| Background:Granulomatous lobular mastitis（GLM）is a chronic benign breast disease confined to the breast lobules and characterized by non-caseous necrotizing granuloma of the breast[1].It was first proposed by Kessler and Wolloch in 1972[2].This disease is good at postpartum 2-6 years of non-lactating women of childbearing age.Its initial visible unilateral or bilateral breast lumps,after the development of the local lumps can be manifested in swelling,purulent,rupture,sinus,etc.,the course of disease and high recurrence rate,known as"deathless cancer".Because most of the clinical manifestations are breast lumps with unclear boundaries and irregular shapes,it is easy to be misdiagnosed as breast cancer,plasma cell mastitis and breast tuberculosis and other diseases,resulting in mistreatment and mistreatment.The etiology and pathogenesis of this disease are not clear yet.Most clinical doctors believe that the occurrence of this disease may be related to autoimmune reaction,hypersensitivity of milk,dysregulation of hormone levels in vivo and other problems.The risk factors may be related to the history of local breast trauma,long-term use of psychiatric drugs such as anti-anxiety and depression,emergency contraception,recent abortion,nipple inversion,irregular menstruation and other factors.At present,there are many differences in the treatment plan of this disease at home and abroad.Western medicine treatment means such as surgery,immunosuppressant,hormone,antibiotic,etiology treatment are more common.The treatment of this disease in Chinese medicine mainly focuses on internal treatment and external treatment,and domestic experts have formed a basic consensus on the treatment plan.However,due to the complexity of the disease and its protracted course and susceptibility to recurrence,and the lack of unified conclusion on etiology and treatment,the clinical diagnosis and treatment of GLM still face great challenges,which require further exploration and research.The author follow teachers based on the actual clinical work found that teacher has taught according to many years clinical experience concluded that for a granulomatous lobular mastitis treatment,should give full play to the combined with Chinese medicine and modern medicine their advantages,through the combination of Chinese and western medicine comprehensive treatment of the disease by stages,curative effect is distinct,and the recurrence rate is low,at the same time to maximize the chance that the breast appearance,the clinical satisfaction is high.Objective:The purpose of this study was to investigate the etiology,characteristics,clinical manifestations,stages and types of granulomatous lobular mastitis,as well as the methods of treating GLM with integrated traditional Chinese and western medicine.Through retrospective analysis,the case data of Professor Zeng Yi’s GLM outpatient department were sorted out,and the clinical characteristics and diagnosis and treatment experience of granulomatous lobular mastitis were summarized and analyzed,in order to provide further reference for the clinical work of the majority of practitioners.Methods:The cases of granulomatous lobular mastitis diagnosed by pathology were collected from Professor Zeng Yi’s Breast Surgery Department of the First Affiliated Hospital of Tianjin University of Chinese Medicine.By referring to the case data system in the hospital,a questionnaire was developed to collect the original information of the cases,including general information,clinical condition,treatment and recovery,etc.,and the classified and registered data were analyzed retrospectively,including the clinical characteristics,possible inducing factors,treatment course and recovery.Excel software was used to summarize the data,and SPSS 21.0 data software was used for statistical analysis.RESULTS:1.169 patients with granulomatous lobular mastitis were all female,and the onset age was mainly between 31 and 35 years old,with a median age of 33 years old.The onset population was mainly postpartum postpartum women who were 2-5 years old.2.The disease can occur all the year round.The mean BMI was 25.54kg/m2and the standard deviation was 3.85 kg/m2.Those with BMI≥24kg/m2accounted for 61.54%.3.Among the patients included in this study,97.63%were fertile patients and 2.37%were unfertile patients.95.15%of the patients got pregnant naturally,3.03%of the patients got pregnant by ovulation induction,and 1.82%of the patients got pregnant by IVF.In addition,58.79%of the patients had a history of lactation,21.30%had a history of milk blocking during lactation,and 41.21%of the patients did not lactation.There was no obvious abnormality in menstruation in 63.91%of the patients.4.Before the onset,31.95%of the patients had a history of breast trauma;23.67%patients had mood mutation;23.08%of patients had a history of sudden fatigue;13.02%patients had a history of taking special drugs;12.43%of the patients had a history of breast ductectasis;9.47%patients had a history of abnormal food consumption;4.73%had a history of abortion;2.37%of patients had residual lesions after surgery in other hospitals.5.Among the patients admitted to our hospital,78.11%had the first attack,17.16%had the second attack,and 4.73%had the third attack or more.6.92.90%of the patients had unilateral disease and 7.10%of the patients had bilateral disease.One quadrant was involved in 69.23%of patients,two quadrants were involved in23.67%of patients,three quadrants were involved in 2.96%of patients,and four quadrants were involved in 4.14%of patients.7.91.12%of the patients visited our hospital with breast mass as the first symptom.For the first time,75.74%of the patients with breast pain of different degrees,75.74%of the patients with breast duct dilatation,52.66%of the patients with breast local redness and swelling,32.54%of the patients with nipple secretion,31.95%of the patients with nipple inflexion or deformity,and 26.63%of the patients with skin ulceration accounted for.8.22.49%of patients with fever of different degrees,17.75%with pain in different parts of the body,13.02%with fatigue of different degrees,10.06%with erythema nodosum of the extremities,and 7.69%with cough caused by non-pulmonary diseases at the time of consultation.9.At the time of consultation,47.34%of the patients were accompanied by increased inflammatory indexes;Abnormal increase or decrease of the six female hormone indexes in63.31%of the patients,among which the patients with elevated prolactin level accounted for the highest 29.58%.10.The internal treatment of traditional Chinese medicine is based on the addition and subtractionof oral administration of Yanhe Decoction.Among them,drugs for tonifying deficiency account for 23.91%at most,drugs for clearing heat account for 21.74%in the second place,and drugs for promoting blood circulation and removing blood stasis account for 11.96%in the third place.The others include Qi regulating drugs,phlegm reducing drugs,moistening drugs,tranquilizing drugs,antiphlegm drugs,dampening drugs,hemostasis drugs,astringent drugs,liver calming and wind extinguishing drugs,warm li drugs,wind dampening drugs,etc.Xihuang capsule accounted for 99.41%,followed by Xiaojin pill accounted for38.46%.External treatment of traditional Chinese medicine（TCM）for patients without ulcers is mainly based on external dressing to reduce swelling,disperse knots and relieve pain.After ulcers,the local lesions are scratched and explored on the principle of supporting toxin out,lifting pus and removing rot to fully change the dressing.After that,TCM gauze made in the hospital is used to fill the wound for full drainage.Western medicine surgery was divided into debridement and drainage treatment group（13.01%）and debridement/incision and drainage+debridement and suture treatment group（86.98%）.11.The correlation between lesion size and age,BMI value and PRL value of 20 patients in mass stage admitted to our hospital without any treatment was analyzed.The results showed that there was no correlation between lesion size and age and PRL value,but there was positive correlation with BMI value.12.All the patients included in this study were treated by stage and comprehensive treatment with integrated traditional Chinese and western medicine.The statistical results of the overall curative effect showed that 72.19%of the patients reached the cure standard after3-6 months follow-up,23.67%of the patients reached the clinical cure,0%of the patients did not recover,the overall recurrence rate was 4.14%,and the new incidence rate was 10.65%.The statistical results of the overall postoperative repair time showed that 18.34%of the patients with the postoperative repair time were 1-3 months,34.91%of the patients with 3-6months,29.59%of the patients with 6-12 months,and 17.16%of the patients with the postoperative repair time greater than or equal to 12 months.The statistical results of breast shape recovery showed that after treatment,the breast size and shape were roughly the same as the opposite breast（excellent）accounted for 52.67%;the breast retraction or skin change involved less than 1/4 of the original（good）accounted for 34.91%;the breast retraction or skin change involved 1/2-1/4 of the original（normal）accounted for 6.51%.The cases involving more than 1/2 breast deformity accounted for 5.92%.The statistical results of the overall breast shape satisfaction showed that 11.24%of the patients were very satisfied,65.09%were satisfied,17.75%were generally satisfied,and 5.92%were not satisfied with the shape.13.According to whether incision and drainage were performed,169 patients were divided into direct surgery group and secondary surgery group.The general conditions,symptoms and signs of patients in the direct operation group and the secondary operation group were compared.The statistical results showed that in general,there was no significant difference in age and BMI between the two groups（P>0.05）,but there was a significant difference in breastfeeding（P=0.006<0.05）.In terms of symptoms and signs,there were no significant differences between the two groups in the site of onset,lesion involvement quadrant,PRL,local symptoms,systemic symptoms,initial course of disease,staging type,and the longest diameter of the lesion as shown by color ultrasound（P>0.05）.In the case of recovery,there was a significant difference in the postoperative repair time between the two groups（P=0.017<0.05）,and the repair time of the direct surgery group was shorter than that of the secondary surgery group,but there was no significant difference in the recovery,recurrence,breast shape and shape satisfaction of the two groups（P>0.05）.Conclusions:1.According to the results of this study,it is speculated that the onset of GLM is common in postpartum women within 2-5 years.2.The disease can come on all the year round,the pathogenesis is unknown,and the inducing factors are complex and diverse,considering that the disease is most closely related to the endocrine system and the immune system.In this study,it was found that there was a positive correlation between lesion size and BMI value,but the specific demonstration still needs to be further studied.3.In this study,the incidence of this disease was more common in the left breast,and more common in the inner upper quadrant and outer upper quadrant of the first site.Clinically,breast lumps are the first symptoms of treatment.With the progression of the disease or the delay of previous treatment,local lesions may appear redness,swelling and pain,or rupture and pus,forming sinus fistula and other manifestations.Heavy people can be accompanied by fever,cough,general fatigue,limb joint pain,inconvenient movement and lower limb nodular erythema and other systemic symptoms.The abnormal elevation of inflammatory markers and PRL value were most common in laboratory examination.Bacterial culture results of pus were mainly aseptic growth.The diagnosis of this disease is mainly based on histopathological examination as the gold standard.4.GLM was treated by integrated traditional Chinese and western medicine in this study.The application of traditional Chinese medicine treatment of internal treatment and external treatment combined with limited lesions,the toxin out,internal treatment to Yang and Tang Hua Qing to add and subtraction to warm Yang disperse cold,phlegm anticoagulant,blood tonic stagnation,supplemented by Xihuang capsule,Xiaojin pill and other Chinese medicine Sanjie detumescent pain relief;Before the external treatment is broken,the external application is used to reduce swelling and relieve pain.After the broken,the local lesions and the sinus are scratched and explored to change the dressing,and the wound is filled with a twist made from pharmaceutical yarn in the hospital.The self-made twist is easy to make,the surface is smooth and conducive to drainage,and the drugs can continue to act slowly on the wound.This dressing change method can effectively remove necrotic tissue,shorten the course of disease,and promote the limitation of lesion area.Western medicine treatment is based on the treatment of traditional Chinese medicine,mainly surgery combined with symptomatic adjuvant treatment of drugs.Surgical treatment includes debridement/incision and drainage+debridement and suture or simple debridement and suture.Debridement/incision and drainage are beneficial to the relief of local breast symptoms and systemic symptoms,and promote the discharge of necrotic tissue from local lesions.When the time is ripe,debridement and suture can be performed to completely remove the lesions.Pure debridement and suture was also performed on the basis of traditional Chinese and western medicine treatment,and the lesions were completely removed when the time was ripe.Antibiotics should be used reasonably for anti-infection treatment after operation.Patients with systemic symptoms also need to review the cause of symptomatic treatment according to the actual situation to promote recovery and prevent recurrence.Among them,the treatment of traditional Chinese medicine plays an important role in limiting the scope of the lesion,shortening the course of the disease,promoting the progress of treatment,promoting the timing of surgery,ensuring the appearance and recovery of the breast,consolidating treatment and preventing recurrence,etc.5.The combination of traditional Chinese and western medicine has a significant effect on the treatment of this disease,with low recurrence rate,less breast shape damage and high patient satisfaction.According to the severity of the patient’s condition and the progression of the disease,patients in need of medical treatment can reasonably choose the optimal treatment according to the patient’s own situation and personal will.All the treatments in this study can be used as effective treatments for GLM as long as they are properly used. |
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