柳州市妇幼保健院 耳鼻咽喉科 柳州 545001
广西卫生健康委员会自筹经费科研课题（Z-B2021581）
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目的：分析儿童分泌性中耳炎鼓膜置管术后通气管留置时间与疗效的关系及早期脱落的风险因素。方法：对115例（183耳）行鼓膜置管术的患儿的临床诊疗和随访资料进行回顾性分析。结果：115例（183耳）行鼓膜置管术时的平均年龄为（4.68±2.54 ）岁，多集中在3.5～7岁，占86.57%。183耳术后通气管留置时间多为3～18个月，平均留置时间为（9.43±3.82 ）个月，痊愈耳（126 耳）通气管留置时间平均为（11.82±3.11 ）个月，未愈耳（57耳）平均时间为（9.13±3.21）个月，之间有统计学差异（P<0.01）；留置时间＜6个月的痊愈率为51.92%，≥6个月者为75.58%，之间存在差异（P＜0.05）。单因素卡方分析鼓膜显著塌陷或菲薄、通气管堵塞、术后中耳感染、术后早期活动等因素与鼓膜置管术后通气管早期脱落相关（P＜0.05 ）；多因素Logistic回归分析，发现手术时鼓膜重度塌陷或菲薄、术后通气管堵塞、术后中耳感染、术后不按时复查、术后早期较强活动是儿童鼓膜置管术后通气管早期脱落的独立危险因素（P＜0.05 ）。结论：鼓膜置管术后通气管过早脱管或取管，导致复发率升高。鼓膜重度塌陷或菲薄、术后通气管堵塞、术后中耳感染、术后不按时复查、术后早期较强活动是主要危险因素，临床上应以重视。
objective：To analyze the relationship between the indwelling time of the ventilation tube and the curative effect and the risk factors of early exfoliation after eardrum catheterization in children with secretory otitis media.Method：The clinical diagnosis, treatment and follow-up data of 115 children (183 ears) who underwent myringotomy were analyzed retrospectively.Result：The average age of 115 cases (183 ears) who underwent tympanic membrane intubation was (4.68 ± 2.54) years old, most of them were between 3.5 and 7 years old, accounting for 86.57%. The indwelling time of ventilation tube in 183 ears after operation was mostly 3-18 months, with an average indwelling time of (9.43 ± 3.82) months,the average time of tracheal indwelling in 126 cured ears was (11.82 ± 3.11) months, and that in 57 untreated ears was (9.13 ± 3.21) months, with statistical difference (P<0.01); The recovery rate of patients with retention time<6 months was 51.92%, and that of patients with retention time ≥ 6 months was 75.58%. There was a difference between them (P<0.05).Single-factor chi-square analysis showed that significant collapse or thinning of the tympanic membrane, obstruction of the ventilation tube, postoperative middle ear infection, and early postoperative activity were related to the early fall of the ventilation tube after tympanic membrane intubation (P<0.05);Multivariate logistic regression analysis found that severe collapse or thinness of tympanic membrane during operation, blockage of ventilation tube after operation, middle ear infection after operation, delayed re-examination after operation, and early strong activity after operation were independent risk factors for early fall of ventilation tube after tympanic membrane intubation in children (P<0.05).Conclusion：After tympanic membrane intubation, the ventilation tube was prematurely removed or removed, resulting in a higher recurrence rate. Severe collapse or thinning of the tympanic membrane, blockage of the ventilation tube after operation, middle ear infection after operation, delayed re-examination after operation, and early strong activity after operation are the main risk factors, which should be paid attention to clinically.
