低龄及学龄儿童鼓膜置管手术预后及其影响因素分析  

Prognosis and the analysis on influencing factors of tube insertions for in younger children and school age children

作　　者：杨扬[1] 陈敏[1] 郝津生[1] 刘薇[1] 刘世琳[1] 张杰[1] 

机构地区：[1]首都医科大学附属北京儿童医院耳鼻咽喉头颈外科,儿童耳鼻咽喉头颈外科疾病北京市重点实验室,北京100045

出　　处：《中国耳鼻咽喉头颈外科》2016年第8期440-442,453,共4页Chinese Archives of Otolaryngology-Head and Neck Surgery

基　　金：北京市医管局临床医学发展专项(XM201409)

摘　　要：目的探讨低龄和学龄儿童鼓膜置管术的预后及其影响因素。方法2012年1～12月间因分泌性中耳炎于我科行鼓膜置管术的100例儿童患者病例，对其进行2年的术后随访，依据年龄将病例分成两组，低龄组和学龄组，比较两组间术前纯音测听平均听阈、术后（2周、0．5年、1年和2年）纯音测听平均听阈、手术方式、置管脱出时间、鼓膜愈合情况、OME复发和二次置管情况。结果两组术前纯音测听平均听阈比较，差异无统计学意义；两组术前与术后各阶段纯音测听平均听阈比较，差异有统计学意义；两组手术方式比较，差异有统计学意义（z2=-2．067，P=-0．039）；两组置管脱出或取出时间比较，差异有统计学意义（Z=-0．045，P=0．952）；两组0ME复发比较，差异无统计学意义；两组二次置管情况比较，差异有统计学意义（X2=-2．254，P=-0．012）。鼓膜出现钙斑者5例，残留穿孔者2例，1例行鼓膜修补术；术后出现耳漏者7例，均治愈。手术方式及置管时间与二次置管之间具有显著相关性。结论低龄组二次置管情况低于学龄组，可能与同期行腺样体切除术有关。OBJECTIVE To investigate the prognosis of grommet insertions for younger children or school age children with otitis media with effusion （OME）, and to analyze the factors that may influence the results. METHODS A retrospective review of 100 children with tube insertions for OME with effusion between January 2012 and December 2012 was performed. They were divided into two groups （the younger group and school age group）. and observed their clinical manifestations, etiology and prognosis by two years＇ follow-up. The preoperative pure tone audiometry （PTA） hearing threshold, PTA in after surgery （two weeks, half of one year, one year, two years）, the method of operation, the time of tube extrusion, the result of tympanic membrane＇s healing, the relapse of OME and repeat operation between two groups were compared. RESULTS The difference of preoperative PTA is not significant （Z=-0.045, P=0.952）. The difference of preoperative PTA and postoperative PTA is significant. The difference of operation＇s methods is significant （x2=-2.067, P=0.039）. The difference of tube extrusion＇s time is significant （Z=-0.045, P=0.952）. The difference of relapse is not significant （X2=-1.767, P=0.097）. The difference of repeat operation is significant （x2=-2.254, P=0.012）. Tympanic membrane appears calcium plaque in 5 cases, residual perforation occurred in 2 cases, 1 patient received myringoplasty; postoperative otorrhea occurred in 7 cases were cured. There are a significant statistical correlation between operation＇s methods and tube extrusions time with repeat operation. CONCLUSION The recurrence of second grommet is lower in younger children group than in school age group, and it may be related to the adenoidectomy.

关 键 词：儿童 中耳炎 伴渗出液 咽鼓管 耳外科手术 预后 置管 

分 类 号：R764.9[医药卫生—耳鼻咽喉科]