Gillespie M Boyd, Koch Michael, Iro Heinrich, Zenk Johannes
Department of Otolaryngology–Head and Neck Surgery, Medical University of South Carolina, Charleston, 29425-5500, USA.
Arch Otolaryngol Head Neck Surg. 2011 Sep;137(9):903-8. doi: 10.1001/archoto.2011.130. Epub 2011 Aug 15.
To determine whether unique patterns of care are evolving in the United States compared with Germany in endoscopic management of chronic sialadenitis.
Comparison of consecutive series of patients.
Academic tertiary salivary referral centers in Germany and the United States.
A total of 446 patients having chronic sialadenitis treated with salivary endoscopy.
To compare practice patterns and outcomes at each location, databases tracking patients having chronic sialadenitis treated with salivary endoscopy were searched for the following variables: age, sex, involved gland, radiographic studies, endoscopic findings, endoscopic-related complications, gland preservation rate, patient symptom control, and techniques for managing salivary stones and intraductal scar tissue.
Significantly more patients in the US cohort had chronic sialadenitis of the parotid gland (P = .03) and multiple gland involvement (P < .001). Salivary endoscopy was regularly performed using local anesthesia in Germany and using general anesthesia in the United States (P < .001). Endoscopic-related complication rates were higher (10.9% vs 1.6%) and gland preservation rates lower (85.9% vs 98.4%) among US patients; however, patients with intact glands demonstrated similar rates of symptom control at both centers (92.7% in the United States vs 85.3% in Germany) at the last follow-up visit. The lower rate of gland preservation in the United States is largely because of lack of access to lithotripsy for larger salivary stones.
Different patterns of care are emerging in the endoscopic management of chronic sialadenitis in the United States compared with Germany, where these techniques were largely developed. Nevertheless, patients with chronic sialadenitis at both locations who undergo endoscopic gland-preserving therapy have high rates of gland preservation and symptom control.
确定在美国与德国相比，慢性涎腺炎的内镜治疗中是否正在形成独特的治疗模式。
连续系列患者的比较。
德国和美国的学术性三级唾液转诊中心。
共有446例接受唾液内镜治疗的慢性涎腺炎患者。
为比较每个地点的治疗模式和结果，在追踪接受唾液内镜治疗的慢性涎腺炎患者的数据库中搜索以下变量：年龄、性别、受累腺体、影像学检查、内镜检查结果、内镜相关并发症、腺体保留率、患者症状控制以及唾液结石和导管内瘢痕组织的处理技术。
美国队列中患有腮腺慢性涎腺炎（P = 0.03）和多腺体受累（P < 0.001）的患者明显更多。在德国，唾液内镜检查通常采用局部麻醉，而在美国则采用全身麻醉（P < 0.001）。美国患者的内镜相关并发症发生率较高（10.9% 对1.6%），腺体保留率较低（85.9% 对98.4%）；然而，在最后一次随访时，腺体完整的患者在两个中心的症状控制率相似（美国为92.7%，德国为85.3%）。美国腺体保留率较低主要是因为无法对较大的唾液结石进行碎石治疗。
与这些技术主要发源地德国相比，美国在慢性涎腺炎的内镜治疗中正在出现不同的治疗模式。尽管如此，两个地点接受内镜下腺体保留治疗的慢性涎腺炎患者的腺体保留率和症状控制率都很高。
