下颌下腺腺门区扩张与导管结石存在的相关性研究

阻塞性唾液腺疾病常发生于下颌下腺及腮腺，病因多为物理性阻塞物的存在或导管病理性狭窄。在阻塞性唾液腺疾病中，涎石病约占66%[1]。据报

道，每年新发涎石病6000万例，在普通人群中发病率为1.2%[2-4]。另有报道称人群中每年涎石病新发比率约为1∶20000~1∶30000[5-6]。然而，涎石病的病因目前仍不十分清楚。有学者提出，涎石的形成，首先是由脱落上皮细胞、异物、细菌分解产物、微生物或黏液栓子等形成核心，然后碳酸盐逐渐沉积于核心上，从而使涎石增大[7-11]。

腺体分泌唾液黏稠呈碱性，下颌下腺导管路径

下颌下腺腺门区扩张与导管结石存在的相关性研究

石

欢，

俞创奇，

郑凌艳，

浦益萍，

谢李松，

王知俊

（上海交通大学医学院附属第九人民医院·口腔医学院口腔颌面外科，

上海市口腔医学重点实验室,上海

200011)

[摘要]目的:研究下颌下腺导管解剖形态的改变与涎石形成的关系。方法：回顾性分析372例下颌下腺导管结石患

者，在接受内镜治疗过程中镜下观察到的导管解剖形态资料，并用自凝塑料复制10例离体下颌下腺导管解剖形态铸型，分析导管解剖形态的改变与涎石形成的关系。结果：372例涎腺镜术中有326例在镜下发现涎石，在所发现的

426颗结石中约67%的涎石位于导管腺门端1/3或腺门区。在发现涎石的病例中，内镜探查导管系统发现87.4%的

病例存在腺门区壶腹状扩张现象。10例下颌下腺导管铸型均直观地表现出导管系统树形结构及腺门区壶腹状扩张现象。结论：下颌下腺导管结石患者普遍存在腺门区壶腹状扩张现象。大部分下颌下腺导管结石位于近导管腺门端

1/3或腺门区。[关键词]

下颌下腺；腺门区扩张；涎石；涎腺镜；铸型

[中图分类号]R781.75[文献标志码]A

[文章编号]1005-4979（2013）02-0101-04

doi:10.3969/j.issn.1005-4979.2013.02.006

Dilatation of Glandular Hilum and Obstructive Salivary Diseases:A Retrospective Analysis

SHI Huan,YU Chuang -qi,ZHENG Ling -yan,PU Yi-p ing ,XIE Li -song,WANG Zhi -jun

(Department of Oral and Maxillofacial Surgery,College of Stomatology,the Ninth People ′s Hospital,School of Medicine ，Shanghai Jiaotong University,Shanghai Key Laboratory of Stomatology,Shanghai 200011,China)

[Abstract]

Objective:To analyze whether variation of anatomic morphology of salivary ductal system was associated

with the occurrence of obstructive salivary diseases.Methods:372cases of submandibular gland obstructive disease with sialolithiasis were retrospectively reviewed.Variations of duct hilum observed by sialoendoscopy,and ductal systems acrylic resin replicated cast of 10patients were used to analyze any association between anatomical variances in the ductal system and sialolith formation.Results:Sialolithiasis was detected in 87.6%（326/372）of these patients who presented with obstructive symptoms.Roughly 67%(285/426)of the stones were located in the distal third of the ducts or at the hilum of the submandibular gland.87.4%(285/326)hilums were noted to be dilated,like a basin by sialoendoscopy.The anatomy of the duct from the replicated casts demonstrated a tree -like structure and the basin -like widening of the hilum was found in all the 10replicated casts.Conclusion:A high number of patients presenting with sialolithiasis in the submandibular gland seem to have an anatomical variance in the hilar region.

[Key words]submandibular gland;widened hilum;sialolith;sialoendoscopy;replicated casts

基金项目：国家自然科学基金资助项目(81100766)；上海市重点学

科建设项目（S30206）；上海高校创新团队发展计划；上海交通大学医学院校基金（YZ1024）；上海市科学技术委员会医学引导类基金(08DZ2271100，10411964400)

作者简介：石欢（1987—），女，湖南湘潭人，硕士研究生.E -mail:

catherine18021312@

通信作者：俞创奇，教授.E -mail:ycq616@

口腔颌面外科杂志2013年4月第23卷第2期

Journal of Oral and Maxillofacial Surgery Vol．23No．2April ,2013

101

··