摘要：

目的：介绍一种经口内黏膜切口治疗下颌下腺腺门区合并腺内多发结石的手术方法，并对其临床应用进行评价。方法：全麻下对20例下颌下腺腺门区合并腺内多发结石的患者行口底黏膜切开取石术。术前超声、CT定位，术中首先口底定位腺门区结石，切开黏膜导管壁取出结石，保持上述切口敞开通畅，按压颌下区，使腺内结石自切口排出，冲洗导管，放置导管支架，观察术后并发症及治疗效果。结果：20例患者均成功取出腺门区及所有腺内结石，共取出结石56枚。腺门区结石直径为4.5~15.0 mm，腺内结石直径为0.5~4.5 mm，腺门区结石与腺内结石之间的直线距离为3.58~28.28 mm。术后5例患者出现舌麻木，4例患者出现颌下区轻度肿痛，均逐渐恢复。结论：下颌下腺腺门区结石合并腺内直径小于5 mm的结石可通过口内入路取石术全部取出，且治疗效果良好。

关键词: 下颌下腺结石, 腺门区结石, 腺内结石, 口内入路, 取石术

Abstract:

Objective: To introduce a surgical method for the treatment of multiple calculi in the hilar and parenchyma of the submandibular gland through an intraoral mucosal incision, and to clinically evaluate its application. Methods: Under general anesthesia, 20 patients with submandibular hilar and parenchyma stones underwent lithotomy via mouth floor mucosal incision. Preoperative ultrasound and CT were used to locate the stones. During the operation, locate the hilar stone on mouth floor firstly, remove the stones from the incision, keep the incision open and unobstructed, press the submandibular area, so that the stones in the glands are discharged from the same incision, flush the duct, place the scaffold. Postoperative follow-up was conducted to evaluate the treatment effect. Results: All 20 patients underwent successful removal of the hilar and parenchyma stones. A total of 56 stones were removed. The diameter of the hilum stones was between 4.5 and 15 mm, the diameter of the parenchyma stones in the gland was between 0.5 and 4.5 mm, and the linear distance between the hilum stones and parenchyma stones was between 3.58 and 28.28 mm. After the operation, 5 patients suffered tongue numbness, and 4 patients suffered mild swelling and pain in the submandibular area. All of them gradually relieved. Conclusion: The stones in the hilum area of the submandibular gland combined with parenchyma stones with a diameter of less than 5 mm can be completely removed by intraoral approach, and the treatment effect is satisfactory.

Key words: submandibular gland stone, hilum stone, parenchyma stone, intraoral approach, sialolithotomy