Jeong Shin Young, Lee Jaetae
Department of Nuclear Medicine, Kyungpook National University Hospital, 50 Samduck-dong 2-ga, Jung-gu, Daegu, 700-721 Korea.
Nucl Med Mol Imaging. 2010 Jun;44(2):102-9. doi: 10.1007/s13139-010-0027-y. Epub 2010 Apr 21.
Radioactive iodine ((131)I) is accumulated in the thyroid tissue and plays an important role in the treatment of differentiated papillary and follicular cancers after thyroidectomy. Simultaneously, (131)I is concentrated in the salivary glands and secreted into the saliva. Dose-related damage to the salivary parenchyma results from the (131)I irradiation. Salivary gland swelling and pain, usually involving the parotid, can be seen. The symptoms may develop immediately after a therapeutic dose of (131)I and/or months later and progress in intensity with time. In conjunction with the radiation sialadenitis, secondary complications reported include xerostomia, taste alterations, infection, increases in caries, facial nerve involvement, candidiasis, and neoplasia. Prevention of (131)I sialadenitis may involve the use of sialogogic agents to hasten the transit time of the radioactive iodine through the salivary glands. However, studies are not available to delineate the efficacy of this approach. Treatment of the varied complications that may develop encompass numerous approaches and include gland massage, sialogogic agents, duct probing, antibiotics, mouthwashes, good oral hygiene, and adequate hydration. Recently interventional sialoendoscopy has been introduced an effective tool for the management of patients with (131)I-induced sialadenitis that is unresponsive to medical treatment.
放射性碘(¹³¹I)在甲状腺组织中蓄积,在甲状腺切除术后分化型乳头状癌和滤泡状癌的治疗中发挥重要作用。同时,¹³¹I在唾液腺中浓聚并分泌到唾液中。¹³¹I照射会导致唾液腺实质出现剂量相关损伤。可出现唾液腺肿胀和疼痛,通常累及腮腺。这些症状可能在给予治疗剂量的¹³¹I后立即出现和/或数月后出现,并随时间推移而加重。与放射性涎腺炎相关的继发性并发症包括口干、味觉改变、感染、龋齿增加、面神经受累、念珠菌病和肿瘤形成。预防¹³¹I涎腺炎可能包括使用催涎剂以加快放射性碘通过唾液腺的转运时间。然而,尚无研究阐明这种方法的疗效。对可能出现的各种并发症的治疗包括多种方法,如腺体按摩、催涎剂、导管探查、抗生素、漱口水、良好的口腔卫生和充足的水分摄入。最近,介入性涎腺内镜已被引入,成为治疗对药物治疗无反应的¹³¹I诱导涎腺炎患者的有效工具。