不同术式治疗伴腺样体肥大的儿童分泌性中耳炎的疗效及安全性

The Efficacy and Safety of Different Operations for the Treatment of Children with Secretory Otitis Media

目的探讨不同手术方式治疗伴腺样体肥大的儿童分泌性中耳炎的疗效及安全性。方法回顾性分析2011年4月至2014年7月收治的81例(149耳)腺样体肥大伴分泌性中耳炎患儿的临床资料,其中Ⅰ组22例(41耳)行单纯鼓膜切开置管术、Ⅱ组33例(59耳)行单纯腺样体切除术、Ⅲ组26例(49耳)行鼓膜置管加腺样体切除术;比较三组术前、术后3个月平均听阈,分析各组术后疗效及并发症。结果Ⅰ、Ⅱ、Ⅲ三组患儿术前平均听阈分别为53.54±6.68、53.61±6.98、52.92±7.28dB HL,组间两两比较差异无统计学意义(P>0.05);Ⅰ、Ⅱ、Ⅲ三组患儿术后平均听阈分别为17.63±5.09、14.47±3.62、14.88±3.92dB HL,Ⅰ组听力恢复较Ⅱ组、Ⅲ组差(P<0.05),而Ⅱ组与Ⅲ组之间差异无统计学意义(P>0.05)。Ⅰ、Ⅱ、Ⅲ组术后分别有6、2、8例出现脱管、感染、创面出血等并发症。结论单纯腺样体切除术治疗伴腺样体肥大的儿童分泌性中耳炎疗效确切,并发症少。

Objective To study the efficacy and safety of the different operations on the treatment of adenoidal hypertrophy in children with otitis media with effusion .Methods A total of 81 children （149 ears） who had adeoidal hypertrophy with secretory otitis media were included in this retrospective study .They were divided into 3 groups ,which were group Ⅰ ,22 cases （41 ears） with simple myringotomy tube insertion ,group Ⅱ ,33 patients （59 ears） with simple adenoidectomy and group Ⅲ ,26 patients （49 ears） underwent tympanostomy tube plus adenoidectomy .The efficacy and pastoperative complications were compared before surgery and 3 months after surgery .Results Three groups preoperative hearing threshold was 53 .54± 6 .68 ,53 .61 ± 6 .98 and 52 .92 ± 7 .28 dB HL ,respectively ,with no significant difference （P〈0.05） .Groups Ⅰ ,Ⅱ ,Ⅲ after surgery hearing threshold was 17 .63 ± 5 .09 ,14 .47 ± 3 .62 ,14 .88 ± 3 .92 dB HL ,respectively .Group Ⅰshowed less hearing recovery compared with that of in group Ⅱ and group Ⅲ （P〈0 .05） ,while the difference between group Ⅱ and group Ⅲ was not statistically significant （P〈0 .05） .Group Ⅰ ,Ⅱ and Ⅲ had 6 ,2 ,8 cases detached ,infection ,wound bleeding and other complications ,respectively .Conclusion Simple adenoidectomy showed better efficacy and fewer complications for the treatment of children adenoidal hypertrophy with secretory otitis media .