低温等离子手术治疗分泌性中耳炎的临床研究

Clinical Study of Secretory Otitis Media low Temperature Plasma Surgery

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-temperature 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, 3moth and 6moth 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 ear 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 ）.