李中玉治疗浆细胞性乳腺炎经验

Professor Li Zhongyu's Experience in Treating Plasma Cell Mastitis

浆细胞性乳腺炎诊治关键在于早期明确诊断,早期治疗,只要方法得当,可以使肿块消散或病变局限,为根治手术创造最佳时机。李老师特别强调,脓肿一定要等到肿块较为局限,波动应指明显时方可切开,切开脓肿术口要与肿块等长,尤其要将大导管病变位置切开,直至乳头。切开脓肿后,最好掺一些(适量)具有腐蚀作用的红升丹,并随坏死组织的多少,新生肉芽的好坏,掺用生肌敛口药,外贴传统太乙膏药更好。对溃疡瘘管期,一是选择清创手术要掌握好时机,只要肿块局限,好坏组织边界清楚,即便仍有炎症样红肿、溃疡,只要清创后不太影响乳房形态,就可以实施清创术,切除范围大者可以行腺体重新分布整形,有乳头凹陷者一并整形,结合压垫法包扎。

Plasma cell mastitis（ PCM） has the inflamed hot pain festering sores as inflammatory symptoms,but there is a big difference between the pathological essence and bacterial inflammation,clinical practice proves that application of antibiotics has tiny curative effect; Anti-tuberculosis medicine only can be used for clear diagnosis of TB case; Hormone,immune inhibitors are tried only under helpless situation. If TCM diagnoses it as yang carbuncle,treats it with bitter and cold drugs such as Huanglian（ Rhizoma Coptidis）,Huangqin（ Radix Scutellariae）,the curative effect is poor. But if TCM diagnoses it as yin carbuncle,treats it with not only drugs with functions of activating blood circulation and removing blood stasis,regulating qi and resolving phlegm,drying dampness and promoting urination,but also the ones with functions of warming,dredging and dispersing drugs,for example,Yanghe Decoction（ YHD）,good curative effects can be achieved. During stage of abscess,each doctor can do conventional open surgical drainage,but cutting time,cutting range,ways of changing medicine have very big differences. The pus cavity filled with drainage of gauze is often used in Western medicine treatment,which easily cause fistula,so it should gradually reduce,evacuate in order to make the pus cavity naturally subside,narrow,rather than to count on newborn granulation completely filled. Professor Li emphasizes it is necessary to wait until the mass is relatively limited,volatility is clear,opened operation mouth should be as long as the lump,especially the catheter lesion location until the nipple should be cut. After abscess incision,it is better to mix some hydrargyrum oxydatum crudum with corrosion effect. Besides,with the amount of necrotic tissue,the condition of new granulation,medicine for producing muscles and healing wound can also be added,plus external application of traditional Taiyi Plasters（ TYP）. During ulcer fistula period,the debridement surgery should grasp the good time; As long as the mass is limited,boundaries between good and bad organizations,even there are still inflammatory swelling,and big ulceration,as long as the operation will not influence the breast shape,the debridement surgery can be done. For the patients with big cutting range,glands can be redistributed for plastic. For those with inverted nipple,plastic combined with the method of pressure pad dressing can be done together.