术前超声病灶定位联合病变切除及腺体瓣成形术治疗肉芽肿小叶性乳腺炎患者的疗效

Efficacy of preoperative ultrasound lesion localization combined with lesion excision and glandular flap plasty in patients with granulomatous lobular mastitis

目的探讨术前超声病灶定位联合腺体瓣成形术及病变切除治疗肉芽肿小叶性乳腺炎(GLM)患者的效果。方法收集新乡市中心医院2020年4月至2022年10月收治的80例GLM患者作为研究对象,按手术方案不同分成A组和B组,每组40例。B组接受腺体瓣成形术联合病变切除治疗;A组在实施腺体瓣成形术联合病变切除治疗前,采用超声进行病灶定位。对比两组术前及术后3、7 d视觉模拟评分法(VAS)评分,手术指标,术前及术后1、3个月炎症因子指标[肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、IL-1α、C反应蛋白(CRP)]水平、免疫球蛋白(IgA、IgM、IgG)水平和复发率。结果与术前相比,术后3、7 d两组VAS评分均降低(P<0.05),但手术前后两组VAS评分比较,差异无统计学意义(P>0.05);两组拔出引流管时间、手术耗时、术中失血量比较,差异均无统计学意义(P>0.05);术后1、3个月A组血清TNF-α、IL-6、IL-1α、CRP、IgA、IgG、IgM水平低于B组(P<0.05);随访3个月,A组复发率[2.50%(1/40)]低于B组[20.00%(8/40)],差异有统计学意义(P<0.05)。结论术前超声病灶定位联合腺体瓣成形术及病变切除治疗GLM患者可进一步减少复发,减轻炎症反应,改善免疫功能。

Objective To investigate the results of preoperative ultrasound lesion localization combined with glandular flap plasty and lesion excision in patients with granulomatous lobular mastitis(GLM).Methods Eighty patients with GLM enrolled in Xinxiang Central Hospital from April 2020 to October 2022 were collected and divided into group A and group B according to the surgical protocol,40 cases in each group.The group B received glandular flap plasty combined with lesion excision treatment,and the group A was added with ultrasound lesion localization before glandular flap plasty combined with lesion excision treatment.The preoperative and 3,7 d postoperative visual analog scoring method(VAS)scores,surgical indexes,preoperative and 1 and 3 months postoperative inflammatory factor indexes[tumor necrosis factor-α(TNF-α),interleukin-6(IL-6),IL-1α,C-reactive protein(CRP)]levels,immunoglobulin(IgA,IgM,IgG)levels and recurrence rate were compared between the two groups.Results Compared with the preoperative period,the VAS scores of the two groups decreased in 3 d and 7 d after surgery(P<0.05),but there was no statistically significant difference between the two groups(P>0.05).There was no statistically significant difference on the time to remove the drain,time consumed in surgery and intraoperative blood loss between the two groups(P>0.05).The serum TNF-α,IL-6,IL-1α,CRP,IgA,IgG and IgM levels were lower in group A than those in group B at 1 month and 3 months after surgery(P<0.05).After 3-month follow-up,the recurrence rate in the group A[2.50%(1/40)]was lower than that in the group B[20.00%(8/40)]with statistically significant difference(P<0.05).Conclusion Preoperative ultrasound lesion localization combined with glandular flap plasty and lesion excision for patients with GLM can further reduce recurrence,relieve inflammatory response,and improve immune function.