鼓膜置管或鼓膜穿刺对腺样体切除治疗儿童分泌性中耳炎的影响

发布时间：2018-08-25 15:26

【摘要】：目的探讨耳内镜下鼓膜穿刺或鼓膜置管联合鼻内镜下腺样体切除对保守治疗无效的儿童分泌性中耳炎的影响。方法选取112例南京医科大学附属儿童医院耳鼻喉科2013年7月至2015年8月经药物保守治疗无效的分泌性中耳炎伴腺样体肥大患儿,分为3组,A组38例(68耳)行鼻内镜下腺样体切除术,B组37例(60耳)行鼻内镜下腺样体切除加鼓膜穿刺术,C组37例(59耳)行鼻内镜下腺样体切除加鼓膜切开置管术。观察并比较3组患儿术后的临床治疗效果、中耳积液时间、术后复发情况及并发症发生率。结果 3组术后3个月总有效率均较术后1周有所提高(P0.05),B、C两组在术后1周及术后3个月其总有效率均高于A组(P0.05),而C组在术后3个月总有效率也明显高于B组(P0.05)。3组患儿术后1年听觉脑干诱发电位(ABR)阈值及ABRⅠ波潜伏期均较术前有所降低(P0.05),B、C组术后1周及术后1年ABR变化均低于A组(P0.05)。术后C组中耳积液时间与复发率均小于A、B组(P0.05),A组并发症发生率低于B、C组(P0.05)。结论鼓膜置管联合鼻内镜下腺样体切除术能有效提高患儿听力,不但能缩短中耳积液时间,还能有效减少复发率。
[Abstract]:Objective to investigate the effect of endoscopic tympanic membrane puncture or tympanic tube insertion combined with endoscopic adenoidectomy on secretory otitis media in children with ineffective conservative treatment. Methods 112 children with secretory otitis media accompanied with adenoid hypertrophy were selected from July 2013 to August 2015, Department of Otorhinolaryngology, affiliated Children's Hospital of Nanjing Medical University. Group A (n = 38) received endoscopic adenoidectomy (n = 68) and group B (n = 37) underwent endoscopic adenoidectomy plus tympanic membrane puncture (n = 37). Group C (n = 37) underwent endoscopic adenoidectomy and tympanic membrane incision (n = 59). The clinical effect, the time of middle ear effusion, the recurrence rate and the incidence of complications were observed and compared among the 3 groups. Results the total effective rate in group C was higher than that in group A at 1 week and 3 months after operation (P0.05), and the total effective rate in group C was significantly higher than that in group B (P0.05). The (ABR) threshold of auditory brainstem evoked potential and the latency of ABR I wave in group A were lower than those in group A (P0.05). The changes of ABR in group C were lower than those in group A 1 week after operation and 1 year after operation (P0.05). The time and recurrence rate of middle ear effusion in group C were lower than those in group A (P0.05) and the incidence of complications in group A was lower than that in group B (P0.05). Conclusion Endoscopic adenoidectomy combined with tympanic membrane insertion can effectively improve the hearing of children, not only shorten the time of middle ear effusion, but also reduce the recurrence rate.
【作者单位】：南京医科大学附属儿童医院耳鼻咽喉科;西安交通大学第二附属医院耳鼻咽喉头颈外病院;
【基金】：国家自然科学基金资助项目(81271068) 高等学校博士学科点专项科研基金资助项目(20120201110060) 南京市医学科技发展专项资金资助项目(YKK13134) 南京医科大学科技发展基金资助项目(2012NJMU059)
【分类号】：R764.21

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