咽鼓管球囊扩张联合鼓膜穿刺术与鼓膜切开术在分泌性中耳炎的应用

发布时间：2018-02-26 05:04

本文关键词： 分泌性中耳炎咽鼓管功能障碍咽鼓管球囊扩张术鼓膜穿刺术鼓膜切开术　出处：《遵义医学院》2017年硕士论文　论文类型：学位论文

【摘要】：目的:探讨咽鼓管球囊扩张联合鼓膜穿刺术与鼓膜切开术对分泌性中耳炎治疗效果的对比评估,为分泌性中耳炎治疗新方法提供理论基础。方法:选取2015年3月至2016年7月深圳龙岗区耳鼻咽喉医院耳鼻咽喉科收治的分泌性中耳炎患者32人(41耳)为研究对象,上述对象均符合分泌性中耳炎的诊断标准,纯音听阈示骨气导差(500、1000、2000及4000Hz)平均值"g15d B,鼓室导抗图示“B”型或“C”型曲线,行耳内镜检查鼓膜完整合并鼓室积液,无鼻咽部肿瘤或腺样体肥大,药物保守治疗"g3个月。患者结合自身情况自愿分为两组,A组15人(20耳),B组17人(21耳)。A组为进行咽鼓管球囊扩张联合鼓膜穿刺术的患者,B组为进行鼓膜切开术的患者。所有患者术前、术后2周、术后1个月、术后3个月均行耳内镜的检查、纯音测听检测、声导抗检测、咽鼓管功能障碍评分(the eustachian tube dysfunction questionnaire,ETDQ-7)的评估,最后对数据进行统计学分析。结果:A组术后2周治愈率45%(9/20),好转率40%(8/20),无效率15%(3/20),有效率85%(17/20),有效率为痊愈率与好转率的总和;术后1月治愈率85%(17/20),好转率10%(2/20),无效率5%(1/20),有效率95%(19/20);术后3月治愈率90%(18/20),好转率5%(1/20),无效率5%(1/20),有效率95%(19/20)。B组术后2周治愈率28.6%(6/21),好转率66.7%(14/21),无效率4.8%(1/21),有效率95.3%(20/21);术后1月治愈率47.6%(10/21),好转率0%(0/21),无效率52.4%(11/21),有效率47.60%(10/21);术后3月治愈率47.6%(10/21),好转率0%(0/21),无效率52.4%(11/21),有效率47.6%(10/21)。A组与B组术后1月、3月疗效对比存在显著差异(P0.05)。通过手术前后ETDQ-7评分比较可发现,A组与B组术后1月、3月评分对比存在显著差异(P0.05),有统计学意义;A组术后1月与3月评分存在显著差异(P0.05)。结论:对于排除鼻咽部肿物及鼻窦炎的慢性分泌性中耳炎患者,咽鼓管球囊扩张联合鼓膜穿刺术跟单纯鼓膜切开术相比有更好的短期疗效,该手术创伤较小,在短期的临床随访时间内治疗效果稳定,有一定的优势,是一种安全、可行的手术。
[Abstract]:Objective: to evaluate the efficacy of eustachian tube balloon dilatation combined with tympanic membrane puncture and tympanic membrane incision in the treatment of secretory otitis media. Methods: from March 2015 to July 2016, 32 patients (41 ears) with secretory otitis media treated in Department of Otolaryngology, Longgang District Otolaryngology Hospital, Shenzhen, were selected. All the above objects were in accordance with the diagnostic criteria of secretory otitis media. The pure tone hearing threshold showed the mean value of "g15dB", the tympanic conductance curve was "B" or "C" curve, and the tympanic membrane intact with tympanic effusion was examined by endoscopy. No nasopharyngeal neoplasms or adenoid hypertrophy, Drug conservative therapy "g3 months. Patients were voluntarily divided into two groups according to their own conditions: group A, 15 patients with 20 ears, group B, 17 patients with 21 ears, group A, patients undergoing balloon dilation of the eustachian tube combined with tympanic membrane puncture, group B, patients undergoing tympanotomy, and group B, patients undergoing tympanectomy." All patients before operation, 2 weeks after operation, 1 month after operation, 3 months after operation, all patients were assessed by endoscopy, pure tone audiometry, acoustic conductance, and the score of the eustachian tube dysfunction questionnairere 7 (ETDQ-7). Finally, the data were analyzed statistically. Results in group A, the cure rate was 459 / 20, the improvement rate was 40 / 20, the inefficiency was 15 / 20, the effective rate was 8517 / 20, and the effective rate was the sum of the recovery rate and the improvement rate. On January, the cure rate was 85 / 17 / 20, the improvement rate was 10 / 2 / 20, the inefficiency was 5 / 20 / 20, the effective rate was 95 / 20; on March, the cure rate was 9018 / 20, the improvement rate was 5 1 / 20, the inefficiency was 5% 1 / 20, the effective 9519 / 20 / B group had a cure rate of 28.666 / 21, the improvement rate was 66.714 / 21 / 21, the inefficiency was 4.881 / 21, the effective rate was 95.330.20% / 21; the cure rate was 47.66% / 10 ~ (21) after January. On March, the cure rate was 47.610 / 21, the improvement rate was 0 / 21, the ineffective rate was 52.610 / 21, the effective rate was 57.610 / 21 / 21, the effective rate was 47.610 / 21 / 21, the effective rate was 52.610 / 21 / 21, the effective rate was 47.610 / 21 / 21 and the effective rate was 47.610 / 21 / 21 / 11 / 21. There was a significant difference in the curative effect between group A and group B on January and March. By comparing the ETDQ-7 scores before and after operation, we can find that there is a significant difference between group A and group B. There were significant differences in scores between January and March in group A and P 0.05 in group A. Conclusion: for patients with chronic secretory otitis media who exclude nasopharyngeal masses and sinusitis, there is a significant difference between group A and group A in terms of postoperative scores of January and January. Compared with simple tympanic membrane incision, eustachian tube balloon dilation combined with tympanic membrane puncture has better short-term curative effect. A viable operation.
【学位授予单位】：遵义医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R764.9

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