Hals-, Nasen-, Ohren-Klinik, Kopf- und Hals-Chirurgie, Department of Otolaryngology, Head and Neck Surgery, Friedrich-Alexander-University of Erlangen-Nuremberg, Waldstrasse 1, 91054 Erlangen, Germany.
Eur Arch Otorhinolaryngol. 2013 May;270(6):1933-40. doi: 10.1007/s00405-012-2286-y. Epub 2012 Dec 6.
Objective was to assess the medium to long-term results and patients' perceive of success after combined sialoendoscopic and transcutaneous access in salivary gland diseases. A retrospective analysis was performed in a tertiary referral centre. A total of 19 patients have been treated with a combined sialoendoscopic and transcutaneous access. The main indication was sialolithiasis in 89.5 % of cases (n = 17), in 2 of these cases simultaneous complications were treated. Other indications included treatment-resistant stenosis and traumatic transection of the parotid duct. Intraductal stents were placed in 52.6 % of the cases. Patients were evaluated by clinical investigation, ultrasound examination and by a questionnaire to assess patients perceive of success. As a result the treatment was successful in 89.5 % of all cases, and in 94.1 % of the patients with sialolithiasis. Parotidectomy was required in two patients, as reconstruction of the ductal system was not possible intraoperatively (sialolithiasis, n = 1) or was unsuccessful (stenosis, n = 1). Prerequisites for successful treatment were the endoscopic access to the pathology, the possibility to reconstruct the duct and recovery of gland function postoperatively. A mean follow-up time for successfully treated patients was 40.67 months. All patients were satisfied with the results and reported a significant reduction in symptoms and improvement of their perceived quality of life (p = 0.001 each). As conclusion the combined access is a valuable alternative treatment in patients with sialolithiasis. Additional indications may include treatment-resistant stenosis and injuries to the parotid duct. However, the indication in stenosis needs to be carefully weighed up.
目的是评估涎腺疾病经涎腺内镜和经皮联合入路治疗的中远期疗效和患者对成功的感知。在一家三级转诊中心进行了回顾性分析。共有 19 名患者接受了涎腺内镜和经皮联合入路治疗。主要适应证为涎石症，占 89.5%（n=17），其中 2 例同时治疗了并发症。其他适应证包括治疗抵抗性狭窄和腮腺导管外伤性横断。52.6%的病例放置了导管内支架。通过临床检查、超声检查和问卷调查评估患者对成功的感知来评估患者。结果所有病例的治疗成功率为 89.5%，涎石症患者的治疗成功率为 94.1%。有 2 例患者需要行腮腺切除术，因为术中无法重建导管系统（涎石症，n=1）或重建不成功（狭窄，n=1）。成功治疗的前提是内镜进入病变部位、重建导管的可能性和术后腺体功能的恢复。成功治疗的患者平均随访时间为 40.67 个月。所有患者对结果均满意，并报告症状明显减轻，生活质量感知得到改善（p=0.001）。结论联合入路是治疗涎石症患者的一种有价值的替代治疗方法。其他适应证可能包括治疗抵抗性狭窄和腮腺导管损伤。然而，在狭窄的适应证中需要仔细权衡。
