Isaacson Glenn
Department of Otolaryngology-Head and Neck Surgery, Temple University School of Medicine, Philadelphia, PA 19140, USA.
Otolaryngol Head Neck Surg. 2008 Sep;139(3):353-7. doi: 10.1016/j.otohns.2008.06.012.
To evaluate a protocol designed to avoid complications during tympanostomy tube insertion by residents.
Ten-year consecutive cases series by a single surgeon supervising residents.
Tertiary children's hospital.
Children 6 weeks to 21 years.
Residents followed a defined protocol for tube insertion. A resident operated until the tube was placed or he/she committed one major or two minor errors.
Incidence of 1) major complications: profound sensorineural hearing loss (SNHL), injury to major vascular structures, or disruption of the ossicular chain; and 2) minor complications: tube loss into the middle ear, tympanic membrane tears, or tube occlusion by blood clot.
There were no major complications in 10,000 tube insertions. Two children had unilateral profound SNHL; both were found to have Mondini malformations. Five tubes were recovered from the middle ear. Eight tympanic membrane tears healed with gelatin patches. Three tubes were occluded by blood clots.
By following a defined protocol, major complications of a common operation can be reduced to the five-sigma level and minor complications minimized.
评估一项旨在避免住院医师在鼓膜置管插入过程中出现并发症的方案。
由一名监督住院医师的外科医生进行的连续十年病例系列研究。
三级儿童医院。
6周龄至21岁的儿童。
住院医师遵循既定的置管方案。一名住院医师进行手术，直到置管成功或出现一次重大失误或两次轻微失误。
1）重大并发症的发生率：严重感音神经性听力损失（SNHL）、主要血管结构损伤或听骨链中断；2）轻微并发症的发生率：中耳内的导管丢失、鼓膜撕裂或血凝块堵塞导管。
在10000次置管中未出现重大并发症。两名儿童出现单侧严重SNHL；两人均被发现患有Mondini畸形。从中耳中取出了5根导管。8例鼓膜撕裂用明胶贴片愈合。3根导管被血凝块堵塞。
通过遵循既定方案，常见手术的重大并发症发生率可降至五个标准差水平，并将轻微并发症降至最低。
