山东大学耳鼻喉眼学报 ›› 2021, Vol. 35 ›› Issue (2): 71-75.doi: 10.6040/j.issn.1673-3770.1.2020.097

• 临床研究 • 上一篇    下一篇

腺样体消融联合鼓膜打孔术治疗儿童腺样体肥大合并分泌性中耳炎55例

吴华,孙永明,郑建华,蔡雪花   

  1. 中国人民解放军陆军第七十三集团军医院/厦门大学附属成功医院 眼耳鼻喉科, 福建 厦门 361003
  • 发布日期:2021-04-20
  • 通讯作者: 郑建华. E-mail:zhengjh174@163.com

Application of endoscopic adenoids cryoablation combined with low-temperature plasma tympanostomy in the treatment of 55 children with adenoid hypertrophy and secretory otitis media

WU Hua, SUN Yongming, ZHENG Jianhua, CAI Xuehua   

  1. Department of Ophthalmology & Otolaryngology, Chenggong Hospital Affiliated to Xiamen University, Xiamen 361003, Fujian, China
  • Published:2021-04-20

摘要: 目的 探讨同时运用低温等离子技术开展腺样体消融术联合耳内镜下鼓膜打孔术的前提下,治疗腺样体肥大合并分泌性中耳炎患儿的临床疗效。 方法 将确诊为腺样体肥大合并分泌性中耳炎的患儿111例(183耳)随机分为实验组55 例(89耳)和对照组56 例(94耳),两组均接受鼻内窥镜下腺样体低温等离子消融术,对照组实施鼓膜切开术,实验组给予耳内镜下低温等离子鼓膜打孔。术后观察两组临床疗效、感染发生率,随访6个月统计两组复发率。 结果 浆液型分泌性中耳炎在实验组与对照组中的有效率、感染率、复发率方面无统计学意义(P>0.05)。黏液型分泌性中耳炎在实验组与对照组的感染率方面差异无统计学意义(P=0.191),而在有效率方面实验组高于对照组,差异有统计学意义(P=0.006),术后复发率则相反,差异有统计学意义(P=0.012)。 结论 采用腺样体低温等离子消融联合耳内镜下低温等离子鼓膜打孔治疗分泌性中耳炎的疗效显著,特别是在儿童黏液型分泌性中耳炎,且在减少术后复发风险方面具有一定价值。

关键词: 分泌性中耳炎, 腺样体肥大, 腺样体消融, 低温等离子, 鼓膜打孔, 儿童

Abstract: Objective To explore the clinical efficacy of low temperature plasma adenoid ablation combined with low-temperature plasma tympanostomy for the treatment of secretory otitis media in children. Methods A total of 111 children(183 ears)with adenoid hypertrophy and secretory otitis media were randomly divided into an experimental group(55 cases, 89 ears)and a control group(56 cases, 94 ears). Both groups underwent low temperature plasma endoscopic adenoid ablation. Additionally, the control group underwent tympanoplasty while the experimental group underwent low-temperature plasma tympanoplasty under otoendoscope. The effectiveness and infection rates in the two groups were recorded after surgery, and the recurrence rate in the two groups was determined after six months of follow-up. Results There was no significant difference in the effective rates, infection rates and recurrence rates of serous secretory otitis media between the experimental group and the control group. The infection rate of mucinous secretory otitis media was not significantly different between the experimental group and the control group(P=0.191), but the effective rate of the experimental group was higher than that of the control group(P=0.006), and the postoperative recurrence rate was opposite, the difference was statistically significant(P=0.012). Conclusion Low temperature plasma adenoid ablation combined with low-temperature plasma tympanostomy has good therapeutic effect on secretory otitis media in children and may reduce the risk of postoperative recurrence.

Key words: Secretory otitis media, Adenoid hypertrophy, Adenoid ablation, Low temperature plasma, Tympanic membrane perforation, Children

中图分类号: 

  • R764.21
[1] 陈文欣, 付勇. 腺样体肥大在儿童分泌性中耳炎发病机制中的作用研究进展[J]. 临床耳鼻咽喉头颈外科杂志, 2018, 32(17): 1359-1362. doi:10.13201/j.issn.1001-1781.2018.17.017. CHEN Wenxin, FU Yong. Advances in the role of adenoid hypertrophy in the pathogenesis of otitis media with effusion in children[J]. Journal of Clinical Otorhinolaryngology Head and Neck Surgery, 2018, 32(17): 1359-1362. doi:10.13201/j.issn.1001-1781.2018.17.017.
[2] 刘冰, 张杰, 陈敏, 等. 分泌性中耳炎患儿前庭功能评价[J]. 听力学及言语疾病杂志, 2016, 24(2): 142-144. doi:10.3969/j.issn.1006-7299.2016.02.008. LIU Bing, ZHANG Jie, CHEN Min, et al. The evaluation of semicircular canal function in children with secretory otitis media[J]. Journal of Audiology and Speech Pathology, 2016, 24(2): 142-144. doi:10.3969/j.issn.1006-7299.2016.02.008.
[3] DeAntonio R, Yarzabal JP, Cruz JP, et al. Epidemiology of otitis media in children from developing countries: a systematic review[J]. Int J Pediatr Otorhinolaryngol, 2016, 85: 65-74. doi:10.1016/j.ijporl.2016.03.032.
[4] 杨洁, 王艳琦, 孙家强, 等. 咽鼓管解剖和功能与慢性化脓性中耳炎发生发展的相关性研究[J]. 临床耳鼻咽喉头颈外科杂志, 2019, 33(12): 1121-1124. doi:10.13201/j.issn.1001-1781.2019.12.002. YANG Jie, WANG Yanqi, SUN Jiaqiang, et al. Anatomy and function of the Eustachian tube influence the development of chronic suppurative otitis media[J]. Journal of Clinical Otorhinolaryngology Head and Neck Surgery, 2019, 33(12): 1121-1124. doi:10.13201/j.issn.1001-1781.2019.12.002.
[5] Rosenfeld RM, Shin JJ, Schwartz SR, et al. Clinical practice guideline: otitis media with effusion executive summary(update)[J]. Otolaryngol Head Neck Surg, 2016, 154(2): 201-214. doi:10.1177/0194599815624407.
[6] 顾凌澜, 纪洋洋, 陈晓彩, 等. 低温等离子鼓膜造孔治疗慢性分泌性中耳炎的临床观察[J]. 中国中西医结合耳鼻咽喉科杂志, 2020, 28(1): 17-20. doi:10.16542/j.cnki.issn.1007-4856.2020.01.004. GU Linglan, JI Yangyang, CHEN Xiaocai, et al. Application of low temperature plasma tympanostomy in chronic secretory otitis media[J]. Chinese Journal of Otorhinolaryngology in Integrative Medicine, 2020, 28(1): 17-20. doi:10.16542/j.cnki.issn.1007-4856.2020.01.004.
[7] 陶佳, 罗仁忠, 陈彦球, 等. 鼓膜切开或置管—儿童腺样体肥大合并分泌性中耳炎手术治疗方式对比[J]. 临床耳鼻咽喉头颈外科杂志, 2020, 34(3): 207-210. doi:10.13201/j.issn.2096-7993.2020.03.005. TAO Jia, LUO Renzhong, CHEN Yanqiu, et al. Myringotomy or tympanostomy tube insertion, comparison of surgical treatment of adenoid hypertrophy and otitis media with effusion in children[J]. Journal of Clinical Otorhinolaryngology Head and Neck Surgery, 2020, 34(3): 207-210. doi:10.13201/j.issn.2096-7993.2020.03.005.
[8] 刘娅, 杨军, 张杰, 等. 临床实践指南: 分泌性中耳炎(更新版)[J]. 听力学及言语疾病杂志, 2016, 24(5): 499-519. doi:10.3969/j.issn.1006-7299.2016.05.020. LIU Ya, YANG Jun, ZHANG Jie, et al. Otolaryngology-head and neck surgery 2016[J]. Journal of Audiology and Speech Pathology, 2016, 24(5): 499-519. doi:10.3969/j.issn.1006-7299.2016.05.020.
[9] 于海洋, 毛传远, 翟冰, 等. 鼻内镜下经咽鼓管置管治疗分泌性中耳炎[J]. 中华耳科学杂志, 2004, 2(2): 106-108. doi:10.3969/j.issn.1672-2922.2004.02.007. YU Haiyang, MAO Chuanyuan, ZHAI Bing, et al. Indwelling tympanal catheterization through the eustachian tube with the aid of nasal endoscopy for treatment of secretory otitis media[J]. Chinese Journal of Otology, 2004, 2(2): 106-108. doi:10.3969/j.issn.1672-2922.2004.02.007.
[10] 刘燕, 魏萍, 寇巍, 等. 儿童腺样体肥大与耳鼻咽喉科常见疾病关系的研究进展[J]. 山东大学耳鼻喉眼学报, 2019, 33(4): 149-154. doi:10.6040/j.issn.1673-3770.0.2018.266. LIU Yan, WEI Ping, KOU Wei, et al. Research of the relationship between adenoid hypertrophy and the common diseases of pediatric otolaryngology[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2019, 33(4): 149-154. doi:10.6040/j.issn.1673-3770.0.2018.266.
[11] Saunders NC, Hartley BE, Sell D, et al. Velopharyngeal insufficiency following adenoidectomy[J]. Clin Otolaryngol Allied Sci, 2004, 29(6): 686-688. doi:10.1111/j.1365-2273.2004.00870.x.
[12] 江文博, 张建耀, 胡建道, 等. 腺样体切除术同时行鼓膜置管或鼓膜切开对分泌性中耳炎的疗效分析[J]. 中国中西医结合耳鼻咽喉科杂志, 2018, 26(1): 13-15. doi:10.16542/j.cnki.issn.1007-4856.2018.01.004. JIANG Wenbo, ZHANG Jianyao, HU Jiandao, et al. Effects of adenoidectomy with myringotomy or grommet insertion on children with secretory otitis media[J]. Chinese Journal of Otorhinolaryngology in Integrative Medicine, 2018, 26(1): 13-15. doi:10.16542/j.cnki.issn.1007-4856.2018.01.004.
[13] 康一, 谈晓文, 朱丽烨, 等. 鼓膜穿刺和鼓膜激光打孔及鼓膜置管在治疗儿童分泌性中耳炎中的疗效比较[J]. 临床耳鼻咽喉头颈外科杂志, 2018, 32(22): 1723-1727. doi:10.13201/j.issn.1001-1781.2018.22.010. KANG Yi, TAN Xiaowen, ZHU Liye, et al. Comparison of tympanocentesis, CO2 laser tympanostomy and grommet insertion in the treatment for secretory otitis media in children[J]. Journal of Clinical Otorhinolaryngology Head and Neck Surgery, 2018, 32(22): 1723-1727. doi:10.13201/j.issn.1001-1781.2018.22.010.
[14] Cotter CS, Kosko JR. Effectiveness of laser-assisted myringotomy for otitis media in children[J]. Laryngoscope, 2004, 114(3): 486-489. doi:10.1097/00005537-200403000-00018.
[15] Kalcioglu MT, Cokkeser Y, Kizilay A, et al. Follow-up of 366 ears after tympanostomy tube insertion: why is it draining?[J]. Otolaryngol Head Neck Surg, 2003, 128(4): 560-564. doi:10.1016/s0194-5998(03)00120-7.
[16] 张开昌, 张军梅, 张建新, 等. 腭裂修复术同期等离子鼓膜打孔治疗分泌性中耳炎疗效观察[J]. 临床耳鼻咽喉头颈外科杂志, 2015, 29(8): 753-755. doi:10.13201/j.issn.1001-1781.2015.08.022. ZHANG Kaichang, ZHANG Junmei, ZHANG Jianxin, et al. Curative effect observation of plasma eardrum perforation homochronous with palatoplasty in the treatment of chronic secretory otitis media[J]. Journal of Clinical Otorhinolaryngology Head and Neck Surgery, 2015, 29(8): 753-755. doi:10.13201/j.issn.1001-1781.2015.08.022.
[17] 王昭迪, 李占珍, 李金海, 等. 耳内镜下低温等离子鼓膜打孔术治疗成人分泌性中耳炎的疗效观察[J]. 临床耳鼻咽喉头颈外科杂志, 2018, 32(7): 554-556. doi:10.13201/j.issn.1001-1781.2018.07.020. WANG Zhaodi, LI Zhanzhen, LI Jinhai, et al. Effect observation of low-temperature plasma radiofrequency ablation under endotoscope in treatment of otitis media with effusion in the adult[J]. Journal of Clinical Otorhinolaryngology Head and Neck Surgery, 2018, 32(7): 554-556. doi:10.13201/j.issn.1001-1781.2018.07.020.
[18] Casas P, Ascaso FJ, Vicente E, et al. Retinal and optic nerve evaluation by optical coherence tomography in adults with obstructive sleep apnea-hypopnea syndrome(OSAHS)[J]. Albrecht Von Graefes Arch Fur Klinische Und Exp Ophthalmol, 2013, 251(6): 1625-1634. doi:10.1007/s00417-013-2268-9.
[19] Shaikh N, Wang EE, Arguedas A, et al. Acute otitis media severity of symptom score in a tympanocentesis study[J]. Pediatr Infect Dis J, 2011, 30(3): 253-255. doi:10.1097/INF.0b013e31820662d7.
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