分泌性中耳炎合并腺样体肥大的外科治疗方法比较  

Surgical Treatment for Secretory Otitis Media with Adenoidal Hypertrophy

作　　者：李秀国[1] 张慧 张媛媛[1] 类延华[1] LI Xiuguo;ZHANG Hui;ZHANG Yuanyuan;LEI Yanhua(Department of Otorhinolaryngology Head & Neck Surgery, Jining First People’s Hospital, Jining, Shandong, China,272000;College of Basic Medical Sciencee, Jining Medical University, Jining, Shandong, China, 272000)

机构地区：[1]济宁市第一人民医院耳鼻咽喉头颈外科 [2]济宁医学院基础医学院

出　　处：《中华耳科学杂志》2019年第3期347-352,共6页Chinese Journal of Otology

基　　金：济宁市医药卫生科技项目,项目编号:2013jnwk119~~

摘　　要：目的探讨不同外科治疗方法对分泌性中耳炎合并腺样体肥大患者的治疗效果。方法分析2014年6月至2017年6月期间收治的106例(172耳)合并腺样体肥大伴分泌性中耳炎患者的临床资料,根据患者的病史、听力受损程度分为3组,其中A组20例(37耳)行单纯内镜下腺样体刮除术,B组25例(42耳)行内镜下腺样体刮除+鼓膜切开鼓室冲洗术,C组61例(93耳)行内镜下腺样体刮除+鼓膜切开鼓室冲洗+鼓膜置管术。比较三组术前及术后2周、1月、3月的纯音听阈和/或声导抗检查结果,分析各组术后疗效。由于A组患者术前平均听阈正常,因此主要以声导抗检查结果评价该组的治疗效果。结果在术后1个月、术后3个月时A组和B组患者的咽鼓管功能均有好转,但是在同一时间节点两组之间的差异不明显。B组、C组患者在术后的平均听阈均较术前明显降低,B组患者在术后3月平均听阈恢复正常水平,但是,C组患者在术后1月平均听阈已恢复正常水平。并且,术后1月时C组患者的平均听阈明显优于B组患者(P<0.05)。虽然C组患者比A组、B组患者接受了更多手术方式治疗,但是,术后并发症发生率并没有增加。结论对分泌性中耳炎合并腺样体肥大的患者根据病史及听力情况选择不同的治疗方法是切实可行的。内镜下腺样体刮除、鼓膜切开及鼓室冲洗并鼓膜置管术虽然增加了更多的手术治疗,但是并没有增加术后并发症发生率,并且可以保证较久的治疗效果,对于筛选后的患者值得推广。Objective To report outcomes of various surgical treatments for secretory otitis media(SOM) with adenoidal hypertrophy. Methods Clinical data from 106 cases of SOM with adenoidal hypertrophy(172 ears) treated between June 2014 and June 2017 were reviewed. According to degree of hearing loss and medical history, these patients were divided into three groups. Treatments included endoscopic adenoidectomy(Group A, n = 20, 37 ears), endoscopic adenoidectomy plus tympanotomy and tympanic cavity lavage(Group B n = 25, 42 ears) and endoscopic adenoidectomy plus tympanic cavity lavage and tympanostomy tube insertion(Group C, n = 61, 93 ears). Pure tone and acoustic immitance tests were conducted before and at 2 weeks, 1 month and 3 months, and compared among the groups. Patients in group A had almost normal hearing preoperatively and received only acoustic immittance test. Results Eustachian tube function improved and was similar in groups A and B at 1 and 3 months postoperative. Postoperative Average auditory threshold in both groups B and C significantly improved compared to before surgery. Average auditory threshold in group B returned to normal at 3 months postoperative, while that in group C returned to normal at 1 month postoperative and better than that in group B(P<0.05). Although patients in group C received more surgical procedures than those in groups A and B, there was no increase in incidence of postoperative complications. Conclusion Surgical treatments for secretory otitis media with adenoidal hypertrophy can be customized based on patients history and hearing status. While bundling endoscopic adenoidectomy, tympanotomy, tympanic cavity syringe and tympanostomy tube insertion increases the number of surgical procedures, it does not seem to increase the incidence of postoperative complications, and may ensure longer treatment efficacy and may be worthy of adoption in selected cases.

关 键 词：分泌性中耳炎 腺样体刮除术 鼓膜切开术 鼓室冲洗 鼓膜置管术 

分 类 号：R764[医药卫生—耳鼻咽喉科]