CO_(2)激光鼓膜造孔直径对放疗后分泌性中耳炎的疗效影响  

Effect of the diameter of tympanostomy with CO_(2) laser on secretory otitis media after radiotherapy

作　　者：王梦圆 陈佳琦 陈鹏 崔万明[3] 郭睿 WANG Mengyuan;CHEN Jiaqi;CHEN Peng;CUI Wanming;GUO Rui(Department of Otolaryngology,Air Force Medical Center,PLA,Beijing,100089,China;Department of Otolaryngology,Chengdu First People’s Hospital;Department of Otolaryngology,the First Affiliated Hospital of Dalian Medical University)

机构地区：[1]中国人民解放军空军特色医学中心耳鼻咽喉科,北京100089 [2]成都市第一人民医院耳鼻咽喉科 [3]大连医科大学附属第一医院耳鼻咽喉科

出　　处：《临床耳鼻咽喉头颈外科杂志》2022年第5期368-371,共4页Journal of Clinical Otorhinolaryngology Head And Neck Surgery

摘　　要：目的:比较头颈肿瘤放疗后并发分泌性中耳炎患者采用不同直径的CO_(2)激光鼓膜造孔的疗效,以确定最佳造孔直径范围。方法:采用随机数字表法将23例(40耳)头颈肿瘤放疗后并发分泌性中耳炎患者分为造孔直径≤3 mm组和>3 mm组,每组20耳,两组均以确诊时鼓室图及造孔术后纯音听阈测听为对照参考,分别于术后1、3、6个月行纯音听阈测听、鼓室图及耳内镜检查,同时请患者协助填写咽鼓管功能障碍评分量表(ETDQ-7),了解临床症状的差异性,分析术后疗效及统计术后并发症。结果:(1)术后≤3 mm组纯音听阈气骨导差均值明显小于>3 mm组(P<0.05),即≤3 mm组患者术后听力恢复较>3 mm组患者为佳。(2)术后6个月内,≤3 mm组鼓膜愈合患者较>3 mm组为多(P<0.01);鼓膜未闭合患者中,≤3 mm组鼓膜直径变小者较>3 mm组为多(P<0.01)。(3)≤3 mm组和>3 mm组术后6个月的有效率分别为75%与35%,≤3 mm组术后疗效显著。(4)术后6个月≤3 mm组和>3 mm组患者中耳感染、鼓室硬化等术后并发症发生率分别为25%和45%,两组差异有统计学意义(P<0.05)。(5)≤3 mm组患者手术治疗后主观感受明显好转(P<0.01);≤3 mm组和>3 mm组术后1个月ETDQ-7评分差异有统计学意义(P<0.01)。结论:在2~4 mm的造孔直径范围内,造孔直径为2.5~3.0 mm时术后效果较好。Objective:To investigate the postoperative effect of different diameters of CO_(2)laser tympanostomy in the treatment of secretory otitis media caused by radiotherapy in patients with head and neck tumor,and to find out the best diameter range of tympanostomy according to the curative effect.Methods:The 40 ears after radiotherapy in the otorhinolaryngology department.The average 40 ears were divided into two groups:the diameter of perforation≤3 mm and the diameter of perforation>3 mm.Each group was 20 ears.Both groups were compared with tympanum and pure tone threshold after perforation,and then performed pure tone threshold measurement,tympanoplasty,and otoendoscopy 1,3,6 month after operation respectively.Meanwhile,patients were asked to assist in filling in the score scale of eustachian tube dysfunction(ETDQ-7),to understand the difference in clinical symptoms and to count the complications after the operation.The changes of the size of the holes were compared with the corresponding attractors during the follow-up.Results:(1)After the operation,the mean value of pure tone hearing threshold air bone conduction difference in the diameter of perforation≤3 mm group was significantly lower than that in the diameter of perforation>3 mm group(P<0.05),indicating that the postoperative hearing recovery in the diameter of perforation≤3 mm group was better than that in the diameter of perforation>3 mm group.(2)Within six months after the operation,the tympanic membrane in the group a healed more than that in the diameter of perforation>3 mm group(P<0.01);in patients with an unclosed tympanic membrane in the diameter of perforation≤3 mm group and the diameter of perforation>3 mm group,the number of smaller tympanic membrane diameter in the diameter of perforation≤3 mm group was more than that in the diameter of perforation>3 mm group(P<0.01).(3)The effective rates of the diameter of perforation≤3 mm group and the diameter of perforation>3 mm group were 75%and 35%,respectively.(4)The incidence of postoperative

关 键 词：头颈部肿瘤 中耳炎 伴渗出液 鼓膜造孔直径 放射疗法 

分 类 号：R764.21[医药卫生—耳鼻咽喉科]