口腔疾病防治 ›› 2021, Vol. 29 ›› Issue (5): 289-295.DOI: 10.12016/j.issn.2096-1456.2021.05.001

• 专家论坛 • 上一篇    下一篇

下颌下腺结石的现代治疗策略

陶谦(),黄韵   

  1. 中山大学光华口腔医学院·附属口腔医院口腔颌面外科,广东省口腔医学重点实验室, 广东 广州(510055)
  • 收稿日期:2020-06-07 修回日期:2020-11-12 出版日期:2021-05-20 发布日期:2021-03-08
  • 通讯作者: 陶谦
  • 基金资助:
    广东省科技计划项目(2017A020211025)

Modern therapeutic strategies for submandibular lithiasis

TAO Qian(),HUANG Yun   

  1. Department of Oral and Maxillofacial Surgery, Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Stomatology, Guangzhou 510055, China
  • Received:2020-06-07 Revised:2020-11-12 Online:2021-05-20 Published:2021-03-08
  • Contact: Qian TAO
  • Supported by:
    Science and Technology Project of Guangdong Province(2017A020211025)

摘要:

唾液腺结石好发于下颌下腺,常引起反复发作的进食后腺体肿胀和疼痛,曾是摘除腺体的主要原因之一。在现代医学愈来愈强调微创治疗的大趋势下,下颌下腺结石诊治过程中的腺体保留和功能恢复得到越来越多重视。临床上广泛应用的锥形束CT(cone beam computed tomography,CBCT)以及唾液腺内镜等新设备新技术,有助于精确定位和微创取出结石,丰富了下颌下腺结石的治疗手段。本文根据笔者临床诊治的经验体会,参阅和借鉴相关文献,尝试总结出分布于下颌下腺导管系统不同部位结石的治疗策略:①强调器官保存和恢复功能并重;②内镜与微创优先;③科学分类,精准施治。针对导管系统中结石的特点选择合适的治疗方案:导管前中段结石以内镜取石为主,腺门结石需根据其特点选择内镜治疗或/和切开取石,腺体内结石建议观察。同时应注重腺体的功能评价,取出结石后尽可能恢复下颌下腺的分泌功能。

关键词: 下颌下腺结石病, 临床特点, 诊断, 分类, 功能评估, 治疗策略, 内镜, 切开取石, 导管成形术

Abstract:

Most salivary gland stones involve the submandibular gland, which often cause recurrent swelling and pain of the glands after meals, and used to be the main reasons for the gland removals. With the trend of minimally invasive treatment, gland preservation and functional recovery in the diagnosis and the treatment of submandibular lithiasis have been paid more and more attention. New equipment and technologies such as CBCT and sialendoscopy, which are widely used in clinical practice, have contributed a lot to the accurate orientation and minimally invasive treatment of stones, and enriched the managements of submandibular lithiasis. Based on our experience and the review of relevant literature, this paper attempts to summarize the treatment strategies for submandibular stones distributed in different parts of the duct: ① emphasizing on the integrity and functions of the organ; ② endoscopy and minimal invasiveness come first; ③ scientific classifications and personal managements. Appropriate treatment options should be selected according to the features of the stones: endoscopic lithotomy helps a lot in removing those located in the anterior or middle part of the duct; endoscopic lithotomy or/and sialolithotomy are needed according to the features of hilar stones; the regular follow-up is required for the intraglandular stones. Meanwhile, the evaluation of the gland function is also important. After the removals of sunmandibular stones, the functions of the glands should be promoted to restore as far as possible.

Key words: submandibular lithiasis, clinical characteristics, diagnosis, classification, functional evaluation, therapeutic strategies, endoscopy, transoral sialolithotomy, sialodochoplasty

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