激素联合手术及三联药物联合手术治疗重症肉芽肿性乳腺炎的疗效观察

发布时间：2018-05-17 11:01

本文选题：重症肉芽肿性乳腺炎 + 术前辅助治疗　；参考：《郑州大学》2016年硕士论文

【摘要】：背景:肉芽肿性小叶性乳腺炎(granulomatous mastitis,GLM)是在以往的乳腺炎症中发病率较低的一种疾病,但近几年此种类型的乳腺炎症的患者逐渐增多,在临床工作中已成为较常见的一种乳腺良性疾病,且此病病程较长,患者偏年轻化。此病的临床初始表现为乳腺肿块,随病情进展可出现乳房脓肿、皮损、形成窦道,然后迁延不愈,且最终需行手术治疗,极有可能导致全乳切除,给患者及家人带来严重的心理负担及经济压力,尤其是重症肉芽肿性小叶性乳腺炎,因病变范围广、皮损严重,治疗的最终可能会导致全乳的切除,给患者及家人带来巨大的身心痛苦。且因此病的病因、发病机制等尚不明确,临床对其的治疗仍在探索中,方案多种多样,寻找一套合理、有效的治疗方案是所有临床工作者的最终目标。目的:本研究为前瞻性临床试验性研究,通过对比观察术前使用抗结核三联药物治疗重症GLM与术前使用激素治疗重症GLM患者的治疗效果、术后乳房外形以及术后复发率等,寻找一种更加有效的用于术前辅助治疗重症GLM的方案,目的在于治愈患者疾病的同时,可以最大程度的满足患者对于术后乳房外形的要求。方法:收集2013年6月至2015年6月就诊于郑州大学第一附属医院乳腺外二科的98例重症GLM患者,随机分为A、B两组,A组为实验组,49人,患者术前给予每天口服三联抗结核药物(异烟肼,利福平,乙胺丁醇)辅助治疗,B组为对照组,49人,给予口服激素药物(甲泼尼龙)辅助治疗,若伴有原发性泌乳素升高的重症GLM患者,同时给予口服溴隐亭治疗,密切观察患者病情变化,待病情达到药物治疗有效并可行手术治疗的判定标准后,即行手术治疗。统计三联抗结核药物治疗重症GLM患者的有效率及激素治疗GLM的有效率;参照波士顿哈佛放射治疗联合中心的乳房术后外形评估标准,随访统计抗结核三联药治疗的患者术后乳房外形优良率及术前辅助激素药物治疗的患者术后乳房外形优良率;对所有患者术后6个月随访统计其术后复发率。采用SPSS18.0统计软件对数据进行分析,检验标准p0.05,分析:1.两组药物治疗有效率是否存在差异;2.两组术后乳房外形优良率是否存在差异?结果:实验组(A组)49例患者,于治疗过程中失访2例,最终可评价病例:47例,3例患者经药物治疗1个月后病情未缓解,遂停药行患乳扩大切除术,44例患者口服三联药物治疗2至4个月不等,达到临床评判有效及可行手术的标准,有效率达93.6%,最终有7例患者口服药物治疗达到临床及影像学上的痊愈而未术,共40例患者行手术治疗,术后乳房外形满意度评估:优秀5/40个(12.5%),良好25/40个(62.5%),总优良率75%。对照组(B组)49例患者,治疗过程中失访1例,最终可评价病例:48例,7例患者口服激素治疗10天以上病情未见稳定或缓解,4例患者病情继续进展,6例患者初始口服药物治疗有效,于药物减量过程中病情突然爆发,遂共17例患者药物治疗无效后直行手术治疗,31例患者经激素治疗一个月至两个月不等,皮肤表面红肿减退、范围缩小,肿块变软,或窦道部分闭合,有效率达64.6%,最终共48例患者行手术治疗,术后乳房外形满意度评估:优秀2/48个(4.1%),良好18/48个(37.5%),总优良率41.7%。两组之间药物治疗有效率及术后乳房优良率的差别具有统计学差异(p0.05)。术后6个月再次随访所有患者,无复发者。结论:1.术前辅助三联药物或激素对于治疗重症GLM均有一定的临床疗效。2.术前辅助三联药物治疗重症GLM的疗效相对更好。3.术前辅助三联药物组可达较高的术后乳房外形优良率
[Abstract]:Background: granulomatous lobular mastitis (granulomatous mastitis, GLM) is a disease with a low incidence of mastitis in the past, but in recent years, this type of breast inflammation has gradually increased. In clinical work, it has become a common kind of breast benign disease, and the course of this disease is longer and the patient is younger. The initial clinical manifestation of the breast is the breast lump. With the progress of the disease, the breast abscess, the skin lesion, the formation of the sinus, and the continuation of the disease are not healed, and the surgical treatment is necessary. It is very possible to cause total breast resection and bring serious psychological burden and economic pressure to the patients and family, especially the severe granulomatous lobular mastitis, because of the wide range of lesions. The skin lesions are serious. The treatment may eventually lead to the resection of whole milk and bring great physical and mental pain to the patients and their families. Therefore, the etiology and pathogenesis of the disease are not clear. The treatment of the disease is still in the exploration, the scheme is varied, and the final goal of all clinical workers is to find a set of reasonable and effective treatment programs. The purpose of this study is to find a more effective scheme for the treatment of severe GLM in the treatment of severe GLM with preoperative use of antituberculous triad drugs and preoperative hormone treatment for severe GLM patients, and to find a more effective scheme for preoperative adjuvant treatment of severe GLM. At the same time, patients can meet the patients' requirements for postoperative breast shape to the maximum degree. Methods: 98 patients with severe GLM from June 2013 to June 2015 at the First Affiliated Hospital of Zhengzhou University were collected and divided into groups of A, B two, group A as experimental group and 49 people. The patients were given three anti tuberculosis drugs every day before operation. The adjuvant therapy (isoniazid, rifampicin, ethambutol) was used in the group B as the control group and 49 people were treated with oral hormone drugs (methylprednisolone). If the patients with severe GLM with higher prolactin were treated with oral bromocriptine, the patient's disease changes were observed closely, and the treatment was effective and operative treatment was practiced. The effectiveness of the triple antituberculous drugs for severe GLM patients and the efficiency of hormone therapy for GLM were statistically analyzed after the criteria were performed. The rate of good breast shape after the drug treatment; the postoperative recurrence rate of all the patients after 6 months of operation was analyzed. The data were analyzed by SPSS18.0 software, and the standard P0.05 was tested. The difference in the effective rate of the 1. two groups was analyzed. Whether there was a difference in the good rate of breast shape after operation in the 2. two groups? Results: experimental group (group A) 49 cases, 2 cases were lost during the treatment, 47 cases were evaluated, 3 cases were not relieved after 1 months of drug treatment, 3 patients were treated with extended excision of milk, 44 cases were treated with triple drugs for 2 to 4 months, to reach the standard of clinical evaluation and operation, the effective rate was 93.6%, and 7 patients finally were. A total of 40 patients were treated by oral medicine for clinical and imaging treatment. 40 patients were treated with surgical treatment. The postoperative satisfaction of the breast was evaluated: excellent 5/40 (12.5%), good 25/40 (62.5%), 49 patients with total excellent rate 75%. control group (group B), 1 cases in the treatment process, 48 cases, 7 patients with oral hormone treatment 10. No stable or relieved condition above, 4 cases of patients continued to progress, 6 cases of initial oral drug treatment effective, in the process of drug reduction in the process of sudden onset, then 17 cases of patients after the treatment of invalid direct operation, 31 patients with hormone treatment for one month to two months, the skin surface redness and swelling decreased, the scope narrowed, The swelling was soft, or the sinus tract was partially closed, the effective rate was 64.6%. A total of 48 patients were finally operated on. The postoperative satisfaction of the breast was evaluated: excellent 2/48 (4.1%), good 18/48 (37.5%), and the total good rate of 41.7%. two groups had statistical difference between the effective rate of drug treatment and the postoperative breast good rate (P0.05). 6 months after the operation again. All patients were followed up with no recurrence. Conclusion: 1. combined drugs or hormones had a certain clinical effect on the treatment of severe GLM before operation. The curative effect of.2. before operation was better than that of the triple drug treatment of severe GLM, and the higher rate of postoperative breast shape after operation was higher than that of the adjuvant triple drug group.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R655.8

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