Zhao Jian, Zhang Lei, Liu Deng-gao, Zhang Zu-yan, Yu Guang-yan
Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing 100081, China; Department of Head and Neck Surgery, Kai Luan General Hospital, Hebei Tangshan 063000, China.
Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing 100081, China.
Beijing Da Xue Xue Bao Yi Xue Ban. 2014 Feb 18;46(1):39-42.
To explore the clinical application of endoscope-assisted operative retrieval of large parotid stones as a minimally invasive alternative.
From January 2010 to April 2013, 6 patients (male: 5, female: 1, age from 30-62 years, and median age: 49.5 years)suffering from recurred swelling of parotid gland due to sialoliths were treated by endoscope-assisted parotid surgery in Peking University School and Hospital of Stomatology. All of the patients underwent clinical, ultrasonographic and cone-beam CT (CBCT) examinations to get the detailed information of the number, location and size of stones, which was recorded in the medical records. endoscope-assisted parotid surgery was performed under general anesthesia in all the 6 cases after the failure of basket or forcep retrieval firstly. During the operation, sialoendoscope was used to locate the stone exactly and then the calculus was exposed through a pre-auricular approach and released by incising the duct. The postoperative complications were recorded and observed during the follow-up periods.
Preoperative radiological examinations showed that all of the sialoliths were near the hilum of parotid gland ducts in the 6 cases, which were 5-9 mm in diameter. All of the stones were removed successfully by endoscope-assisted operative retrieval. The incisions healed smoothly in all the 6 cases. There were no cases of facial nerve weakness, infection or salivary fistula. After a mean follow-up of 19 months (ranging from 6-36 months), 5 patients remained asymptomatic and 1 patient had mild obstructed or infective symptoms. The final results were satisfied.
It is suggested that endoscope-assisted operative retrieval is a viable minimally invasive alternative to remove the large or recalcitrant parotid stones with a high successful rate and low complications.
探讨内镜辅助下手术取出腮腺大结石作为一种微创替代方法的临床应用。
2010年1月至2013年4月，北京大学口腔医学院口腔医院对6例（男5例，女1例，年龄30 - 62岁，中位年龄49.5岁）因涎石病导致腮腺反复肿胀的患者行内镜辅助腮腺手术。所有患者均接受临床、超声及锥形束CT（CBCT）检查，以获取结石数量、位置及大小的详细信息，并记录于病历中。6例患者在最初使用篮式取石器或镊子取石失败后，均在全身麻醉下行内镜辅助腮腺手术。术中，使用涎腺内镜精确定位结石，然后通过耳前入路暴露结石，并切开导管取出结石。记录术后并发症，并在随访期间进行观察。
术前影像学检查显示，6例患者的涎石均位于腮腺导管开口附近，直径5 - 9 mm。所有结石均通过内镜辅助手术成功取出。6例患者切口均顺利愈合。无一例出现面神经麻痹、感染或涎瘘。平均随访19个月（6 - 36个月）后，5例患者无症状，1例患者有轻度梗阻或感染症状。最终结果满意。
内镜辅助手术取出腮腺大结石或难取性结石是一种可行的微创替代方法，成功率高，并发症少。
