环乳晕切口应用于乳腺脓肿引流术的临床研究

A Clinical Study on Breast Abscess Drainage via Periareolar Incision for Breast Abscess

目的探讨环乳晕切口在哺乳期乳腺脓肿行乳晕区切开引流术(abscess incision anddrainage,AID)中的应用。方法回顾性分析2005年6月～2012年5月收治的48例哺乳期乳腺脓肿患者的临床资料,均行AID治疗。其中,有9例(A组)脓肿中心靠近或位于乳晕区,采用了环乳晕切口。另外39例(B组)因为脓肿位置原因,采用了非环乳晕切口行AID。均进行术中排脓、适当冲洗、纱布充填引流、术后换药以及抗菌素应用等方法治疗。比较两组在手术时间、出血量、切口愈合时间、术后住院时间、延期缝合患者例数以及术口美观满意度等方面的差异。结果 A、B组手术时间、出血量分别为(28.8±5.6)min vs.(25.8±3.9 min),(110.3±15.2)ml vs.(99.5±14.6)ml,组间比较无统计学差异(P>0.05)。两组均彻底排脓,术后均无乳头乳晕坏死。A组切口愈合时间、术后住院时间分别为(15.7±3.4)d vs.(25.3±2.9)d,(16.4±3.0)d vs.(26.4±2.7)d,组间比较无统计学差异(P>0.05);A组需延期缝合病例数较B组少,差异存在统计学意义(5 vs 39,P<0.05),两组切口均Ⅱ期愈合。48例获随访,平均随访时间24(6～54)个月。术后6个月均无慢性感染或复发。A组患者对于切口美观的满意度较B组高(66.7%vs.25.6%,P<0.05)。结论乳房脓肿患者AID术中合理应用环乳晕切口,引流效果可靠,减少了延期缝合操作,且患者对切口美观较为满意。

Objective To explore the application of periareolar incision in the breast abscess incision and drainage（AID） for breast abscess.Methods The clinic data of 48 women with breast abscess admitted from June 2005 to May 2012 were analyzed retrospectively.All 48 cases were treated by AID.The circum-areola incision was applied in 9 cases（group A,n=9） with breast abscess located in periareola site,and non-circumareola incision was applied in the other 39 cases（group B,n=39） with breast abscess located in non-areola site.The treatment of purulent discharge,irrigating,gauze-filled drainage,change of dressing,antibiotic drug administer was applied in both two groups.The operative duration,intro-operative blood loss,incision healed duration,postoperative hospital stay,the patients with delayed suturation and scar cosmetic result were compared between two groups.Results There was no statistic difference in operative time and intra-operative blood loss between two groups（（28.8±5.6） min vs.（25.8±3.9 min）,（110.3±15.2）ml vs.（99.5±14.6） ml,P0.05））.Sufficient purulent discharge and blood-supply of nipple and areola was obtained in all 48 patients.No significant difference was found in incision healing time and hospitalized time after AID between two groups（（15.7±3.4）d vs.（25.3±2.9） d,（16.4±3.0）d vs.（26.4±2.7） d,P0.05））.The cases performed delayed suturation was 5 cases in group A,and was obviously less than 39 of group B（P0.05）.The incisions were healed in stage Ⅱ in both two groups.A total of 48 cases were followed up for 6 to 54 months with an average of 24 months.No chronic infection and recurrence was found 6 months after the AID.The degree of satisfaction on cosmetic result in group A was remarkable higher than that of group B（66.7% vs.25.6%,P0.05）.Conclusion The reasonable application of circum-areola incision can achieve sufficient drainage,less delayed suturation and satisfied cosmetic result in AID for breast abscess.