血管化自体颌下腺移植治疗重症角结膜干燥症指南

角结膜干燥症是全身或局部因素引起泪膜功能障碍导致的以角结膜干燥症状为主的疾病,是眼科的常见病,其发病率呈上升趋势.严重者视力减退,甚至可致失明.现有治疗方法以对症治疗为主,如应用人工泪液等,治疗方法对轻症者有一定疗效,重症者基本无效.以颌下腺分泌液代替泪液的血管化自体颌下腺移植已成为治疗重症角结膜干燥症的有效方法[1-3].然而,血管化自体颌下腺移植的技术要求较高,影响手术成功的因素和环节较多[4].     

颌下腺移植治疗角结膜干燥症的手术要点及并发症处理

目的 总结血管化自体颌下腺移植治疗重症角结膜干燥症的手术要点及并发症预防与处理的经验。方法 用该技术治疗23例重症角结膜干燥症，术后行^99m锝核素显像，随诊及并发症相应处理。结果 19例腺体移植成功，眼干症状消失，停用人工泪液；4例腺体未成活；5例出现泪溢，经切除部分移植腺体后症状消失；1例颌下腺导管闭锁，行导管重建术后症状减轻。结论 静脉桥接可解决腺体静脉与颞浅静脉管径不匹配问题；断离腺体前，保留颌外动脉，观察3条静脉渗血情况及游离颌一腺行颌外动脉肝素生理盐水灌注，观察3条静脉渗出情况，有助于选择合适的供体静脉。恰当处理与颌下腺移植治疗重症角结膜干燥症手术相关的各个环节，可提高手术成功率。     

血管化自体下颌下腺移植治疗重症角结膜干燥症的初步研究

目的:应用血管化自体下颌下腺移植的方法治疗重症角结膜干燥症,并评价其疗效.方法:纳入重症角结膜干燥症患者4例,将患者下颌下腺移植至颞部,完成血管吻合,并将移植腺体导管重新开口于患眼.术后监测移植腺体血运并调控其分泌功能,对患眼治疗效果进行评估.结果:2017—2019年共治疗了4例患者的5只眼,其中1例接受双侧眼部手术...     

血管化自体下颌下腺移植术后腺体功能的变化及干预

目的 总结血管化自体下颌下腺移植术后腺体功能的变化规律，分析各种干预方法的效果。方法 接受血管化自体下颌下腺移植治疗并获得手术成功的重症角结膜干燥症患者40例，手术后通过施墨试验监测移植后腺体的分泌功能。对其中部分患者在其休眠期内分别给予热敷加按摩、红外线理疗、辣椒刺激和使用博利康尼等干预措施，对比应用上述措施之后腺体分泌功能的变化。结果 血管化自体下颌下腺移植成功后，腺体功能的变化分为4个阶段，即：术后短暂失功能期、术后暂时性泪溢期、术后腺体休眠期以及术后功能恢复稳定期。在腺体休眠期内，采用局部热敷并按摩腺体、红外线理疗、辣椒刺激等方法可促进腺体分泌，但是使用博利康尼后对腺体分泌没有显著影响。结论 血管化自体下颌下腺移植成功后，腺体功能的变化有其规律性，其中在第3阶段即腺体休眠期内，应采取必要的干预措施促进腺体分泌，以避免导管堵塞。     

第二期血管化下颌下腺移植治疗角结膜干燥症学习班及中德研讨会会议纪要

由中华口腔医学会口腔颌面外科专业委员会涎腺疾病学组主办、北京大学口腔医学院承办的国家级继续教育项目———血管化下颌下腺移植治疗角结膜干燥症学习班及中德研讨会于2004年10月25日至27日在北京召开,来自德国、新加坡和国内的代表近30余人参加了会议。在国际上较早开展血管化下颌下腺移植治疗研究的德国吕贝克大学Sieg教授带领其研究小组参加了本次研讨会。本次学习班是第二期血管化下颌下腺移植治疗角结膜干燥症学习班,来自北京大学口腔医学院以及北京市同仁医院的7名专家作了专题讲座,全面介绍了眼干症的综合治疗、血管化自体下颌…     

自体颌下腺移植治疗角结膜干燥症实验研究

目的 通过兔自体颌下腺移植试验，研究自体颌下腺移植治疗角结膜干燥症的可行性，移植术中、术后可能发生的问题及解决方法。方法 健康大耳白家兔20只，分成2组。试验组功除泪腺，通过血管吻合移植自体颌下腺至左颞部，导管植入外下穹隆结膜；对照组仅切除泪腺，不移植颌下腺。术后观察2个月，于术后1、2、3、4及8周分别进行施墨试验、移植眼泪液唾液淀粉酶测定、移植颌下腺造影、移植腺体及角膜组织病理学检查。结果 对照组兔术后施墨试验滤纸条长度低于术前，移植组施墨试验滤纸条长度高于术前。移植眼唾液淀粉酶浓度高于术前。移植腺体造影可清楚显示移植颌下腺完好的导管及腺泡结构，组织病理学观察，移植成功腺体结构正常，移植侧角膜无受破坏现象。结论 自体颌腺移植可适当增加角结膜干燥症兔泪液量，移植腺体分泌的唾液不会对眼部结构造成破坏，是治疗角治膜干燥症的有效方法。施墨试验及唾液淀粉酶浓度测定对壑移植腺体是否成活及移植腺体功能具有重要意义。移植颌下腺造影是检查移植腺体结构及功能的一种较好方法。     

治疗角结膜干燥症自体颌下腺移植的血管处理

目的总结血管化自体颌下腺游离移植治疗角结膜干燥症的血管处理方法。方法对1999年8月至2004年4月完成的68例血管化自体颌下腺游离移植的血管处理作回顾性研究，分析受区和供区的血管、术后血管危象的发生和处理以及腺体的成活情况。结果68例游离颌下腺移植的供区和受区动脉均为颌外动脉与颞浅动脉，所用供区静脉中，面前静脉55例，颌外动脉伴行静脉12例，腺门静脉1例；所用受区静脉中，62例为颞浅静脉，1例为颢深静脉，5例经头静脉桥接后，回流至颈外静脉或颈内静脉的属支。术后10例出现血管危象，其中9例静脉危象，1例动脉危象，1例静脉危象经抢救腺体获得成活，本组移植腺体的成活率为86．8％（59／68）。结论血管化自体颌下腺移植的静脉变异较大，应根据每一病例的具体特点作出相应的处理，其中以颌外动脉伴行动脉与颞浅静脉的吻合最为可靠，显微镜下的血管吻合有助于降低术后血管危象的发生率，提高移植腺体的成活率。     

自体颌下腺移植治疗角结膜干燥症术后泪液成份分析

目的 了解自体颌下腺移植术后泪液成份的变化。方法 采用实验室常规方法检测移植术后8例患者泪液及30例正常人泪液,颌下腺液的化学成份并进行比较。测定项目包括;淀粉酶,溶菌酶,钠、钾、钙、磷,渗透压,尿素、肌酐,尿酸,总蛋白、免疫球蛋白,甘油三脂,葡萄糖,酸碱度等。结果 正常人泪液中各种成分在唾液中均可检出;移植术后的“唾液泪液”（S-T）中淀粉酶（AMY）呈高分泌状态;钠（Na)含量低于正常泪液;渗透压介于唾液与泪液之间,呈低渗,尿酸（Ua)含量高于正常泪液;溶菌酶（LZ）含量明显低于正常泪液。结论 颌下腺移植术后S-T液的性质介于正常泪液与颌下腺液之间;高分泌水平的AMY表明移植腺体保持良好的分泌功能。AMY可作为腺体移植成活的生化标准;某些成分的明显差异能否对移植效果造成影响,有待进一步观察。     

血管化自体颌下腺移植术中重建血液循环的护理配合

目的 探讨和总结血管化自体颌下腺移植术中重建血液循环的护理配合措施.方法 分析2005年1月-2009年3月北京大学口腔医院手术室完成的56例血管化自体颌下腺移植手术的临床资料,总结术中血液循环重建时的护理配合体会.结果 56例自体颌下腺移植手术结束时,移植腺体的血液循环全部重建满意,吻合口血流通畅,没有血栓形成.术后...     

涎腺疾病

20051965 紫杉醇及β榄香烯对人涎腺腺样囊性癌细胞株SACC-83细胞毒作用的研究；20051966 涎腺腺样囊性癌细胞凋亡的诱导与P53基因的修复；20051967 腮腺癌术后放疗的评价；20051968 涎腺腺样囊性癌中p53、PCNA评分和Bcl-2表达与病理分型和复发的关系；20051969 自体下颌下腺移植治疗重症干眼症的供体制备；20051970KAT性腮腺炎8例报告……     

Microvascular autologous submandibular gland transfer in severe cases of keratoconjunctivitis sicca

The objective is to evaluate the technique of microvascular autologous submandibular gland transfer for the treatment of severe keratoconjunctivitis sicca. From August 1999 to April 2002, 38 patients with severe keratoconjunctivitis sicca were treated by autologous submandibular gland transfer to the temporal region of the skull. The related vessels were anastomosed to the superficial temporal artery and vein. When the vein was too small, venous bridging was applied. Prior to cutting off the gland, the facial artery was preserved and infused with heparin in normal saline after the gland had been freed to allow inspection of the blood oozing from the three veins. This would be helpful in the selection of a relevant vein for anastomosis. Wharton's duct was transplanted to the upper lateral conjunctiva fornix, and the gland was left denervated. Postoperative scintigraphy with Tc99m pertechnetate, follow-up studies, and management of complications were performed. The transplantations were successful in 33 cases, their symptoms of xerophthalmia disappeared. The discomfort resulting from bright light and wind was also relieved. These patients could stop applying artificial tears. In five patients the transplanted glands did not survive. Epiphora occurred in eight cases. They were successfully treated by reducing the size of the graft. Obliteration of Wharton's duct took place in two cases and was treated by the reconstruction of the duct or duct orifice. Microvascular autologous submandibular gland transfer is a lasting and effective solution for severe cases of keratoconjunctivitis sicca.     

面动脉伴行静脉作为自体颌下腺移植回流静脉的可靠性探讨

目的 探讨面动脉伴行静脉作为血管化自体颌下腺移植供区静脉的可靠性,以期为临床提供指导.方法 对1999年8月至2007年11月期间完成的117例共122侧血管化自体颌下腺移植回顾性研究,根据腺体移植时所选用供区静脉的不同,将全部病例分成3组:面静脉组(93侧)、伴行静脉组(27侧)和腺门静脉组(2侧),并分析各组腺体移植术后静脉危象的发生率及其处理情况.结果 术后共有16侧移植腺体出现静脉危象,其中面静脉组14侧(15%),伴行静脉组2侧(7%),两者差异有统计学意义(P<0.01).面静脉组中有7侧因静脉危象导致失败(8%),伴行静脉组中有2侧因静脉危象导致失败(7%),两者差异无统计学意义(P>0.05).结论 面动脉伴行静脉是自体颌下腺移植可靠的回流静脉,只要管径合适,面动脉伴行静脉应作为自体颌下腺移植的首选供区静脉.     

Long-term results of autologous submandibular gland transfer for the surgical treatment of severe keratoconjunctivitis sicca.

AIM: The aim of this study was to assess the long-term results of autologous submandibular gland transfer for surgical correction of severe keratoconjunctivitis sicca. PATIENTS AND METHODS: A survey was undertaken of 32 patients who had undergone submandibular gland transfer (42 glands) and by following up 11 patients (15 glands) for 5-10 years. Subjective benefit was evaluated as well as clinical findings at the ocular surface. The biochemical consistency of the secreted "saliva-tear" was analysed and compared with natural submandibular saliva of a matched control-group. The vitality and function of the transplants was tested by means of sialoscintigraphy. Immunohistochemical investigations were carried out in specimens of submandibular tissue, gained during reduction procedures of the transplants to correct secretory excess. RESULTS: Patient evaluation and clinical assessment revealed a long-lasting subjective benefit in 2/3 of the patients and a stabilisation at the ocular surface in all cases. The secretion remained as highly concentrated submandibular saliva. Glandular vitality and function was shown scintgraphically. Immunohistochemical investigations revealed no progressive atrophy after transplantation, the ability of cell division remained intact and there was still neuronal tissue in all transplants, even several years after transfer. As all transplants responded well to parasympathomimetic drugs, this might be an indication of re-innervation of the gland.     

IgG4相关下颌下腺炎伴局部淋巴结病变的临床与病理特点分析

目的 :分析IgG4相关下颌下腺炎伴局部淋巴结病变的临床和病理特点,并深入探讨其鉴别诊断与治疗方法。方法:回顾2007-09—2015-08期间,诊断为IgG4相关下颌下腺炎性病变患者14例,其中男性5例,女性9例,年龄范围16~75岁,分析临床及影像学表现和病理特点。结果:IgG4相关下颌下腺炎可发生于多个年龄段,下颌下腺肿大可伴口干、眼干及泪腺肿大症状,血清IgG4分类水平3 380~21 600mg/L。增强CT表现为弥漫性肿大,均匀强化,边界清晰。病理显示小叶结构破坏,大量IgG4阳性细胞浆细胞浸润伴有淋巴滤泡形成,席纹状纤维化和闭塞性静脉炎。淋巴结病变表现为大量的淋巴滤泡伴增生活跃的生发中心。结论:IgG4相关疾病是一类病因不明的纤维化炎症性疾病,有独特的临床及病理表现。活检确诊IgG4相关下颌下腺炎的患者,建议进行全身系统性评估,发现其他器官累及可能,以利整体治疗计划的制定。     

颌下腺多形性腺瘤及其复发的临床研究

目的:评价颌下腺多形性腺瘤及其复发的临床特点及原因。方法:对8例颌下腺多形性腺瘤复发的临床特点和24例颌下腺手术野术中脱落细胞学进行分析及检测。结果:本院颌下腺多形性腺瘤术后有3例复发(3/366例,0.8%),另5例复发性颌下腺多形性腺瘤均为外院转入我院。8例病例复发时间均在1年以上,其中1例第2次复发时间为第1次复发术后5个月。1例复发性颌下腺多形性腺瘤术中见瘤体深叶处存留少许腺细胞,7例无腺细胞残留。术中脱落细胞显示8例原发性肿瘤手术野冲洗前有3例检测到腺泡细,5例为血液细胞,冲洗后2例为腺泡细胞,6例为血液细胞,8例复发性肿瘤冲洗前后均为1例腺泡细胞,7例血液细胞。8例非瘤性病变冲洗前1例为腺泡细胞,7例血液细胞,冲洗后均为血液细胞,3组之间无显著性差异(P>0.05)。结论:颌下腺多形性腺瘤复发罕见,可能与细胞学穿刺及瘤旁腺泡有关。     

Maxillofacial diagnostic features of the enigmatic metastasizing pleomorphic adenoma

Considering the confusion in the literature regarding local recurrence, spread, or metastases of pleomorphic adenoma (PA) in the head and neck region, the aim of this study was to enhance understanding of the characteristics of metastasizing pleomorphic adenoma (MPA) by reviewing the literature and presenting a case. English language articles with proof of metastases were included in the literature review. Of the 80 cases in the literature with MPA, 46 were female and 33 were male (sex missing for one case). Thirty-five percent of the neoplasms affected the bones; the maxilla was affected in five cases and the mandible in three. The parotid was the primary site in 72.5% of cases and the submandibular gland in 16.2% of cases. The local recurrence rate was 70%. The mean interval between primary PA and MPA was 15.52 years. The total mortality rate was 8.7%. A case of PA of the submandibular gland that recurred after surgical excision and metastasized (confirmed by the presence of intact cortical borders) to the ipsilateral mandibular body, upper lip, and neck is described. The high mortality rate in a histologically defined benign disease that metastasizes demands that management include careful primary excision and long-term clinical follow-up.