1 Department of Otorhinolaryngology, Head and Neck Surgery, University of Erlangen-Nuremberg, Erlangen, Germany.
Otolaryngol Head Neck Surg. 2018 Sep;159(3):449-455. doi: 10.1177/0194599818775946. Epub 2018 Jul 3.
Objective To assess the value of ultrasound, if indicated, supplemented by sialendoscopy, in the diagnosis of sialolithiasis. Study Design Retrospective study. Setting Referring center for salivary gland diseases. Subjects and Methods All patients who presented with a suspected diagnosis of obstructive sialopathy between January 2011 and April 2017 and had not undergone any treatment were retrospectively evaluated. A total of 2052 patients and 2277 glands were included in the study. Ultrasound examinations were carried out initially and followed by sialendoscopy in all cases. Direct demonstration of sialothiasis by sialendoscopy, transoral ductal surgery, and discharge of concrements/observation of fragments during sialendoscopy after extracorporeal shock-wave lithotripsy were regarded as definitive evidence of sialolithiasis. Results Ultrasound had an accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of 94.77%, 94.91%, 94.57%, 96.14%, and 92.89%, respectively, for the diagnosis of sialolithiasis. All false-positive findings were correctly diagnosed, and in all false-negative findings, stones/fragments were visualized by sialendoscopy. Over 95% of the false-negative findings in major salivary glands (64/67) had visible ductal dilation in sonography, and in 73.1%, the stones not detected on ultrasound were located in the distal part of the duct, which is easily accessible with the sialendoscope. Conclusion This study shows that sialolithiasis can be diagnosed using ultrasonography with a high degree of certainty. If supplemented by sialendoscopy, the correct diagnosis could be established in virtually all cases of sialolithiasis. Ultrasound supplemented by sialendoscopy has the potential to serve as an alternative diagnostic standard in the future.
目的 评估超声（如有指征）联合涎腺内镜检查在涎石病诊断中的价值。
研究设计 回顾性研究。
设置 涎腺疾病转诊中心。
研究对象和方法 回顾性评估 2011 年 1 月至 2017 年 4 月间疑似患有阻塞性涎腺病且未接受任何治疗的所有患者。本研究共纳入 2052 例患者和 2277 个腺体。所有患者均行超声检查，随后行涎腺内镜检查。涎腺内镜下直接显示涎石、经口导管手术以及体外冲击波碎石后涎腺内镜下排出结石/观察到结石碎片被视为涎石病的明确证据。
结果 超声对涎石病的诊断准确性、敏感度、特异度、阳性预测值和阴性预测值分别为 94.77%、94.91%、94.57%、96.14%和 92.89%。所有假阳性发现均得到正确诊断，所有假阴性发现均经涎腺内镜检查显示出结石/碎片。大多数涎腺（64/67）的假阴性发现中，超声均显示导管扩张，95%以上的扩张导管可经涎腺内镜到达，且 73.1%的情况下，超声未检出的结石位于导管的远端，也可经涎腺内镜到达。
结论 本研究表明，超声可高度准确地诊断涎石病。若联合涎腺内镜检查，几乎可确诊所有涎石病患者。超声联合涎腺内镜检查具有成为未来替代诊断标准的潜力。
