鼓膜置管术与腺样体切除术治疗儿童分泌性中耳炎的效果及复发的影响因素分析

Influencing factors on efficacy and recurrence of tympanic tube placement with adenoidectomy in the treatment of secretory otitis media in children

目的 探讨鼓膜置管术与腺样体切除术治疗儿童分泌性中耳炎的疗效及复发的影响因素。方法 选取2019年12月至2020年12月收治的60例分泌性中耳炎患儿,按治疗方法分为试验组和对照组,每组30例。对照组实施单纯鼓膜置管术,试验组实施鼓膜置管术+腺样体切除术。对比2组治疗效果、临床指标、不同时间点炎性因子水平、并发症发生率及复发率;分析儿童分泌性中耳炎复发因素。结果 试验组治疗总有效率显著高于对照组(P<0.05);试验组患儿恢复听力、耳鸣消失、鼓膜愈合、中耳积液消失时间均短于对照组(P<0.05);试验组治疗后1、3个月白介素-6(IL-6)、白介素-8(IL-8)、白介素-1β6(IL-1β)、肿瘤坏死因子-α(TNF-α)水平显著低于对照组(P<0.05);试验组并发症发生率、复发率低于对照组(P<0.05);复发组有慢性鼻炎、过敏性鼻炎、腭裂、反复上呼吸道感染、腺样体肥大、乳突气化不良、术后感染占比高于未复发组,通气管保留时间短于未复发组(P<0.05);有过敏性鼻炎、反复上呼吸道感染,腺样体肥大Ⅲ°、Ⅳ°,通气管保留时间短是儿童分泌性中耳炎复发的危险因素(P<0.05)。结论 鼓膜置管术与腺样体切除术疗效佳,可减少患儿恢复时间,降低炎性因子、并发症发生率、复发率。

Objective To investigate the influencing factor on efficacy and recurrence of tympanic tube placement with adenoidectomy in the treatment of secretory otitis media in children.Methods The children with secretory otitis media(n=60)admitted to our hospital from December 2019 to December 2020 were enrolled,they were equally allocated to the experimental group and the control group based on treatment method.The control group received tympanic tube placement alone,the experimental group received tympanic tube placement+adenoidectomy.The treatment effects,clinical indicators,levels of inflammatory factors at different time points,complications and recurrence rates were included as comparisons.An analysis of recurrence factors of secretory otitis media in children was performed.Results The total effective rate of treatment in the experimental group was significantly higher than that in the control group(P<0.05).The recovery of hearing,disappearance of tinnitus,healing of tympanic membrane and disappearance of middle ear effusion were shorter in the experimental group than in the control group(P<0.05).The levels of interleukin-6(IL-6),interleukin-8(IL-8),interleukin-1β(IL-1β)and tumor necrosis factor-α(TNF-α)were significantly lower in the experimental group than in the control group at 1 and 3 months after treatment(P<0.05).The incidence of complications and recurrence rates in the experimental group were lower than those in the control group(P<0.05).The recurrence group had chronic rhinitis,allergic rhinitis,cleft palate,recurrent upper respiratory tract infection,adenoid hypertrophy,mastoid dysplasia,and postoperative infection in higher proportions with respect to the non-recurrence group,and the duration of ventilation tube retention in the recurrence group was significantly shorter than that in the non-recurrence group(P<0.05).The presence of allergic rhinitis,recurrent upper respiratory tract infections,adenoid hypertrophyⅢandⅣ,and short retention time of ventilation tubes were risk factors for recurrence of secretory otitis media in children(P<0.05).Conclusion Tympanic tube placement with adenoidectomy is effective in reducing recovery time,inflammatory factors,complication rates,and recurrence rates in children.