浆细胞性乳腺炎治疗方式的选择及手术时机的把握

发布时间：2018-06-09 00:14

本文选题：浆细胞性乳腺炎 + 治疗方式　；参考：《重庆医科大学》2017年硕士论文

【摘要】：目的研究不同临床分型的浆细胞性乳腺炎(Plasma cell mastitis,PCM)经治疗后的治愈率及复发率,探讨浆细胞性乳腺炎治疗方式及手术时机的把握。方法采用回顾性分析研究方法,收集我院2006年1月~2015年12月临床诊断的178例女性PCM患者,所有病例均经术后病理学检查确诊为PCM。按就诊时的临床表现分为四组,分型标准参照耿翠芝所提出的分类标准[1],肿块型急性炎症期89例,肿块型慢性炎症期47例,脓肿型36例,瘘管型6例。其中对于肿块型PCM,又可根据肿块边缘与乳晕边缘的位置关系,分为晕周型(肿块边缘距乳晕边缘2cm)和周围型(肿块边缘距乳晕边缘2cm)。对于处于急性期、局部炎症反应明显的PCM患者,于术前予以静脉输注抗生素治疗。针对脓肿型PCM患者,用药前取患者乳腺病灶区脓液或者分泌物进行培养及药敏试验,选用广谱抗生素,用药期间根据临床症状改善情况及药敏试验结果更换敏感抗生素。部分PCM患者局部感染症状较重、可加用抗厌氧菌药物及地塞米松,发挥抗厌氧菌作用及抗炎作用。89例肿块型急性炎症期PCM患者,58例肿块属于晕周型,视肿块大小行肿块切除术或肿块切除术+局部腺体瓣翻转整形术,31例肿块属周围型,行肿块切除术或区段切除术。47例肿块型慢性炎症期PCM患者中,均行病变乳腺区段切除术或象限切除术;36例脓肿型PCM患者中,14例脓腔直径较大,行脓肿切开引流术,充分完全引流脓液,22例因脓肿较小,局部炎症控制后行病灶扩大切除术;6例瘘管型PCM患者行瘘管及周围部分正常乳腺组织切除术。多个瘘管形成、局部粘连严重病例行皮下腺体全切术或者乳房单纯切除术,术后行一期假体植入术,所有伴乳头内陷畸形的PCM患者均予以内陷乳头畸形矫正术。术后门诊或电话随访1~3年,中位随访时间22个月。记录每组的治愈率及复发率。结果(1)89例肿块型急性炎症期的PCM患者,治愈87例,治愈率97.75%(87/89),复发2例,复发率2.25%(2/89);(2)47例肿块型慢性炎症期PCM患者,44例治愈,占93.62%(44/47),复发3例,占6.38%(3/47);(3)36例脓肿型PCM患者,切开引流组治愈3例,治愈率21.43%(3/14),复发11例,复发率78.57%(11/14)。扩大切除组治愈20例,治愈率90.91%(20/22),复发2例,复发率9.09%(2/22);(4)6例瘘管型,5例治愈,治愈率83.33%(5/6),复发1例,复发率16.67%(1/6)。结论PCM肿块型急性炎症期宜予以药物治疗控制局部炎症反应,炎症反应消退或局限后的肿块静止期宜行手术治疗。PCM的治疗关键在于早期诊断早期治疗,针对不同临床类型的PCM治疗方式上建议采取综合性治疗手段。
[Abstract]:Objective to study the cure rate and recurrence rate of plasma cell mastitis (PCM) with different clinical types, and to explore the treatment methods and the timing of operation for plasmacytic mastitis. Methods 178 cases of female PCM diagnosed in our hospital from January 2006 to December 2015 were collected by retrospective analysis. All cases were confirmed as PCM by postoperative pathological examination. According to the clinical manifestations of the patients, they were divided into four groups. According to the classification criteria proposed by Geng Cuizhi, 89 cases of acute inflammatory stage of mass type, 47 cases of chronic inflammatory stage of mass type, 36 cases of abscess type and 6 cases of fistula type were classified. According to the position relationship between the edge of the mass and the edge of the areola, PCM can be divided into two types: the perihalo type (2 cm from the edge of the mass to the edge of the areola) and the peripheral type (2 cm from the edge of the mass to the edge of the areola). Patients with PCM in acute phase with obvious local inflammatory reaction were treated with antibiotics before operation. For the patients with abscess PCM, the abscess or secretion of the patients with breast lesions were taken for culture and drug sensitivity test, and broad-spectrum antibiotics were selected. During the treatment, the sensitive antibiotics were replaced according to the improvement of clinical symptoms and the results of drug sensitivity test. Partial PCM patients with severe local infection symptoms can be added with anti-anaerobe drugs and dexamethasone to play the role of anti-anaerobes and anti-inflammatory effect .89 cases of mass type of acute inflammation of PCM patients 58 cases of mass belong to the halo type. According to the size of the mass, 31 patients were treated with local glandular flap turnover surgery according to the size of the mass, and 47 patients with chronic inflammatory phase PCM were treated with mass resection or segmental resection. Of the 36 patients with PCM with abscess type, 14 patients had large abscess cavity diameter, 22 patients had full and complete drainage of abscess because of the small abscess, 14 patients had large abscess cavity diameter, 22 patients had complete drainage of abscess because of the small abscess. Six patients with fistula PCM were treated with fistula and normal breast tissue resection after local inflammation control. Patients with multiple fistula and severe local adhesion underwent subcutaneous adenectomy or simple mastectomy. All PCM patients with nipple invagination malformation were treated with correction of inverted papillary deformity. Postoperative outpatient or telephone follow-up 1 ~ 3 years, the median follow-up time 22 months. The cure rate and recurrence rate of each group were recorded. Results among 89 patients with PCM in acute inflammatory stage of mass type, 87 cases were cured, the cure rate was 97.75 / 87 / 89, recurrence was 2 cases, recurrence rate was 2.25% / 89%, 44 cases (93.622% / 47) were cured (93.622% 44 / 47), 3 cases (6.38% ~ 347%) with abscess type PCM. In the incision and drainage group, 3 cases were cured, the cure rate was 21.43%, and the recurrence rate was 11 cases. The recurrence rate was 78.57%. In the extended resection group, 20 cases were cured, the cure rate was 90.91% 20 / 22%, the recurrence rate was 2 cases, the recurrence rate was 9.09% / 22%, 4 cases of fistula type were cured in 5 cases, the cure rate was 83.33% / 6%, the recurrence rate was 1 case and the recurrence rate was 16.67%. Conclusion the local inflammatory reaction should be controlled by drug therapy in acute inflammatory stage of PCM. The key to the treatment of PCM is early diagnosis and early treatment. Comprehensive treatment is recommended for different clinical types of PCM.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R655.8

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