儿童鼓膜切开置管术的并发症及其防治

Myringotomy With Grommet Insertion in Children:Complications and Its Prevention

目的 探讨儿童鼓膜切开置管术并发症的原因及防治。方法 回顾性分析 48例 (83耳 )应用鼓膜切开置管术治疗的儿童分泌性中耳炎。结果 术后随访半年至 5年 ,83耳中 76耳语频听力提高 15～ 35dB ,7耳听力无明显改善 ,与鼓膜穿孔和内陷有关。手术治愈率达 91.5 6 % (76 / 83)。术后并发症 :耳漏 6耳经治疗后干耳 ,转归为穿孔 ;通气管坠入中耳腔 1耳 ,扩大切口取出 ,转归为穿孔 ;通气管阻塞 4耳 ;通气管脱出 3耳 ;鼓室硬化 4耳 ;鼓膜内陷 5耳。并发症发生率是 2 7.71% (2 3/ 83)。结论 儿童鼓膜切开置管术的并发症与诸多因素有关 ,可影响少数患儿远期的听力恢复 ,应积极防治 ,以提高儿童分泌性中耳炎的治愈率。

Objective To explore the complications and its prevention of myringotomy with grommet insertion in children. Methods 48 children with secretory otitis media(83 ears), treated with myringotomy with grommet insertion, were retrospectively analyzed. Results All cases were postoperatively followed up from half a year to four years. In 76 of 83 ears, hearing in the phonetic frequency improved 15～35 dB. In 7 of 83 ears, the hearing did not improve, which was associated directly with tympanic membrane perforation and tympanic membrane retraction. The cure rate was 91.56%(76/83). As postoperative complication, otorrhea was firstly found in 6 ears. After treatment, Otorrhea disappeared and perforations were found at last in 6 ears. Ventilation tube falling into the middle ear presented in 1 ears. The ventilation tube was taken out by enlarging the incision, and perforation existed finally. Obstructed ventilation tube presented in 4 ears. 3 ears with ventilation tube falling out. Tympanosclerosis and tympanic membrane retraction were respectively found in 4 and 5 ears. The complication incidence rate was 27.71%(23/83) in our study. Conclusion Complications of myringotomy with grommet insertion are related to many factors, which may affect the long-term hearing recovery in a few children. In order to increase the cure rate, prevention and therapy of operative complications must be emphasized.