儿童腺样体形态学与分泌性中耳炎的相关性研究

发布时间：2018-09-19 09:39

【摘要】：目的：通过儿童腺样体的大体形态、影像学形态、细胞学形态三方面分析,探讨儿童腺样体形态学与SOM的相关性,以及儿童SOM的诊治。 方法：采用病例观察研究,将遵义医学院三附属医院耳鼻咽喉头颈外科2011年1月2011年10月98例184耳(双耳患病者86例,单耳患病者12例)SOM并行腺样体切除术的患儿,均行鼻咽部三维CT、纤维鼻咽镜、声导抗、病理学检查,必要时行ABR,以排除蜗性及蜗后病变；年龄大于5岁者,行纯音测听检查,术中B型鼓室压图者行鼓室穿刺；将确诊为儿童SOM,同时排除鼻咽部肿瘤、脑膜脑膨出、中耳外伤的98例患儿纳为研究对象,分成三组：单纯腺样体肥大引起SOM、炎症性腺样体引起的SOM和过敏性因素引起的SOM,结合近年来相关文献,从腺样体的大体形态、影像学形态、细胞学形态三方面评估和统计分析腺样体形态学与SOM的相关性。 结果：98病例中经鼓室穿刺证实合并SOM者26例(26.5%)、而经声导抗检查+纯音测听检查证实且病史中有明确听力减退者72例(73.5%)。并对这些病例从腺样体的大体形态、影像学形态、细胞学形态三方面进行统计分析发现,腺样体的形态学与SOM发病有明显相关性,其中影响最显著的因素是腺样体形态与咽鼓管咽口关系的密切程度。腺样体的形态学检查中,肥大型、A/N值≥0.71、炎症性、过敏性的腺样体易患SOM,导致咽鼓管功能障碍致鼓室图异常,造成儿童听力下降,而平坦型、A/N值≤0.60、单纯肥大的腺样体对儿童听力的影响较小。 结论：腺样体的形态学与SOM有相关性,故有必要对所有腺样体肥大患儿常规进行听力学检查、鼻咽部三维CT扫描、腺样体组织进行细胞学检查,以进一步辅助确认或除外SOM诊断。
[Abstract]:Objective: to investigate the correlation between adenoid morphology and SOM in children and the diagnosis and treatment of SOM in children by analyzing the gross morphology, imaging morphology and cytological morphology of adenoids in children. Methods: 98 cases of 184 ears (86 patients with binaural disease, 12 patients with monaural disease) treated with adenoidectomy were treated with SOM in Oct. 2011 in the third affiliated Hospital of Zunyi Medical College, in which 98 cases (86 cases of binaural disease and 12 cases of monaural disease) were treated with adenoidectomy. Three dimensional nasopharynx CT, fiberoptic nasopharyngoscope, acoustic impedance, pathological examination, ABR, to exclude cochlear and retrocochlear lesions, pure tone audiometry and tympanic cavity puncture were performed in patients over 5 years old, and tympanic cavity puncture was performed in patients with type B tympanogram during operation. Ninety-eight children diagnosed as children with SOM, at the same time excluded nasopharyngeal tumors, meningeal encephalocele and middle ear trauma were included in the study. They were divided into three groups: SOM caused by SOM, inflammation caused by adenoid hypertrophy and SOM, caused by anaphylaxis combined with related literature in recent years. The relationship between adenoid morphology and SOM was evaluated and statistically analyzed in three aspects of cytology and morphology. Results 26 cases (26.5%) were confirmed with SOM by tympanic puncture, and 72 cases (73.5%) were confirmed by pure tone audiometry and history of hearing loss. It was found that the morphology of adenoid and the incidence of SOM were significantly correlated with the morphology of adenoids from three aspects: gross morphology, imaging morphology and cytological morphology. Among them, the most significant factor is the close relationship between adenoid morphology and pharyngostomy of eustachian tube. In the morphological examination of adenoids, A / N value 鈮，

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