| Background: Granulomatous mastitis(GM,hereinafter referred to as GM)is a chronic inflammatory disease that is neutral in the breast lobules and multifocal microabscesses are seen around it.Non-caseous necrosis and necrotic granulation Swelling is a pathological feature of an autoimmune disease,so it is also called granulomatous lobular mastitis.Occurs in primiparous or postpartum women aged 20-40 who have a history of breast feeding and are 2-5 years after weaning.In recent years,the incidence has been increasing year by year.-In addition to the "gold standard" for pathological diagnosis in clinical practice,it has no other obvious specificity and is easily misdiagnosed as breast cancer and other diseases.Great damage.Objective: In the first part of this article,the research progress of the epidemiology,etiology,diagnosis,differential diagnosis and treatment of GM is reviewed,and the key to the etiology and diagnosis of GM is as far as possible.At the same time,it puts forward urgent problems and finds out the next direction of clinical research of GM.The second part is a retrospective analysis of 60 patients with GM who have been cured in our hospital,as well as 1048 patients who have analyzed the diagnosis and treatment of GM in the past ten years.The general situation,incidence characteristics and causes,diagnosis and treatment characteristics,and follow-up follow-up To systematically understand the recurrence situation,accumulate clinical experience in the disease,and then carry out other studies on the disease as a basis for providing a reference for the future clinical work of the disease.Methods: In the first part of the Chinese and English database,"Granulomatous mastitis" and "granulomatous mastitis" were used as keywords.A large number of relevant literatures were searched from 1988 to February 2019 and summarized and summarized.Part 2 1.Search for "granulomatous mastitis" as a keyword in the Chinese database,and use "analysis" as a secondary search in the results.According to the inclusion criteria,there are 20 remaining documents,and a total of 1048 patients are extracted.Related information.2.Collect 60 cases of granulomatous mastitis patients treated in the Department of Breast Surgery of Tianjin University of Traditional Chinese Medicine from December 2016 to December 2019.By consulting the medical records,follow-up surveys in the clinic and online,to understand their The situation,with 1,048 cases in the literature,a total of 1108 patients with retrospective analysis of some general conditions and clinical symptoms and signs,some examinations and diagnosis and treatment,combined with the relevant content in the first part of the literature to summarize clinical experience.Results: 1.All 60 patients in our hospital are females,and the age range is 25-44 years old.The majority of patients are 25-35 years old,accounting for 68.3% of the total.Among them,the largest 1048 patients in the literature have BMI outside the normal range.65 years old,youngest 16 years old,mainly concentrated in 25-40 years old.The age range is wide and the span is large.The disease can occur throughout the year and the season is not limited.The research in this hospital focuses on the frequent occurrence in summer.Literature studies mention frequent fall.2.Most occur in primiparous and menstrual women within 2.5 years after weaning.A total of 235 cases of lactating mastitis or milk silt in the study accounted for 23% of the total number of studies.There are multiple unilateral breasts,and only 20 cases of bilateral breasts occurred in the study.The rest were unilateral breasts.In the 60 cases studied in this hospital,there were more left breasts than right breasts,of which 39 were involved in single quadrant.For example,it is mainly concentrated in the outer upper quadrant.Twenty-one cases occurred in two quadrants,and three of them developed whole breasts.The lesion size was mainly 5-10 cm,with 32 cases(53.3%).3.In this study,the course of disease in our hospital was 7d-14 months,with an average of 3.03 months.This hospital is divided into mass type,abscess type,sinus type and mixed type.Of the 60 patients,53 had been treated in a foreign hospital,23(38.3%)had a mass type,15 had an abscess type(25.0%),and 13 had a sinus type(21.7).%),9 cases of mixed type(15.0%);4.Of the 60 patients in this study,24 had congenital nipple deformities,19 had lactating mastitis or milk stasis,and 15 had a history of breast trauma on the affected side.There were 8 patients with oral contraceptives or psychotropic substances.In the literature review,there were 239 cases of lactating mastitis,223 cases of congenital malformation or depression,50 cases of trauma on the affected side,53 cases of abortion,34 cases of drug history,and 28 cases of prolactin increase.5.During the relevant examinations,48 patients(80%)of the ipsilateral breast duct were dilated,60 patients(73.3%)of fluid flow(liquid dark area),and 22 patients(36.7%)of the enlarged lymph nodes on the affected side.).427 ultrasound results were reported in the literature,of which 82 cases were misdiagnosed as breast cancer,and the rest were mainly irregular hypoechoic nodules or masses,some showing fluid dark areas,abscess formation,and consideration of inflammatory masses.During the sex hormone test,69 abnormal items occurred in abnormal patients,of which 32(53.3%)prolactin was out of the normal range.Of the 60 patients,43 had bacterial culture + drug sensitivity,42 had aseptic growth,and 1 had secretions containing Staphylococcus aureus.In the literature,there were also 129 cases of inflammatory cell infiltration,26 cases of suspected malignant transformation,and a higher misdiagnosis rate.7.The treatments used in the literature include antibiotics,Chinese medicine,hormones,drainage,external application,surgery,etc.The main surgical methods are surgical section resection,simple mass resection,subcutaneous gland resection,breast reconstruction,and total breast resection..There are two methods of treatment in our hospital,the first is traditional Chinese medicine + surgery,and the second is traditional Chinese medicine + drainage + surgery.The treatment of traditional Chinese medicine is based on syndrome differentiation.Drainage is performed by common incision and drainage with scalp dressing.The operation is debridement and suture.There was no statistically significant difference in age,course of disease,type,quadrant distribution,and concomitant symptoms between the two treatments(P> 0.05).The two groups had the same baseline and were of comparative significance.Nine cases were cured in the Chinese medicine + surgery group,12 cases were markedly effective,24 cases were cured by Chinese medicine + drainage + surgery,15 cases were markedly effective,and the total effective rate was 100%.The overall effect of the two groups(P = 0.00 <0.05),the effect was statistically different,It is proved that the two groups are effective,and the effect is obvious;there is no statistical difference between the two groups in terms of breast shape(P> 0.05);the longest diameter of the two groups is compared before and after treatment,and the first group and the second group are compared respectively Before and after treatment,there was a statistically significant difference(P <0.05).The longest path before treatment of the first group and the second group was not statistically significant(P> 0.05),while the first group and the second group were treated.The comparison of the posterior longest diameter was statistically significant(P = 0.00 <0.05),indicating that the traditional Chinese medicine + drainage + surgery group was better than the traditional Chinese medicine + surgery group in the size of the postoperative lesions.8.The average follow-up was 22.46 ± 8.834 months in the outpatient clinic and We Chat.Two cases(3.3%)relapsed in the original position in the traditional Chinese medicine + surgery group.After incision and drainage,they were cured after debridement and suture.No recurrence was observed during the follow-up.Traditional Chinese medicine + drainage + No recurrence of the original position was observed during the follow-up of the surgery group.Conclusion:1.The incidence of this disease has increased in recent years,and it is generally female and male patients(but because the number of patients is limited,we do not count male patients).2.The disease is more common in primiparous or postpartum women aged 20-40 who have a history of breastfeeding and 2-5 years after weaning.3.The disease can occur in four seasons,and it is frequently occurred in the middle and summer.4.It is usually a history of breast trauma,oral contraceptives,psychotropic drugs,trauma,increased prolactin,ovulation promotion,oral sex hormones,lactating mastitis or milk stasis,obesity,smoking and other bad habits.Tips may include GM.Related factors.5.Both breasts can be ill,multiple unilateral,multiple in the left side in this study,all four quadrants can be ill,and multiple in the upper and lower quadrants in this study.6.The onset of the disease is mainly a breast mass with pain in the early stage,the development of ulceration and pus in the later stage to form a sinus or fistula and it is unhealed,and the development process is rapid.Maybe accompanied by lymphadenopathy,fever,cough,joint swelling and pain,erythema on the extremities,nipple discharge and other symptoms.7.The disease can be diagnosed based on the clinical symptoms,signs,and auxiliary examination,but the GM diagnostic gold standard for pathological examination.8.The treatment depends on the patient's condition.The combination of traditional Chinese and western medicine for the treatment of this disease is currently considered by the author to be one of the most worthwhile methods to promote.9.This disease is very easy to relapse.The scope of resection should be considered carefully.Maintaining the beautiful appearance of the breast is also one of the important areas of treatment considerations.Drug conditioning is also required for a certain period of time after surgery to prevent recurrence. |
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