| Research Background:Granulomatous mastitis,also known as idiopathic granulomatous mastitis.It is a chronic breast disease centered on the lobules of the breast,with necrotizing granuloma as the pathological feature,with micro abscess formation and non-caseating necrosis.The disease is more common in non-lactating young and middle-aged women,and the incidence rate has shown a clear upward trend in recent years.At present,modern medicine has not formed a clear and unified standard in the etiology,pathogenesis,diagnosis and treatment of this disease.The law is also controversial.Granulomatous mastitis belongs to the category of non-lactating mastitis clinically and plasma cell mastitis.The clinical manifestations of the two are similar and are easily confused.Severe granulomatous mastitis is also clinically misdiagnosed as breast cancer.It is not uncommon to cause mistreatment or loss of treatment.The treatment period of this disease is long,the condition is prone to repeated attacks,and the delay is not healed,which causes great pain to the patient's body and mind,and finally chooses mastectomy,so it is also called "undead breast cancer".Histological diagnosis is the "gold standard" for the diagnosis of granulomatous mastitis.According to the progression of the disease,it can be divided into three stages: mass stage,abscess stage,and late ulcer stage.Treatment methods include hormone drugs,immunosuppressants,antibiotics,traditional Chinese medicine and surgical treatment.Surgery is recognized as an effective treatment.Depending on the location and scope of the lesion,different surgical incisions are selected:such as radial incisions,arc incisions around the areola,and arc incisions under the breast folds.Common surgical procedures include incision and drainage,simple lesion resection,enlarged necrosis,and Simple mastectomy.In the late stage of ulceration,due to the characteristics of large lesion range,multi-site sinus tract formation,and poor skin integrity,plus the patient's expectation of breast shape,conventional incisions and surgical treatments are not ideal,so how to completely remove the lesion and retain more Reversible glands and ensuring a good breast shape are the key to the short-term and long-term efficacy of this period,and the choice of incision is the guarantee of surgical treatment.In this study,based on the characteristics of the lesions in this period,a composite incision covering all lesions wasselected,such as: radial incision + arc incision around the areola,radial incision + nipple fissure penetration incision,double radial incision,"S"-shaped incision,etc,which is conducive to the exploration of all For lesions,especially microscopic lesions,choose to encroach on debridement,glandular valve transfer and filling treatment to achieve complete removal of the lesion,retain a good breast shape,and reduce the patient's fear of changing the dressing on the open wound.At the same time,it cooperates with the comprehensive treatment of internal and external treatment of traditional Chinese medicine to consolidate the curative effect,further shorten the clinical cure time,reduce the treatment cost and recurrence rate,and ensure a good breast shape.Research purposes:By observing patients with granulomatous mastitis in the late stage of ulceration after combined incision debridement combined with OPS and single incision scraping debridement combined with VSD,the prognostic effect was analyzed and studied in order to explore a way to shorten the clinical cure time To reduce the financial burden of patients,completely remove the lesions,avoid postoperative recurrence,and ensure the treatment of female breasts,provide a reliable evidence-based medical basis for clinical diagnosis and treatment of patients with granulomatous mastitis.Research methods:By collecting patients who were in the late ulcer stage at the outpatient clinic of the First Affiliated Hospital of Tianjin University of Traditional Chinese Medicine from 2017 to 2019 and were hospitalized in the ward for surgical treatment,and were diagnosed as granulomatous mastitis by pathological examination,and met the exclusion criteria.A total of56 cases were divided into a treatment group and a control group according to different surgical treatment methods,with 28 cases in each group.Treatment group: Compound incision debridement combined with OPS was used during operation.Control group: use a single incision to crawl and debride together with VSD.Collect and summarize the clinical data of the enrolled patients,use SPSS21.0 software to analyze the obtained data in detail,and observe the difference in clinical cure time,relapse rate,relapse time and breast shape evaluation between the treatment group and the control group to evaluate the late stage of ulceration Patients with granulomatous mastitis using composite incision cannibalizationdebridement combined with OPS clinical cure time,recurrence rate,recurrence time and breast shape.Research result:1.General information analysis:In this study,a total of 56 patients with GM confirmed by pathology in the late stage of ulceration were collected.The patients were all females,including the maximum age of 45 years,the minimum age of 25 years,the median age of 33.5 years,and the average age of onset(33.27 ± 4.249)years,according to statistical results,13 cases(23.2%)were <30 years old,40 cases(71.4%)were ?30-<40 years old,3 cases(5.4%)were ?40-<50 years old,and no were ?50 years old.Of the 56 patients,3 were unproductive,and the rest were all parturient,with 53 cases of birth history(94.6%),42 cases of breastfeeding who experienced postpartum(75.0%),22 cases of affected nipple depression(39.3%),bilateral There were 7cases(12.5%)with nipple depressions,27 cases(48.2%)without nipple depressions,9 cases(16.1%)with a history of breast trauma,and 2 cases(3.6%)had a long history of oral antipsychotic drugs,all of which were resistant Depressant.Among the enrolled patients,staff had the highest incidence,with a total of 23 cases(41.1%),followed by teachers,a total of 13cases(23.2%),11 unemployed persons(19.6%),4 enterprise management staff(7.1%),farmers 2 cases(3.6%),1 professional technician(1.8%),1 civil servant(1.8%),and 1 worker(1.8%).2.Analysis of clinical symptoms at the time of treatment:In the GM patients in this study,the initial symptoms were more common than the inadvertently found masses.The patients reported that they had been suddenly hit by the child before the onset of the disease,or had a history of worry and anger,or no obvious cause of the disease.At the beginning of the onset,there were 10 cases of breasts with localized lumps,44 cases with lumps with pain,20 cases with lumps with pain and local skin color reddening,and3 cases with erythema on both legs after onset.The time of onset was mostly within 3 years and 5 years after the last delivery,and they were all 21 cases(39.6%).Within 1 year after the last delivery,5 cases(9.4%)were more than 5 years(9.4%).There were 1 case of pregnancy and 3 cases of pregnancy Married,not pregnant and unborn.Both breasts can develop in this disease,including 34 cases(60.7%)with left breast,18 cases(32.1%)with right breast,and 4cases(7.1%)with both breasts.When the patient was admitted to the hospital,the diameter of the tumor was measured.The longest diameter of the tumor in this study was 16 cm and the shortest diameter was 1cm.Among them,there were 27 cases with tumor diameter ?5cm,23 cases with> 5-?10cm,5 cases with> 10-?15cm,and 1 case with> 15 cm.The most common cases were masses located in the outer and upper quadrants,25 cases(44.6%),12 cases(21.4%)in the outer and lower quadrants,21 cases(37.5%)in the inner and upper quadrants,and 11 cases in the inner and lower quadrants.(19.6%),56 patients with breast masses not only affect one quadrant,but multiple quadrants can coexist,and those with nipple inversion can also affect the nipple and areola area.In this study,16 cases were located in the nipple and areola area(28.6%).The lesions involved 32 patients(57.1%)in 1 quadrant,19 patients(34.0%)in 2 quadrants,and 5 patients(8.9%)in 3 or more quadrants.3.Abnormal analysis of laboratory inspection:All patients in this study were tested for blood routine and female hormones at the time of admission.The total number of white blood cells and prolactin values were counted.In 56 patients,the endocrine secretions of the lesions were taken for bacterial culture.In the test results,there were 29 cases with elevated white blood cells,14 cases with elevated prolactin,the highest value of prolactin> 200 ng / m L,and 14 cases with positive bacterial culture.The bacteria cultured in the mammary gland secretions include Staphylococcus aureus,Staphylococcus epidermidis,Acinetobacter baumannii,Acinetobacter baumannii complex,Corynebacterium rhizogenes and Enterobacter aerogenes.4.Evaluation of curative effect:In the treatment group,one-stage suture was used after surgery.The longest clinical cure time was 50 days and the shortest was 10 days.The average clinical cure time was 22.14 ±11.78 days,and 15(53.6%)of 28 patients had postoperative Achieve one-stage healing and reduce the clinical cure time;the control group needs long-term dressing treatment until the wound heals,the longest clinical cure time is 128 days,the shortest is 30 days,the average clinical cure time is 72.82 ± 31.26 days,clinical cure It takes longer.In the treatment group,2cases relapsed after operation,and 26 cases did not relapse;in the control group,10 cases relapsed and 18 cases did not relapse.In the treatment group,the shortest postoperative relapse time was 40 days,the longest time was 152 days,and the average relapse time was96.00 ± 64.66 days.The shortest postoperative relapse time in the control group was 33 days,and the longest time was 100 days.The average relapse time was 51.80 ± 18.84 days.The relapse time between the two groups did not conform to the normal distribution,using rank sum test,P = 0.061> 0.05,the difference was not statistically significant.In the treatment group,19 cases had excellent breast shape,7 cases were good,and 2 cases were normal.In the control group,7 cases had excellent breast shape,7 cases were good,and 14 cases were general.Chi-square test was used to compare the breast shape evaluation between the two groups,and the difference was statistically significant(P = 0.001 <0.05).Analysis conclusion:1.Compound incision debridement combined with OPS in the late stage of ulceration has a certain clinical effect in the treatment of patients with GM.2.Compound incision debridement combined with OPS at the late stage of ulceration is more effective than the use of single incision scraping and debridement combined with VSD.3.Combined incision debridement and debridement combined with OPS in the late stage of ulcer treatment for GM patients can shorten the clinical cure time,reduce the recurrence rate,and improve the postoperative breast shape evaluation.4.Most of the female occupations in this study are staff,suggesting that occupations may be related to the incidence of GM. |
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