涎腺内镜辅助下涎腺导管手术治疗无涎石病的涎腺炎的一年疗效
One-year outcomes of sialendoscopic-assisted salivary duct surgery for sialadenitis without sialolithiasis.
作者信息
Plonowska Karolina A, Gurman Zev R, Humphrey Amanda, Chang Jolie L, Ryan William R
机构信息
University of California, San Francisco School of Medicine, San Francisco, San Francisco, California, U.S.A.
the Division of General Otolaryngology, Salivary Gland Surgery Center, Department of Otolaryngology-Head and Neck Surgery, San Francisco, San Francisco, California, U.S.A.
出版信息
Laryngoscope. 2019 Apr;129(4):890-896. doi: 10.1002/lary.27433. Epub 2018 Aug 27.
OBJECTIVES
To prospectively examine durability of long-term outcomes in sialendoscopy-assisted salivary duct surgery (SASDS) in chronic obstructive sialadenitis without sialolithiasis (COSWS).
METHODS
A prospective cohort study of adult patients with COSWS who completed Chronic Obstructive Sialadenitis Symptoms (COSS) Questionnaire prior to and at 3 months and 1 year following SASDS. COSS scores scaled to 0 to 100 were analyzed by statistically significant improvements and previously published ranges corresponding to complete, partial, and nonresolution of symptoms.
RESULTS
Twenty-nine patients with COSWS affecting 41 glands had statistically significant improvements in COSS scores at 3 months following SASDS. These improvements usually were sustained at 1 year, supporting durability of treatment effect over time. A majority of cases (30 of 41, 73%) achieved at least a partial resolution of sialadenitis symptoms (COSS score ≤ 25) at 1-year follow-up. Symptom improvement after SASDS was noted in 14 of 18 (78%) glands with radioiodine-induced sialadenitis (RAI-IS). The highest proportion of persistent or recurrent disease at 1-year post-SASDS was found in autoimmune sialadenitis (2 of 4, 50%) and glands with proximal or multifocal stenoses (6 of 12, 50%). At 1 year, distal duct stenoses achieved a significantly higher proportion of partial or complete symptom resolution (18 of 21, 86%) than cases with proximal or multifocal stenoses (6 of 12, 50%; P = 0.044).
CONCLUSIONS
SASDS is effective in reducing symptoms in duct stenosis and RAI-IS, usually with durable treatment benefits at long-term follow-up. Distal stenoses appear to be more amenable to sialendoscopic treatment, achieving greater symptom reduction than proximal/multifocal stenoses. Additional larger multi-center studies are needed to further characterize risk factors for COSWS refractory to SASDS.
LEVEL OF EVIDENCE
2 Laryngoscope, 129:890-896, 2019.
目的
前瞻性研究在无涎石病的慢性阻塞性涎腺炎（COSWS）中，涎腺内镜辅助涎腺导管手术（SASDS）长期疗效的持久性。
方法
对成年COSWS患者进行前瞻性队列研究，这些患者在SASDS术前、术后3个月和1年时完成慢性阻塞性涎腺炎症状（COSS）问卷。对范围为0至100的COSS评分进行分析，观察具有统计学意义的改善情况以及先前发表的与症状完全缓解、部分缓解和未缓解相对应的范围。
结果
29例患有COSWS且累及41个腺体的患者在SASDS术后3个月时COSS评分有统计学意义的改善。这些改善通常在1年时得以维持，支持了治疗效果随时间的持久性。在1年随访时，大多数病例（41例中的30例，73%）涎腺炎症状至少得到部分缓解（COSS评分≤25）。在18例放射性碘诱导的涎腺炎（RAI-IS）腺体中，有14例（78%）在SASDS术后症状改善。在SASDS术后1年，自身免疫性涎腺炎（4例中的2例，50%）以及近端或多灶性狭窄的腺体（12例中的6例，50%）中持续性或复发性疾病的比例最高。在1年时，远端导管狭窄实现部分或完全症状缓解的比例（21例中的18例，86%）显著高于近端或多灶性狭窄的病例（12例中的6例，50%；P = 0.044）。
结论
SASDS在减轻导管狭窄和RAI-IS症状方面有效，在长期随访中通常具有持久的治疗益处。远端狭窄似乎更适合涎腺内镜治疗，比近端/多灶性狭窄能实现更大程度的症状减轻。需要更多更大规模的多中心研究来进一步明确对SASDS难治的COSWS的危险因素。
证据级别
2《喉镜》，129:890 - 896，2019年。
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