穿刺与置管治疗鼻咽癌放疗后分泌性中耳炎疗效研究  

Tympanocentesis and Ventilation Tube Insertion in the Treatment of Otitis Media with Effusion After Radiotherapy for Nasopharyngeal Carcinoma

作　　者：邓锐 王朝永 陈华娇 王益玲 骆小华 DENG Rui;WANG Chaoyong;CHEN Huajiao;WANG Yiling;LUO Xiaohua(Chongqing Medical University,Chongqing 408000,China;不详)

机构地区：[1]重庆医科大学,重庆400000 [2]重庆大学附属涪陵医院耳鼻咽喉头颈外科 [3]重庆医科大学附属第三医院

出　　处：《中华耳科学杂志》2024年第6期936-940,共5页Chinese Journal of Otology

基　　金：重庆市科卫联合医学科研面上项目(2021MSXM279);重庆市涪陵区科卫联合医学科研项目(2023KWLH002)。

摘　　要：目的评估鼓膜穿刺冲洗与鼓室置管联合药物灌洗两种不同疗法在鼻咽癌放疗后分泌性中耳炎的临床应用价值。方法回顾性分析2017年7月至2022年2月重庆大学附属涪陵医院治疗的鼻咽癌放疗后分泌性中耳炎病例66例,其中观察组28例行鼓室置管联合药物灌洗,对照组38例行鼓室穿刺冲洗,观察两组疗效、生活质量、远期并发症。生活质量评估指标主要包括:听力改善(纯音听阈气导提升值)、耳鸣改善(THI耳鸣残疾评估量表得分)、咽鼓管功能(ETDQ-7评分量表)。结果随访时间超过1年,观察组总有效率75.0%(21/28)高于对照组47.4%(18/38)(P=0.042);纯音听阈气导(air conduction,AC)提升值19.86±5.848 dB HL优于对照组8.50±7.918 dB HL(P<0.001)、耳鸣残疾评估量表(tinnitus handicap inventory,THI)得分2.50±4.948低于对照组9.58±7.100(P<0.001);咽鼓管功能障碍评分量表(7-item eustachian tube dysfunction questionnaire,ETDQ-7)得分9.36±2.947分低于对照组12.47±6.263分(P=0.009);而远期并发症如化脓性中耳炎、鼓膜穿孔、耳道溢液、鼓室粘连等在观察组的发生率为25.0%(7/28),高于对照组2.6%(1/38)(P=0.018)。结论鼓室置管联合药物灌洗治疗鼻咽癌放疗后分泌性耳炎的效果要好于鼓膜穿刺冲洗,对患者的听力、耳鸣和咽鼓管功能都有有效的改善,但术后远期并发症比较高。Objective To compare outcomes and long-term complications between tympanocentesis and ventilation tube insertion combined with drug irrigation in the treatment of otitis media with effusion after radiotherapy for nasopharyngeal carcinoma.Methods Data from 66 cases of otitis media with effusion after radiotherapy form nasopharyngeal carcinoma treated at Chongqing University affiliated Fuling Hospital from July 2017 to February 2022 were retrospectively analyzed,including 28 cases treated with ventilation tube insertion combined with drug irrigation(the observation group)and 38 cases treated with tympanocentesis and irrigation(the control group).Treatment efficacy,quality of life and long-term complications were compared between the two groups,including air conduction hearing improvement,THI score and the ETDQ-7 Eustachian tube dysfunction scale.Results At one-year follow-up,the rate of total effectiveness(75.0%,21/28)in the observation group was significantly higher than in the control group(47.4%,18/38)(P=0.042),with greater improvement in air conduction pure tone thresholds(P<0.001),lower THI(P<0.001)and ETDQ-7(P=0.009)scores.However,the incidence of long-term complications,including suppurative otitis media,tympanic membrane perforation,otorrhea and tympanic adhesion,was higher in the observation group(25.0%,7/28)than that in the control group(2.6%,1/38)(P=0.018).Conclusion Ventilation tube insertion combined with drug irrigation is more effective than tympanocentesis in the treatment of otitis media with effusion after radiotherapy for nasopharyngeal carcinoma,and can effectively improve hearing,tinnitus and eustachian tube function,although with relatively frequent long-term complications.

关 键 词：鼻咽癌 分泌性中耳炎 鼓膜置管术 鼓膜穿刺 药物冲洗 

分 类 号：R739.63[医药卫生—肿瘤] R764.21[医药卫生—临床医学]