九华膏换药与瘘管切除术治疗乳漏临床效果比较

Comparison of Clinical Effect of Dressing Change of Jiuhua Cream and Fistulectomy in the Treatment of Mammary Fistula

目的对比观察九华膏外治法与瘘管切除术治疗乳漏的效果。方法84例均为湖南中医药大学第一附属乳腺科2017年4月—2018年12月收治的乳漏患者,按随机数字表法分为观察组(44例)和对照组(40例),观察组采用九华膏瘘管填充换药外治,对照组采用常规瘘管切除手术。观察两组愈合时间、复发率、乳房外观、疤痕评分及不良反应;取创口周围肉芽组织进行病理观察;采用酶联免疫(ELISA)法检测治疗前及治疗结束后患者肉芽组织缺氧诱导因子-1α(HIF-1α)、血管内皮生长因子(VEGF)含量。结果观察组平均愈合时间为(25.22±14.31)天,对照组平均愈合时间为(19.80±11.32)天,两组愈合时间比较,差异无统计学意义(t=1.952,P>0.05);观察组复发率为4.55%(2/44),对照组复发率22.50%(9/40),两组比较,差异有统计学意义(χ^(2)=4.462,P<0.05);乳房外观、疤痕评分比较,观察组优于对照组,差异亦有统计学意义(P<0.05);与治疗前比较,治疗后观察组HIF-1α、VEGF含量下降,对照组HIF-1α、VEGF含量上升,两组比较,差异有统计学意义(P<0.01);与对照组比较,观察组治疗后病理可见炎症细胞明显减少、纤维组织增生减少、杂乱无章血管少;两组均未观察到明显不良反应。结论九华膏瘘管填充换药治疗乳漏,疗效可靠,复发率低,可提高乳房外形美观满意度,减少疤痕形成,且无明显不良反应。其作用机制可能与其降低肉芽组织HIF-1α、VEGF水平有关。

Objective To compare and observe the effect of Jiuhua Cream(JHC)and fistulectomy for the treatment of mammary fistula.Methods Totally 84 patients were admitted to Breast Department,First Affiliated Hostpital,Hunan University of Chinese Medicine from April 2017 to December 2018.According to random number table,they were assigned to observation group(44 cases)and control group(40 cases).Patients in the observation group received external treatment with JHC fistula filling and dressing change,while those in the control group received conventional fistula resection.The healing time,recurrence rate,breast appearance,scar score,and adverse reactions were observed in the two groups.Granulation tissues were taken out at the week of invasion for pathological observation,and the levels of hypoxia-inducing factor-1α(HIF-1α)and vascular endothelial growth factor(VEGF)in granulation tissues were detected by ELISA before and after treatment.Results The average healing time was(25.22±14.31)days in the observation group and(19.80±11.32)days in the control group,with no significant difference between the two groups(t=1.952,P>0.05).The recurrence rate was 4.55%(2/44)in the observation group and 22.50%(9/40)in the control group,with significant difference between the two groups(χ^(2)=4.462,P<0.01).The comparison of breast appearance and scar score in the observation group was better than that in the control group(P<0.05).After treatment,the levels of HIF-1αand VEGF in the wound tissue decreased in the observation group,while they increased in the control group,with statistical significance(P<0.05).Compared with the control group,significantly reduced inflammatory cells,decreased fibrous tissue proliferation,and less disordered blood vessels could be seen in observation group.No significant adverse reactions were observed in the two groups.Conclusions JHC fistula filling and dressing change in the treatment of mammary fistula had reliable efficacy and low recurrence rate,which improve the satisfaction of breast appearance and reduced scar formation,without obvious adverse reactions.Its mechanism might be related to reducing HIF-1αand VEGF levels in the wound tissue.