微创旋切联合抗生素封闭灌洗治疗肉芽肿性乳腺炎

Treatment of Granulomatous Mastitis by Minimally Invasive Biopsy Technique of Mammotome and Close Washing With Antibiotics

目的探讨微创旋切技术联合抗生素局部封闭灌洗治疗肉芽肿性乳腺炎的效果。方法2019年1月~2021年6月,对25例肉芽肿性乳腺炎行Mammotome微创旋切手术,旋切针道间隔0.5~0.8 cm,垂直交叉“网格状”切除肿块区域腺体以利充分引流。术后用含头孢呋辛和替硝唑的灌洗液局部封闭灌洗6~9 d。术后每3个月复诊,经临床查体配合超声检查观察疗效。结果25例均经病理确诊,抗酸染色阴性。未发生出血等严重并发症。治疗结束后炎症消退,肿块消失,伤口愈合,均治愈出院。中位住院时间15 d(11~22 d)。2例失访,23例有完整随访记录。中位随访8个月(3~28个月),仅1例术后18个月复发。按照肉芽肿性乳腺炎美学评估标准,患侧乳房外观评估优15例(65.2%),良7例(30.4%),差1例(4.3%)。优良率95.7%(22/23)。结论应用微创旋切联合抗生素局部封闭灌洗治疗肉芽肿性乳腺炎效果良好,具有恢复快、复发率低和对乳房外观影响小等优势。

Objective To explore the efficacy of treatment for granulomatous mastitis by using the minimally invasive biopsy technique of Mammotome system and close washing locally.Methods Twenty-five patients with granulomatous mastitis was treated by using minimally invasive biopsy technique of Mammotome system combined with close washing locally from January 2019 to June 2021.The needle track interval of rotary-cut was 0.5-0.8 cm.At same time,the mass area of the gland was given vertical cross“grid”resection to benefit fully drainage.After operation,the lavage liquid composed of cephalosporins and tinidazole was used for local close washing for 6-9 days.The follow-ups were carried out every 3 months after operation,including clinical examination and ultrasonography.Results All the patients were diagnosed by pathology,and the acid-fast stain was negative.There was no serious complication such as bleeding during and after operation.After treatment,the inflammation subsided,the mass disappeared,and the wound healed.All the 25 patients were cured to discharge.Two cases were lost and 23 cases had complete follow-up records.After a median follow-up of 8 months(range,3-28 months),only 1 case recurred 18 months after operation.According to the aesthetic evaluation standard of granulomatous mastitis,the appearance evaluation of the affected side of the breast was excellent in 15 cases(65.2%),good in 7 cases(30.4%)and poor in 1 case(4.3%).The excellent and good rate was 95.7%(22/23).ConclusionThe treatment of granulomatous mastitis by minimally invasive biopsy technique and close washing has the priority of fast recovery,low recurrence rate and little effect on the breast appearance.