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目的 通过采用YAG激光行鼓膜造孔并结合外耳道负压吸引治疗分泌性中耳炎 (SOM) ,探寻治疗SOM一新的方法并确定最佳造孔大小。方法 对一组初次就诊的SOM患者 14 7例 2 5 8耳 (初诊组 )和一组经穿刺 (或切开 )后复发的SOM患者 87例 114耳 (复发组 )随机用YAG激光在鼓膜前下方分别造 1 0mm、2 0mm、3 0mm直径的小孔 ,再在外耳道予以 - 0 .0 2Mp负压吸出鼓室内液体 ,随访 3月并比较不同造孔大小与疗效的关系。结果 所有患者治疗后早期均取得明显临床疗效 ,1 0mm、2 0mm和 3 0mm的造孔平均闭合时间分别为 1.4 8周、2 .70周和 3.17周 ,但 3.0mm造孔组有一例导致永久性穿孔。初诊组 2 0mm与 3 0mm造孔复发率无显著性差异 (P >0 5 0 ) ,而复发组 2 0mm造孔复发率高于 3 0mm造孔 (P <0 0 5 )。结论 YAG激光鼓膜造孔结合外耳道负压吸引治疗SOM是一种简单、经济和有效的方法 ,对初诊患者可先采用 2 0mm直径的造孔 ,复发者则以选择 3 0mm直径的造孔为宜。
Objective To explore a new method to treat SOM and to determine the optimal pore size by using tympanostomy with YAG laser in combination with external auditory canal suction to treat secretory otitis media (SOM). Methods A total of 147 cases (285 cases) of newly diagnosed SOM patients (group A) and 87 cases of 114 cases (recurrent group) of SOM patients who had recurrence after puncture (or incision) were randomized to receive YAG laser before tympanic membrane The bottom were made of 1 0mm, 20mm, 30mm diameter holes, and then in the external auditory canal to be -0.0 2Mp vacuum suction liquid inside the drum, followed up for 3 months and compare the size of the relationship between the hole and curative effect. Results All patients achieved obvious clinical efficacy early after treatment. The average closure time of 110 mm, 20 mm and 30 mm were 1.4 weeks, 2.70 weeks and 3.17 weeks, respectively. However, one case of 3.0mm perforation group resulted in permanent Perforation. There was no significant difference in the recurrence rates of 20 mm and 30 mm in the newly diagnosed group (P> 0.05), while the recurrence rate of 20 mm hole in the recurrence group was higher than that in the 30 mm hole (P <0.05). Conclusion YAM laser tympanostomy combined with external auditory canal vacuum suction treatment of SOM is a simple, economical and effective method for the newly diagnosed patients can be used to 20mm diameter hole, the recurrence of those who choose to 30mm diameter hole should be appropriate .