腺样体的不同形态与分泌性中耳炎的关系的研究  

The relationship of adenoid hypertrophy with OME

作　　者：谷庆隆[1] 陆颖霞[1] 韩佳[1] 高帆[1] 杜君[1] 赵晶[1] 庞冲[1] 黄春雷[1] 

机构地区：[1]首都儿科研究所耳鼻喉科,北京100020

出　　处：《北京医学》2010年第8期675-677,共3页Beijing Medical Journal

摘　　要：目的探讨腺样体的不同形态同分泌性中耳炎(OME)间的关系以及充分切除咽鼓管咽口周围的腺样体组织对OME患儿预后的影响。方法 2009年1月～12月行低温等离子射频消融手术腺样体的患儿,均行听力测试,手术中根据腺样体与咽鼓管圆枕间接触的紧密程度,作者将腺样体的形态依次分为以下4组:Ⅰ组(无压迫型)、Ⅱ组(挤压型)、Ⅲ组(紧贴型)及Ⅳ组(混合型),伴OME的患儿术后1个月行听力复查,分析各种分型在伴OME和不伴OME的患儿中的差异以及手术对OME预后的影响。结果 191例患儿中有145侧(包括54例双侧OME患儿和37例单侧OME患儿)伴OME,另237侧(100例)无OME;Ⅰ组无压迫型腺样体伴发OME比例较低(P<0.05),而Ⅱ组、Ⅲ组及Ⅳ组腺样体是否伴发OME无显著性差异;进一步对37例单侧OME的患儿进行比较,3侧无压迫型腺样体都位于无OME侧,Ⅱ组伴发OME的比例较低(P<0.05),而Ⅳ组以伴发OME为显著(P<0.05),Ⅲ组在两侧间无明显差异;OME患儿术后1个月复诊,痊愈率85.5%,总有效率92.4%。结论腺样体与咽鼓管咽口间存在的不同毗邻关系,压迫越严重越易导致与OME,有效切除压迫咽鼓管咽口的腺样体可有效治疗OME。Objective To delineate the relationship between adenoid hypertrophy and otitis media with effusion （OME） and to investigate the efficacy of coblation Adenoidectomy, which allows removing adenoid surrounding Eustachian tube （ET） orifice, to patients with OME.Methods Acoustic immittance testing was performed before the surgery to all children who had Coblation adenoidectomy from January to December 2009.At the time of surgery, according to adenoid size and its position in relation to the ET orifice adenoid hypertrophy was categoried into 4 groups defined as non-oppres-sion group（Ⅰ）,oppression group（Ⅱ）,tightness group（Ⅲ） and mixed group（Ⅳ）.P test was then used to analyze the incidence of OME and the outcome of the surgery in difference group of patients.Results In all 191 patients, 145 sides had OME including 54 both sides and 37 single sides, while the other 100 children （237 sides） didn＇t.The children in group Ⅰ accompanied with lower proportions of SOM, however, no significant difference in group Ⅱ, Ⅲ and Ⅳ.Further analysis for 37 case with one side of SOM, 3 cases with non-oppression adenoid absolutely did not occur SOM, SOM happened lower in group Ⅱ （P=0.05）, while higher in group Ⅳ, and no significant difference in group Ⅲ.For patients with OME, the same acoustic test was performed again one month after the surgery.the recovery rate was 85.5%, and the effective rate was 92.4%.Conclusion The more severely adenoid press ET orifice, the more chance to have OME.Coblation ade-noidectomy offers significant advantages to treat OME.

关 键 词：腺样体 分泌性中耳炎 咽鼓管咽口 低温等离子射频腺样体切除术 

分 类 号：R764[医药卫生—耳鼻咽喉科]