CO_2激光鼓膜造孔与鼓膜置管在治疗鼻咽癌放疗后分泌性中耳炎的对照研究  

A comparative research of CO_2 laser tympanostomy and Grommet insertion in the treatment of nasopharyngeal carcinoma after radiotherapy with otitis media with effusion

作　　者：徐志坚[1] 骆辉珍[1] 钟晓燕[1] 廖艳萍[1] 杜宝文[1] 

机构地区：[1]广东省惠州市中心人民医院耳鼻咽喉头颈外科,516001

出　　处：《中国中西医结合耳鼻咽喉科杂志》2017年第1期37-40,共4页Chinese Journal of Otorhinolaryngology in Integrative Medicine

基　　金：惠州市科技计划项目(0038905150503024)

摘　　要：目的对比CO_2激光鼓膜造孔与鼓膜置管在治疗鼻咽癌放疗后分泌性中耳炎的疗效及并发症。方法 2014年8月至2015年8月,前瞻对照研究71例鼻咽癌放疗后并发分泌性中耳炎的患者,分别接受两种治疗方式的治疗结果。其中37例(59耳)接受CO_2激光鼓膜造孔术(CO_2激光造孔组),34例(55耳)接受耳内镜下鼓膜置管术(鼓膜置管组),比较两组疗效及并发症。结果疗效情况:CO_2激光造孔组治愈27耳(45.8%),好转18耳(30.5%),无效14耳(23.7%);鼓膜置管组治愈24耳(43.6%),好转15耳(27.3%),无效16耳(29.1%),两组间有效率比较,差异无统计学差异(P>0.05)。并发症情况:CO_2激光造孔组59耳中术后复发25耳(42.4%);耳漏5耳(8.4%);鼓膜穿孔不愈合5耳(8.4%)。鼓膜置管组55耳中术后复发9耳(16.4%);耳漏14耳(25.5%);鼓膜穿孔不愈合6耳(10.9%)。两组间并发症比较,复发率CO_2激光造孔组高于鼓膜置管组,而CO_2激光造孔组的耳漏发生率显著低于鼓膜置管组,差异具有统计学意义(P<0.05);鼓膜穿孔发生率两组间差异无统计学意义(P>0.05)。结论 CO_2激光鼓膜造孔在治疗鼻咽癌放疗后分泌性中耳炎虽然存在一定的复发率,患者需多次接受手术,但显著降低中耳感染,更值得临床所推崇。Objective To assess the risks and the advantages of CO2 laser tympanostomy treating nasopharyngeal carcinoma after radiotherapy with otitis media with effusion by comparing it with grommet insertion. Methods From August 2014 to August2015, a prospective controlled study that 71 cases（114 ears） of patients with nasopharyngeal carcinoma after radiotherapy with otitis media with effusion were treated with two methods respectively was done. Among them, 37 cases（59 ears） accepted CO2 laser tympanostomy while 34 cases（55 ears） accepted grommet insertion. To compare the curative effect and complications between the two groups. Results The curative effect： The CO2 laser tympanostomy group cured 27 ears（45.8%）, improved 18 ears（30.5%）, invalid 14ears（23.7%）; The rommet insertion group cured 24 ears（43.6%）, improved 15 ears（27.3%）, invalid 16 ears（29.1%）. To compare the efficiency between the two groups, there was no statistically difference（P0.05）. Complication： In the CO2 laser tympanostomy group,25 ears had recurrence（42.4%）, 5 ears occurred otorrhea（8.4%）, 5 ears occurred perforations（8.4%）; In the grommet insertion group,9 ears had recurrence（16.4%）, 14 ears occurred otorrhea（25.5%）, 6 ears occurred perforations（10.9%）. There was statistically significant difference between the two groups in the recurrence rate（P〈0.05）. In the otorrhea rate, grommet insertion group is significantly higher than CO2 laser tympanostomy group（P〈0.05）. There was no statistically significant difference between the two groups in the perforations rate（P0.05）. Conclusion Although there is a certain recurrence rate in the treatment of nasopharyngeal carcinoma after radiotherapy with otitis media with effusion with CO2 laser tympanostomy, the patients need surgery for many times,but the CO2 laser tympanostomy significantly lower middle ear infection, it is more worthy of clinical promotion.

关 键 词：鼻咽癌 放射疗法 分泌性中耳炎 CO2激光鼓膜造孔术 鼓膜置管 并发症 

分 类 号：R739.63[医药卫生—肿瘤] R764.21[医药卫生—临床医学]