谭向杲 许卫华 戴德 吴蕙敏

[摘要]目的 探討咽鼓管球囊扩张术加鼓膜穿刺抽液治疗顽固性分泌性中耳炎的效果。方法 选取2016年3月～2017年9月茂名石化医院收治的50例顽固性分泌性中耳炎患者作为研究对象，按照随机数字表法将其分为观察组（n=25）和对照组（n=25）。对照组患者局部激素治疗后采用咽鼓管吹张、鼓膜穿刺和置管等传统治疗，观察组患者采用咽鼓管球囊扩张术加鼓膜穿刺抽液治疗。比较两组患者治疗前和治疗后24个月的纯音听阈均值（PTA）、气骨导间距（ABG）、咽鼓管测压（TMM）、咽鼓管功能（ETS）评分;检测两组治疗前和治疗后24个月的30 mbar有R值、40 mbar有R值、50 mbar有R值患者的占比。结果 治疗后，两组患者的PTA、ABG水平低于治疗前，ETS评分高于治疗前，差异有统计学意义（P<0.05）;治疗后，观察组患者的PTA、ABG水平低于对照组，ETS评分高于对照组，差异有统计学意义（P<0.05）。治疗后，观察组30、40、50 mbar有R值患者的占比高于对照组，差异有统计学意义（P<0.05）。结论 传统治疗能使患者症状短期缓解，咽鼓管球囊扩张术治疗使阻塞的咽鼓管再通畅，根源性解决中耳生理通气功能阻碍，症状改善明显，作用持久，疗效确切，值得推广。

[关键词]咽鼓管球囊扩张术;顽固性分泌性中耳炎;临床研究;临床疗效

[中图分类号] R764.29          [文献标识码] A          [文章编号] 1674-4721（2020）7（a）-0156-04

Effect of eustachian tube balloon dilatation combined with tympanic membrane puncture and drainage in the treatment of refractory secretory otitis media

TAN Xiang-gao1   XU Wei-hua2   DAI De2   WU Hui-min1

1. Department of Ophthalmology and Otorhinolaryngology， Maoming Petrochemical Hospital， Guangdong Province， Maoming   525011， China; 2. Department of Otolaryngology， Affiliated Hospital of Guangdong Medical University， Guangdong Province， Zhanjiang   524000， China

[Abstract] Objective To investigate the effect of eustachian tube balloon dilatation combined with tympanic membrane puncture and drainage in the treatment of refractory secretory otitis media. Methods Fifty patients with refractory secretory otitis media treated in Maoming Petrochemical Hospital from March 2016 to September 2017 were selected as the research subjects. They were divided into observation group （n=25） and control group （n=25） according to the random number table method. The control group was treated with traditional methods such as eustachian tube bluffing， tympanic membrane puncture， and tube placement after local hormone treatment， and the observation group was treated with eustachian tube balloon dilatation combined with tympanic membrane puncture and drainage. The pure tone hearing threshold （PTA）， air-bone conduction gap （ABG）， eustachian tube manometer （TMM）， and eustachian tube function score （ETS） of the two groups were compared before and after 24 months. The proportion of patients with R value of 30 mbar， R value of 40 mbar， and R value of 50 mbar before and 24 months after surgery were measured. Results After treatment， the levels of PTA and ABG in the two groups were lower than those before treatment， and the score of ETS was higher than that before treatment， the differences were statistically significant （P<0.05）. After treatment， the levels of PTA and ABG in the observation group were lower than those in the control group， the ETS score was higher than that in the control group， the differences were statistically significant （P<0.05）. After treatment， the proportion of patients with R value at 30， 40， and 50 mbar in the observation group were higher than those in the control group， the differences were statistically significant （P<0.05）. Conclusion Traditional treatment can relieve the symptoms of patients in a short period of time. Eustachian tube balloon dilatation can make the eustachian tube obstructed again， and it can solve the obstruction of physiological ventilation function of the middle ear. The symptom improvement is obvious， the effect is lasting， the curative effect is definite， it is worth popularizing.

[Key words] Eustachian tube balloon dilation; Refractory secretory otitis media; Clinical research; Clinical efficacy

分泌性中耳炎是以中耳积液及听力下降为特征的中耳非化脓性炎性疾病，常迁延不愈形成慢性病程，并逐渐向慢性化脓性中耳炎和中耳胆脂瘤等中耳疾病转变[1-3]。由于咽鼓管位置隐蔽、结构复杂，传统的局部激素治疗、咽鼓管吹张、鼓膜穿刺和置管等并不能针对病因进行有效治疗[4]。咽鼓管球囊扩张术作为一种新的治疗手段，已为大多数顽固性分泌性中耳炎患者带来满意的效果[5-6]。本研究选取茂名石化医院收治的50例顽固性分泌性中耳炎患者作为研究对象，比较传统治疗方式和咽鼓管球囊扩张术治疗顽固性分泌性中耳炎的效果，考察咽鼓管球囊扩张术加鼓膜穿刺抽液在顽固性分泌性中耳炎的应用，旨在为临床治疗顽固性分泌性中耳炎治疗方式的选择及手术操作技巧提供参考，现报道如下。……