超声引导下穿刺抽脓术与超声引导下置管引流冲洗术治疗不同脓腔直径乳腺脓肿的效果对比研究

Comparative study on the efficacy of ultrasound-guided puncture and pus extraction and ultrasound-guided catheter drainage in the treatment of breast abscess with different purulent cavity diameters

目的对比超声引导下穿刺抽脓冲洗术与超声引导下置管引流冲洗术治疗不同脓腔直径乳腺脓肿的效果。方法对2021年3月至2023年3月嘉峪关市第一人民医院收治的90例乳腺脓肿患者进行回顾性研究,根据治疗方式不同将患者分成穿刺抽脓组(n=40)和置管引流组(n=50)。穿刺抽脓组患者接受超声引导下穿刺抽脓冲洗术,置管引流术组患者接受超声引导下置管引流冲洗术治疗。比较2组的不同脓腔直径(脓腔直径≤5 cm、脓腔直径>5 cm)围手术期相关指标[手术时间、术中引流量、术中单次出血及累计出血量、切口长度、引流时间、引流总量、康复时间、瘢痕长度和及术后单次和累及视觉模拟评分法(VAS)评分]、治疗满意度、治愈率、不良反应发生情况、术后复发及继续哺乳情况。结果脓腔直径≤5 cm的乳腺脓肿:2组的脓腔大小、引流总量、康复时间、治愈率比较,差异均无统计学意义(P>0.05);置管引流组的手术时间、术中引流量、术中单次出血量、术中累计出血量、切口长度、瘢痕长度、术后单次VAS评分均显著高于穿刺抽脓组,差异均有统计学意义(P<0.05);置管引流组的引流时间、术后累计VAS评分和满意度评分显著低于穿刺抽脓组,差异均有统计学意义(P<0.05)。脓腔直径>5 cm的乳腺脓肿:2组的脓腔大小、术中累计出血、引流总量比较,差异均无统计学意义(P>0.05);置管引流组的手术时间、术中引流量、术中单次出血量、切口长度、瘢痕长度、术后单次VAS评分、满意度评分和治愈率均显著高于穿刺抽脓组,差异均有统计学意义(P<0.05);置管引流组的引流时间、康复时间、术后累计VAS评分均显著低于穿刺抽脓组,差异均有统计学意义(P<0.05)。2组术后总的不良反应发生率比较差异无统计学意义(P>0.05)。术后6个月,置管引流组术后复发率为2.00%,显著低于穿刺抽脓组(12.50%),差异有统计学意义(P<0.05)。置管引流组术后总的继续哺乳率为82.00%,显著高于穿刺抽脓组(62.50%),差异有统计学意义(P<0.05)。2组脓腔直径≤5 cm和脓腔直径>5 cm的术后复发率和继续哺乳率比较,差异均无统计学意义(P>0.05)。结论对于脓腔直径≤5 cm的乳腺脓肿,穿刺抽脓可缩短手术时间,减少术中出血量、切口大小及瘢痕长度,患者满意度更高;对于脓腔直径>5 cm的乳腺脓肿,置管引流可缩短康复时间,提高治愈率和患者满意度。

Objective To compare the efficacy of ultrasound-guided puncture and pus extraction and ultrasound-guided catheter drainage in the treatment of breast abscess with different purulent cavity diameters.Methods A total of 90 patients with breast abscess admitted to Jiayuguan First People's Hospital from March 2021 to March 2023 were included in this retrospective study and were divided into the puncture and pus extraction group(n=40) and the catheter drainage group(n=50) based on different treatment methods.The puncture and pus extraction group received ultrasound guided puncture and drainage,while the catheter drainage group received ultrasound-guided catheter drainage.The following parameters were compared between the two groups:cure rate,perioperative variables related to different abscess cavity diameters(abscess cavity diameter≤5 cm and abscess cavity diameter>5 cm) [including operation time,intraoperative drainage volume,intraoperative single bleeding and cumulative bleeding volume,incision length,drainage time,total drainage volume,recovery time,scar length,postoperative single and cumulative Visual Analog Scale(VAS) scores],treatment satisfaction,occurrence of adverse reactions,postoperative recurrence,and continued breastfeeding status.Results For the breast abscesses with a abscess cavity diameter of ≤5 cm,there were no statistically significant difference in the size of the pus cavity,total drainage volume,recovery time,and curative rate between the two groups(P>0.05).The surgical time,intraoperative drainage volume,intraoperative blood lossper episod,cumulative intraoperative bleeding,incision length,scar length,and postoperative single VAS score of the catheter drainage group were higher than those of the puncture and pus extraction group,the drainage time,postoperative cumulative VAS score,and satisfaction score of the catheter drainage group were lower than those of the puncture and pus extraction group,the differences were statistically significant(P<0.05).For the breast abscesses with abscess cavity diameter>5 cm,there were no statistically significant differences in the size of the purulent cavity,cumulative intraoperative bleeding,and total drainage volume,between the two groups(P>0.05).The intraoperative drainage volume,surgical time,intraoperative single bleeding volume,incision length,scar length,postoperative single VAS score,satisfaction score,and curative rate of the catheter drainage group were higher than those of the puncture and pus extraction group,the drainage time,rehabilitation time,and postoperative cumulative VAS score of the catheter drainage group were lower than those of the puncture and pus extraction group,the differences were statistically significant(P<0.05).After 6 months of surgery,the postoperative recurrence rate in the catheter drainage group was 2.00%,which was significantly lower than that in the puncture and pus extraction group(12.50%),the difference was statistically significant(P<0.05).The overall continued breastfeeding rate in the catheter drainage group after surgery was 82.00%,which was significantly higher than that in the puncture and pus extraction group(62.50%),the difference was statistically significant(P<0.05).There were no statistically significant differenced in the postoperative recurrence rate and continued breastfeeding rate between the two groups with abscess cavity diameter≤5 cm and abscess cavity diameter>5 cm(P>0.05).Conclusion For breast abscesses with a diameter of ≤5 cm,the effect of puncture and drainage is better than that of the drainage group,it can can shorten surgical time,reduce intraoperative bleeding,incision size,and scar length,resulting in higher patient satisfaction.For breast abscesses with a diameter of>5 cm,the drainage group has a better effect,it can shorten rehabilitation time,improve cure rate and patient satisfaction.