本文關(guān)鍵詞： 分泌性中耳炎 咽鼓管功能障礙 咽鼓管球囊擴(kuò)張術(shù) 鼓膜穿刺術(shù) 鼓膜切開術(shù)　出處：《遵義醫(yī)學(xué)院》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:探討咽鼓管球囊擴(kuò)張聯(lián)合鼓膜穿刺術(shù)與鼓膜切開術(shù)對(duì)分泌性中耳炎治療效果的對(duì)比評(píng)估,為分泌性中耳炎治療新方法提供理論基礎(chǔ)。方法:選取2015年3月至2016年7月深圳龍崗區(qū)耳鼻咽喉醫(yī)院耳鼻咽喉科收治的分泌性中耳炎患者32人(41耳)為研究對(duì)象,上述對(duì)象均符合分泌性中耳炎的診斷標(biāo)準(zhǔn),純音聽閾示骨氣導(dǎo)差(500、1000、2000及4000Hz)平均值"g15d B,鼓室導(dǎo)抗圖示“B”型或“C”型曲線,行耳內(nèi)鏡檢查鼓膜完整合并鼓室積液,無鼻咽部腫瘤或腺樣體肥大,藥物保守治療"g3個(gè)月�；颊呓Y(jié)合自身情況自愿分為兩組,A組15人(20耳),B組17人(21耳)。A組為進(jìn)行咽鼓管球囊擴(kuò)張聯(lián)合鼓膜穿刺術(shù)的患者,B組為進(jìn)行鼓膜切開術(shù)的患者。所有患者術(shù)前、術(shù)后2周、術(shù)后1個(gè)月、術(shù)后3個(gè)月均行耳內(nèi)鏡的檢查、純音測(cè)聽檢測(cè)、聲導(dǎo)抗檢測(cè)、咽鼓管功能障礙評(píng)分(the eustachian tube dysfunction questionnaire,ETDQ-7)的評(píng)估,最后對(duì)數(shù)據(jù)進(jìn)行統(tǒng)計(jì)學(xué)分析。結(jié)果:A組術(shù)后2周治愈率45%(9/20),好轉(zhuǎn)率40%(8/20),無效率15%(3/20),有效率85%(17/20),有效率為痊愈率與好轉(zhuǎn)率的總和;術(shù)后1月治愈率85%(17/20),好轉(zhuǎn)率10%(2/20),無效率5%(1/20),有效率95%(19/20);術(shù)后3月治愈率90%(18/20),好轉(zhuǎn)率5%(1/20),無效率5%(1/20),有效率95%(19/20)。B組術(shù)后2周治愈率28.6%(6/21),好轉(zhuǎn)率66.7%(14/21),無效率4.8%(1/21),有效率95.3%(20/21);術(shù)后1月治愈率47.6%(10/21),好轉(zhuǎn)率0%(0/21),無效率52.4%(11/21),有效率47.60%(10/21);術(shù)后3月治愈率47.6%(10/21),好轉(zhuǎn)率0%(0/21),無效率52.4%(11/21),有效率47.6%(10/21)。A組與B組術(shù)后1月、3月療效對(duì)比存在顯著差異(P0.05)。通過手術(shù)前后ETDQ-7評(píng)分比較可發(fā)現(xiàn),A組與B組術(shù)后1月、3月評(píng)分對(duì)比存在顯著差異(P0.05),有統(tǒng)計(jì)學(xué)意義;A組術(shù)后1月與3月評(píng)分存在顯著差異(P0.05)。結(jié)論:對(duì)于排除鼻咽部腫物及鼻竇炎的慢性分泌性中耳炎患者,咽鼓管球囊擴(kuò)張聯(lián)合鼓膜穿刺術(shù)跟單純鼓膜切開術(shù)相比有更好的短期療效,該手術(shù)創(chuàng)傷較小,在短期的臨床隨訪時(shí)間內(nèi)治療效果穩(wěn)定,有一定的優(yōu)勢(shì),是一種安全、可行的手術(shù)。
[Abstract]:Objective: to evaluate the efficacy of eustachian tube balloon dilatation combined with tympanic membrane puncture and tympanic membrane incision in the treatment of secretory otitis media. Methods: from March 2015 to July 2016, 32 patients (41 ears) with secretory otitis media treated in Department of Otolaryngology, Longgang District Otolaryngology Hospital, Shenzhen, were selected. All the above objects were in accordance with the diagnostic criteria of secretory otitis media. The pure tone hearing threshold showed the mean value of "g15dB", the tympanic conductance curve was "B" or "C" curve, and the tympanic membrane intact with tympanic effusion was examined by endoscopy. No nasopharyngeal neoplasms or adenoid hypertrophy, Drug conservative therapy "g3 months. Patients were voluntarily divided into two groups according to their own conditions: group A, 15 patients with 20 ears, group B, 17 patients with 21 ears, group A, patients undergoing balloon dilation of the eustachian tube combined with tympanic membrane puncture, group B, patients undergoing tympanotomy, and group B, patients undergoing tympanectomy." All patients before operation, 2 weeks after operation, 1 month after operation, 3 months after operation, all patients were assessed by endoscopy, pure tone audiometry, acoustic conductance, and the score of the eustachian tube dysfunction questionnairere 7 (ETDQ-7). Finally, the data were analyzed statistically. Results in group A, the cure rate was 459 / 20, the improvement rate was 40 / 20, the inefficiency was 15 / 20, the effective rate was 8517 / 20, and the effective rate was the sum of the recovery rate and the improvement rate. On January, the cure rate was 85 / 17 / 20, the improvement rate was 10 / 2 / 20, the inefficiency was 5 / 20 / 20, the effective rate was 95 / 20; on March, the cure rate was 9018 / 20, the improvement rate was 5 1 / 20, the inefficiency was 5% 1 / 20, the effective 9519 / 20 / B group had a cure rate of 28.666 / 21, the improvement rate was 66.714 / 21 / 21, the inefficiency was 4.881 / 21, the effective rate was 95.330.20% / 21; the cure rate was 47.66% / 10 ~ (21) after January. On March, the cure rate was 47.610 / 21, the improvement rate was 0 / 21, the ineffective rate was 52.610 / 21, the effective rate was 57.610 / 21 / 21, the effective rate was 47.610 / 21 / 21, the effective rate was 52.610 / 21 / 21, the effective rate was 47.610 / 21 / 21 and the effective rate was 47.610 / 21 / 21 / 11 / 21. There was a significant difference in the curative effect between group A and group B on January and March. By comparing the ETDQ-7 scores before and after operation, we can find that there is a significant difference between group A and group B. There were significant differences in scores between January and March in group A and P 0.05 in group A. Conclusion: for patients with chronic secretory otitis media who exclude nasopharyngeal masses and sinusitis, there is a significant difference between group A and group A in terms of postoperative scores of January and January. Compared with simple tympanic membrane incision, eustachian tube balloon dilation combined with tympanic membrane puncture has better short-term curative effect. A viable operation.
【學(xué)位授予單位】：遵義醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R764.9

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