• 1. 四川大學(xué)華西醫(yī)院耳鼻咽喉科,成都,6100412. 四川大學(xué)華西醫(yī)院中國循證醫(yī)學(xué)中心;

目的 　評價腺樣體切除術(shù)(adenoidectomy,AT)治療兒童分泌性中耳炎(otitis media with effusion,OME)的療效及安全性.
方法 　機(jī)檢Medline(1966～2001)、EMbase(1974～2001)、Cochrane 臨床對照試驗(yàn)資料庫(CCTR)和中國生物醫(yī)學(xué)文獻(xiàn)數(shù)據(jù)庫(CBM,1989～2001),手檢5種國內(nèi)耳鼻咽喉科雜志的有關(guān)文獻(xiàn),查閱合格文章的參考文獻(xiàn),篩選出符合納入標(biāo)準(zhǔn)的AT治療兒童OME的隨機(jī)對照試驗(yàn),至少由兩位研究者獨(dú)立評估試驗(yàn)質(zhì)量和提取數(shù)據(jù).應(yīng)用RevMan 4.1軟件進(jìn)行統(tǒng)計學(xué)分析.
結(jié)果 　共收集到相關(guān)文獻(xiàn)248篇,共納入文獻(xiàn)13篇,1 430例病人(耳).這13篇文獻(xiàn)總的方法學(xué)質(zhì)量較高,全部來自歐、美國家.在AT與鼓膜切開術(shù)以及不治療比較的試驗(yàn)中,未發(fā)現(xiàn)AT的療效優(yōu)于其他療法.AT與鼓膜置管術(shù)比較的4個試驗(yàn)提示,鼓膜置管術(shù)的療效優(yōu)于AT.10篇文獻(xiàn)描述了術(shù)后出血、鼻咽狹窄和腭咽功能不全等并發(fā)癥.
結(jié)論 　目前尚無證據(jù)表明AT治療OME的療效優(yōu)于鼓膜切開術(shù)、鼓膜置管術(shù)和不治療,也沒有證據(jù)表明哪一種手術(shù)方式的療效最佳,但是必須注意其術(shù)后并發(fā)癥.對于藥物治療無效的OME患兒,如同時存在復(fù)發(fā)的多種危險因素,早期施行AT聯(lián)合鼓膜置管術(shù)可能為最合理的治療方法.

引用本文： 古慶家,劉亞峰,周光耀,秦學(xué)玲,梁傳余,衛(wèi)茂玲,張鳴明. 腺樣體切除術(shù)治療兒童分泌性中耳炎的系統(tǒng)評價. 中國循證醫(yī)學(xué)雜志, 2004, 04(6): 389-392. doi: 復(fù)制

1. ［1］Gates GA, Avery CA, Prihoda TJ, Cooper JC. Effectiveness of adenoidectomy and tympanostomy tubes in the treatment of chronic otitis media with effusion[J ]. New Engl J Med, 1987;317(3) :1 444-1 451.
2. ［2］Bulman CH, Brook SJ, Berry MG. A prospective randomized trial of adenoidectomy vs grommet insertion in the treatment of glue ear [J]. Clin Otolaryngol, 1984; 9(1): 67-75.
3. ［3］Roydhouse N. Adenoidectomy for otitis media with effusion with mucoid effusion[J]. Ann Otol Rhinol Laryngol, 1980; 89(Suppl 68): 312-315.
4. ［4］Black N,CrowtherJ,Freeland A. The effectiveness of adenoidectomy in the treatment of glue ear: arandomized controlled trial[J]. Clin Otolaryngol, 1986; 11(2): 149-155.
5. ［5］Gates GA, Avery CA, Cooper JC. Chronic secretory otitis media: effects of surgical management [J]. Ann Otol Rhino Laryngol, 1989; Suppl138:2-32.
6. ［6］Terris MH, Magit AE, Davidson TM. Otitis media with effusion in infants and children[J]. Postgraduate medicine, 1995;97(1): 137-151.
7. ［7］Gates GA,Avery CA, Prihoda TJ. Effect of adenoidectomy upon children with chronic otitis media with effusion[J]. Laryngoscope, 1988; 98(1): 58-63.
8. ［8］Marshak G, Netian ZB. Adenooidectomy versus tympanostomy in chronic secretory otitis media[J]. Ann Otol Rhinol Laryngol, 1980; 89(Suppl 68,part2): 316-318.
9. ［9］Paradise JL, Blustone CD, Rogers KD, Taylor FH. Efficacy of adenoidectomy in recurrent otitis media-historical overriew and preliminary results from a ramdomized,controlled trial[J].Ann Otol Rhinol Laryndaryngol, 1980; 89 (Suppl 68,pait2): 319-321.
10. ［10］Black NA, Sanderson CF, Freeland AP, Vessey MP. A randomized controlled trial of surgery for glueear [ J ] . BMJ,1990; 300(6 739): 1 551-1 556.
11. ［11］Gates GA, Muntz HR, Gaylis B. Adenooidectomy and otitis media[J]. Ann Otol Rhino Laryngol, 1992; 101 ( 1 ): 24-32.
12. ［12］Paradise JL, Blustone CD, Rogers KD, Taylor FH, Colborn DK, Bachman RZ, Bernard BS, Schwarzbach RH. Efficacy of adenoidectomy for recurrent otitis media in children previously treated with tympanostomy-tube placement [ J ]. JAMA,1990; 263 (15) : 2066-2073.
13. ［13］Paradise JL, Blustone CD, Colbom DK, Bernard BS, Smith CG, Pockette HE, Lasky MK. Adenoidectomy and adenotonsillectomy for recurrent acute otitis media-parallel randomized clinical trials in children not previously treated with tympanostomy tubes[J]. JAMA, 1999; 282(10): 945-953.
  1. 1. ［1］Gates GA, Avery CA, Prihoda TJ, Cooper JC. Effectiveness of adenoidectomy and tympanostomy tubes in the treatment of chronic otitis media with effusion[J ]. New Engl J Med, 1987;317(3) :1 444-1 451.
  2. 2. ［2］Bulman CH, Brook SJ, Berry MG. A prospective randomized trial of adenoidectomy vs grommet insertion in the treatment of glue ear [J]. Clin Otolaryngol, 1984; 9(1): 67-75.
  3. 3. ［3］Roydhouse N. Adenoidectomy for otitis media with effusion with mucoid effusion[J]. Ann Otol Rhinol Laryngol, 1980; 89(Suppl 68): 312-315.
  4. 4. ［4］Black N,CrowtherJ,Freeland A. The effectiveness of adenoidectomy in the treatment of glue ear: arandomized controlled trial[J]. Clin Otolaryngol, 1986; 11(2): 149-155.
  5. 5. ［5］Gates GA, Avery CA, Cooper JC. Chronic secretory otitis media: effects of surgical management [J]. Ann Otol Rhino Laryngol, 1989; Suppl138:2-32.
  6. 6. ［6］Terris MH, Magit AE, Davidson TM. Otitis media with effusion in infants and children[J]. Postgraduate medicine, 1995;97(1): 137-151.
  7. 7. ［7］Gates GA,Avery CA, Prihoda TJ. Effect of adenoidectomy upon children with chronic otitis media with effusion[J]. Laryngoscope, 1988; 98(1): 58-63.
  8. 8. ［8］Marshak G, Netian ZB. Adenooidectomy versus tympanostomy in chronic secretory otitis media[J]. Ann Otol Rhinol Laryngol, 1980; 89(Suppl 68,part2): 316-318.
  9. 9. ［9］Paradise JL, Blustone CD, Rogers KD, Taylor FH. Efficacy of adenoidectomy in recurrent otitis media-historical overriew and preliminary results from a ramdomized,controlled trial[J].Ann Otol Rhinol Laryndaryngol, 1980; 89 (Suppl 68,pait2): 319-321.
  10. 10. ［10］Black NA, Sanderson CF, Freeland AP, Vessey MP. A randomized controlled trial of surgery for glueear [ J ] . BMJ,1990; 300(6 739): 1 551-1 556.
  11. 11. ［11］Gates GA, Muntz HR, Gaylis B. Adenooidectomy and otitis media[J]. Ann Otol Rhino Laryngol, 1992; 101 ( 1 ): 24-32.
  12. 12. ［12］Paradise JL, Blustone CD, Rogers KD, Taylor FH, Colborn DK, Bachman RZ, Bernard BS, Schwarzbach RH. Efficacy of adenoidectomy for recurrent otitis media in children previously treated with tympanostomy-tube placement [ J ]. JAMA,1990; 263 (15) : 2066-2073.
  13. 13. ［13］Paradise JL, Blustone CD, Colbom DK, Bernard BS, Smith CG, Pockette HE, Lasky MK. Adenoidectomy and adenotonsillectomy for recurrent acute otitis media-parallel randomized clinical trials in children not previously treated with tympanostomy tubes[J]. JAMA, 1999; 282(10): 945-953.