腮腺慢性阻塞性疾病的再认识

doi:10.12016/j.issn.2096-1456.2021.09.001

摘要/Abstract

摘要：

腮腺慢性阻塞性疾病(chronic obstructive diseases of parotid)在临床多见,病情反复,治疗效果欠佳。本文参阅“腮腺反复肿胀”相关文献,结合个人临床实践和研究成果,从病因学的角度将腮腺阻塞性疾病分为机械性阻塞、特异性阻塞和非特异性阻塞3大类,并引入流体力学的原理解释腮腺阻塞的机制,针对不同病因提出改变腮腺微流场中唾液流动状态,减少流动阻力以解除阻塞的治疗新思路:传统的结石取出可清除导管内机械性阻塞,药物促进唾液分泌以改变唾液粘滞度,内镜下扩张导管或放置支架以扩大管径,选择性栓塞侧支导管以减少流场中高压区和低速区等等,这些方法均能有效提高唾液流动速率,减少唾液滞留和腮腺阻塞的发生。

关键词: 腮腺阻塞, 结石病, 慢性复发性腮腺炎, 舍格伦综合征, IgG4相关性腮腺炎, 放射性腮腺炎, 非特异性腮腺炎, 流体力学, 治疗策略

Abstract:

Chronic obstructive diseases of the parotid gland are common clinically, with repeated swelling and a prolonged course and poor treatment outcomes. Based on the summarization of clinical practice and related literature, from the viewpoint of etiology, parotid obstructive diseases can be classified as mechanical obstructions, specific obstructions and non-specific obstructions. The principles of fluid mechanics are introduced to explain the formation of parotid obstructions. According to the different causes, the methods of changing the flow pattern of saliva in the parotid to reduce the resistance and relieve the obstruction, are proposed, such as mechanical factors removals, application of drugs that promote saliva secretion and lower saliva viscosity, ductal expansion under endoscopy and stent placement, and embolization of collateral ducts. These managements can effectively increase the salivary flow rate, reduce the occurrence of the saliva stranded and parotid gland obstructions.

Key words: obstruction of parotid gland, lithiasis, chronic recurrent parotitis, Sjögren’s syndrome, IgG4-related parotitis, radiation-induced parotitis, non-specific parotitis, fluid mechanics, therapeutic strategy

中图分类号:

陶谦,黄韵. 腮腺慢性阻塞性疾病的再认识[J]. 口腔疾病防治, 2021, 29(9): 577-583.

TAO Qian,HUANG Yun. Re-cognition of chronic obstructive diseases of the parotid gland[J]. Journal of Prevention and Treatment for Stomatological Diseases, 2021, 29(9): 577-583.

图/表 4

图1 左侧腮腺导管结石

Figure 1 A stone in Stensen’s duct of the left side Male, 26 years old, complained of recurrent swelling of the left parotid gland for more than 3 months after meals, which subsided within an hour after meals. Panoramic images (a) and CBCT views (b) showed ductal filling defects (indicated by the arrow) and proximal ductal dilation. The ductal edema (c) and ulcer (d) caused by stone (e) obstruction were observed by endoscopy (images from the database of our research group)

图2 右侧慢性复发性腮腺炎

Figure 2 Chronic recurrent parotitis of the right side Patient A: female, 42 years old, complained of repeated swelling of the right parotid gland for more than 2 months, with ductal expansion in the panoramic images (a). Patient B: male, 57 years old, complained of repeated swelling of the right parotid gland for more than 1 year, ductal expansion and stenosis were observed after the 3-dimensional reconstruction of CBCT images, with scattered iodine dots inside the gland (b), under the endoscope, stenosis of the partial duct can be seen (c), mucus plugs are visible in the duct and the tube is pale in appearance (d). There was no relationship between the swelling and meals in these two patients, swelling lasted for several hours to several days, and both patients acknowledged a history of juvenile recurrent parotitis (images from the database of our research group)

图3 舍格伦综合征

Figure 3 Sj?gren’s syndrome Female, 36 years old, complained of swelling of the bilateral parotid glands for more than one year, accompanied by dryness of the mouth and eyes. Serological examination revealed positivity for the anti-SS-A and anti-SS-B antibodies. MRI showed the expansion of bilateral parotid glands(a). CBCT demonstrated expansion of the posterior duct (b). Under the endoscope, the wall is pale in appearance and mucus plugs (c & d) can be seen in the duct (images from the database of our research group)

图4 IgG4相关性唾液腺炎

Figure 4 IgG4-related sialadenitis Male, 53 years old, complained of persistent swelling of the bilateral submandibular and parotid glands for more than half a year. Signal enhancement of the bilateral parotid glands was seen in the axial position of MRI under the T1 signal (a). Obvious swelling of the submandibular glands was observed (b). Coronally, enlargement of the submandibular gland was shown in MRI under the T1 signal (c) (images from the database of our research group)

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