Shockwave lithotripsy of salivary duct stones
Shockwave lithotripsy of salivary duct stones
复制标题
唾液管结石冲击波碎石术
DOI：
10.1016/0140-6736(92)91968-e
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发表时间：
1992
期刊：
影响因子：
--
通讯作者：
C. Ell
中科院分区：
文献类型：
--
作者：
H. Iro;C. Fodra;G. Waitz;N. Nitsche;H. Heinritz;H. Schneider;J. Benninger;C. Ell
对于无法通过扩张或解剖唾液管去除结石的唾液结石病例，需要手术切除受影响的腺体。压电碎石机能够将冲击波传送到一个小病灶，使得唾液腺结石的体外冲击波碎石术具有潜在的安全性。其安全性和有效性已在 51 名患有症状性孤立性唾液腺结石且无法通过保守措施去除的患者中进行了评估。结石的中位直径为 8（范围 4-18）毫米，69% 的患者位于颌下腺，31% 位于腮腺。在连续超声监测下总共进行了 72 次冲击波治疗（每位患者最多 3 次）。 45 名患者 (88%) 的结石完全碎裂（碎片≤ 3 毫米）。没有患者需要麻醉、镇静剂或镇痛剂。唯一的不良反应是 72 次治疗中的 10 次 (13%) 后出现局部点状出血，以及 2/72 (3%) 次治疗中施加冲击波后腺体立即肿胀。第一次疗程后 20 周，90% (46/51) 的患者没有出现不适，53% (27/51) 的患者没有结石。腮腺结石患者的结石清除率（81%）高于颌下腺结石患者（40%）。只有颌下腺结石患者（20%）才需要采取扩张或解剖唾液管等辅助措施。在中位随访 9 (1-24) 个月期间，未发现治疗后的唾液腺或邻近组织结构出现长期损伤。体外压电冲击波疗法似乎是治疗唾液腺结石的一种安全、舒适且有效的微创、非手术治疗方法。
Surgical extirpation of the affected gland has been necessary for cases of sialolithiasis in which the stone cannot be removed by dilatation or dissection of the salivary duct. The ability of the piezoelectric lithotripter to deliver shockwaves to a small focus makes extracorporeal shockwave lithotripsy of salivary gland stones potentially safe. Its safety and efficacy have been assessed in 51 patients with symptomatic solitary salivary stones that could not be removed by conservative measures. The stones had a median diameter of 8 (range 4-18) mm and were located in the submandibular gland in 69% of patients and in the parotid gland in 31%. A total of 72 shockwave treatment sessions (maximum 3 per patient) were given under continuous sonographic monitoring. In 45 patients (88%) complete fragmentation (fragments ≤ 3 mm) of the concrements was achieved. No patient needed anaesthesia, sedatives, or analgesics. The only untoward effects were localised petechial haemorrhages after 10 (13%) out of 72 treatments and transient swelling of the gland immediately after delivery of shockwave in 2/72 (3%) sessions. 20 weeks after the first session 90% (46/51) of patients were free of discomfort, and 53% (27/51) were stone free. Stone-clearance rate was higher among patients with stones in the parotid gland (81%) than among those with stones of the submandibular gland (40%). Auxiliary measures such as dilatation or dissection of the salivary duct were required only in patients with stones in the submandibular gland (20%). No long-term damage to the treated salivary gland or to adjacent tissue structures was noted during the median follow-up of 9 (1-24) months. Extracorporeal piezoelectric shockwave therapy seems likely to be a safe, comfortable, and effective minimally-invasive, non-surgical treatment for salivary stones.