耳内镜下鼓室置管联合药物灌注治疗鼻咽癌放疗后分泌性中耳炎的疗效分析  

Effectiveness of endoscope-guided myringotomy and ventilation tube insertion combined with drug perfusion in the treatment of otitis media with effusion in patients with post-irradiated nasopharyngeal carcinoma

作　　者：胡林 陈建超[1] Hu Lin;Chen Jianchao(Department of Otolaryngology Head and Neck Surgety,Affiliated Hospital of Jiangnan University,Wuxi 214000,China)

机构地区：[1]江南大学附属医院耳鼻咽喉头颈外科,无锡214000

出　　处：《国际耳鼻咽喉头颈外科杂志》2020年第4期191-194,共4页International Journal of Otolaryngology-Head and Neck Surgery

摘　　要：目的回顾性研究鼓膜置管联合药物灌注(地塞米松+α-糜蛋白酶)治疗鼻咽癌放疗后分泌性中耳炎的临床疗效.方法选择鼻咽癌放疗后分泌性中耳炎患者40例(63耳),耳内镜下行鼓膜置管加地塞米松和糜蛋白酶灌注中耳治疗3周,随访1年,观察患者临床有效率.结果40例(63耳)中,治愈32耳(50.8%),好转24耳(38.1%),无效7耳,总有效率88.9%.术后并发症发生率54.0%(34/63),包括初次置管后通气管脱落10耳(15.9%),均予以再次鼓膜置管;耳漏12耳(19.0%),经抗感染治疗后好转,遗留鼓膜穿孔3耳(4.8%);通气管堵塞9耳(14.3%),耳内镜下予以3%双氧水清洗吸除后再通;术后复发8耳(12.7%).结论耳内镜下鼓膜置管联合地塞米松及α-糜蛋白酶灌注,治疗鼻咽癌放疗后分泌性中耳炎有较好的疗效,术后并发症发生率较高,但经过积极治疗预后良好.Objective To study the clinical effect of myringotomy and ventilation tube insertion combined with drug perfusion(dexaniethasone+a-chymotrypsin)in the treatment of otitis media with effusion(OME)in patients with post-irradiated nasopharyngeal carcinoma(NPC).Methods 40 patients(63 ears)with OME after NPC radiotherapy were treated by myringotomy plus grommet insertion combined with drug perfusion(dexamethasone+a-chymotrypsin)with the help of otoendoscopy for three weeks,followed up for one year to observe the clinical effevtiveness.Results In 40 cases(63 ears),complete OME resolution in 32 ears(50.8%)and improvement in 24 ears(38.1%),with an efficiency rate of 88.9%.The postoperative complications occured in 54.0%(34/63)of the ears,including:10 ears(15.9%)with ventilation tube falling off,all of which were treated with tympanic membrane catheterization again;12 ears(19.0%)with otorrhea which were healed after antibiotic treatment,leaving 3 ears(4.8%)with dry tympanic membrane perforation without further treatment;9 ears(14.3%)with ventilation tube occlusion which were recanalized after 3%hydrogen peroxide ear drops treatment.8 ears(12.7%)recurred.Conclusion Endoscope-guided myringotomy and ventilation tube insertion combined with dexamethasone and a-chymotrypsin perfusion is effective in the treatment of OME after NPC radiotherapy.The postoperative complication rate is high,but the prognosis is good after active treatment.

关 键 词：鼻咽肿瘤 中耳炎 伴渗出液 内窥镜检查 地塞米松 糜蛋白酶 放射疗法 鼓膜置管 

分 类 号：R764.21[医药卫生—耳鼻咽喉科] R739.63[医药卫生—临床医学]