tympanostomy管插入带有和没有腺切除术
Z Jason Qian1,2, Mai Thy Truong3, Jennifer C Alyono3
1Department of Otolaryngology, UC San Diego School of Medicine, La Jolla, California.
JAMA otolaryngology-- head & neck surgery
|October 17, 2024
概括
在4岁以下的儿童中,用 tympanostomy 管 (TTs) 进行腺切除术可以减少抗生素的使用,但不能重复输入管. 在4岁及以上的儿童中,腺切除术和TTs降低了重复插入和抗生素使用,这表明对老年儿童有好处.
科学领域:
- 耳鼻喉科 耳鼻喉科 耳鼻喉科
- 儿科手术 儿科手术
- 医疗保健服务研究 医疗服务研究
背景情况:
- 由于先前的研究局限性,膜切除术与 tympanostomy 管 (TT) 插入一起对耳部治疗结果的有效性仍在争论中.
- 现有研究往往受到小样本大小,多样化的设计和不一致的结果措施的影响,阻碍了清晰的解释.
研究的目的:
- 评估一大批接受TT插入的美国儿童中腺切除术和耳科结局之间的关联.
- 为临床决策提供可概括的证据,用于结合腺切除术和TT手术.
主要方法:
- 一项匹配的队列研究利用了来自Merative MarketScan研究数据库 (2007-2021) 的索赔数据.
- 包括601,848名接受TT的儿童,重点关注那些同时接受腺切除和TT插入 (Ad+TT) 的儿童.
- 没有腺切除术的对照组与年龄,性别和先前的TT程序相匹配;分析的结果包括重复的TT插入和口服抗生素处方.
主要成果:
- 在4岁以下的儿童中,Ad+TT与减少口服抗生素的使用有关 (OR,0.59),但增加了重复的TT插入 (OR,1.24).
- 在4岁及以上的儿童中,Ad+TT与重复TT插入 (OR,0.78) 和随后口服抗生素处方 (OR,0.63) 的几率降低有关.
结论:
- 对于4岁以下的儿童,Ad+TT可能会减少抗生素疗程,但不会减少重复的TT插入.
- 对于4岁及以上的儿童,Ad+TT通过减少重复的TT插入和抗生素使用来证明其益处,这支持其考虑改善耳部治疗结果.
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