| Objective: through a retrospective study of granulomatous mastitis patients treated by Professor Zeng Yi,according to Professor Zeng Yi’s diagnosis and treatment ideas and methods and cure rate for the majority of breast surgery professionals to provide diagnosis and treatment ideas for the treatment of GLM,to improve the level of diagnosis and treatment of DLM.Methods: the information of patients with granulomatous lobular mastitis was collected and statistically analyzed by Professor Zeng Yi of the Department of Breast surgery of the first affiliated Hospital of Tianjin University of traditional Chinese Medicine,including general data,clinical treatment,prognosis recovery and so on.Results: 1.Among the 111 cases included in the study criteria,all were female,the maximum age was 44 years old,the minimum age was 25 years old,and the average age was36.5 years old.According to this statistics,the age of onset of the disease is in the majority of patients aged 40 years old,accounting for 70.3% of the total.The distribution of age group is wide and the span is large.Among them,the number of people whose BMI is not in the normal range accounts for 64.9% of the total.The disease can occur all year round,and the season is not limited.The results of this study showed that the incidence of multiple episodes in summer and autumn accounted for 59.4%.Most of them occur in 5-year-old primigravida and parturient women.There were multiple unilateral breasts.Among the 111 cases,only 9cases had double breast disease,and the left breast was more than the right breast,of which73 cases were involved in single quadrant,mainly in the upper inner quadrant.There were 73patients(65.8%)involved in one quadrant,29(26.1%)in two or more quadrants,4(3.6%)in three quadrants,and 5(4.5%)in full breast quadrants(breasts).2.The disease can be divided into mass type,abscess type,sinus type and mixed type.Of the 111 patients,108 were treated in other hospitals,and 82 were undiagnosed,accounting for 73.9% of the total.There were 43cases(38.7%)of mass type,25 cases(22.5%)of abscess type,23 cases(20.7%)of sinus type(who had cut the abscess or underwent surgery in the other hospital),and 20 cases(18.0%)of mixed type with at least two of the three types.At the time of onset,breast masses occurred in103 cases(92.7%),breast pain in 85 cases(76.5%),red-hot breast skin in 60 cases(54.0%),and breast skin rupture in 32 cases(28.8%).Among the 60 patients,29(26.1%)had complications including irregular menstruation,30(27.0%)with fever,22(19.8%)with fatigue,20(18.0%)with nipple discharge,12(10.8%)with limb joint pain and erythema,13(11.7%)without erythema and 9(8.1%)with cough after onset.3.Among the 111 patients,there were 36 cases of congenital nipple deformity,50 cases of lactation mastitis or breast siltation,43 cases of history of breast trauma(including breast massage,cupping,acupuncture,etc.),12 cases of oral contraceptive,psychotropic or sex hormone drugs,10 cases of short-term weight gain exceeding 5kg,28 cases of overwork and 36 cases of mental and emotional fluctuation.4.Among the 111 cases examined by Doppler color ultrasound,there were 85 cases of ductal dilatation,accounting for 76.6% of the total,67 cases of lymph node enlargement on the affected side,accounting for 60.4% of the total,and 78 cases of fluid flow in the hypoechoic area,accounting for 70.3% of the total.The lesions were mostly 1-5cm in40 cases(36.0%)and 5-10 cm in 58 cases(52.3%).87 cases(78.4%)were abnormal in sex hormone test and 52 cases(46.8%)were abnormal in prolactin.There were 43 cases of bacterial culture + drug sensitivity,42 cases of aseptic growth and 1 case of secretion containing Staphylococcus aureus.5.111 patients shared four treatment schemes according to their specific characteristics.The first is traditional Chinese medicine syndrome differentiation and treatment of conservative treatment in 1 case;the second is traditional Chinese medicine + surgical treatment in 11 cases;the third kind of traditional Chinese medicine + incision and drainage + surgical treatment in 93 cases;the fourth is traditional Chinese medicine + drainage in 6 cases.Among them,7 patients of the first and fourth types were cured within 6 months,and no recurrence or other abnormalities were found in the follow-up for one year.Traditional Chinese medicine syndrome differentiation and treatment,drainage with ordinary incision and drainage combined with scratching to change dressing,the operation is nibbling debridement and suture.There was no significant difference in age,course of disease,classification,quadrant distribution and concomitant symptoms between the second and third treatment schemes(P >0.05).The baseline of the two groups was the same and had comparative significance.In the traditional Chinese medicine + operation group,4 cases were cured,5 cases were markedly effective,2 cases were effective,14 cases were cured by traditional Chinese medicine + drainage + operation,5 cases were markedlyeffective,36 cases were effective,and the total effective rate was 100%.The effective rates of both groups were 100%,and there was a comparison between the two groups(P >0.05).It is proved that both groups are effective.There was no significant difference in breast shape between the two groups(P >0.05).Of the 104 patients in the two groups,18 cases were repaired less than 3 months after operation,48 cases needed 3Mel for 6 months,and 38 cases needed 6Mel for 12 months.6.During the follow-up of 22.46 ±8.834 months through outpatient clinic and questionnaire,there was no ipsilateral breast recurrence in situ,8 cases(7.2%)in different quadrants of ipsilateral breast,9 cases(8.1%)in contralateral breast,and no recurrence was found in other patients after follow-up for more than one year.Conclusion:1.According to the analysis of the data of 111 patients,GLM mainly occurred in women who were weaned at childbearing age,and the incidence rate of male was very low,and no cases meeting the inclusion criteria were collected.2.The disease can occur frequently in summer and autumn in the whole year,in all quadrants,and in inner and outer upper quadrants.Both breasts can occur,multiple on one side,and more in the left breast than in the right breast.3.GLM occurs rapidly,and in severe cases,it may be accompanied by fever,nodular erythema,cough and other systemic symptoms.The incidence of GLM is closely related to nipple deformity,history of local trauma,oral psychotropic drugs,obesity,mental and emotional disorders,menstrual disorders and other factors.4.Pathological examination is the gold standard of GLM,and it can also be diagnosed by imaging examination.5.The treatment scheme of traditional Chinese medicine combined with operation is the best,and the cure rate is high.After operation,we should continue the dialectical oral consolidation treatment of traditional Chinese medicine,and the postoperative repair time is between 12 months,and most of them can be cured in 6 months,and the recurrence rate is low. |
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