CAJ | 학술논문

目的：??探索腭裂患儿分泌性中耳炎（SOM）的治疗方法。方法??选择3~14岁先天性腭裂合并SOM的患儿319例（524耳）设为试验组，根据中耳积液性状分为3组：A组为浆液性积液，112例（198耳）；B组为黏液性积液，162例（248耳）；C组为中耳负压无积液，45例（78耳）。同时选择年龄相当的腺样体合并扁桃体肥大伴SOM患儿208例（246耳）设为对照组，同样根据积液性状分为对应的A1、B1、C1组。两组患儿分别进行腭裂修复术和腺样体、扁桃体切除手术后，对A、A1组进行鼓膜穿刺，B、B1组进行鼓室置管，C、C1组行鼓膜穿刺；术后均辅助药物治疗。比较各组SOM的治愈率和复发率。结果??术后12个月，试验组总治愈率为77.29%（405/524），总复发率为14.57%（59/405），对照组总治愈率为93.09%（229/246），总复发率为3.93%（9/229），对照组SOM治愈率明显高于试验组，复发率明显低于试验组（P<0.05）。试验组治疗过程较对照组复杂，一次性治愈率低，需行反复、多次治疗。结论??腭裂患儿SOM的治疗方法与普通中耳炎有较大差异，应对腭裂SOM予以专门检查，开展特异性治疗。根据鼓室积液性状，反复鼓膜穿刺或6个月以上的鼓室置管是较好的治疗方法。
목적：??탐색악렬환인분비성중이염（SOM）적치료방법。방법??선택3~14세선천성악렬합병SOM적환인319례（524이）설위시험조，근거중이적액성상분위3조：A조위장액성적액，112례（198이）；B조위점액성적액，162례（248이）；C조위중이부압무적액，45례（78이）。동시선택년령상당적선양체합병편도체비대반SOM환인208례（246이）설위대조조，동양근거적액성상분위대응적A1、B1、C1조。량조환인분별진행악렬수복술화선양체、편도체절제수술후，대A、A1조진행고막천자，B、B1조진행고실치관，C、C1조행고막천자；술후균보조약물치료。비교각조SOM적치유솔화복발솔。결과??술후12개월，시험조총치유솔위77.29%（405/524），총복발솔위14.57%（59/405），대조조총치유솔위93.09%（229/246），총복발솔위3.93%（9/229），대조조SOM치유솔명현고우시험조，복발솔명현저우시험조（P<0.05）。시험조치료과정교대조조복잡，일차성치유솔저，수행반복、다차치료。결론??악렬환인SOM적치료방법여보통중이염유교대차이，응대악렬SOM여이전문검사，개전특이성치료。근거고실적액성상，반복고막천자혹6개월이상적고실치관시교호적치료방법。
Objective??To?discuss?the?treatment?characteristics?of?secretory?otitis?media?(SOM)?in?cleft?palate?children. Methods??A?total?of?319?patients?(524?ears)?with?SOM?and?cleft?palate?(3-14?years?old)?who?accepted?treatment?were?divided?into?experiment?group?A,?group?B,?and?group?C?according?to?effusion?characteristics?in?the?middle?ear?and?tympanic?pressure.?Group?A?included?112?patients?with?serous?effusion?(198?ears).?Group?B?included?162?patients?with?mucinous?effusion?(248?ears).?Group?C?included?45?patients?(78?ears)?with?negative?pressure?in?the?middle?ear?without?effusion?and?an?acoustic?immit-tance.?A?total?of?208?patients?(246?ears)?with?SOM?and?tonsil?and?adenoid?hypertrophy?were?divided?into?control?group?A1,?group?B1,?and?group?C1?matched?with?the?same?effusion?characteristics?in?the?middle?ear?and?tympanic?pressure.?Group?A?and?A1?accepted?puncture?in?the?tympanic?cavity,?group?B?and?B1?accepted?tympanostomy?tubes,?and?group?C?and?C1?accepted?puncture?in?the?tympanic?cavity?after?palatoplasty,?adenoidectomy,?and?tonsillectomy.?All?groups?were?treated?with?antibiotics?and?ear?drops.?Cure?rate?and?recurrence?rate?between?the?experiment?group?and?the?control?group?were?compared.?Results??The?control?group?had?a?better?cure?rate?[93.09%?(229/246)]?than?the?experiment?group?[77.29%?(405/524)]?12?months?after?treatment.?The?experiment?group?had?a?higher?recurrence?rate?[14.57%?(59/405)]?than?the?control?group?[3.93%?(9/229)].?Statistical?diffe-rences?were?observed?between?the?two?groups?(P<0.05).?SOM?with?cleft?palate?initially?had?a?low?cure?rate,?and?thus?it?was?treated?repeatedly?for?many?times.?Conclusion??SOM?with?cleft?palate?is?different?from?normal?otitis?media?in?terms?of?clinical?manifestation,?treatment,?outcome,?and?prognosis.?This?case?should?be?considered?a?special?otitis?media?to?be?treated?with?special?examination?and?therapy?to?obtain?better?results.?Repeated?puncture?in?the?tympanic?cavity?and?tympanostomy?tubes?for?six?months?according?to?effusion?characteristics?are?better?treatment?options?for?patients?with?SOM?and?cleft?palate.