De Peppo Francesco, Caccamo Romina, Garganese Maria Carmen, Ceriati Emanuela, Marchetti Paola, Adorisio Ottavio Domenico, Cerchiari Antonella, Battaglia Sonia
Unit of Pediatric Surgery, Department of Surgery, Bambino Gesù Children's Hospital, Rome, Italy.
Service of Nuclear Medicine, Imaging Department, Bambino Gesù Children's Hospital, Rome, Italy.
Clin Otolaryngol. 2021 Jan;46(1):222-228. doi: 10.1111/coa.13650. Epub 2020 Oct 8.
The best surgical option to treat drooling in neurodisabilities is still under debate. The aim of this study was to describe the technique of subtotal functional sialoadenectomy (SFS) (ie four-duct ligation (4-DL) together with bilateral sublingual gland excision) and its long-term outcomes, in comparison with 4-DL.
Retrospective observational cohort study.
Unit of Pediatric Surgery of Bambino Gesù Children's Hospital (Rome).
Seventy-five patients surgically treated for drooling between 2002 and 2012, with at least five years of follow-up, divided into two groups: 4-DL group (19 patients) underwent four-duct ligation, and SFS group (56 patients) underwent subtotal functional sialoadenectomy.
Primary end points were the evaluation of drooling improvement after surgery (parameters: Drooling Severity and Frequency Scale, DSFS; no of bibs/day; no of shirts/day; no of pneumonia/year; use of antidrooling drugs) and the comparison between two different surgical techniques.
Median age at surgery was 10 years (1-35). Long-term outcomes showed significant improvement in DSFS and in no of shirts/day in both groups. Significantly better results were found in the SFS group than in the 4-DL group as far as DSFS (P value .045), no of bibs/day (P value .041), no of shirts/day (P value .032) are concerned. Reoperation rate for recurrence was 42% in the 4-DL group and 0% in the SFS group (P value < .0001). Six patients (8%; 2 in the 4-DL group and 4 in the SFS group) experienced perioperative complications, while 4 patients (5%; 2 in the 4-DL group and 2 in the SFS group) recorded long-term complications, with no difference between groups neither need for surgical treatment. No surgery-related mortality was recorded.
In our experience, subtotal functional sialoadenectomy ensured significantly greater long-term effects than four-duct ligation for drooling treatment in neurologically impaired child, with equal complication rate.
治疗神经功能障碍患者流涎的最佳手术方案仍存在争议。本研究旨在描述功能性腮腺次全切除术（SFS）（即四导管结扎术（4-DL）联合双侧舌下腺切除术）的技术及其长期疗效，并与4-DL进行比较。
回顾性观察队列研究。
罗马 Bambino Gesù 儿童医院小儿外科。
2002年至2012年间接受手术治疗流涎且至少随访5年的75例患者，分为两组：4-DL组（19例患者）接受四导管结扎术，SFS组（56例患者）接受功能性腮腺次全切除术。
主要终点是评估术后流涎改善情况（参数：流涎严重程度和频率量表，DSFS；每日围兜使用次数；每日衬衫更换次数；每年肺炎发生次数；抗流涎药物使用情况）以及两种不同手术技术之间的比较。
手术时的中位年龄为10岁（1 - 35岁）。长期疗效显示两组的DSFS和每日衬衫更换次数均有显著改善。就DSFS（P值0.045）、每日围兜使用次数（P值0.041）、每日衬衫更换次数（P值0.032）而言，SFS组的结果明显优于4-DL组。4-DL组复发再手术率为42%，SFS组为0%（P值<0.0001）。6例患者（8%；4-DL组2例，SFS组4例）出现围手术期并发症，4例患者（5%；4-DL组2例，SFS组2例）出现长期并发症，两组之间无差异，也无需手术治疗。未记录到与手术相关的死亡病例。
根据我们的经验，对于神经功能受损儿童的流涎治疗，功能性腮腺次全切除术比四导管结扎术具有显著更大的长期效果，且并发症发生率相同。
