腺样体切除术对小儿鼓膜置管再插入术的保护作用：一项基于人群的出生队列研究。
The protective effect of adenoidectomy on pediatric tympanostomy tube re-insertions: a population-based birth cohort study.
作者信息
Wang Mao-Che, Wang Ying-Piao, Chu Chia-Huei, Tu Tzong-Yang, Shiao An-Suey, Chou Pesus
机构信息
Department of Otolaryngology Head Neck Surgery, Taipei Veterans General Hospital, Taipei, Taiwan and School of Medicine, National Yang-Ming University, Taipei, Taiwan; Institute of Public Health and Community Medicine Research Center, National Yang-Ming University, Taipei, Taiwan.
Institute of Public Health and Community Medicine Research Center, National Yang-Ming University, Taipei, Taiwan; Department of Otolaryngology Head Neck Surgery, Mackay Memorial Hospital, Taipei, Taiwan and Department of Audiology and Speech Language Pathology and School of Medicine, Mackay Medical College, New Taipei City, Taiwan.
出版信息
PLoS One. 2014 Jul 1;9(7):e101175. doi: 10.1371/journal.pone.0101175. eCollection 2014.
OBJECTIVES
Adenoidectomy in conjunction with tympanostomy tube insertion for treating pediatric otitis media with effusion and recurrent acute otitis media has been debated for decades. Practice differed surgeon from surgeon. This study used population-based data to determine the protective effect of adenoidectomy in preventing tympanostomy tube re-insertion and tried to provide more evidence based information for surgeons when they do decision making.
STUDY DESIGN
Retrospective birth cohort study.
METHODS
This study used the National Health Insurance Research Database for the period 2000-2009 in Taiwan. The tube reinsertion rate and time to tube re-insertion among children who received tympanostomy tubes with or without adenoidectomy were compared. Age stratification analysis was also done to explore the effects of age.
RESULTS
Adenoidectomy showed protective effects on preventing tube re-insertion compared to tympanostomy tubes alone in children who needed tubes for the first time (tube re-insertion rate 9% versus 5.1%, p = 0.002 and longer time to re-insertions, p = 0.01), especially those aged over 4 years when they had their first tube surgery. After controlling the effect of age, adenoidectomy reduced the rate of re-insertion by 40% compared to tympanostomy tubes alone (aHR: 0.60; 95% CI: 0.41-0.89). However, the protective effect of conjunction adenoidectomy was not obvious among children with a second tympanostomy tube insertion. Children who needed their first tube surgery at the age 2-4 years were most prone to have tube re-insertions, followed by the age group of 4-6 years.
CONCLUSIONS
Adenoidectomy has protective effect in preventing tympanostomy tube re-insertions compared to tympanostomy tubes alone, especially for children older than 4 years old and who needed tubes for the first time. Nonetheless, clinicians should still weigh the pros and cons of the procedure for their pediatric patients.
目的
腺样体切除术联合鼓膜置管术治疗小儿分泌性中耳炎和复发性急性中耳炎已争论了数十年。不同外科医生的做法各异。本研究利用基于人群的数据来确定腺样体切除术在预防鼓膜置管再次插入方面的保护作用，并试图在外科医生做决策时为他们提供更多基于证据的信息。
研究设计
回顾性出生队列研究。
方法
本研究使用了台湾2000 - 2009年的国民健康保险研究数据库。比较了接受或未接受腺样体切除术的鼓膜置管儿童的置管再次插入率和再次插入时间。还进行了年龄分层分析以探讨年龄的影响。
结果
与仅接受鼓膜置管术的儿童相比，腺样体切除术对首次需要置管的儿童预防置管再次插入具有保护作用（再次插入率9%对5.1%，p = 0.002，再次插入时间更长，p = 0.01），尤其是那些首次进行置管手术时年龄超过4岁的儿童。在控制年龄影响后，与仅行鼓膜置管术相比，腺样体切除术使再次插入率降低了40%（调整后风险比：0.60；95%置信区间：0.41 - 0.89）。然而，在接受第二次鼓膜置管的儿童中，联合腺样体切除术的保护作用并不明显。2 - 4岁首次需要置管手术的儿童最容易出现置管再次插入，其次是4 - 至6岁年龄组。
结论
与仅行鼓膜置管术相比，腺样体切除术在预防鼓膜置管再次插入方面具有保护作用，特别是对于4岁以上且首次需要置管的儿童。尽管如此，临床医生仍应权衡该手术对其儿科患者的利弊。
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