山东大学耳鼻喉眼学报 ›› 2022, Vol. 36 ›› Issue (1): 7-12.doi: 10.6040/j.issn.1673-3770.0.2021.506

• 临床研究 • 上一篇    下一篇

咽鼓管球囊扩张联合腺样体切除术治疗儿童分泌性中耳炎疗效分析

高信忠,林宗通,沈翎,刘平凡,林兴,许杨杨   

  1. 福建省福州儿童医院/福建医科大学附属福州儿童医院 耳鼻咽喉科, 福建 福州 350005
  • 出版日期:2022-01-10 发布日期:2022-02-22
  • 作者简介:高信忠,林宗通为共同第一作者
  • 基金资助:
    福州市科技计划项目(2014-S-141-4)

Analysis of the efficacy of balloon eustachian tuboplasty combined with adenoidectomy in the treatment of otitis media with effusion in children

GAO Xinzhong, LING Zongtong, SHEN Ling, LIU Pingfang, LIN Xin,XU Yangyang   

  1. Department of Otolaryngology, Fuzhou Children's Hospital of Fujian Province, Fuzhou Children's Hospital of Fujian Medical University, Fuzhou 350005, Fujian, China
  • Online:2022-01-10 Published:2022-02-22

摘要: 目的 探讨咽鼓管球囊扩张联合腺样体切除术治疗儿童分泌性中耳炎的中短期疗效及安全性。 方法 回顾性分析2020年7月至2021年2月就诊的分泌性中耳炎伴腺样体肥大患儿66例,其中35例采用咽鼓管球囊扩张联合腺样体切除术为治疗组,31例采用单纯腺样体切除术为对照组,比较两组术后疗效及并发症发生比例。 结果 术后1个月、3个月治疗组疗效优于对照组,差异有统计学意义(P<0.05),术后3个月治疗组疗效最佳,优于术后1个月(P<0.05);术后6个月两组疗效差异无统计学意义(P>0.05);两组术中出血量术后并发症的差异无统计学意义(P均>0.05)。 结论 咽鼓管球囊扩张联合腺样体切除术治疗儿童分泌性中耳炎短期疗效显著,且微创安全,无明显并发症。

关键词: 分泌性中耳炎, 儿童, 咽鼓管球囊扩张术, 腺样体切除术

Abstract: Objective To investigate the medium-and short-term efficacy and safety of Eustachian tube balloon dilatation combined with adenoidectomy in the treatment of secretory otitis media in children. Methods Sixty-six children with secretory otitis media and adenoid hypertrophy in our department from July 2020 to February 2021 were analyzed retrospectively. Among them, 35 cases were treated with Eustachian tube balloon dilatation combined with adenoidectomy as the treatment group, and 31 cases with simple adenoidectomy as the control group. The postoperative curative effect and the proportion of complications were compared between the two groups. Results The curative effects at 1 month and 3 months after the operation in the treatment group were significantly better than those in the control group(all P<0.05), with the best curative effect observed at 3 months after the operation in the treatment group, which was significantly better than that at 1 month post-operation(P<0.05). There was no significant difference in the curative effects 6 months after the operation(P>0.05)and in intraoperative blood loss and postoperative complications between the two groups(all P>0.05). Conclusion Eustachian tube balloon dilatation combined with adenoidectomy can improve the curative effect in the short term, and it is minimally invasive and safe, with no obvious complications.

Key words: Otitis media with effusion, Children, Balloon Eustachian tuboplasty, Adenoidectomy

中图分类号: 

  • R764.21
[1] 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.
[2] 刘宇鹏, 杨军. 儿童分泌性中耳炎治疗国际共识(IFOS)解读及国内诊疗现状[J]. 临床耳鼻咽喉头颈外科杂志, 2018, 32(21): 1674-1678. doi:10.13201/j.issn.1001-1781.2018.21.017. LIU Yupeng, YANG Jun. International consensus on the treatment of pediatric otitis media with effusion and current status of treatment in China[J]. Journal of Clinical Otorhinolaryngology Head and Neck Surgery, 2018, 32(21): 1674-1678. doi:10.13201/j.issn.1001-1781.2018.21.017.
[3] 中华耳鼻咽喉头颈外科杂志编辑委员会,中华医学会耳鼻咽喉头颈外科学分会小儿学组。儿童分泌性中耳炎诊断和治疗指南(2021)[J].中华耳鼻咽喉头颈外科杂志,2021,56(6):556-567. doi:10.3760/cma.j.cn115330-20210511-00264.
[4] Leichtle A, Hollfelder D, Wollenberg B, et al. Balloon eustachian tuboplasty in children[J]. Eur Arch Otorhinolaryngol, 2017, 274(6): 2411-2419. doi:10.1007/s00405-017-4517-8.
[5] Tisch M, Maier H, Sudhoff H. Balloon dilation of the Eustachian tube: clinical experience in the management of 126 children[J]. Acta Otorhinolaryngol Ital, 2017, 37(6): 509-512. doi:10.14639/0392-100X-1690.
[6] Rosenfeld RM, Shin JJ, Schwartz SR, et al. Clinical practice guideline: otitis media with effusion(update)[J]. Otolaryngol Head Neck Surg, 2016, 154(1 Suppl): S1-S41. doi:10.1177/0194599815623467.
[7] 黄选兆,汪吉宝,孔维佳. 实用耳鼻咽喉头颈外科学[M]. 2版. 北京: 人民卫生出版社, 2008.
[8] Schröder S, Lehmann M, Ebmeyer J, et al. Balloon Eustachian tuboplasty: a retrospective cohort study[J]. Clin Otolaryngol, 2015, 40(6): 629-638. doi:10.1111/coa.12429.
[9] 沈翎, 林宗通, 林兴, 等.儿童阻塞性睡眠呼吸暂停低通气综合征危险因素的病例对照研究[J]. 山东大学耳鼻喉眼学报, 2018, 32(2):25-29. doi:10.6040/j.issn.1673-3770.0.2018.086. SHEN Ling, LIN Zongtong, LIN Xing, et al. Risk factors associated with obstructive sleep apnea-hypopnea syndrome in children: a retrospective case-control study. Journal of Otolarygology and Ophthalmology of Shandong University, 2018, 32(2):25-29. doi:10.6040/j.issn.1673-3770.0.2018.086.
[10] Chen SW, Zhao M, Zheng WW, et al. Myringotomy and tube insertion combined with balloon eustachian tuboplasty for the treatment of otitis media with effusion in children[J]. Eur ArchOtorhinolaryngol, 2020, 277(5): 1281-1287. doi:10.1007/s00405-020-05828-9.
[11] Cai T, McPherson B, Li CW, et al. Hearing loss in children with otitis media with effusion: actual and simulated effects on speech perception[J]. Ear Hear, 2018, 39(4): 645-655. doi:10.1097/AUD.0000000000000519.
[12] Roberts JE, Burchinal MR, Campbell F. Otitis media in early childhood and patterns of intellectual development and later academic performance[J]. J Pediatr Psychol, 1994, 19(3): 347-367. doi:10.1093/jpepsy/19.3.347.
[13] 潘宏光, 李兰, 魏明辉, 等. 幼儿慢性分泌性中耳炎与学语迟缓的关系[J]. 临床耳鼻咽喉科杂志, 2004, 18(10): 595-596. doi:10.3969/j.issn.1001-1781.2004.10.007. PAN Hongguang, LI Lan, WEI Minghui, et al. Analysis on the infants of speech delay with chronic secretory otitis media[J]. Journal of Clinical Otorhinolaryngology Head and Neck Surgery, 2004, 18(10): 595-596. doi:10.3969/j.issn.1001-1781.2004.10.007.
[14] 陈平, 唐安洲, 苏纪平, 等. 语言障碍儿童与分泌性中耳炎的关系(附1 108例分析)[J]. 临床耳鼻咽喉科杂志, 2005, 19(13): 580-582. doi:10.3969/j.issn.1001-1781.2005.13.002. CHEN Ping, TANG Anzhou, SU Jiping, et al. Relationship between secretory otitis media and language disorder in children: analysis of 1108 cases[J]. Journal of Clinical Otorhinolaryngology Head and Neck Surgery, 2005, 19(13): 580-582. doi:10.3969/j.issn.1001-1781.2005.13.002.
[15] Ito M, Takahashi H, Iino Y, et al. Clinical practice guidelines for the diagnosis and management of otitis media with effusion(OME)in children in Japan, 2015[J]. Auris Nasus Larynx, 2017, 44(5): 501-508. doi:10.1016/j.anl.2017.03.018.
[16] Lee HJ, Park SK, Choi KY, et al. Korean clinical practice guidelines: otitis media in children[J]. J Korean Med Sci, 2012, 27(8): 835-848. doi:10.3346/jkms.2012.27.8.835.
[17] Blanc F, Ayache D, Calmels MN, et al. Management of otitis media with effusion in children. Société française d'ORL et de chirurgie cervico-faciale clinical practice guidelines[J]. Eur Ann Otorhinolaryngol Head Neck Dis, 2018, 135(4): 269-273. doi:10.1016/j.anorl.2018.04.008.
[18] Heidemann CH, Lous J, Berg J, et al. Danish guidelines on management of otitis media in preschool children[J]. Int J Pediatr Otorhinolaryngol, 2016, 87: 154-163. doi:10.1016/j.ijporl.2016.06.003.
[19] 梁玉芳, 杨军. 分泌性中耳炎对儿童的影响及诊断治疗策略[J]. 上海交通大学学报(医学版), 2007, 27(1): 35-38. doi:10.3969/j.issn.1674-8115.2007.01.010. LIANG Yufang, YANG Jun. Impact of otitis media with effusion on children and its diagnosis and therapy[J]. Journal of Shanghai Jiao Tong University(Medical Science), 2007, 27(1): 35-38. doi:10.3969/j.issn.1674-8115.2007.01.010.
[20] Ockermann T, Reineke U, Upile T, et al. Balloon dilatation eustachian tuboplasty: a clinical study[J]. Laryngoscope, 2010, 120(7): 1411-1416. doi:10.1002/lary.20950.
[21] Poe DS, Hanna BM. Balloon dilation of the cartilaginous portion of the eustachian tube: initial safety and feasibility analysis in a cadaver model[J]. Am J Otolaryngol, 2011, 32(2): 115-123. doi:10.1016/j.amjoto.2009.11.008.
[22] Tisch M, Maier S, Hecht P, et al. Bilateral Eustachian tube dilation in infants: an alternative treatment for persistent middle ear functional dysfunction[J]. HNO, 2013, 61(6): 492-493. doi:10.1007/s00106-013-2713-4.
[23] Maier S, Tisch M, Maier H. Balloon dilation of the Eustachian tube in pediatric chronic obstructive Eustachian tube dysfunction patients[J]. HNO, 2015, 63(10): 686-688, 690-4, 696-7. doi:10.1007/s00106-015-0050-5.
[24] 侯昭晖, 李瑞香, 吴南, 等. 咽鼓管球囊扩张术治疗顽固性分泌性中耳炎的疗效评价[J]. 中华耳科学杂志, 2016, 14(5): 560-565. doi:10.3969/j.issn.1672-2922.2016.05.001. HOU Zhaohui, LI Ruixiang, WU Nan, et al. Outcomes of balloon eustachian tuboplasty for refractory otitis media with effusion[J]. Chinese Journal of Otology, 2016, 14(5): 560-565. doi:10.3969/j.issn.1672-2922.2016.05.001.
[25] 张浩亮, 于锋, 吴云文. 咽鼓管功能障碍的慢性化脓性中耳炎治疗分析[J]. 山东大学耳鼻喉眼学报, 2019, 33(2): 72-75. doi: 10.6040/j.issn.1673-3770.0.2018.094. ZHANG Haoliang, YU Feng, WU Yunwen. Analysis of treatment approaches for chronic suppurative otitis media with eustachian tube dysfunction[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2019, 33(2): 72-75. doi: 10.6040/j.issn.1673-3770.0.2018.094.
[26] 余力生, 郑宏伟, 韩琳. 分泌性中耳炎与中耳通气系统[J]. 中华耳科学杂志, 2020, 18(3): 428-430. doi:10.3969/j.issn.1672-2922.2020.03.001. YU Lisheng, ZHENG Hongwei, HAN Lin. Otitis media with effusion and venting system in middle ear[J]. Chinese Journal of Otology, 2020, 18(3): 428-430. doi:10.3969/j.issn.1672-2922.2020.03.001.
[27] Hong J, Chen KG, Lyu HY, et al. Age-related changes in the morphological relationship between the supratubal recess and the Eustachian tube[J]. Auris Nasus Larynx, 2018, 45(1): 88-95. doi:10.1016/j.anl.2017.05.010.
[28] Toll EC, Browning M, Shukla R, et al. Cartilaginous Eustachian tube length and carotid canal dehiscence in children: a radiological study[J]. Eur Arch Otorhinolaryngol, 2018, 275(11): 2675-2682. doi:10.1007/s00405-018-5128-8.
[29] Yoshioka S, Naito K, Fujii N, et al. Age change in the eustachian tube three-dimensionally measured by multislice CT[J]. Nippon Jibiinkoka Gakkai Kaiho, 2008, 111(7): 523-532. doi:10.3950/jibiinkoka.111.523.
[30] Tisch M, Maier S, Preyer S, et al. Balloon Eustachian Tuboplasty(BET)in Children: a Retrospective Multicenter Analysis[J]. Otology & Neurotology, 2020, 41(2020):1-13.doi:10.1097/MAO.0000000000002789.
[1] 杨扬, 王晓旭, 张杰. 儿童中耳胆脂瘤诊治进展[J]. 山东大学耳鼻喉眼学报, 2022, 36(1): 1-6.
[2] 马宁,陈敏,刘薇,杨扬,邵剑波,郝津生,刘冰,张晓,段晓岷,张祺丰,张杰. 儿童颞骨骨折临床特点和治疗策略[J]. 山东大学耳鼻喉眼学报, 2022, 36(1): 13-19.
[3] 胡春燕,党攀红,张睿,樊孟耘. 儿童单侧感音性听力损失的听力学及影像学特征149例分析[J]. 山东大学耳鼻喉眼学报, 2022, 36(1): 31-36.
[4] 党攀红,张睿,胡春燕,王洁,樊孟耘. 儿童乳突-颞下迷路外面神经减压术8例临床分析[J]. 山东大学耳鼻喉眼学报, 2022, 36(1): 37-42.
[5] 刘珊珊, 韩书婧, 王晓旭, 李艳红, 倪鑫, 张杰. 儿童细菌性脑膜炎后听力损害危险因素的系统评价与Meta分析[J]. 山东大学耳鼻喉眼学报, 2022, 36(1): 48-54.
[6] 焦雪梅,杨扬,李春凤,张晓琳. 鼓膜置管对分泌性中耳炎患儿咽鼓管功能的影响[J]. 山东大学耳鼻喉眼学报, 2022, 36(1): 60-63.
[7] 王蓬鹏,葛文彤,唐力行,杨小健,张薇,肖潇,韩阳. 开放性鼻整形切口治疗儿童先天性鼻中线囊肿及瘘管4例及文献复习[J]. 山东大学耳鼻喉眼学报, 2022, 36(1): 64-69.
[8] 李孟辉,郅莉莉,戚凯文,王珊珊,高倩,步美玲,姜荷云,冯绛楠,王金荣. 皮下免疫治疗对单一尘螨和合并霉菌过敏儿童哮喘的临床研究[J]. 山东大学耳鼻喉眼学报, 2022, 36(1): 75-80.
[9] 赵海涛, 王亚芳, 赫莉, 陈文静, 邢民者, 郑文娟,阎玉彦,刘晓峰. 可视喉镜在先天性舌根囊肿患儿手术麻醉中的应用[J]. 山东大学耳鼻喉眼学报, 2022, 36(1): 106-110.
[10] 师晓丽, 牟鸿. 多学科联合诊治重度儿童阻塞性睡眠呼吸暂停综合征并发肺动脉高压1例[J]. 山东大学耳鼻喉眼学报, 2022, 36(1): 116-119.
[11] 赵兴贺,樊明月,窦训武,贾广彪. 儿童原发扁桃体弥漫大B细胞淋巴瘤1例并文献复习[J]. 山东大学耳鼻喉眼学报, 2022, 36(1): 120-124.
[12] 龙婷,刘雨薇,王生才,张杰,李艳珍,张雪溪,刘悄吟,刘志勇,孙念,倪鑫. 内镜CO2激光烧灼术治疗273例儿童先天性梨状窝瘘的临床分析[J]. 山东大学耳鼻喉眼学报, 2022, 36(1): 125-130.
[13] 袁晨阳, 刘燕综述房振胜审校. 儿童阻塞性睡眠呼吸暂停低通气综合征对肺功能的影响[J]. 山东大学耳鼻喉眼学报, 2022, 36(1): 143-148.
[14] 刘艺,于明坤,孙伟,邵震,胡媛媛,毕宏生. 角膜塑形术控制儿童近视有效性与安全性的Meta分析[J]. 山东大学耳鼻喉眼学报, 2021, 35(6): 92-100.
[15] 李丹阳综述梁辉审校. 口面肌功能治疗对阻塞性睡眠呼吸暂停研究进展[J]. 山东大学耳鼻喉眼学报, 2021, 35(4): 108-114.
Viewed
Full text


Abstract

Cited

  Shared   
  Discussed   
[1] 周斌,李滨 . 鼻内窥镜下鼻窦鼻息肉手术75例疗效观察[J]. 山东大学耳鼻喉眼学报, 2006, 20(1): 24 -26 .
[2] 张玉光,韩旭光,张华,王旭,徐湘辉 . 改良穿透性角膜移植术治疗真菌性角膜炎[J]. 山东大学耳鼻喉眼学报, 2006, 20(1): 94 -95 .
[3] 隆梅辉,何明强,牟艳云,田利健 . 上颌窦炎性肌纤维母细胞瘤1例并文献复习[J]. 山东大学耳鼻喉眼学报, 2008, 22(4): 329 -330 .
[4] 邹 俊,卢 奕,褚仁远 . 体外培养人胚晶状体上皮细胞生长特性的研究[J]. 山东大学耳鼻喉眼学报, 2008, 22(5): 453 -456 .
[5] 夏文清,郑 敏,满晓飞,李建平 . 手法劈核治疗老年性白内障[J]. 山东大学耳鼻喉眼学报, 2008, 22(5): 467 -469 .
[6] 李学昌,王金磊,张玉莉,董文汇,韩在文 . 中药冲洗对鼻黏膜纤毛超微结构的影响[J]. 山东大学耳鼻喉眼学报, 2006, 20(6): 522 -524 .
[7] 康宏建,李晓红,王保安,周 涛 . 重型颅脑损伤患者行气管切开术的意义[J]. 山东大学耳鼻喉眼学报, 2007, 21(3): 234 -236 .
[8] 闫 蕊,朱淋洁 . 翼状胬肉显微手术切除后角膜干细胞移植[J]. 山东大学耳鼻喉眼学报, 2007, 21(3): 243 -244 .
[9] 黄 方,朱从月 . p21、p73及PTEN在头颈部多原发癌中的表达及意义[J]. 山东大学耳鼻喉眼学报, 2007, 21(5): 388 -392 .
[10] 徐豪杰,李学忠,陈成芳,王学海 . 鼻内镜下鼻腔泪囊吻合术17例[J]. 山东大学耳鼻喉眼学报, 2008, 22(2): 132 -134 .