分泌性中耳炎二次手术影响因素分析

Analysis of the factors influencing reoperation of secretory otitis media

目的通过对分泌性中耳炎二次手术及同期行相应手术的患者进行分析,了解分泌性中耳炎二次手术因素及其病情特征.方法回顾性分析自2017年8月至2020年5月在我院诊断为双耳分泌性中耳炎并行手术治疗后,门诊随诊至少1年的患儿,查阅这些患儿的住院及术后门诊就诊记录,分析其二次手术的病情特征及可能因素.结果380例患儿中有9例需要二次手术,1例与置管脱落入鼓室有关,8例与复发有关,复发患儿中7例可见鼻咽部分泌物多或圆枕肥厚,咽鼓管咽口被阻塞;348例患儿行中耳置管手术+腺样体、扁桃体手术者,其二次手术的比例为1.44%;23例患儿行中耳切开引流术+腺样体、扁桃体手术者,其二次手术的比例为13.04%;9例患儿单纯行中耳置管术者,其二次手术的比例为11.11%.中耳置管手术联合腺样体、扁桃体手术,其二次手术比例最小,与切开引流+腺样体、扁桃体手术以及单纯中耳置管手术比较,差异有统计学意义(P<0.05).结论分泌性中耳炎二次手术主要受复发影响,复发风险主要与手术方式及鼻窦炎反复发作有关,对于合并扁桃体和/或腺样体肥大的分泌性中耳炎患儿,推荐首选中耳置管+腺样体手术,扁桃体切除与否与分泌性中耳炎二次手术的风险没有明显关联.

Objective To understand the factors and characteristics of the patients with reoperation of secretory otitis media.Methods A retrospective analysis of patients in our hospital who were diagnosed with binaural secretory otitis media in our hospital from August 2017 to May 2020 and followed up for at least one year in the outpatient clinic.The inpatient and postoperative outpatient medical records of these children were reviewed to analyze the characteristics and possible factors of reoperation.Results Nine out of 380 children required reoperation,one of which was plugged tube,and the other of which were related to recurrenee.What's more,7 cases of recurrence developed nasopharyngeal discharge,torus tubarius hypertrophy or blocked eustachian tubes.Moreover,reoperation rate in 348 patients on tympanostomy tube insertion+adenoidectomy with/without tonsillectomy was 1.44%,meanwhile reoperation rate in 23 patients on myringotomy+adenoidectomy with/without ton sillectomy surgery was 13.04%,and reoperation rate in 9 patients on simply myringotomy was 11.11%.The reoperation risk of tympanostomy tube insertion combined with adenoidectomy with/without tonsillectomy was the lowest,of which the chi-square values were statistically significant(P<0.05).Conclusion The reoperation of secretory otitis media is mainly affected by recurrence,which is mainly related to the way of operation and the recurrence of sinusitis.It is recommended to choose the tympanostomy tube insertion+adenoidectomy for children with secretory otitis media with tonsil and adenoid hypertrophy.Tonsillectomy or not is not significantly related to the risk of reoperation of secretory otitis media.