Observation Of The Curative Effect Of Puncture And Irrigation Treatment Of Lactating Mammary Abscess

Backgroud: Acute mastitis is an inflammation of breast tissue, which mainly results from milk stasis and bacterial infection, most commonly seen in lactating women.Infection is the commonest diagnosis for breast inflammation and is usually associated with coagulase-positive Staphylococcus aureus, which characteristically causes pyogenic abscess development.local drainage is necessary to improve localised and systemic reactions after a breast abscess formation occurs. The traditional incision-drainage is a effective treatment, however it has some inevitable shortcomings at the same time such as invasive and painful,produces milk fistulas or localized eczema, and has prolonged healing time, interference with lactation, possible unpleasant cosmetic outcome. Puncture and irrigation is an less invasive procedure with few complications, meanwhile it may be considered controversial because of differences in reporting on outcomes obtained and factors affecting success.Objectives: The purpose of the present study was to compare the classic incision and drainage method and the novel approach of puncture and irrigation of breast abscesses in lactating women.Methods:A total of Num lactating women with breast abscesses were enrolled between January 2013 to June 2014, including outpatients and inpatients presented in Yancheng Maternal and Child Care Service Centre. Patients with breast abscess were randomizedto proceed either to incision and drainage or to puncture and irrigation in accordance with inclusion and exclusion criteria. These patients in both groups were given standardized systemic antibiotic treatment. All patients were followedclinically for white cell count, temperature, length of antibiotic treatment and hospital stay, degree of pain,number of aspiration, cessation of breastfeeding,overall costs as well as cosmetic result.Results: During the follow up period,Both study groups were comparable on cure rate.There was no significant difference between incision and drainage and puncture and irrigation groups on the time of recovery normal of body temperature and leukocyteand the time ofantibiotic treatment(P>0.05).This study showed a median of 4 aspirations(range3-6) for complete resolution in puncture and irrigation group,while 19(range10-32) in the control group.The mean overall costs for patients in incision and drainage arm was almost 0.5 times that of puncture and irrigation(P<0.05).When comparing pain scores, puncture and irrigation group reported significantly less pain than the control groups(P<0.05).Patients in puncture and irrigation group had a shortercessation(range 6-9 days vs range 14-61days) and a higher recovery rate of breastfeeding(91.8% vs 38.6%) than those inincision and drainage group.The cosmetic result was significantly more satisfactory with puncture and irrigation compared with incision and aspiration(P<0.05).Conclusion: Puncture and irrigation is an effective treatment option for lactational breast abscesses. The risk factors for failure of Puncture and irrigation include superficial abscess presenting with skin changes, ulceration, necrosis,ruptured,thick pus fullfiled,multiloculated and recurrent breast abscess.Compared to incision and drainage, This procedure has a similar cure rate,and may be less invasive, lower complication rate, shorter healing time and superior cosmetic outcome.