CO2激光鼓膜造孔术治疗儿童分泌性中耳炎临床疗效观察  

Efficacy of CO2 Laser Myringotomy in the Treatment of Otitis Media with Effusion in Children

作　　者：曾薇[1] 陈美珍[1] 傅敏仪[1] 叶飞[1] 陈嵘 ZENG Wei;CHEN Meizhen;FU Minyi;YE Fei;CHEN Rong(Department of Otolaryngology-Head and Neck Surgery,Affiliated Zhongshan Hospital,SUN Yat-sen Univerdity,Zhongshan 528403,China)

机构地区：[1]中山大学附属中山医院耳鼻咽喉头颈外科,中山528403

出　　处：《中华耳科学杂志》2020年第3期454-458,共5页Chinese Journal of Otology

基　　金：中山市卫生局科研基金,项目编号:B2017100。

摘　　要：目的比较CO2激光鼓膜造孔术及鼓膜置管术治疗儿童分泌性中耳炎(Otitis media with effusion,OME的临床疗效,探讨CO2激光鼓膜造孔术能否替代鼓膜置管术。方法79例(139耳)OME患儿随机分为两组:激光组:40例(73耳)采用CO2激光鼓膜造孔术;置管组:39例(66耳)采用鼓膜置管术。比较两种手术方法的有效率、复发率、并发症发生率以及浆液型、粘液型鼓室积液的治疗效果。结果术后6月激光组治疗有效率63.01%,置管组治疗有效率84.85%,两组差异有统计学意义(χ^2=8.460,P=0.004);激光组鼓膜穿孔平均愈合时间为19.49±5.774天;激光组的复发率为31.5%,置管组的复发率为9.09%,两组差异有统计学意义(χ^2=10.549,P=0.001);激光组并发症发生率为2.74%,置管组并发症发生率为13.64%,两组差异有统计学意义(χ^2=5.648,P=0.017);浆液型积液耳激光组与置管组治疗有效率比较差异无统计学意义(χ^2=1.801,P=0.180),粘液型积液耳激光组与置管组治疗有效率比较差异有统计学意义(χ^2=5.064,P=0.024),置管组有效率优于激光组。结论CO2激光鼓膜造孔术是治疗儿童OME的一种安全、有效的术式,但并未能因此代替鼓膜置管术,需根据患儿是否伴发合并症情况及鼓室积液类型选择合适的手术方法,对于鼓室积液粘稠、同时合并有腺样体肥大、慢性鼻-鼻窦炎或过敏性鼻炎等合并症患者,鼓膜置管术仍为最有效的手术方式。Objective To compare CO2 laser myringotomy with ventilation tubes in children with otitis media with effusion for potential replacement of ventilation tubes by CO2 laser myringotomy.Methods Seventy nine children(139 ears)with otitis media with effusion were randomly divided to receive CO2 laser myringotomy(40 cases,73 ears)or ventilation tubes(39 case,66 ears).Efficacy,recurrence,complications and changes in tympanic effusion were compared between the two methods.Results 6 months after the procedure,the effective rate was 63.01%in the laser group and 84.85%in the tube group(χ^2=8.460,P=0.004).Average tympanic membrane perforation healing time in the laser group was 19.49±5.774 days with a recurrence rate of 31.5%,and 9.09%in the ventilation tubes group(χ^2=10.549,P=0.001).The rate of complication was 2.74%in the laser group and 13.64%in the ventilation tubes group(χ^2=5.648,P=0.017).The effective rate was not statistically different between the two groups when the nature of effusion was serous(χ^2=1.801,P=0.180),but higher in the tube group than in the laser group with mucous type effusion(χ^2=5.064,P=0.024).Conclusion CO2 laser myringotomy is a safe and effective treatment for otitis media with effusion in children,although not a replacement of ventilation tubes.It is necessary to choose the appropriate treatment mode based on concurrent conditions and nature of effusion.In patients with mucous effusion,adenoid hypertrophy,chronic rhinosinusitis or allergic rhinitis,ventilation tubes is still the most effective surgical treatment.

关 键 词：分泌性中耳炎 CO2激光鼓膜造孔术 鼓膜置管术 

分 类 号：R764[医药卫生—耳鼻咽喉科]