鼓膜置管治疗难治性分泌性中耳炎鼓膜穿孔危险因素分析

摘要

Objective To explore the treatment using two different ventilation tubes insertion for secretory o-titis media ,and to determine which factors are associated with the tympanic membrane perforation after a extrusion or surgical removal of a ventilation tube(VT) .Methods A retrospective analysis of 121 cases (210 ears) with re-fractory secretory otitis media from 1998 June to 2013 March was carried out .There were 58 cases (105 ears ) and 63 cases (105 ears) in patients and control group ,respectively .All subjects had more than 2 years of history ,and were treated by two types of ventilation tube (Goode -T and Shepard tube) .Various factors were analyzed to deter-mine the factors associated with persistence of a tympanic membrane perforation after VT extrusion or removal ,in-cluding gender ,age ,medical history ,ventilation tube pattern ,location ,history of previous VT insertions ,intuba-tion period reason for VT insertion ,condition of the TM ,nature of the tympanic cavity effusion and previous ade-noidectomy ,et .Results Analysis factors of perforation group (105 ears) and the control group (without perfora-tion ,105 ears) ,were statistically significant in ventilation tube pattern (χ2 =6 .916 ,P<0 .01) ,history of previous VT insertions(χ2 =7 .325 ,P<0 .01) ,frequency of previous VT insertions (χ2 =13 .01 ,P<0 .01)and the nature of the tympanic cavity effusion(χ2 =7 .04 ,P<0 .01) .The proportion of perforation group about Goode - T ventilation tube ,history of previous VT insertions ,the frequency of tube (more than 3 times) ,mucus of the middle ear cavity were 58 .4% ,57 .3% ,66 .7% and 57 .9% respectively ,others had no significant difference between the two groups . The multivariate analysis showed that ,regardless of the ventilation tube ,the frequency of tube was the tympanic membrane perforation risk factor ;Goode-T tube increased the risk of perforation of tympanic membrane was 1 .637 times than Shepard tube(OR=1 .637 ,P<0 .01) .Conclusion Using the Goode - T type ventilation tube ,history of previous VT insertions ,the frequency of tube (more than 3 times) ,mucus of the middle ear cavity were four risk factors for persistence of a tympanic membrane perforation after VT insertion for secretory otitis media .%目的：探讨鼓膜通气管治疗难治性分泌性中耳炎后，患侧鼓膜永久性穿孔的危险因素。方法回顾性分析1998年6月～2013年3月收治的病程超过2年的121例（210耳）难治性分泌性中耳炎患者的临床资料，其中穿孔组58例（105耳），对照组（未穿孔组）63例（105耳）。所有患者均使用Goode-T型或Shepard哑铃型通气管行鼓膜置管治疗，分析可能影响患侧鼓膜永久性穿孔的因素，包括性别、年龄、病程、通气管类型、置管史、置管次数、鼓膜表象、置管位置、中耳腔积液性质、是否行腺样体切除术及拔管时间等。结果单因素分析显示，穿孔组Goode-T型通气管、有置管史、置管次数（3次以上）、中耳腔粘液性积液分别占58．4％、57．3％、66．7％和57．9％，且均高于对照组（均为 P＜0．01）。Logistic回归分析提示无论采用何种通气管，置管次数增多则患侧鼓膜永久性穿孔的风险增加，采用Goode-T型管较Shepard哑铃型管鼓膜发生穿孔的危险性增加1．637倍（OR＝1．637，P＜0．01）。结论难治性分泌性中耳炎患者鼓膜置管术后，使用Goode-T型通气管、有置管史、置管次数（3次以上）和中耳腔积液为黏液性四因素为鼓膜永久性穿孔的危险因素。