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

doi:10.6040/j.issn.1673-3770.0.2021.506

摘要/Abstract

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均<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

高信忠, 林宗通, 沈翎, 刘平凡, 林兴, 许杨杨. 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[J]. 山东大学耳鼻喉眼学报, 2022, 36(1): 7-12.

GAO Xinzhong, LING Zongtong, SHEN Ling, LIU Pingfang, LIN Xin, XU Yangyang. Analysis of the efficacy of balloon eustachian tuboplasty combined with adenoidectomy in the treatment of otitis media with effusion in children[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2022, 36(1): 7-12.

参考文献

[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.

多维度评价

Viewed

Full text

Abstract

Cited

Shared

Discussed