal third of parotid gland ducts are removed via “peri-ostium incision”, which is applied to avoid a cicatricial stenosis from a direct ostium incision. Impacted parotid stones located in the middle and proximal third of the Stensen’s duct are removed via a direct mini-incision or a peri-auricular flap. A direct transcutaneous mini-incision is commonly performed under local anesthesia with an imperceptible scar, and is indicated for most of impacted stones located in the middle third, hilum and intraglandular ducts. By contrast, a peri-auricular flap is performed under general anesthesia with r

关 键 词：唾液腺结石病 腮腺 下颌下腺 取石术 激光碎石术 

分 类 号：R781.75[医药卫生—口腔医学]