鼓膜置管治疗难治性分泌性中耳炎鼓膜穿孔危险因素分析

Factors Affecting Tympanic Membrane Perforation in Refractory Secretory Otitis Media after the Extubation of Ventilation Tube

目的探讨鼓膜通气管治疗难治性分泌性中耳炎后，患侧鼓膜永久性穿孔的危险因素。方法回顾性分析1998年6月-2013年3月收治的病程超过2年的121例（210耳）难治性分泌性中耳炎患者的临床资料，其中穿孔组58例（105耳），对照组（未穿孔组）63例（105耳）。所有患者均使用Goode—T型或Shepard哑铃型通气管行鼓膜置管治疗，分析可能影响患侧鼓膜永久性穿孔的因素，包括性别、年龄、病程、通气管类型、置管史、置管次数、鼓膜表象、置管位置、中耳腔积液性质、是否行腺样体切除术及拔管时间等。结果单因素分析显示，穿孔组Goode-T型通气管、有置管史、置管次数（3次以上）、中耳腔粘液性积液分别占58．4％、57．3％、66．7％和57．9％，且均高于对照组（均为P〈0．01）。Logistic回归分析提示无论采用何种通气管，置管次数增多则患侧鼓膜永久性穿孔的风险增加，采用Goode-T型管较Shepard哑铃型管鼓膜发生穿孔的危险性增加1．637倍（OR=1．637，P〈0．01）。结论难治性分泌性中耳炎患者鼓膜置管术后，使用Goode-T型通气管、有置管史、置管次数（3次以上）和中耳腔积液为黏液性四因素为鼓膜永久性穿孔的危险因素。

Objective To explore the treatment using two different ventilation tubes insertion for secretory o-titis media, and to determine which factors are associated with the tympanic membrane perforation after a extrusion or surgical removal of a ventilation tube（VT）. Methods A retrospective analysis of 121 cases （210 ears） with re-fractory secretory otitis media from 1998 June to 2013 March was carried out. There were 58 cases （105 ears ） and 63 cases （105 ears） in patients and control group, respectively. All subjects had more than 2 years of history, and were treated by two types of ventilation tube （Goode-T and Shepard tube）. Various factors were analyzed to deter- mine the factors associated with persistence of a tympanic membrane perforation after VT extrusion or removal , in- cluding gender, age, medical history, ventilation tube pattern, location , history of previous VT insertions, intuba-tion period reason for VT insertion, condition of the TM, nature of the tympanic cavity effusion and previous ade-noidectomy,et. Results Analysis factors of perforation group （105 ears） and the control g,＇oup （without perfora-tion, 105 ears）, were statistically significant in ventilation tube pattern（x^2= 6. 916, P〈0.01）, history of previous VT insertions（X^2 = 7. 325, P〈0.01）, frequency of previous VT insertions （X^2= 13.01, P〈0.01 ） and the nature of the tympanic cavity effusion（X^2=7.04 ,P〈0.01）. The proportion of perforation group about Goode - T ventilation tube, history of previous VT insertions, the frequency of tube （more than 3 times）, mucus of the middle ear cavity were 58.4%, 57.3%, 66.7% and 57.9% respectively,others had no significant difference between the two groups. The multivariate analysis showed that, regardless of the ventilation tube, the frequency of tube was the tympanic membrane perforation risk factor; Goode-T tube increased the risk of perforation of tympanic membrane was 1. 637 times than Shepard tube（OR=1. 637,P〈0.01）. Oonclusion Using the Goode - T type ventilation tube, history of previous VT insertions, the frequency of tube （more than 3 times）, mucus of the middle ear cavity were four risk factors for persistence of a tympanic membrane perforation after VT insertion for secretory otitis media.