低温等离子手术治疗分泌性中耳炎的临床研究
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摘要
目的探讨内镜下低温等离子手术(耳内镜下鼓膜打孔术+鼻内镜下腺样体和/或下鼻甲消融术/功能性鼻内镜术)治疗"分泌性中耳炎"的疗效,并发症,优势及复发率。资料与方法分析研究156例病史超过3个月,由腺样体肥大和慢性鼻-鼻窦炎引起的分泌性中耳炎患者,所有病例针对病因先行鼻内镜下等离子腺样体和/或下鼻甲消融术/功能性鼻内镜术,研究组(78例)患者同期行等离子鼓膜打孔术,对照组(78例)行鼓膜置管术。结果所有患者随访6个月,以术后1周、1月、3月及6月时的检查结果作对比,研究组78例患者鼓膜打孔处约1-3月愈合,两组治愈好转率经比较,P值均<0.001,差异有统计学意义。并发症以中耳感染、流脓为主要参考指标,对照组的并发症在不同时段均明显高于研究组,经卡方检验,术后1周P值为0.043,其余均P<0.001,两组患者在并发症的发生率上有显著差别,差异有统计学意义。结论内镜下低温等离子手术(腺样体和/或下鼻甲消融术/功能性鼻内镜术+鼓膜打孔术)治疗分泌性中耳炎具有疗效好,创伤小,并发症少,复发率低等优势。
Objective to compare the efficacy,complications,advantage and the recurrence rate of secretory otitis media.with the ear endoscope tympanic membrane perforationdownside of low-temper- ature plasma and under the nose endoscope plasma adenoidectomy and or inferior turbinate ablation / functional endoscopic sinus surgery.Materials and methods We analysised 156 cases who were suffered from secretory otitis media over 3 months because of adenoid hypertrophy and chronic sinusitis,for the cause first plasma enddscopic adenoidectomy and/or inferior turbinate ablation/functional nasal endoscopic surgery,Another 78 cases(study group) using plasma tympanic membrane punch,78 cases(control group) using tympanostomy tube treatment.Results All patients were followed for six months to 1 week、3 moth and 6 moth after surgery test results for comparison,Study group of 78 patients with tympanic membrane perforation healed in about 1 to 3 months,Two groups of cure rate comparison,p<0.001,there is statistically significant.Complications of middle car infections,ear discharge as the main reference index,Complication of group control in different time were significantly higher in the study group,the chi-square test,1 weeks after the operation,p=0.043,the others p <0.001,There are significant differences between the two groups in the incidence of complications,there are statistically significant.Conclusion It is effect,slight trauma,less complications,low recurrence rate advantages,to treat secretory otitis media with Endoscope under low temperature plasma surgery,(adenoidectomy and/or inferior turbinate ablation/functional nasal endoscopic surgery plus tympanic membrane punch).
Objective to compare the efficacy,complications,advantage and the recurrence rate of secretory otitis media.with the ear endoscope tympanic membrane perforationdownside of low-temper- ature plasma and under the nose endoscope plasma adenoidectomy and or inferior turbinate ablation / functional endoscopic sinus surgery.Materials and methods We analysised 156 cases who were suffered from secretory otitis media over 3 months because of adenoid hypertrophy and chronic sinusitis,for the cause first plasma enddscopic adenoidectomy and/or inferior turbinate ablation/functional nasal endoscopic surgery,Another 78 cases(study group) using plasma tympanic membrane punch,78 cases(control group) using tympanostomy tube treatment.Results All patients were followed for six months to 1 week、3 moth and 6 moth after surgery test results for comparison,Study group of 78 patients with tympanic membrane perforation healed in about 1 to 3 months,Two groups of cure rate comparison,p<0.001,there is statistically significant.Complications of middle car infections,ear discharge as the main reference index,Complication of group control in different time were significantly higher in the study group,the chi-square test,1 weeks after the operation,p=0.043,the others p <0.001,There are significant differences between the two groups in the incidence of complications,there are statistically significant.Conclusion It is effect,slight trauma,less complications,low recurrence rate advantages,to treat secretory otitis media with Endoscope under low temperature plasma surgery,(adenoidectomy and/or inferior turbinate ablation/functional nasal endoscopic surgery plus tympanic membrane punch).
引文
1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.中华耳科学杂志,2004,2(2):106-108.
2马丽品,王军,叶京英,等.鼓膜打孔及腺样体切除术治疗儿童分泌性中耳炎,中国耳鼻咽喉头颈外科,2006,13(9):647-648.
3张英华,盛才华,儿童分泌性中耳炎合并腺样体肥大治疗体会.听力学及言语疾病杂志,2004,12(3):188-189.
4 Gould JM.Matz PS.Otitis media.Pediatr Rev,2010,31:102-116.
5黄雪琨,詹益斯,许庚,等.慢性鼻窦炎对咽鼓管咽口形态和功能的影响,耳鼻咽喉-头颈外科,2000,7:309-310.
6朱杭军,廖建春,杜云翔,等.咽鼓管咽口的临床解剖学观测[J].中国耳鼻咽喉颅底外科杂志,2004.10(6):347-348.
7张志坚,刘鸿源,分泌性中耳炎的发病机制.医学综述.2001,10:751-753.
8 Cotter CS,Kosko JR.Effectiveness of laser-assisted myringotomy for olitis media in children[J].Laryngoscope.2004,114:486.
9 Kalcioglu MT.Cokkeser Y.Kizilay A.et al.Follow-up of 366 ears after tympanostomy tubes insertion:Why is it draining[J].Otolaryngol Head Neck Surg,2003,128:560.
10唐旭兰,周慧群,殷善开.CO_2激光鼓膜造孔术治疗分泌性中耳炎的近期疗效观察,听力学及言语疾病杂志,2010,18(5):499-500.
11陈芳,李晓艳,鼓膜穿刺和置管治疗儿童OSAHS合并分泌性中耳炎疗效分析,听力学及言语疾病杂志,2012,20(2):132-134.
12陈伟,郭睿,龚维等,耳内镜下低温等离子鼓膜打孔治疗分泌性中耳炎的临床疗效观察,中国临床医生,2013.41(2):119-120.
13徐恩明,徐忠强,王智楠等.鼻内镜下等离子刀切除腺样体对儿童分泌性,中耳炎转归的影响,听力学及言语疾病杂志,2011,19(4):362-363.
2马丽品,王军,叶京英,等.鼓膜打孔及腺样体切除术治疗儿童分泌性中耳炎,中国耳鼻咽喉头颈外科,2006,13(9):647-648.
3张英华,盛才华,儿童分泌性中耳炎合并腺样体肥大治疗体会.听力学及言语疾病杂志,2004,12(3):188-189.
4 Gould JM.Matz PS.Otitis media.Pediatr Rev,2010,31:102-116.
5黄雪琨,詹益斯,许庚,等.慢性鼻窦炎对咽鼓管咽口形态和功能的影响,耳鼻咽喉-头颈外科,2000,7:309-310.
6朱杭军,廖建春,杜云翔,等.咽鼓管咽口的临床解剖学观测[J].中国耳鼻咽喉颅底外科杂志,2004.10(6):347-348.
7张志坚,刘鸿源,分泌性中耳炎的发病机制.医学综述.2001,10:751-753.
8 Cotter CS,Kosko JR.Effectiveness of laser-assisted myringotomy for olitis media in children[J].Laryngoscope.2004,114:486.
9 Kalcioglu MT.Cokkeser Y.Kizilay A.et al.Follow-up of 366 ears after tympanostomy tubes insertion:Why is it draining[J].Otolaryngol Head Neck Surg,2003,128:560.
10唐旭兰,周慧群,殷善开.CO_2激光鼓膜造孔术治疗分泌性中耳炎的近期疗效观察,听力学及言语疾病杂志,2010,18(5):499-500.
11陈芳,李晓艳,鼓膜穿刺和置管治疗儿童OSAHS合并分泌性中耳炎疗效分析,听力学及言语疾病杂志,2012,20(2):132-134.
12陈伟,郭睿,龚维等,耳内镜下低温等离子鼓膜打孔治疗分泌性中耳炎的临床疗效观察,中国临床医生,2013.41(2):119-120.
13徐恩明,徐忠强,王智楠等.鼻内镜下等离子刀切除腺样体对儿童分泌性,中耳炎转归的影响,听力学及言语疾病杂志,2011,19(4):362-363.