腭裂与非腭裂患儿分泌性中耳炎临床治疗效果的比较  

Clinical comparative study on the treatment characteristics of secretory otitis media between cleft and non-cleft palate patients

作　　者：李森[1] 张洪[1] 魏云[1] 张茜蕾 吴映儒 钱江[1] 沈亮[1] 张正健[1] 

机构地区：[1]达州市第二人民医院耳鼻咽喉头颈外科,达州635000

出　　处：《华西口腔医学杂志》2015年第3期259-262,共4页West China Journal of Stomatology

基　　金：四川省卫生厅科研基金资助项目(110634)

摘　　要：目的探索腭裂患儿分泌性中耳炎（SOM）的治疗方法。方法选择3-14岁先天性腭裂合并SOM的患儿319例（524耳）设为试验组,根据中耳积液性状分为3组：A组为浆液性积液,112例（198耳）;B组为黏液性积液,162例（248耳）;C组为中耳负压无积液,45例（78耳）。同时选择年龄相当的腺样体合并扁桃体肥大伴SOM患儿208例（246耳）设为对照组,同样根据积液性状分为对应的A1、B1、C1组。两组患儿分别进行腭裂修复术和腺样体、扁桃体切除手术后,对A、A1组进行鼓膜穿刺,B、B1组进行鼓室置管,C、C1组行鼓膜穿刺;术后均辅助药物治疗。比较各组SOM的治愈率和复发率。结果术后12个月,试验组总治愈率为77.29%（405/524）,总复发率为14.57%（59/405）,对照组总治愈率为93.09%（229/246）,总复发率为3.93%（9/229）,对照组SOM治愈率明显高于试验组,复发率明显低于试验组（P〈0.05）。试验组治疗过程较对照组复杂,一次性治愈率低,需行反复、多次治疗。结论腭裂患儿SOM的治疗方法与普通中耳炎有较大差异,应对腭裂SOM予以专门检查,开展特异性治疗。根据鼓室积液性状,反复鼓膜穿刺或6个月以上的鼓室置管是较好的治疗方法。Objective To discuss the treatment characteristics of secretory otitis media （SOM） in cleft palate children. Methods A total of 319 patients （524 ears） with SOM and cleft palate （3-14 years old） who accepted treatment were divided into experiment group A, group B, and group C according to effusion characteristics in the middle ear and tympanic pressure. Group A included 112 patients with serous effusion （198 ears）. Group B included 162 patients with mucinous effusion （248 ears）. Group C included 45 patients （78 ears） with negative pressure in the middle ear without effusion and an acoustic immit-tance. A total of 208 patients （246 ears） with SOM and tonsil and adenoid hypertrophy were divided into control group A1, group B1, and group C1 matched with the same effusion characteristics in the middle ear and tympanic pressure. Group A and A1 accepted puncture in the tympanic cavity, group B and B1 accepted tympanostomy tubes, and group C and C1 accepted puncture in the tympanic cavity after palatoplasty, adenoidectomy, and tonsillectomy. All groups were treated with antibiotics and ear drops. Cure rate and recurrence rate between the experiment group and the control group were compared. Results The control group had a better cure rate [93.09% （229/246）] than the experiment group [77.29% （405/524）] 12 months after treatment. The experiment group had a higher recurrence rate [14.57% （59/405）] than the control group [3.93% （9/229）]. Statistical diffe-rences were observed between the two groups （P〈0.05）. SOM with cleft palate initially had a low cure rate, and thus it was treated repeatedly for many times. Conclusion SOM with cleft palate is different from normal otitis media in terms of clinical manifestation, treatment, outcome, and prognosis. This case should be considered a special otitis media to be treated with special examination and therapy to obtain better results. Repeated puncture in the tympanic cavity and tympanostomy tubes for six months according to ef

关 键 词：腭裂 分泌性中耳炎 鼓膜穿刺 鼓室置管 

分 类 号：R782.22[医药卫生—口腔医学]