两种手术方式治疗儿童腺样体肥大合并分泌性中耳炎疗效对比及术后复发的相关因素分析

Comparison of two surgical methods in treatment of adenoidal hypertrophy complicated with secretory otitis media in children and analysis of related factors of postoperative recurrence

目的 回顾性对比分析鼓膜置管联合腺样体切除术和单纯鼓膜置管术治疗小儿分泌性中耳炎(otitis media with effusion, OME)的临床疗效,并分析影响其预后和复发的相关因素。方法 收集2018年1月至2020年10月期就诊于湖北医药学院附属医院(十堰市太和医院)诊断为OME伴腺样体肥大的110例手术治疗患儿作为研究对象,将其分为鼓膜置管联合腺样体切除术组(A组)68例和单纯鼓膜置管术组(B组)42例。比较两组的临床疗效、手术前后气导听阈的变化、并发症发生情况和中耳积液复发情况。在所有随访结束后,按是否出现OME复发再次分为两组,分析渗出性中耳炎复发的影响因素。结果 术后1年时A组总有效率明显高于B组(89.71%vs. 78.57%)(P<0.05)。术后6个月和12个月时A组和B组的纯音听阈较术前均明显降低(P均<0.05),但两组在术后6个月和12个月组间相比较,差异无统计学意义(P>0.05)。术后1年A组和B组总并发症发生率(17.65%vs. 30.95%)比较,差异无统计学意义(P>0.05),但两组术后复发率相比较A组11.76%的复发率明显低于B组28.57%的复发率(P<0.05)。术后Logistic回归分析发现,反复呼吸道感染和留置导管时间<10个月是OME术后复发的危险因素(P<0.05),而鼓膜置管置联合腺样体切除是OME术后复发的保护因素(P<0.05)。结论 鼓膜置管联合腺样体切除术治疗儿童OME的临床疗效优于单纯鼓膜置管术,两种术式均能改善患儿的术后听力水平,但两组差异无统计学意义(P>0.05);联合手术与单纯鼓膜置管术相比,能有效降低复发率。此外,辅助腺样体切除术是OME手术治疗后复发的保护因素,但术前反复呼吸道感染、置管留置时间小于10个月是OME复发的危险因素。

【Objective】 To retrospectively contrast the clinical outcomes of tympanic tube placement combined with adenoidectomy and tympanic tube placement alone in the treatment of otitis media with effusion(OME) in children, and to analyze the factors associated with its prognosis and recurrence. 【Methods】 The clinical and follow-up data of all 110 children with a clear diagnosis of OME with adenoid hypertrophy who visited our department between January 2018 and October 2020 were prospectively collected according to inclusion and exclusion criteria. They were divided into tympanic tube placement combined with adenoidectomy group(Group A) and tympanic tube placement alone group(Group B). The clinical outcomes, changes in airconduction hearing thresholds before and after surgery, the occurrence of complications and recurrence of middle ear effusion were compared between the two groups. At the end of all follow-up visits, the groups were again divided into two groups according to whether OME recurrence occurred, and the factors influencing recurrence of oozing otitis media were analysed. 【Results】 A total of 68 cases were included in group A and 42 cases were included in group B. There was no statistical difference between the two groups in terms of gender, mean age, mean duration of disease before surgery, adenoidal hypertrophy classification and tympanic conduction pattern typing(all P>0.05). At 1 year postoperatively, the overall effective rate of 89.71% in group A was significantly higher than that of 78.57% in group B(P=0.029). The pure tone hearing threshold in group A was significantly lower than that before surgery at 6 and 12 months after surgery(P=0.000 for both groups), and the pure tone hearing threshold in group B was also significantly lower than that before surgery at 6 and 12 months after treatment(P=0.001 and P=0.000 respectively). However, there were no statistically significant differences between the two groups at 6 and 12 months postoperatively(P=0.208 and P=0.101respectively). There was no statistically significant difference in the overall complication rate of 17.65% in group A compared with30.95% in group B at 1 year postoperatively(P=0.106), but the recurrence rate of 11.76% in group A was significantly lower than the recurrence rate of 28.57% in group B when compared between the two groups(P=0.026). Postoperative logistic regression analysis revealed that recurrent respiratory infections(P=0.016) and duration of indwelling catheter <10 months(P=0.003) were risk factors for recurrence after OME, while tympanic tube placement combined with adenoidectomy was a protective factor for recurrence after OME(P=0.001). 【Conclusion】 The clinical efficacy of tympanic tube placement combined with adenoidectomy for OME in children was better than that of tympanic tube placement alone. Both procedures improved the postoperative hearing level of children, but there was no statistically significant difference between the two groups;the combined procedure was effective in reducing the recurrence rate compared to tympanic tube placement alone. In addition, adenoidectomy was a protective factor for recurrence after surgical treatment of OME, but recurrent preoperative respiratory infections and tube placement for less than 10months were risk factors for recurrence of OME.