不同年龄段伴腺样体肥大的分泌性中耳炎患儿的疗效分析

The curative effect analysis for Otitis Media with Effusion(OME)with Adenoid Hypertrophy(AH)in different age groups children

目的研究不同年龄段伴腺样体肥大的分泌性中耳炎患儿仅行腺样体切除术与联合鼓膜置管术的疗效比较。方法选取我科2015年1月-2019年3月收治的104例(197耳)分泌性中耳炎伴腺样体肥大的患儿作为研究对象,分为A组:≤3岁年龄组,共18例(34耳);B组:3-7岁年龄组,共53例(100耳);C组:≥7岁年龄组,共33例(63耳),分别给予单纯腺样体切除和腺样体切除联合鼓膜置管术。术前均常规行鼻咽侧位片或电子鼻咽镜、耳纤维内镜、声阻抗、纯音测听或听性脑干反应检查。随访统计不同年龄段患儿两种术式的术后疗效。结果相同术式比较:行单纯腺样体切除的患儿,A组[10例(19耳),有效率100%],疗效明显优于B组[16例(29耳),有效率65.5%]和C组[10例(18耳),有效率61.1%](P<0.05)。行联合置管术的患儿,A组[8例(15耳),有效率46.7%]、B组[37例(71耳),有效率84.5%]和C组[23例(45耳),有效率100%],随年龄增加,疗效渐优(P<0.05),同时B、C组术后并发症的发生率(2.8%,2.2%)明显低于A组26.7%(P<0.05)。不同术式比较:A组行单纯腺样体切除疗效[10例(19耳),有效率100%]较联合置管术疗效[8例(15耳),有效率46.7%]更优,并发症发生率更低(P<0.05);B组联合置管术疗效[37例(71耳),有效率84.5%]和C组联合置管术疗效[23例(45耳),有效率100%]较单纯腺样体切除术疗效[16例(29耳),有效率65.5%]和[10例(18耳),有效率61.1%]更优(P<0.05),但两组不同术式术后并发症的发生率比较均差异无统计学意义(χ^(2)=0.016,p=0.900;χ^(2)=0.000,p=1.000;P>0.05)。结论伴腺样体肥大的分泌性中耳炎患儿,年龄段≤3岁的患儿单纯行腺样体切除术疗效好,并发症少,但需要严格把握适应症。年龄段>3岁的患儿,随年龄段增长,联合置管术后疗效越好,并发症发生渐少。

Objective To study the efficacy of the different operations on the treatmet of OME with AH in different age groups children.Methods 104 cases(197ears)of OME with AH treated from January 2015 to March 2019 were analyzed.All cases divided into A[18 cases(34ears)],B[53 cases(100ears)]and C[33 cases(63ears)]group and confirmed by lateral nasopharyngeal radiography or nasopharyngoscopy,otoscopy,acoustic impedance,pure tone audiometry or ABR test before surgery.Group A were≤3 years old,group B were 3-7years old,group C were≥7years old.Adenoidectomy only or with tympanostomy tube insertion were given in different age groups.The efficacy was compared between the two surgical methods of different ages.Results Comparison of the same operation methods:For children undergoing simple adenoidectomy,Group A[10 cases(19 ears),the effective rate was 100%],the effect was significantly better than that in group B[16 cases(29 ears),the effective rate was 65.5%]and group C[10 cases(18 ears),the effective rate was 61.1%](P<0.05).For children undergoing adenoidectomy with tympanostomy tube insertion,group A[8 cases(15 ears),the effective rate was 46.7%],group B[37 cases(71 ears),the effective rate was 84.5%]and group C[23 cases(45 ears),the effective rate was 100%],With the older the age,the better the effect(P<0.05).And the incidence of postoperative complications of group B、C(2.8%,2.2%)was significantly lower than that of group A 26.7%(P<0.05).Comparison of two different operations:the curative effect[10 cases(19 ears),the effective rate was 100%]of children received Adenoidectomy only was better than that of combined with tympanostomy tube insertion in group A with lower incidence of complications(P<0.05).In group B and C,the curative effect[37 cases(71 ears),the effective rate was 84.5%;23 cases(45 ears),the effective rate was 100%]of children received Adenoidectomy combined with tympanostomy tube insertion would be more better(P<0.05).However,there was no significant difference in the incidence of postoperative complications between the two methods in 2 groups(χ^(2)=0.016,P=0.900;χ^(2)=0.000,P=1.000;P>0.05).Conclusion For OME with AH in different age groups children,For children aged≤3 years,Adenoidectomy alone is more effective and less complications,However,the indications need to be strictly controlled.For children aged over 3 years,With the increase of age,the postoperative efficacy of combined tympanotomy tube insertion is getting better and the incidence of complications is getting less.