咽鼓管CT三维重建技术在高压氧治疗中的价值
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摘要
目的探索咽鼓管CT三维重建技术在高压氧治疗中的价值。方法收集拟行高压氧治疗的患者80例(共160耳)为研究对象,根据咽鼓管测压检查结果,分为咽鼓管不通组(112耳)和咽鼓管通畅组(48耳)。所有患者均采用多层螺旋CT分别行颞骨静态及Valsalva后CT扫描,并作咽鼓管三维重建,分别测量并比较两组CT重建后软骨段与骨段角度、静态软骨部全长及软骨段开放长度、Valsalva后软骨段开放长度。计算所有高压氧治疗的患者中耳气压伤的发生率。结果咽鼓管不通组的Valsalva后软骨开放长度较通畅组短,差异具有统计学意义(F=3.57,P=0.017);静态咽鼓管软骨段开放长度短,但两组间软骨段与骨段角度、静态下全软骨长度及软骨开放长度无统计学差异。中耳气压伤的发生率为7.2%。结论咽鼓管CT三维重建可直观显示咽鼓管的异常结构及软骨段开放情况;通过对咽鼓管功能障碍患者及时进行针对性的病因治疗,可明显降低高压氧治疗患者的并发症中耳气压伤的发生率。
Objective To explore the value of eustachian tube CT reconstruction in patients with hyperbaric oxygen therapy.Methods Eighty patients(total 160 ears)were recruited.Among 160 ears,112 ears which showed eustachian tube dysfunction in eustachian tube pressure test were grouped into eustachian tube dysfunction group(ETD)and the other 48 ears into normal eustachian tube function group(NETF).All participants underwent CT scanning both in resting state and after performing Valsalva maneuver.3 D CT reformations were done and structural parameters were measured.Analyze the incidence of middle ear barotrauma in patients treated with hyperbaric oxygen.Results Significant difference were found between the ETD and NETF groups for cartilaginous portion length after Valsalva maneuver(F=3.57,P=0.017).However,there was no statistically significant difference between the angle of bony portion and cartilaginous portion,the total length of cartilage between the two groups,the open length of the static lower cartilages.The total incidence of middle ear barotrauma was 7.2%.Conclusion 3 D CT reformation is a valuable tool for revealing eustachian tube structure and assessing its function.The incidence of middle ear barotrauma can be greatly reduced by timely targeted etiological treatment for patients with eustachian tube dysfunction.
Objective To explore the value of eustachian tube CT reconstruction in patients with hyperbaric oxygen therapy.Methods Eighty patients(total 160 ears)were recruited.Among 160 ears,112 ears which showed eustachian tube dysfunction in eustachian tube pressure test were grouped into eustachian tube dysfunction group(ETD)and the other 48 ears into normal eustachian tube function group(NETF).All participants underwent CT scanning both in resting state and after performing Valsalva maneuver.3 D CT reformations were done and structural parameters were measured.Analyze the incidence of middle ear barotrauma in patients treated with hyperbaric oxygen.Results Significant difference were found between the ETD and NETF groups for cartilaginous portion length after Valsalva maneuver(F=3.57,P=0.017).However,there was no statistically significant difference between the angle of bony portion and cartilaginous portion,the total length of cartilage between the two groups,the open length of the static lower cartilages.The total incidence of middle ear barotrauma was 7.2%.Conclusion 3 D CT reformation is a valuable tool for revealing eustachian tube structure and assessing its function.The incidence of middle ear barotrauma can be greatly reduced by timely targeted etiological treatment for patients with eustachian tube dysfunction.
引文
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[5]Memar MY,Yekani M,Alizadeh N,Baghi HB.Hyperbaric oxygen therapy:Antimicrobial mechanisms and clinical application for infections[J].Biomed Pharmacother,2019,109:440-447.
[6]Rodriguez PG,Felix FN,Woodley DT,Shim EK.The role of oxygen in wound healing:a review of the literature[J].Dermatol Surg,2008,34(9):1159-1169.
[7]李宁,黄怀,主编.高压氧临床治疗学[M].北京:中国协和医科大学出版社,2007:3-242.
[8]Camporesi EM.Side effects of hyperbaric oxygen therapy[J].Undersea Hyperb Med,2014,41(3):253-257.
[9]Heyboer M 3rd,Wojcik SM,Grant WD,et al.Middle ear barotrauma in hyperbaric oxygen therapy[J].Undersea Hyperb Med,2014,41(5):393-397.
[10]Klug C,Fabinyi B,Tschabitscher M.Endoscopy of the middle ear through the Eustachian tube:anatomic possibilibies and limitations[J].Am J Otol,1999,20(3):299-303.
[11]Mc Coul ED,Lucente FE,Anand VK.Evolution of Eustachian tubesurgery[J].Laryngoscope,2011,121:661-666.
[12]Schroder S,Reineke U,Lehmann M,et al.Chronic obstructive eustachian tube dysfunction in adults:long term results of balloon eustachian tuboplasty[J].HNO,2013,61(2):142-151.
[13]闫晶晶,梁勇,陈燕萍,等.61例中耳炎咽鼓管多层螺旋CT影像解剖学研究[J].中国临床解剖学杂志,2010,28:50.
[14]高春锦,杨捷云,翟晓辉.高压氧医学基础与临床[M].北京:人民卫生出版社,2008:1-2.
[15]孔磊,许立民,盘晓荣,等.高压氧治疗并发中耳气压伤的原因分析与预防对策[J].中国临床新医学,2011,4(8):711-714.
[16]廖才媛,刘应生,王海云.高压氧治疗引发中耳气压伤的原因分析[J].中华航海医学与高气压医学杂志,2010,17(6):360-361.2019-03-15
[2]Cohn JE,Pfeiffer M,Patel N,et al.Identifying eustachian tube dysfunction prior to hyperbaric oxygen therapy:Who is at risk for intolerance[J]?Am J Otolaryngol,2018,39(1):14-19.
[3]Kikuchi T,Oshima T,Hori Y,et al.Three-dimensional computed tomography imaging of the eustachian tube lumen in patients with patulous eustachian tube[J].ORL J Otorhinolaryngol Relat Spec,2009,71:312-316.
[4]Choudhury R.Hypoxia and hyperbaric oxygen therapy:a review[J].Int J Gen Med,2018,11:431-442.
[5]Memar MY,Yekani M,Alizadeh N,Baghi HB.Hyperbaric oxygen therapy:Antimicrobial mechanisms and clinical application for infections[J].Biomed Pharmacother,2019,109:440-447.
[6]Rodriguez PG,Felix FN,Woodley DT,Shim EK.The role of oxygen in wound healing:a review of the literature[J].Dermatol Surg,2008,34(9):1159-1169.
[7]李宁,黄怀,主编.高压氧临床治疗学[M].北京:中国协和医科大学出版社,2007:3-242.
[8]Camporesi EM.Side effects of hyperbaric oxygen therapy[J].Undersea Hyperb Med,2014,41(3):253-257.
[9]Heyboer M 3rd,Wojcik SM,Grant WD,et al.Middle ear barotrauma in hyperbaric oxygen therapy[J].Undersea Hyperb Med,2014,41(5):393-397.
[10]Klug C,Fabinyi B,Tschabitscher M.Endoscopy of the middle ear through the Eustachian tube:anatomic possibilibies and limitations[J].Am J Otol,1999,20(3):299-303.
[11]Mc Coul ED,Lucente FE,Anand VK.Evolution of Eustachian tubesurgery[J].Laryngoscope,2011,121:661-666.
[12]Schroder S,Reineke U,Lehmann M,et al.Chronic obstructive eustachian tube dysfunction in adults:long term results of balloon eustachian tuboplasty[J].HNO,2013,61(2):142-151.
[13]闫晶晶,梁勇,陈燕萍,等.61例中耳炎咽鼓管多层螺旋CT影像解剖学研究[J].中国临床解剖学杂志,2010,28:50.
[14]高春锦,杨捷云,翟晓辉.高压氧医学基础与临床[M].北京:人民卫生出版社,2008:1-2.
[15]孔磊,许立民,盘晓荣,等.高压氧治疗并发中耳气压伤的原因分析与预防对策[J].中国临床新医学,2011,4(8):711-714.
[16]廖才媛,刘应生,王海云.高压氧治疗引发中耳气压伤的原因分析[J].中华航海医学与高气压医学杂志,2010,17(6):360-361.2019-03-15