中药联合微创旋切术治疗慢性非哺乳期乳腺炎30例

Treatment of chronic non-puerperal mastitis with traditional Chinese medicine combined with vacuumassisted mammotome system:30 case reports

目的:探讨应用自拟疏肝解郁、健脾化痰方联合麦默通微创旋切术加放置引流管治疗慢性非哺乳期乳腺炎(non-puerperal mastitis,NPM)的临床疗效。方法:回顾性分析无锡市中医医院2019年1月至2020年5月收治的30例慢性NPM的患者资料,所有患者经过前期治疗后炎症控制且病灶局限后,在超声引导下行乳腺炎症病灶麦默通微创旋切术加放置引流管,术后予自拟疏肝解郁、健脾化痰方加减治疗。结果:30例患者病灶均被切除,术后病理均被证实为NPM,其中肉芽肿性小叶乳腺炎16例(53.4%),导管周围炎12例(40%),慢性间质性炎1例(3.3%),浆细胞性乳腺炎1例(3.3%)。术后引流置管3~7 d,总引流量20~237 mL,切口3~10 d内愈合。其中,4例出现切口周围轻度瘀斑,7~14 d内完全吸收。术后3个月时随访,5例创腔内有轻度血肿;术后6个月时随访,均无复发,切口愈合良好、瘢痕小、外形美容效果好。结论:自拟疏肝解郁、健脾化痰方联合超声引导下麦默通微创旋切术加引流治疗慢性NPM疗效可靠,安全可行,并保持了乳房的外形美观,值得临床运用与推广。

Objective:To explore the clinical efficacy on the treatment of chronic non-puerperal mastitis by applying traditional Chinese medicine(TCM)for soothing the liver and relieving depression,invigorating the spleen to remove phlem,combined with vacuum-assisted mammotome system and drainage.Methods:A retrospective analysis of the data of 30 patients with chronic mastitis admitted to our hospital from January 2019 to May 2020 was performed in this study.All patients had been treated with pre-treatment and the inflammatory lesions were controlled and localized.The lesions of mastitis were resected and patients were treated with the ultrasound-guided mammotome system with a drainage tube placed in the cavity after admission,combined with the postoperative treatment of TCM for soothing the liver and relieving depression,invigorating the spleen to remove phlem.Results:Thirty patients were subjected to inflammation resection,and all were confirmed to be non-puerperal mastitis in postoperative pathology,in which there were 16 cases of granulomatous lobular mastitis(53.4%),12 cases of periductal mastitis(40%),1 case of chronic interstitial nephritis(3.3%),1 case of plasma cell mastitis(3.3%).The catheter was drained for 3–7 days after the operation,the total drainage volume was 20–237 mL,and the incision healed within 3–10 days.Four cases had mild ecchymosis around the incision,there was mild ecchymosis which was totally absorbed in 7–14 days.Three months after the operation,all patients were followed up,and 5 had a mild hematoma in the wound cavity;6 months after the operation,there was no recurrence,the incision healed well,a small scar,and the shape of the breast was not deformed.Conclusion:TCM for soothing the liver and relieving depression,invigorating the spleen to remove phlem,combined with ultrasound-guided,vacuum-assisted mammotome system and drainage for the treatment of chronic Non-puerperal mastitis lesions is effective,safe and feasible,and it maintains the aesthetic shape of the breast,which is worthy of clinical application and promotion.