穿刺抽脓引流联合局部应用糖皮质激素治疗肉芽肿性小叶性乳腺炎46例

Clinical analysis of treatment with granulomatous lobular mastitis by ultrasonography-guided abscess puncture aspiration or drainage combined with local application of triamcinolone acetonide for 46 cases

目的探讨超声引导下穿刺抽脓引流联合局部应用糖皮质激素曲安奈德治疗肉芽肿性小叶性乳腺炎(GLM)的临床效果。方法选取2015年2月至2017年2月期间武汉市红十字会医院收治的46例难治性GLM患者,23例在B超引导下反复穿刺抽脓引流及冲洗治疗(对照组),另23例在常规穿刺抽吸冲洗治疗后以曲氨奈德注射液40 mg,从穿刺的针眼或引流管少量注入脓腔,加压包扎,每周2次(观察组),比较两组患者的有效率、起效时间、住院天数及治疗后患者满意度。记录观察组患者激素并发症的发生情况。结果观察组中无一例失访,治愈1例,有效17例,其治疗的有效率为78.26%(18/23)。对照组中失访病例1例,无治愈病例,有效10例,治疗的有效率为45.45%(10/22)。两组治疗有效率比较差异有统计学意义(χ~2=5.15,P=0.023),观察组优于对照组。观察组起效时间(6.00±2.09)d,对照组(10.05±2.57)d,观察组较对照组治疗起效时间快,差异有统计学意义(t=5.81,P<0.01);住院天数观察组(15.61±4.15)d,对照组(21.91±3.02)d,两组比较差异有统计学意义(t=5.80,P<0.01),观察组住院天数少;患者满意度观察组为78.26%,对照组为36.36%,两组比较差异有统计学意义(χ~2=8.09,P=0.004),观察组患者满意度高。观察组患者无明显的激素相关不良反应,对照组6例患者出现不适症状,在治疗停止后症状均逐渐消失。结论超声引导下穿刺抽脓引流联合局部应用曲安奈德是一种可供临床选择的治疗难治性GLM的方法。

Objective To investigate the effect of the ultrasonography-guided abscess puncture aspiration or drainage combined with local application of triamcinolone acetonide in the treatment of granulomatous lobular mastitis(GLM).Methods The clinical data of forty-six severe GLM patients from February 2015 to February 2017 were analyzed.Twenty-three patients were treated with the ultrasonography-guided abscess puncture aspiration and irrigation(control group),and the other 23 patients were treated with triamcinolone acetonide injection 40 mg from the pinpoint or a drainage tube into the abscess cavity,pressure dressing,2 times a week after the routine abscess puncture aspiration and irrigation treatment(observation group).The recovery rate,onset time,hospitalization days and patient satisfaction were compared between two groups,and hormone related adverse reaction of observation group was observed.Results There were 17 cases with effective treatment and 1 cured case in the observation group,while 10 cases with effective treatment,no cured case and 1 case lost in control group,with statistical difference(χ^2=5.15,P=0.023).Compared with the control group,the observation group had faster onset time,fewer days of hospitalization,and higher satisfaction of the patients(t=5.81,5.80,χ^2=8.09,P<0.01,<0.01,0.004).The observation group had no obvious hormone-related adverse reactions,whereas 6 patients in the control group had side effects,which gradually disappeared after the cessation of treatment.Conclusion The ultrasonography-guided percutaneous aspiration and drainage combined with local application of triamcinolone acetonide is a choice for clinical treatment of severe GLM.