Sideris Giorgos, Konstantinidis Iordanis, Kourklidou Melina, Chatziavramidis Aggelos, Delides Alexander
School of Medicine, 2nd Otolaryngolgy Department, National & Kapodistrian University of Athens, "Attikon" University Hospital, Rimini 1, Chaidari, Athens 124 62, Greece.
2nd Academic ORL Department, Aristotle University of Thessaloniki, Papageorgiou Hospital, Thessaloniki, Greece.
J Stomatol Oral Maxillofac Surg. 2024 Apr;125(2):101643. doi: 10.1016/j.jormas.2023.101643. Epub 2023 Sep 22.
This retrospective multi-institutional chart review study aims to present results from patients treated with Holmium:YAG laser-assisted sialendoscopic intraductal lithotripsy under local anesthesia.
Preoperative ultrasound and/or CT were used for location and measurement of the stones. Local anesthesia was applied in all patients, Marchal all-in- one 1.3 mm and Erlangen 1.6 sialendoscopes were used. The laser was used with power settings limited by discomfort or pain. Inclusion criteria were stone size (all >5 mm) and fixed stones.
42 patients, 48 stones were treated (30 males/12 females), 21 submandibular and 21 parotid. Ages ranged from 20 to 70 years (95 % CI: 43.37-51.58). Mean size was 6.2 mm (95 % CI: 5.71-6.72). Complete fragmentation was achieved in 66.7 % and incomplete in 33.3 %. Out of the incomplete fragmented 14 cases, seven (50 %) remained symptom free on follow-up. Maximum duration was 120 min. Minimum power settings of the laser was 4.8 Watts and maximum 18 Watts. Six patients expressed pain or discomfort that limited power increase and duration of the procedure. Total follow up time was 10 years. There were no major complications such as hemorrhage, nerve paresis or skin ulceration.
The procedure is safe under local anesthesia, well tolerated by most patients and should be used in cases of small fixed and "intermediate-sized" stones as a single modality. Discomfort may limit power settings and duration. The later is the major disadvantage of the method.
本回顾性多机构图表审查研究旨在呈现接受钬激光辅助唾液腺内镜导管内碎石术局部麻醉治疗患者的结果。
术前超声和/或CT用于结石定位和测量。所有患者均采用局部麻醉，使用Marchal一体化1.3毫米和埃尔朗根1.6毫米唾液腺内镜。激光使用时功率设置受不适或疼痛限制。纳入标准为结石大小（均>5毫米）和固定结石。
42例患者，共治疗48颗结石（男性30例/女性12例），21颗在下颌下腺，21颗在腮腺。年龄范围为20至70岁（95%置信区间：43.37 - 51.58）。平均大小为6.2毫米（95%置信区间：5.71 - 6.72）。66.7%实现完全碎裂，33.3%未完全碎裂。在未完全碎裂的14例中，7例（50%）随访时无症状。最长持续时间为120分钟。激光最低功率设置为4.8瓦，最高为18瓦。6例患者表示疼痛或不适限制了功率增加和手术持续时间。总随访时间为10年。无大出血、神经麻痹或皮肤溃疡等重大并发症。
该手术在局部麻醉下安全，大多数患者耐受性良好，对于小的固定和“中等大小”结石病例应作为单一治疗方式使用。不适可能限制功率设置和持续时间。后者是该方法的主要缺点。
