A Retrospective Study Of The Treatment Of Granulomatous Lobular Mastitis

Background:Granulomatous lobular mastitis(GLM),hereinafter referred to as granulomatous mastitis is a kind of happens at married postpartum lactation female mammary gland inflammatory disease,its symptoms of mammary gland flocculus centered non-cheese,non-vasculitis of granulomatous inflammation reaction,can be seen in the lobules predominantly neutrophils a variety of inflammatory cell infiltration.Current research on the etiology and pathogenesis of this disease is not yet clear,more of the modern research considers the disease caused by autoimmunity.Clinical treatment of the disease is variety,has not yet formed a unified treatment.But the antibiotic treatment effect is poor,hormone treatment of this disease is not uniform dosage usage standard,and because of its side effects obvious reason are controversial.At present is given priority to with the surgical treatment of the disease,and TCM for the disease often can have very good effect.Tutor professor Zhu Dong Sheng after many years of clinical experience summary,think with combined treatment of TCM and western medicine treatment of the disease effect is remarkable,and the curative effect,the recurrence rate is low,is currently one of the more reasonable treatment of GLM solution,with the application of plastic concept,to the greatest extent to protect the shape of the breast.After many years of clinical experience summary department explore a set of clinical effect of treatment of the disease patterns,the concrete inside and outside combination for TCM combined surgery treatment.And according to the requirements of the patients with lesions scope and its use staging surgery or one-time radical surgery of two different treatment mode.TCM internal and external use throughout whole course treatment.Objective:Through the retrospective analysis of GLM the patient's general information and treatment,to explore the etiology and pathogenesis of GLM,and through the analysis of the treatment effect and GLM in our patient,for the treatment of granulomatous lobular mastitis provide reasonable Suggestions.Methods:Collected on May 1,2009 to November 1,2016 in the mammary gland of hospital of our hospital treatment,and conforms to the GLM into standard patients.GLM patients in our hospital treatment,according to the personal willingness to illness weight and patients directly radical surgery treatment of the two kinds of treatment mode.Direct radical surgery includes resection of the content of mammary gland section(Lesion area)lesions under +nipple catheter(Lesion area)resection + nipple angioplasty,and cooperate with the oral TCM and postoperative 3 months.Staging treatment including the use of sharpness remove them debridement of necrotic tissue and rotten meat,with external treatment and postoperative ulcer treatment remove saprophytic muscle,in a lumen narrowed to a certain range,cavity granulation growth in good condition,local inflammatory response significantly reduced or disappeared when undergoing elective radical surgery,and postoperative three months with oral medicine.Statistical cases found in standard to 85 the number of cases,unilateral onset of 80 people,bilateral incidence of 5 people,a total of 90 people.The number of patients treated by staging operation was 61,and the directly radical surgery was about 29.Among them,the patients with pregnancy,birth,past medical history,allergic history were artificial units.Treatment of mass number,quadrant,sinus,outside the hospital,suffering from side of lactation,tumor size,course of disease and treatment were in the treatment of people as a unit.The patient's relevant data statistics and sorting,then use spass 17.0 software for data analysis.Therapeutic effect evaluation in our hospital patients,and compared the two different methods for the treatment of GLM.Evaluation index for the signs,symptoms,treatment,treatment time,the recurrence rate.At the end of the follow-up study destination for.Results:1.GLM is more common in married women and has a history of childbearing.2.the disease can be found in women of all ages,in this study,only 1 cases of unmarried patients in 85 cases.The oldest patient was 49 years old,the youngest was the age of 23 years,with an average age of 32.99±6.072 years old.3.GLM is a diease which Onset of all seasons,its multiple in peripheral quadrants of mammary gland,breast distribution has no obvious difference,in addition,the disease can also affect the mammary areola,axillary rare disease.The disease characterized by local lumps,all patients were accompanied by mass in this study.44 people with skin burst,accounting for 48.89%of the total.Patients admitted to hospital before the course length is differ,the shortest duration is 12 days,most elderly people for four years,the average duration of 5.22 months.Medical history of abortion number of 31 people,accounting for 36.47%of the total,nursing disabilities to 10 people,8 people breast trauma history,3 cases of patients infected with HB,3 cases of antipsychotic drugs,2 cases infected with TB and related drugs,0 cases with a history of smoking,4.85 patients in our hospital,of which 5 people bilateral breast occur disease,the total treatment time was 90,after combine traditional Chinese and western medicine treatment,recovery of 90 person-time,5 cases of recurrence.The cure rate was 100%,the recurrence rate was 5.56%.5.The hospital patients for fire derived from Stagnation of Liver-QI,Stagnation of liver qi and phlegm two card type,there were 1 case of vital energy deficiency with evil-lingering.The top 20 for use of radix bupleuri,selfheal,radix amebiae seu lithospermi,dandelion,angelica dahurica,white and seaweed,hawthorn,platycodon root,poria cocos,radix curcumae,radix trichosanthis,honeysuckle,atractylodes,coix seed,spreading hedyotis herb,radix scutellariae,fritillaria,licorice,Chinese angelica.Its main taste is given priority to with bitter,sweet,cold.The meridians are mostly the stomach,liver,lung and spleen.The saprophytic removing muscledrug has the function of anti inflammation,inhibiting bacteria and promoting wound healing.6.Treated in our hospital patients with direct radical cure and staging treatment two patterns.The direct radical cure group was 29,and the on stage comprehensive treatment group was 61.By statistics,general situation:two groups of patients with gender,age,marriage maternal feed had no obvious difference.Clinical manifestations:there was no difference in the two groups of mass number,the longest diameter of tumor,number of antrum,course,course of treatment,recurrence,obvious difference.Conclusion:1.More of the disease occurred in married and postpartum women.2.The etiology and pathogenesis,GLM can occur in all seasons,consider the climate and environment factors,patients in the study of the history of abortion,accounting for 36.47%of the total consideration may be an important relevant factors of the disease.In addition the pathogeny of the disease complex,combined with the medical history,consider to the cause of the disease is numerous,analyze its possible for some causes resulting in abnormal immune,induce autoimmune disease.Combining with the characteristics of the onset and the literature,to analyze its relationship with sex hormone levels especially estrogen,closely.But still needs further research.3.The clinical manifestations:the disease lump with swelling pain as the main performance.Diagnosis depends on pathological diagnosis,laboratory examination is given priority to with corynebacterium,imaging examination no specificity.In the clinical misdiagnosis rate is high,mainly with PCM,breast cancer in clinical identification.4.The treatment:the disease by combining traditional Chinese and western medicine treatment effect is remarkable,the recurrence rate is lower than the literature reported.TCM treatment of this disease has obvious advantages.5.We thought that the position of GLM is in the breast,and this disease closely associated with liver,lung,spleen,stomach.The pathological factors of the disease of phlegm,fire.For the treatment of the disease in the medicinal taste is more bitter,sweet,cold,belong to the is given priority to with stomach,liver,lungs,spleen by.6 The use of Chinese medicine to eliminate the skin can be anti-inflammatory,inhibit bacteria,promote wound healing,reduce breast shape loss,reduce the recurrence rate.7 This study by Integrative Chinese and Western medicine treatment mode,using one-time radical and stage two treatment methods according to clinical classification of patients,the study found that the direct radical has the advantage of short treatment time,patient suffering and economic burden is relatively less relatively less,but the recurrence rate of treatment is higher compared to the stage.8 The patients in this study were moderate and severe granulomatous mastitis,and the majority of them were critically ill patients.