Harrison J D, Epivatianos A, Bhatia S N
King's College School of Medicine and Dentistry, London, UK.
Histopathology. 1997 Sep;31(3):237-51. doi: 10.1046/j.1365-2559.1997.2530856.x.
Confusion about the aetiology and pathogenesis of chronic submandibular sialadenitis led to the present investigation of 154 cases in which many clinical and histological features were analysed.
By far the greatest number of histological factors, namely liths, atrophy, fibrosis, parenchymal inflammation, lymphoid germinal centres, mucous and ciliary metaplasia, salivary extravasation and glycosaminoglycan accumulation, was related to the degree of inflammation, which appears to be of the greatest importance in the aetiology and pathogenesis. Inflammation, atrophy and fibrosis were related to duration of symptoms, which supports the concept of a chronological progression through increasingly severe histological changes.
Inflammation possibly arises from ascending infection in a normal gland and exerts an obstructive and destructive effect on the parenchyma with the development of the related histological changes and a vicious circle involving further ascending infection. Normal glands contain microliths that possibly by localized obstruction cause atrophic foci that are reservoirs for ascending infection. Microliths and liths were unrelated: microliths were related to age as in normal glands whereas liths were related to duration of symptoms and appeared to be secondary to the sialadenitis. Many glands showed minimal changes, which raises the possibility of conservative treatment.
由于对慢性颌下腺涎腺炎的病因和发病机制存在困惑，因此对154例病例进行了本研究，分析了许多临床和组织学特征。
到目前为止，数量最多的组织学因素，即结石、萎缩、纤维化、实质炎症、淋巴生发中心、黏液和纤毛化生、涎液外渗和糖胺聚糖积聚，都与炎症程度有关，炎症在病因和发病机制中似乎最为重要。炎症、萎缩和纤维化与症状持续时间有关，这支持了随着组织学变化日益严重而按时间顺序进展的概念。
炎症可能源于正常腺体的上行感染，并随着相关组织学变化的发展以及涉及进一步上行感染的恶性循环，对实质产生阻塞和破坏作用。正常腺体含有微结石，可能通过局部阻塞导致萎缩灶，而萎缩灶是上行感染的储存库。微结石和结石无关：微结石与正常腺体中的年龄有关，而结石与症状持续时间有关，似乎是涎腺炎的继发表现。许多腺体显示出微小变化，这增加了保守治疗的可能性。
