Carta F, Farneti P, Cantore S, Macrì G, Chuchueva N, Cuffaro L, Pasquini E, Puxeddu R
Department of Otorhinolaryngology, University of Cagliari, Azienda Ospedaliero Universitaria di Cagliari, Italy.
Ear, Nose and Throat Unit of Sant'Orsola-Malpighi Hospital, Bologna, Italy.
Acta Otorhinolaryngol Ital. 2017 Apr;37(2):102-112. doi: 10.14639/0392-100X-1599.
Obstructive sialadenitis is the most common non-neoplastic disease of the salivary glands, and sialendoscopy is increasingly used in both diagnosis and treatment, associated in selected cases with endoscopic laser lithotripsy. Sialendoscopy is also used for combined minimally invasive external and endoscopic approaches in patients with larger and proximal stones that would require excessively long laser procedures. The present paper reports on the technical experience from the Ear, Nose and Throat Unit of the Sant'Orsola-Malpighi Hospital of Bologna, and from the Department of Otorhinolaryngology of the University Hospital of Cagliari, Italy, including the retrospective analysis of the endoscopic and endoscopic assisted procedures performed on 48 patients (26 females and 22 males; median age 45.3; range 8-83 years) treated for chronic obstructive sialadenitis at the University Hospital of Cagliari from November 2010 to April 2016. The results from the Sant'Orsola-Malpighi Hospital of Bologna have been previously published. The technical aspects of sialendoscopy are carefully described. The retrospective analysis of the University Hospital of Cagliari shows that the disease was unilateral in 40 patients and bilateral in 8; a total of 56 major salivary glands were treated (22 submandibular glands and 34 parotids). Five patients underwent bilateral sialendoscopy for juvenile recurrent parotitis. 10 patients were treated for non-lithiasic obstructive disease. In 33 patients (68.75%) the obstruction was caused by salivary stones (bilateral parotid lithiasis in 1 case). Only 8 patients needed a sialectomy (5 submandibular glands and 3 parotids). The conservative approach to obstructive sialadenitis is feasible and can be performed either purely endoscopically or in a combined modality, with a high percentage of success. The procedure must be performed with dedicated instrumentation by a skilled surgeon after proper training since minor to major complications can be encountered. Sialectomy should be the "extrema ratio" after failure of a conservative approach.
阻塞性涎腺炎是涎腺最常见的非肿瘤性疾病，涎腺内镜检查在诊断和治疗中的应用越来越广泛，在某些病例中还与内镜激光碎石术联合使用。涎腺内镜检查也用于治疗较大的近端结石患者，这些患者若采用激光手术，手术时间会过长，此时可采用微创的外部和内镜联合治疗方法。本文报告了意大利博洛尼亚圣奥索拉-马尔皮基医院耳鼻喉科以及卡利亚里大学医院耳鼻喉科的技术经验，包括对2010年11月至2016年4月在卡利亚里大学医院接受慢性阻塞性涎腺炎治疗的48例患者（26例女性和22例男性；中位年龄45.3岁；年龄范围8 - 83岁）所进行的内镜及内镜辅助手术的回顾性分析。博洛尼亚圣奥索拉-马尔皮基医院的结果此前已发表。文中仔细描述了涎腺内镜检查的技术方面。卡利亚里大学医院的回顾性分析表明，40例患者为单侧疾病，8例为双侧疾病；共治疗了56个主要涎腺（22个下颌下腺和34个腮腺）。5例患者因青少年复发性腮腺炎接受了双侧涎腺内镜检查。10例患者因非结石性阻塞性疾病接受治疗。33例患者（68.75%）的阻塞是由涎石引起的（1例为双侧腮腺结石）。只有8例患者需要进行涎腺切除术（5个下颌下腺和3个腮腺）。阻塞性涎腺炎的保守治疗方法是可行的，可以单纯通过内镜进行，也可以采用联合方式，成功率很高。该手术必须由经过适当培训的熟练外科医生使用专用器械进行，因为可能会遇到从轻微到严重的并发症。保守治疗失败后，涎腺切除术应作为“最终手段”。
