Jing Yunlong,Huang Min,Li Yun,et al.Recurrence factors after endoscopic femoral entricular catheter placement in children with secretory otitis media[J].Journal of Clinical Pediatric Surgery,2021,20(07):652-657.[doi:10.12260/lcxewkzz.2021.07.011]
儿童分泌性中耳炎耳内镜下鼓室置管术后复发因素分析
- Title:
- Recurrence factors after endoscopic femoral entricular catheter placement in children with secretory otitis media
- Keywords:
- Secretory Otitis Media; Endoscopic Femoral Catheterization; Postoperative Recurrence; Risk Factors For; Child
- 分类号:
- R764.21;R764.9
- 摘要:
- 目的 探讨儿童分泌性中耳炎耳内镜下鼓室置管术后复发的相关因素。方法 回顾性分析2017年3月至2018年3月于湖南省儿童医院实施儿童分泌性中耳炎耳内镜下鼓室置管手术的93例患者资料，随访1年，根据复发情况分为复发组（n=23）和未复发组（n=70）。收集患者病程、性别、年龄、吸烟环境、扁桃体炎症、反复呼吸道感染、变应性鼻炎、乳突气化不良、通气管保留时间、慢性鼻窦炎及腺样体肥大或鼻咽部淋巴组织增生等资料，分析术后复发的危险因素。结果 所有患者完成随访，术后23例（24.73%）复发，平均复发时间为术后（9.56±1.56）个月；单因素分析结果显示，两组患者病程、性别、年龄、吸烟环境、扁桃体炎症差异无统计学意义（P>0.05）；反复呼吸道感染、变应性鼻炎、乳突气化不良、通气管保留时间、慢性鼻窦炎及腺样体肥大或鼻咽部淋巴组织增生与术后复发相关（P<0.05）；多因素非条件Logistic分析发现反复呼吸道感染（OR=2.317，95%CI：1.381~3.227）、变应性鼻炎（OR=1.892，95%CI：1.519~3.028）、乳突气化不良（OR=0.723，95%CI：0.386~0.898）、通气管保留时间（OR=1.225，95%CI：0.882~1.897）、慢性鼻窦炎（OR=1.622，95%CI：1.072~2.438）及腺样体肥大或鼻咽部淋巴组织增生（OR=1.187，95%CI：0.825~1.713）是导致儿童分泌性中耳炎耳内镜下鼓室置管术后复发的独立危险因素（P<0.05）。结论 患者反复呼吸道感染、变应性鼻炎、乳突气化不良、通气管保留时间、慢性鼻窦炎及腺样体肥大或鼻咽部淋巴组织增生是儿童分泌性中耳炎内镜下鼓室置管术后复发的危险因素，临床上对于具有复发危险因素的患者应加以重视，提高治疗效果。
- Abstract:
- Objective To explore the recurrence factors after endoscopic femoral entricular catheter placement in children with secretory otitis media.Methods Retrospective analysis was performed for the pathological data of 93 children undergoing endoscopic femoral catheterization for secretory otitis media from March 2017 to March 2018.Based upon follow-up visits,they were divided into observation group (n=23) and non-recurrent control group (n=70).The course of disease,gender,age,smoking environment,tonsil inflammation,recurrent respiratory tract infection,allergic rhinitis,poor mastoid gasification,ventilation duration,chronic sinusitis,adenoid hypertrophy or nasopharyngeal lymphoproliferative tissue and other data were collected for analyzing the risk factors for postoperative recurrence.Results During follow-ups,23 children (24.73%) had postoperative recurrence with a mean recurrence time of (9.56±1.56) months.Univariate analysis revealed no significant inter-group differences in disease course,gender,age,smoking environment or tonsillitis (P>0.05).Recurrent respiratory tract infection,allergic rhinitis,poor mastoid gasification,ventilation tube retention time,chronic sinusitis and adenoid hypertrophy or nasopharyngeal lymphoid tissue hyperplasia were associated with postoperative recurrence (P<0.05).Recurrence was taken as a dependent variable and multivariate unconditional Logistic analysis was performed.Recurrent respiratory tract infection (OR=2.317,95%CI:1.381-3.227),allergic rhinitis (OR=1.892,95%CI:1.519-3.028),poor mastoid gasification (OR=0.723,95%CI:0.386-0.898),airway retention time (OR=1.225,95%CI:0.882-1.897),chronic sinusitis (OR=1.622,95%CI:1.072-2.438) and adenoid hypertrophy or nasopharyngeal lymphoid tissue hyperplasia (OR=1.187,95%CI:0.825-1.713) were independent risk factors for a recurrence of pediatric secretory otitis media after endoscopic tympanoplasty (P<0.05).Conclusion Children with recurrent respiratory tract infection,allergic rhinitis,poor mastoid gasification,ventilation tube retention time,chronic sinusitis,adenoid hypertrophy or nasopharyngeal lymphoproliferative hyperplasia are all risk factors for postoperative recurrence.Clinicians should pay close attention to those with risk factors to improve treatment outcomes.
参考文献/References:
1 赵莹莹,孙书臣,刘娇媚,等.疏风通窍汤治疗急性分泌性中耳炎临床观察[J].长春中医药大学学报,2020,36(3):516-519.DOI:10.13463/j.cnki.cczyy.2020.03.031. Zhao YY,Sun SC,Liu JM,et al.Clinical observation of Shufeng Tongqiao Decoction for acute secretory otitis media[J].Changchun University of Chinese Medicine,2020,36(3):516-519.DOI:10.13463/j.cnki.cczyy.2020.03.031.
2 栗子芳,易世江,王文华,等.鼓膜穿刺或鼓膜置管联合腺样体切除术治疗儿童分泌性中耳炎的疗效分析[J].临床耳鼻咽喉头颈外科杂志,2018,32(5):383-385.DOI:10.13201/j.issn.1001-1781.2018.05.016. Li ZF,Yi SJ,Wang WH,et al.Efficacy analysis of tympanoplasty or tympanoplasty plus adenoidectomy in the treatment of secretory otitis media in children[J].Journal of Clinical Otorhinolaryngology Head and Neck Surgery,2018,32(5):383-385.DOI:10.13201/j.issn.1001-1781.2018.05.016.
3 张家鹏,郭亿莲,卢标清,等.咽鼓管球囊扩张联合鼓膜切开置管术治疗复发性分泌性中耳炎的应用分析[J].临床耳鼻咽喉头颈外科杂志,2018,32(7):551-553.DOI:10.13201/j.issn.1001-1781.2018.07.019. Zhang JP,Guo YL,Lu BQ,et al.Application analysis of eustachian tube balloon dilatation combined with myringotomy and intubation in the treatment of recurrent secretory otitis media[J].Journal of Clinical Otorhinolaryngology Head and Neck Surgery,2018,32(7):551-553.DOI:10.13201/j.issn.1001-1781.2018.07.019.
4 Milan Urík,Ivo ?lapák,Josef Macha?.Chronic secretory otitis media and tympanoplasty in children[J].Casopíslékaru?eskych,2019,158(6):240-242.DOI:10.1097/MAO.0000000000000767.
5 阮开安,吴铖林,张武宁.耳内镜下夹层法鼓膜成形术治疗鼓膜大穿孔的临床研究[J].中国内镜杂志,2020,26(2):60-64.DOI:10.3969/j.issn.1007-1989.2020.02.012. Ruan KJ,Wu L,Zhang WN.Clinical study on the treatment of large perforation of tympanic membrane with sandwich tympanoplasty under otoendoscope[J].Chinese Journal of Endoscopy,2020,26(2):60-64.DOI:10.3969/j.issn.1007-1989.2020.02.012.
6 汪祖益,刘及江.耳内镜与耳显微镜下鼓膜成形术对慢性化脓性中耳炎患者听力改善率及临床疗效的影响[J].临床和实验医学杂志,2019,18(5):534-537.DOI:10.3969/j.issn.1671-4695.2019.05.027. Wang ZY,Liu JJ.Efficacy of tympanoplasty under otoscope and otomicroscope on hearing improvement rate and clinical efficacy of patients with chronic suppurative otitis media[J].Journal of Clinical and Experimental Medicine,2019,18(5):534-537.DOI:10.3969/j.issn.1671-4695.2019.05.027.
7 刘宇鹏,杨军.儿童分泌性中耳炎治疗国际共识(IFOS)解读及国内诊疗现状[J].临床耳鼻咽喉头颈外科杂志,2018,32(21):1674-1678.DOI:10.13201/j.issn.1001-1781.2018.21.017. Liu YP,Yang J.Interpretation of international consensus on the treatment of secretory otitis media in children (IFOS) and current status of diagnosis and treatment in China[J].Journal of Clinical Otolaryngology Head and Neck Surgery,2018,32(21):1674-1678.DOI:10.13201/j.issn.1001-1781.2018.21.017.
8 严斌,吴文文,刘博,等.氨溴索联合雷诺考特鼻喷雾剂对分泌性中耳炎患者血清与耳积液HA sIL-2R Fn炎性介质的影响[J].河北医学,2018,24(5):782-786.DOI:10.3969/j.issn.1006-6233.2018.05.021. Yan B,Wu WW,Liu B,et al.Effects of ambroxol plus Reynolds nasal spray on inflammatory mediators of serum HA and sIL-2R Fn in patients with secretory otitis media[J].Hebei Medicine,2018,24(5):782-786.DOI:10.3969/j.issn.1006-6233.2018.05.021.
9 谢晓兴,熊高云,戈言平,等.分泌性中耳炎患者的血清及中耳积液内炎性因子和转化生长因子水平检测及其临床价值分析[J].中华全科医学,2018,16(9):1449-1451,1478.DOI:10.16766/j.cnki.issn.1674-4152.000396. Xie XX,Xiong GY,Ge YP,et al.Detection of inflammatory factors and transforming growth factor in serum and middle ear effusion of patients with secretory otitis media and analysis of their clinical value[J].Chinese Journal of General Practice,2018,16(9):1449-1451,1478.DOI:10.16766/j.cnki.issn.1674-4152.000396.
10 温鑫,周永青,宋英鸾,等.腺样体切除加鼓膜穿刺耳道正行吹张治疗腺样体肥大并分泌性中耳炎疗效分析[J].听力学及言语疾病杂志,2018,26(1):93-95.DOI:10.3969/j.issn.1006-7299.2018.01.024. Wen X,Zhou YQ,Song YL,et al.Efficacy analysis of adenoidectomy plus tympanic membrane puncture and ear canal positive blowing for adenoid hypertrophy and secretory otitis media[J].Journal of Audiology and Speech Diseases,2018,26(1):93-95.DOI:10.3969/j.issn.1006-7299.2018.01.024.
11 江文博,张建耀,胡建道,等.腺样体切除术同时行鼓膜置管或鼓膜切开对分泌性中耳炎的疗效分析[J].中国中西医结合耳鼻咽喉科杂志,2018,26(1):13-15.DOI:10.16542/j.cnki.issn.1007-4856.2018.01.004. Jiang WB,Zhang JY,Hu JD,et al.Efficacy analysis of adenoidectomy plus tympanic membrane catheterization or tympanic membrane incision for secretory otitis media[J].Chinese Journal of Integrated Traditional Chinese & Western Medicine,2018,26(1):13-15.DOI:10.16542/j.cnki.issn.1007-4856.2018.01.004.
12 邓丽芳,李碧玉,吴盖珍,等.鼻咽癌放疗后并发分泌性中耳炎92例临床分析[J].海南医学,2018,29(12):134-136.DOI:CNKI:SUN:HAIN.0.2018-12-040. Deng LF,Li BY,Wu GZ,et al.Clinical analysis of 92 cases of secretory otitis media after radiotherapy for nasopharyngeal carcinoma[J].Hainan Medical Journal,2018,29(12):134-136.DOI:CNKI:SUN:HAIN.0.2018-12-040.
13 Yin G,Tan J,Li P.Balloon dilation of Eustachian tube combined with tympanostomy tube insertion and middle ear pressure equalization therapy for recurrent secretory otitis media[J].Journal of Otology,2019,14(3):101-105.DOI:10.1016/j.joto.2019.05.003.
14 莫贤海,龙增勇,韦飞虎,等.鼓膜置管术对分泌性中耳炎患儿术后生活质量的影响[J].现代生物医学进展,2020,20(10):115-118.DOI:CNKI:SUN:SWCX.0.2020-10-024. Mo XH,Long ZY,Wei FH,et al.Effect of tympanic membrane catheterization on postoperative quality-of-life in children with secretory otitis media[J].Advances in Modern Biomedicine,2020,20(10):115-118.DOI:CNKI:SUN:SWCX.0.2020-10-024.
15 朱珠,郑国玺,李琦,等.儿童分泌性中耳炎反复发作的相关因素研究[J].重庆医学,2018,47(5):590-593.DOI:10.3969/j.issn.1671-8348.2018.05.005. Zhu Z,Zheng GX,Li Q,et al.Related factors of recurrent secretory otitis media in children[J].Chongqing Medical Journal,2018,47(5):590-593.DOI:10.3969/j.issn.1671-8348.2018.05.005.
备注/Memo
收稿日期:2021-02-05。
基金项目:湖南省儿童医院1233人才工程资助
通讯作者:胡彬雅,Email:zhizi628@126.com