改良新九针微创开道引流治疗哺乳期乳腺巨大脓肿临床研究

Clinical Observation of Modified New Nine Needle Minimally Invasive Drainage in the Treatment of Large Lactational Breast Abscesses

目的观察改良新九针微创开道引流治疗哺乳期乳腺巨大脓肿(最长径≥5cm)的恢复情况。方法系统回顾性研究本院2019年10月至2020年10月的哺乳期乳腺巨大脓肿单发患者110例,所有患者在局麻下采用改良粗火针或改良尖峰针刺入脓肿开道,获得直径不大于5 mm微创穿刺口,改良钩针从穿刺口进入脓腔,钝行分离脓腔内间隔、黏连等,脓液排出后根据患者疼痛忍耐程度适当予以温生理盐水冲洗脓腔,放置药捻引流,每日换药1次并更换药捻引流,换药过程使用改良鍉针探测脓腔深度,必要时使用改良鍉针或改良钩针行乳腺瘘管骚爬,当脓液流尽后停用药捻引流,观察治疗前及术后1周、2周、3周、4周脓肿彩超测量及体表手测最长径变化、药线留置天数、是否回乳、3个月后局部瘢痕、残余病灶有无以及培养细菌情况。结果110例哺乳期乳腺巨大脓肿患者接受了改良新九针微创开道引流治疗,术前脓肿彩超最大径为(7.56±1.47)cm,术前脓肿体表手测最大径为(9.81±1.95)cm,治疗后有7例患者出现乳漏,15例患者选择回乳,脓培养无细菌生长43例,药线留置时间为(14.62±5.02)d,治疗后每周脓肿彩超测量及体表手测最长径较治疗前均减小(P<0.01),治疗后3月有14例乳房局部见瘢痕,16例患者彩超下可见残余病灶,21例患者乳腺查体局部扪及结节。结论改良新九针微创开道引流治疗哺乳期乳腺巨大脓肿安全、有效、美观,允许继续母乳喂养。

Objective:To observe the recovery of modified new nine needle minimally invasive drainage in the treatment of large lactational breast abscesses(the longest diameter≥5cm).Methods:Retrospective study was conducted on 110 cases of single breast abscess in lactating women in our hospital from October 2019 to October 2020.All patients were treated with modified thick fire needle or modified spike needle under local anesthesia,and minimally invasive puncture with diameter less than 5 mm was obtained.After the pus was discharged,warm normal saline was used to flush the pus cavity according to the patient’s pain tolerance,and the drug twist drainage was placed.The dressing was changed once a day and the drug twist drainage was replaced.During the dressing change,the modified needle was used to detect the depth of the pus cavity.If necessary,the modified needle or modified hook needle was used to repair the mammary fistula.When the pus was drained out,the drug twist drainage was stopped.The color Doppler ultrasound measurement and the longest diameter change of body surface hand volume,the days of drug thread indwelling,whether to choose milk regurgitation,the local scar after 3 months,the presence of residual lesions and the culture of bacteria were observed before treatment and 1 week,2 weeks,3 weeks and 4 weeks after operation.Results:The 110 patients with large lactational breast abscess were treated with modified new nine needle minimally invasive drainage.The maximum diameter of the abscess was(7.56±1.47)cm.The maximum diameter of the abscess was(9.81±1.95)cm.After treatment,7 cases had milk leakage,15 cases(13.6%)chose milk regurgitation,43 cases had no bacterial growth in pus culture,and the indwelling time of drug thread was(14.62±5.02)d.After treatment,the maximum diameter of abscess measured by color Doppler ultrasound and hand measurement decreased,and the difference was statistically significant(P<0.01).Three months after treatment,14 cases had local scar,16 cases had residual lesions under color Doppler ultrasound,and 21 cases had local palpation of nodules.Conclusion:The modified new nine needle minimally invasive drainage is safe,effective and beautiful in the treatment of huge breast abscess during lactation,allowing continued breast feeding.