腺样体切除联合耳内镜下鼓膜置管或鼓膜穿刺治疗儿童分泌性中耳炎的疗效比较

摘要

Objective To compare the clinical effect of adenoidectomy combined with ear endoscopic tympanostomy tube placement or tympanocentesis for secretory otitis media in children. Methods A total of 62 cases of chronic secretory otitis media with failed conservative treatment were selected in our hospital from January 2012 to January 2014. They were randomly divided into either observation group or control group, with 31 cases in each group ( 45 ears in the observation group and 49 ears in the control group) . The observation group was treated with tympanostomy tube placement, while the control group was treated with tympanocentesis. The curative effects were juded by clinical features and results of pure tone audiometry testing and acoustic immitance. The effectiveness was defined as pure tone hearing threshold increased by more than 10 dB HL and tympanum admittance in type A or C. Results The two groups were followed up for (42. 3 ± 12. 7) weeks and (40. 6 ± 13. 1) weeks respectively (t=0. 518, P=0. 605). The effective rate in the observation group was higher than that in the control group [86. 7% (39/45) vs. 69. 4% (34/49), χ2 =4. 037, P=0. 045]. The complications in the observation group were fewer than that in the control group [8. 9% (4/45) vs. 28. 6% (14/49),χ2 =5. 870, P=0. 015]. The recurrence rate was lower in the observation group than in the control group [2. 2% (1/45) vs. 16. 3% (8/49), χ2 =3. 884, P=0. 049]. Conclusions Adenoidectomy combined with ear endoscopic tympanostomy tube insertion not only has a clear operation vision, but also has advantages of less trauma and better postoperative recovery. It is worthy of clinical application.%目的：探讨腺样体切除联合耳内镜下鼓膜置管或鼓膜穿刺治疗儿童分泌性中耳炎的临床效果。方法选取我院2012年1月~2014年1月62例药物保守治疗无效的儿童分泌性中耳炎,根据随机数字法分为观察组和对照组,各31例(观察组45耳,对照组49耳),观察组采用腺样体切除术及耳内镜下鼓膜置管术治疗,对照组采用腺样体切除术及耳内镜下鼓膜穿刺术治疗。术后根据临床表现、纯音听阈测定、声导抗测试结果综合判断疗效,纯音听阈提高10 dB HL以上、鼓室导抗图为A型或C型为有效。结果2组随访时间分别为(42.3±12.7)周、(40.6±13.1)周(t=0.518,P=0.605)。与对照组相比,观察组有效率高[86．7%(39/45) vs.69.4%(34/49),χ2=4.037,P=0.045],术后并发症少[8.9%(4/45) vs.28.6%(14/49),χ2=5.870,P=0.015],复发率低[2.2%(1/45) vs.16.3%(8/49),χ2=3.884,P=0.049]。结论腺样体切除联合耳内镜下鼓膜置管治疗儿童分泌性中耳炎,视野清晰,创伤小,恢复快,值得推广应用。