【摘要】：目的：通過兒童腺樣體的大體形態(tài)、影像學(xué)形態(tài)、細(xì)胞學(xué)形態(tài)三方面分析,探討兒童腺樣體形態(tài)學(xué)與SOM的相關(guān)性,以及兒童SOM的診治。 方法：采用病例觀察研究,將遵義醫(yī)學(xué)院三附屬醫(yī)院耳鼻咽喉頭頸外科2011年1月2011年10月98例184耳(雙耳患病者86例,單耳患病者12例)SOM并行腺樣體切除術(shù)的患兒,均行鼻咽部三維CT、纖維鼻咽鏡、聲導(dǎo)抗、病理學(xué)檢查,必要時行ABR,以排除蝸性及蝸后病變；年齡大于5歲者,行純音測聽檢查,術(shù)中B型鼓室壓圖者行鼓室穿刺；將確診為兒童SOM,同時排除鼻咽部腫瘤、腦膜腦膨出、中耳外傷的98例患兒納為研究對象,分成三組：單純腺樣體肥大引起SOM、炎癥性腺樣體引起的SOM和過敏性因素引起的SOM,結(jié)合近年來相關(guān)文獻,從腺樣體的大體形態(tài)、影像學(xué)形態(tài)、細(xì)胞學(xué)形態(tài)三方面評估和統(tǒng)計分析腺樣體形態(tài)學(xué)與SOM的相關(guān)性。 結(jié)果：98病例中經(jīng)鼓室穿刺證實合并SOM者26例(26.5%)、而經(jīng)聲導(dǎo)抗檢查+純音測聽檢查證實且病史中有明確聽力減退者72例(73.5%)。并對這些病例從腺樣體的大體形態(tài)、影像學(xué)形態(tài)、細(xì)胞學(xué)形態(tài)三方面進行統(tǒng)計分析發(fā)現(xiàn),腺樣體的形態(tài)學(xué)與SOM發(fā)病有明顯相關(guān)性,其中影響最顯著的因素是腺樣體形態(tài)與咽鼓管咽口關(guān)系的密切程度。腺樣體的形態(tài)學(xué)檢查中,肥大型、A/N值≥0.71、炎癥性、過敏性的腺樣體易患SOM,導(dǎo)致咽鼓管功能障礙致鼓室圖異常,造成兒童聽力下降,而平坦型、A/N值≤0.60、單純肥大的腺樣體對兒童聽力的影響較小。 結(jié)論：腺樣體的形態(tài)學(xué)與SOM有相關(guān)性,故有必要對所有腺樣體肥大患兒常規(guī)進行聽力學(xué)檢查、鼻咽部三維CT掃描、腺樣體組織進行細(xì)胞學(xué)檢查,以進一步輔助確認(rèn)或除外SOM診斷。
[Abstract]:Objective: to investigate the correlation between adenoid morphology and SOM in children and the diagnosis and treatment of SOM in children by analyzing the gross morphology, imaging morphology and cytological morphology of adenoids in children. Methods: 98 cases of 184 ears (86 patients with binaural disease, 12 patients with monaural disease) treated with adenoidectomy were treated with SOM in Oct. 2011 in the third affiliated Hospital of Zunyi Medical College, in which 98 cases (86 cases of binaural disease and 12 cases of monaural disease) were treated with adenoidectomy. Three dimensional nasopharynx CT, fiberoptic nasopharyngoscope, acoustic impedance, pathological examination, ABR, to exclude cochlear and retrocochlear lesions, pure tone audiometry and tympanic cavity puncture were performed in patients over 5 years old, and tympanic cavity puncture was performed in patients with type B tympanogram during operation. Ninety-eight children diagnosed as children with SOM, at the same time excluded nasopharyngeal tumors, meningeal encephalocele and middle ear trauma were included in the study. They were divided into three groups: SOM caused by SOM, inflammation caused by adenoid hypertrophy and SOM, caused by anaphylaxis combined with related literature in recent years. The relationship between adenoid morphology and SOM was evaluated and statistically analyzed in three aspects of cytology and morphology. Results 26 cases (26.5%) were confirmed with SOM by tympanic puncture, and 72 cases (73.5%) were confirmed by pure tone audiometry and history of hearing loss. It was found that the morphology of adenoid and the incidence of SOM were significantly correlated with the morphology of adenoids from three aspects: gross morphology, imaging morphology and cytological morphology. Among them, the most significant factor is the close relationship between adenoid morphology and pharyngostomy of eustachian tube. In the morphological examination of adenoids, A / N value 鈮，

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