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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。
OBJECTIVE: To understand the related factors of ductal obstruction and stone formation in salivary glands through endoscopic observation of microscopic structure and pathological manifestation of ductal salivary gland duct, so as to provide a theoretical basis for clinical prevention and treatment. Methods: Endoscopic examination of 583 patients with obstructive salivary gland inflammation was performed from October 2002 to February 2012, of which 492 were obstructive submandibular glandularitis and 91 were obstructive mumps, and their intraductal microscopic findings were performed Observe and understand the various causes of obstruction within the catheter as well as the microscopic anatomy. Results: Among 583 patients with obstructive salivary gland inflammation, 574/583 and 98.5% were found in 574 cases of catheters and only 9 cases (9/583 and 1.5%) of them were normal in ducts. Obstructive submandibular duct obstruction mainly stones (439 cases, 89.2%), of which stones wrapped fish-like foreign body in 12 cases. 79 cases of multiple stones (two or more). Endoscopic non-stone causes are mucinous emboli (18 cases), catheter stenosis (28 cases) and non-ductal factors (7 cases), and several factors can occur simultaneously. Among the 91 patients with obstructive parotitis, the obstruction of 89 patients was due to stenosis (67 cases, 73.6%), stones (9 cases, 9.9%), mucus embolus (13 cases, 14.3%) and 2 cases No obstruction was found in the patient’s catheter. Endoscopic, the catheter can be observed in some microstructures, mainly sublingual gland duct openings, wall polyp hyperplasia, Sphincter phenomenon and gland basin structure. CONCLUSIONS: The main cause of obstruction of the submandibular duct is stone, whereas the main cause of obstructive parotitis is ductal stenosis. Endoscopic different pathological changes found in the catheter may lead to poor flow of saliva, inducing catheter retrograde infection and the formation of stones is an important micro-anatomical factors.