哺乳期乳腺脓肿外科治疗的临床分析

Clinical analysis on surgical treatment of breast abscess during lactation

回顾性分析2014年1月至2017年10月于淮安市妇幼保健院乳腺保健科门诊及住院治疗的85例哺乳期乳腺脓肿患者临床资料。其中30例行传统脓肿切开引流(切开引流组)、35例经彩超引导或直接穿刺抽脓(穿刺组)、20例行小切口留置引流管术(小切口引流组)治疗。脓培养为金黄色葡萄球菌24例(28%),耐甲氧西林金黄色葡萄球菌40例(47%)。小切口引流组中14例(14/20)为中央型脓肿,明显高于穿刺组(4/35,P<0.05)。穿刺组的治疗周期、住院费用较低(均P<0.01)。切开引流组的治疗周期较长(P<0.05),痊愈需1个月,部分患者≥2个月;疼痛评分较高(P<0.01),为中、重度疼痛(3和27例);乳房外形满意度较低(P<0.05)。提示穿刺抽脓或者小切口置管引流治疗的周期较短、患者疼痛较轻,愈后乳房外形变化不明显,无不良后遗症。

Clinical data of 85 patients with breast abscess during lactation treated in our hospital from January 2014 to October 2017 were retrospectively analyzed.Among 85 cases,30 patients received traditional abscess incision drainage,35 received needle aspiration,and 20 received negative pressure drainage with small incision.The pus culture findings,average hospitalization expenses,average treatment time,pain score,postoperative breast appearance were evaluated.The pus culture found 24 cases of staphylococcus aureus infection in 85 cases(28%),including 40 cases of Methicillin resistant Staphylococcus aureus(47%).The proportion of central abscess(14/20)in patients with small incision drainage was significantly higher than that of patients with needle aspiration treatment(4/35)(P<0.05).The average hospitalization expense of the puncture group was significantly lower than that of other two groups(P<0.01).The average treatment time of abscess incision drainage group was significantly higher than that of other two groups(P<0.01),and the recovery time was all longer 1 month.The score of pain in the abscess incision drainage group was significantly higher than that in other two groups(P<0.01),and all patients had moderate to severe pain.The breast shape satisfaction of abscess incision drainage group was significantly lower than that of other two groups(P<0.01).The analysis indicates that treatment of breast abscess during lactation with needle aspiration and negative pressure drainage has short treatment time,no scars and less pain;and it is suggested that central abscess may be treated early with negative pressure drainage.