YAG激光鼓膜造孔治疗分泌性中耳炎的临床研究

Clinical Research of YAG Laser-assisted Tympanostomy in Treament of Secretory Otitis Media

目的 通过采用YAG激光行鼓膜造孔并结合外耳道负压吸引治疗分泌性中耳炎 (SOM) ,探寻治疗SOM一新的方法并确定最佳造孔大小。方法 对一组初次就诊的SOM患者 14 7例 2 5 8耳 (初诊组 )和一组经穿刺 (或切开 )后复发的SOM患者 87例 114耳 (复发组 )随机用YAG激光在鼓膜前下方分别造 1 0mm、2 0mm、3 0mm直径的小孔 ,再在外耳道予以 - 0 .0 2Mp负压吸出鼓室内液体 ,随访 3月并比较不同造孔大小与疗效的关系。结果 所有患者治疗后早期均取得明显临床疗效 ,1 0mm、2 0mm和 3 0mm的造孔平均闭合时间分别为 1.4 8周、2 .70周和 3.17周 ,但 3.0mm造孔组有一例导致永久性穿孔。初诊组 2 0mm与 3 0mm造孔复发率无显著性差异 (P >0 5 0 ) ,而复发组 2 0mm造孔复发率高于 3 0mm造孔 (P <0 0 5 )。结论 YAG激光鼓膜造孔结合外耳道负压吸引治疗SOM是一种简单、经济和有效的方法 ,对初诊患者可先采用 2 0mm直径的造孔 ,复发者则以选择 3 0mm直径的造孔为宜。

Objective To evaluate effectiveness of YAG laser-assisted tympanostomy with negative pressure suction through external auditory canal, and to make a proper size hole of tympanostomy in treament of secretory otitis media(SOM). Methods One group was preliminary diagnostic patients with SOM, 147 patients(258 ears). Another group was recurrent patients with SOM in which tympanocentesis was performed, 87 patients(114 ears). The hole diameter of tympanostomy was 1 0mm,2 0mm or 3 0mm at random in all patients. After tympanostomy, we use negative pressure(-0 02Mp) through external auditory canal to aspirate the effusion in tympan and the effects in different groups with tympanostomy of different size in diameter after three months were compared.Results All patients's clinical symptom has improved in early stage after tympanostomy. Tympanostomy of 1 0mm,2 0mm and 3 0mm in diameter was created and healed after 1.48 weeks, 2.70 weeks and 3 17 weeks,respectively. Only one tympanostomy of 3 0mm in diameter leads to persistent perforation. In preliminary diagnosis group, the recurrent rate was no significant different in 2.0mm and 3 0mm group(P>0 50). But in recurrent group, the recurrent rate in 2 0mm group was higher than in the 3 0mm group(P<0 05).Conclusions YAG lazer-assisted tympanostomy with negative pressure suction through external auditory canal is a safe, ecnomicaly-effective procedure for SOM. For preliminary diagnosis patients with SOM, the proper diameter of tympanostomy is 2 0mm, and the 3 0mm one may be optimal for recurrent patients.