鼓膜置管或鼓膜穿刺对腺样体切除治疗儿童分泌性中耳炎的影响  

Effect of tympanostomy tube insertion or tympanocentesis on transnasal endoscopic adenoidectomy in the treatment of pediatric patients with secretory otitis media

作　　者：朱珠[1] 郑国玺[2] 李琦[1] 石秋兰[1] 周洪根[1] 方如平[1] 

机构地区：[1]南京医科大学附属儿童医院耳鼻咽喉科,南京210008 [2]西安交通大学第二附属医院耳鼻咽喉头颈外病院,西安710004

出　　处：《重庆医学》2017年第15期2041-2044,共4页Chongqing medicine

基　　金：国家自然科学基金资助项目(81271068);高等学校博士学科点专项科研基金资助项目(20120201110060);南京市医学科技发展专项资金资助项目(YKK13134);南京医科大学科技发展基金资助项目(2012NJMU059)

摘　　要：目的探讨耳内镜下鼓膜穿刺或鼓膜置管联合鼻内镜下腺样体切除对保守治疗无效的儿童分泌性中耳炎的影响。方法选取112例南京医科大学附属儿童医院耳鼻喉科2013年7月至2015年8月经药物保守治疗无效的分泌性中耳炎伴腺样体肥大患儿,分为3组,A组38例(68耳)行鼻内镜下腺样体切除术,B组37例(60耳)行鼻内镜下腺样体切除加鼓膜穿刺术,C组37例(59耳)行鼻内镜下腺样体切除加鼓膜切开置管术。观察并比较3组患儿术后的临床治疗效果、中耳积液时间、术后复发情况及并发症发生率。结果 3组术后3个月总有效率均较术后1周有所提高(P<0.05),B、C两组在术后1周及术后3个月其总有效率均高于A组(P<0.05),而C组在术后3个月总有效率也明显高于B组(P<0.05)。3组患儿术后1年听觉脑干诱发电位(ABR)阈值及ABRⅠ波潜伏期均较术前有所降低(P<0.05),B、C组术后1周及术后1年ABR变化均低于A组(P<0.05)。术后C组中耳积液时间与复发率均小于A、B组(P<0.05),A组并发症发生率低于B、C组(P<0.05)。结论鼓膜置管联合鼻内镜下腺样体切除术能有效提高患儿听力,不但能缩短中耳积液时间,还能有效减少复发率。Objective To discuss the tympanic membrane puncture or tympanostomy tube under endotoscope combined with adenoidectomy under nasal endoscopy on the influence of invalid conservative treatment of pediatric secretory otitis media.Methods A total of 112 cases of secretory otitis media with invalid conservative treatment were selected in the department of otorhinolaryngology of children′s hospital of Nanjing Medical University from July 2013 to August 2015.They were divided into three groups,the group A of 38cases（68ears）underwent transnasal endoscopic pure adenoidectomy;the group B of 37cases（60ears）underwent transnasal endoscopic adenoidectomy combined with tympanocentesis;the group C of 37cases（59ears）underwent tympanostomy tube insertion.The clinical treatment effect,the period of middle ear effusion,postoperative recurrence and complication were observed and compared.Results The total effective rate of the 3groups was improved after 3months（P〈0.05）;the total effective rate in group B and group C at one week and 3months after operation were higher than those of group A（P〈0.05）;and the total effective rate in group C at 3months after operation was significantly higher than that of group B（P〈0.05）.The level of auditory brainstem evoked potential（ABR）and the latency of ABR waveⅠlatency were decreased at 1year after operation（P〈0.05）;the ABR changes in group B and group C at 1week and 1year after operation were lower than those in group A（P〈0.05）.The incidence of recurrence rate and the period of middle ear effusion in group C were lower than those in group A and B（P〈0.05）.The incidence of complication of group A was lower than those of group B and group C（P〈0.05）.Conclusion Using tympanostomy tube combined with adenoidectomy under endoscope can improve the children with hearing,which not only can shorten the time of the middle ear effusion,but also effectively reduce the recurrence rate.

关 键 词：中耳炎 伴渗出液 腺样体切除术 鼓膜 导管插入术 鼓膜置管 鼓膜穿刺 鼻内窥镜 

分 类 号：R764.21[医药卫生—耳鼻咽喉科]