Clinical Observation Of Different Surgical Methods Combined With Traditional Chinese Medicine In The Treatment Of Granulomatous Lobular Mastitis In Abscess Stage

Research Background:Granulomatous lobular mastitis(GLM)is a chronic inflammatory disease commonly seen in women of childbearing age.Breast lump with or without pain is the main clinical manifestation.The main pathological feature is granuloma.Non caseous necrosis confined to the lobules.At present,the literature about the disease is increasing,but modern medicine has not yet definitively concluded the cause and mechanism of the disease.The understanding of traditional Chinese medicine for the disease is also different.The time of therapy of the disease is long,and it is a type of non-lactation mastitis that is difficult to treat.Ihe clinical manifestations are very similar to plasma cell mastitis and so on.It is easy to misdiagnose in clinical diagnosis.The incidence of GLM is rare,and the incidence has increased in recent years.The clinical misdiagnosis of the disease as breast cancer also happens.Histological diagnosis is the "gold standard" for the diagnosis of granulomatous lobular mastitis.There are many treatments for this disease,direct resection of breast lesions is the main method.Occasionally combined with antibiotics,hormone drugs,immunosuppressants,etc.Most doctors believe that surgery can achieve effective clinical cure.Appropriate timing and method of surgery should be adopted according to the patient’s clinical manifestations.The disease can be divided into mass stage,abscess stage and late ulcerative stage according to the progress of the disease.If the abscess is formed,incision and drainage are often used.Other common surgical methods include simple resection and extensive resection of necrotic lesions.If the lesion is extensive and scattered,total mastectomy may be adopted.For the aesthetic effect after operation,skin flap transfer or prosthesis implantation can be adopted.Most breast operations take radial incisions according to the physiological characteristics of the breast to reduce the damage to the mammary duct.If the lesion is around the areola,choose the arc incision beside the areola.If the lesion is in the lower part of the breast,make an arc incision along the inferior wrinkle of the breast.The abscess stage is the period which most patients see the doctor for the first time.Some patients can even touch the fluctuation,most with pain.Doctors take different treatment methods for this period,all aiming at removing necrotic lesions as much as possible and reducing the purpose of postoperative recurrence.At the same time in order to avoid the appearance of the breast caused greater damage,we should also be careful not to excise too much glandular tissue during the operation.Pay attention to the preserve of reversible glands.Western medicine seeks conservative treatment for some patients using hormones,but several literatures have reported that hormones can cause a higher incidence of complications,and the recurrence can not be ignored.In the early stage,,resection for GLM patients,only the tumor at the breast lesion and the normal tissue of the surrounding 0.5cm were removed.Patients who have this procedure have a high recurrence rate,even up to 50%.In addition,many literature reports have shown that surgery combined with traditional Chinese and western medicine can achieve significant clinical effecacy in the treatment of this disease.Different surgical methods were used according to the lesions of the patients and their own wishes.The clinical data of patients with abscess granulomatous mastitis treated by different surgical methods combined with traditional Chinese medicine were retrospectively analyzed to explore the therapeutic effects of various surgical methods combined with oral and external treatment of traditional Chinese medicine.To provide reliable evidence-based medicine basis for clinical treatment of GLM patients in abscess stage.Objective:To observe the patients with GLM in abscess stage who were treated with debridement necrotic lesions combined with OPS;incision and drainage,and install VSD + secondary debridement combined with OPS;multi-site small incision drainage + secondary debridement combined with OPS.All patients were treated with the same integrated traditional Chinese and western medicine except the surgical method.The prognostic of patients with the above three operations was studied to explore a treatment method that could remove necrotic lesions,reduce the damage to the breast appearance,reduce the recurrence rate and shorten the healing time of the incision.To provide a reliable evidence-based medical basis for the clinical diagnosis and treatment of GLM patients in abscess stage.Methods:Collected 75 GLM patients in abscess stage who were admitted to the outpatient department of the First Teaching Hospital of Tianjin University of Traditional Chinese Medicine from September 2018 to March 2020 and underwent surgical treatment,met the inclusive and exclusion criterias,completed clinical data and regular follow-up.According to the different surgical methods,the patients were classified into different treatment groups:(1)debridement necrotic lesions combined with OPS;(2)incision and drainage,and install VSD+ secondary debridement combined with OPS;(3)multi-site small incision drainage +secondary debridement combined with OPS.All patients were treated with the same integrated traditional Chinese and western medicine except the surgical method.The symptoms,signs,treatment effect,healing time of incision,recurrence and breast appearance of patients in each group were observed,the clinical data of the patients were counted and classified,and the relevant data were analyzed by SPSS22.0 software,evaluated and compared the effects of three different surgical methods combined with traditional Chinese medicine in the treatment of granulomatous lobular mastitis in abscess stage.Hereinafter referred to as group(1),(2)and(3).Research Result:1.General Data Analysis:This study collected 75 cases of patients with GLM confirmed by pathology,all the patients were female,ranging in age from 26 to 41 years old,with median age of 32 years.According to statistical results,21 cases(28%)were aged from 21 to 30,52 cases(69.3%)were aged from 31 to 40,and 2 cases(2.7%)were aged from 41 to 50.Among the 75 patients,4 did not give birth,the rest were parturients.60 cases(80.0%)experienced postpartum lactation.Nipple invagination was found in 14 cases(18.7%),bilateral nipple invagination in 3 cases(4.0%),and no nipple invagination in 61 cases(81.3%).6 cases(8%)had a history of breast trauma.4 cases(5.3%)had a recent history of abortion.Among the patients in the group,the incidence of staff was the highest,with a total of 41 cases(54.7%).Teachers took the second place,with a total of 10 cases(13.3%).Unemployed persons in 9cases(12%),professional and technical personnel in 5 cases(6.7%),freelancers in 4 cases(5.3%),self-employed in 2 cases(2.7%),workers in 2 cases(2.7%),doctors in 1 case(1.3%)and farmers in 1 case(1.3%).2.Analysis of clinical symptoms during treatment:Most of the GLM patients in this study were diagnosed with breast lumps at the initial stage,and most of the patients had a history of anxiety and annoyance caused by recent work stress.It can be seen that some patients complain of large work pressure recently.Some of them had a history of being inadvertently hit by young children before the onset of the disease.Or there is no obvious inducement to the disease.There were 10 cases(13.3%)with nipple discharge,and 65 cases(86.7%)without nipple discharge.There were 65 cases of lumps with pain(86.7%).The skin was red and swollen in 62 cases(82.7%).51 cases(68%)had high skin temperature.The obvious fluctuation of the mass was found in 53 cases(70.7%).Erythema of both lower limbs occurred in 3 cases(4.0%).Left axillary lymph node enlargement was observed in 45 cases(60.0%).The time of onset was mostly within 2-5 years after the last delivery,46 cases(61.3%),and 4 patients were married and infertile.The disease can occur in both breasts,including 46 cases(61.3%)in the left breast,28 cases(37.3%)in the right breast,and 1 case(1.3%)in both breasts.The diameter of the lumps was measured at the first visit,,the longest diameter of the mass in this study was 15 cm,and the shortest diameter was 5cm.The median was 8cm.64 cases(85.3%)had tumors with diameters of 5-10 cm,and 11 cases(14.7%)had tumors with diameters of 11-15 cm.45 cases(60.0%)were located in the upper quadrant.32 cases(42.7%)were located in the outer lower quadrant.24cases(32.0%)were located in the upper inner quadrant.12 cases(16.0%)were located in the inner lower quadrant.In 75 patients,the breast masses did not only involve one quadrant,but could coexist with multiple quadrants,or the nipple inverted could also involve the nipple and areola region.In this study,7 cases(9.3%)of the breast masses were located in the nipple and areola region.There were 37 cases(49.3%)involving one quadrant,31 cases(41.3%)involving two quadrants,and 7 cases(9.3%)involving three quadrants.3.Abnormal analysis of laboratory examination:All patients in this study tested six items of blood routine and female hormones,counted the total number of white blood cells and prolactin,the secretions were taken from the 75 patients during operation for bacterial culture.All 75 patients were taken from the secretaries of lesions during the operation for bacterial culture.The results showed that 38 cases had elevated leucocytes,13 cases had elevated prolactin,and 21 cases had positive bacterial culture.Staphylococcus aureus,Staphylococcus epidermidis and Acinetobacter baumannii were the most common bacteria in the secretions,while Corynebacterium striatum was relatively rare.4.Evaluation of curative effect:The longest wound healing time of the group(1)、(2)、(3)were 88、95、98 days,the shortest were 15、40、50days.The wound healing time of group(1)was shorter than that of group(2)and group(3),and the difference was statistically significant.There were 6,3 and 2patients with recurrence in group(1),(2)and(3).There were 2,2,3 new cases in group(1),(2)and(3).In(1),(2)and(3)groups,there were 12,17 and 16 cases with excellent breast appearance respectively.After treatment,13,8,and 9 patients achieved good or general breast shape evaluation.The breast appearance of the three groups was evaluated by chi-square test,and the difference was not statistically significant.Conclusion:1.Debridement of necrotic lesions combined with OPS has a certain clinical effect on GLM patients in abscess stage..2.The incision healing time of debridement combined with OPS in abscess stage is shorter than that of incision and drainage,and install VSD + secondary debridement combined with OPS and multi-site small incision drainage + secondary debridement combined with OPS..3.Traditional Chinese medicine combined with surgery is effective in the treatment of GLM in abscess stage..Individualized treatment is adopted according to the actual situation of patients.