等离子射频消融辅助咽鼓管成形术在治疗成人难治性分泌性中耳炎中的应用研究  

The application research of eustachian tuboplasty assisted with hypothermy plasma ablation in the threatment of adult refractory otitis media with effusion

作　　者：于海洋[1] 孙丰林[1] 刁秀莉 夏倩[1] 张增[1] 

机构地区：[1]淄博市中心医院耳鼻咽喉头颈外科,山东淄博255031

出　　处：《临床耳鼻咽喉头颈外科杂志》2015年第22期1988-1991,共4页Journal of Clinical Otorhinolaryngology Head And Neck Surgery

基　　金：山东省淄博市科技局项目(No:2014kj010144)

摘　　要：目的:通过应用等离子射频消融辅助咽鼓管形成术,评价其在治疗成人顽固性分泌性中耳炎中的效果。方法:将48例(61耳)顽固性分泌性中耳炎成人患者根据就诊日期分为对照组17例(22耳),治疗组31例(39耳)。对照组中患者的治疗方法为药物及物理治疗,治疗组的治疗方法除应用对照组的方法外,同期应用等离子射频消融患侧咽鼓管咽口周围增生肥厚的组织以完成咽鼓管成形术。分析比较两组患者在治疗后1年内的复发率,同时应用纯音测听及声导抗检查分析比较两组患者治疗前后不同时期(术前1周及术后1个月、3个月、6个月、1年)的听力变化情况。结果:对照组中失访2例(2耳),1年内复发率65.0%(13/20);治疗组中失访4例(4耳),1年内复发率为14.3%(5/35),与对照组比较差异有统计学意义(P<0.01);两组在治疗后1个月时听力的改善相似,但随着时间的推移,治疗组对听力学的改善效果更显著。治疗组中咽鼓管成形术中及术后无一例出现并发症,大多数患耳(28/35)术后1个月即有明显的听力改善,骨气导差值较术前减小(P<0.01);16例患耳鼓室压图由术前异常的B型或C型变为A型(P<0.01)。骨气导差值及鼓室压图异常情况在术后3个月与术后6个月、术后6个月与术后1年时的均差异无统计学意义(P>0.05)。结论:等离子射频消融辅助咽鼓管形成术,对于咽鼓管咽口开放障碍所导致的顽固性分泌中耳炎治疗效果确切,能显著降低复发率。可使该类患者听力在3个月内得到明显改善并逐渐恢复正常。Objective：Through the application of eustachian tuboplasty assisted with hypothermy plasma ablation,we evaluate its efficacy in the threatment of adult refractory otitis media with effusion.Method：We retrospectively reviewed the charts of 48cases（61ears）suffering from adult refractory otitis media with effusion from January 2012 to December 2013.According to the admission date,the patients were divided into the control group（17cases,22ears）and the treatment group（31cases,39ears）.In the control group,the patients were treated with drugs and physical therapy.In the treatment group,the hypothermy plasma ablation technology was used to ablates the hypertrophic tissues around the eustachian orifice besides the pharmaedogical interventions.The recurrence rate of the two groups were analyzed and compared in 1year after treatment.Pure tone audiometry and acoustic immittance measurement were taken for the two groups in differernt periods（one week prior to operation,one months,three months,six months and one year after operation respectively）to evaluate their hearing change and the recurrence rate（within six months after treatment and one year respectively）objectively.Result：In the control group,2cases（2ears）were lost to follow-up,and the recurrence rate was 65%（13/20）in 1year.In the treatment group,four case were lost to follow-up,and the recurrence rate was 14.3%（5/35）in 1year.The difference was statistically significant（P0.01）.There were similar hearing improvement in the two groups after treatment in 1month,but the hearing improvement in the treatment group increased with time.There were no complications occuring during the operation and post-operation.Within a month after operation,the majority of ears（28/35）obtained significant hearing improvement with the decreasing air-bone-gap comparision with the preoperation（P〈0.01）,and the preoperative tympanogram of 16 ears with type B or C turned to type A（P〈0.01）.There were no both statistical significane in the varia

关 键 词：分泌性中耳炎 等离子射频消融 咽鼓管 咽鼓管功能障碍 成人 

分 类 号：R764.21[医药卫生—耳鼻咽喉科]