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中华乳腺病杂志(电子版)

中华乳腺病杂志(电子版) ›› 2016, Vol. 10 ›› Issue (02) : 92 -96. doi: 10.3877/cma.j.issn.1674-0807.2016.02.006

论著

超声引导下多向式负压引流联合敏感抗生素冲洗治疗乳腺脓肿的临床效果评价
尹永硕1,†(), 冠潇2, 王月美3, 马晓1, 黄艳丽1   
  1. 1.250001 济南市妇幼保健院乳腺病诊疗中心
    2.250001 济南市妇幼保健院超声科
    3.250012 济南,山东大学齐鲁医院健康体检中心
  • 收稿日期:2015-09-27 出版日期:2016-04-01
  • 通信作者: 尹永硕

Ultrasound-guided minimally invasive intervention and rinsing with sensitive antibiotics for breast abscess

Yongshuo Yin1,†(), Xiao Guan2, Yuemei Wang3, Xiao Ma1, Yanli Huang1   

  1. 1.Breast Disease Center,Qilu Hospital of Shandong University, Jinan 250012, China
    2.Center for Health Examination, Qilu Hospital of Shandong University, Jinan 250012, China
    3.Department of Ultrasonography, Jinan Maternal and Child Care Hospital, Jinan 250001, China
  • Received:2015-09-27 Published:2016-04-01
  • Corresponding author: Yongshuo Yin
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尹永硕, 冠潇, 王月美, 马晓, 黄艳丽. 超声引导下多向式负压引流联合敏感抗生素冲洗治疗乳腺脓肿的临床效果评价[J/OL]. 中华乳腺病杂志(电子版), 2016, 10(02): 92-96.

Yongshuo Yin, Xiao Guan, Yuemei Wang, Xiao Ma, Yanli Huang. Ultrasound-guided minimally invasive intervention and rinsing with sensitive antibiotics for breast abscess[J/OL]. Chinese Journal of Breast Disease(Electronic Edition), 2016, 10(02): 92-96.

目的

探讨超声引导下微创介入联合敏感抗生素冲洗治疗乳腺脓肿的临床应用。

方法

回顾性分析2014年1月至2015年7月济南市妇幼保健院乳腺病诊疗中心收治的88 例哺乳期乳腺脓肿患者资料,按不同治疗方法分为试验组和对照组(各组n=44),试验组行超声引导下多向式负压引流联合敏感抗生素冲洗治疗,对照组行传统乳腺脓肿切开引流术。 采用t 检验比较两组患者在切口愈合时间、换药次数方面的差异,用χ2 检验比较两组患者在疼痛级别、继续哺乳情况以及术后乳瘘发生率方面的差异,并分析哺乳期乳腺脓肿病原菌的分布。

结果

试验组与对照组相比,两组患者在换药次数、切口愈合时间方面的差异具有统计学意义[(5.27±0.22)次比(15.43±0.55)次、(10.70±2.90) d比(22.70±6.55) d,t=-17.027、-11.102,P 均＜0.050]。 试验组与对照组相比,两组患者在疼痛程度、术后乳瘘发生及能否继续哺乳方面的差异也具有统计学意义(χ2 =17.634、15.529、14.864,P 均＜0.050)。 哺乳期乳腺脓肿细菌感染主要为金黄色葡萄球菌(48/56, 85.72%)。

结论

超声引导下多向式负压引流联合敏感抗生素冲洗治疗乳腺脓肿的临床效果好,能明显减轻患者创伤和痛苦,缩短愈合时间是一种值得推广应用的治疗乳腺脓肿的方法。

关键词: 乳腺炎, 脓肿, 超声检查,介入性, 负压伤口疗法

Objective

To investigate the clinical application of ultrasound-guided minimally invasive intervention and rinsing with sensitive antibiotics in treatment of breast abscess.

Methods

Totally 88 patients with lactational breast abscess in Jinan Maternal and Child Care Hospital from January 2014 to July 2015 were divided into experimental group (n=44) and control group (n=44) according to their treatment scheme. The experimental group received ultrasound-guided multidirectional negative pressure drainage and rinsing with sensitive antibiotics and the control group received traditional incision and drainage. t test was used to compare wound healing time and times of dressing change between two groups. χ2 test was used to compare the difference between two groups in pain scale, postoperative breast-feeding rate and incidence of postoperative breast fistula. Meanwhile, the pathogen distribution of lactational breast abscess was also analyzed.

Results

There were significant differences in wound healing time [(10.70±2.90) d vs (22.70±6.55) d] and times of dressing change (5.27±0.22 vs 15.43±0.55) between the experimental group and control group (t =-17.027, -11.102, all P ＜0.050). The pain scale, postoperative breast-feeding rate and incidence of postoperative breast fistula also indicated a significant difference between two groups (χ2 =17.634, 15.529,14.864, all P＜0.050). The pathogen of lactational breast abscess was mainly staphylococcus aureus (48/56,85.72%).

Conclusion

Ultrasound-guided multidirectional negative pressure drainage and rinsing with sensitive antibiotics can decrease the pain and shorten healing time in patients with breast abscess, worthy of clinical application.

Key words: Mastitis, Abscess, Ultrasonography,interventional, Negative-pressure wound therapy
表1 两组乳腺脓肿患者切口愈合时间与换药次数(±s)
分组 例数 愈合时间(d) 换药次数(次)
试验组 44 10.70±2.90 5.27±0.22
对照组 44 22.70±6.55 15.43±0.55
t值 -11.102 -17.027
P值 ＜0.001 ＜0.001
图1 多向式负压引流联合敏感抗生素冲洗治疗乳腺脓肿 注:a 图示多向式负压引流联合敏感抗生素冲洗治疗患者乳腺脓肿部位负压置管引流,脓肿累及乳头处溃烂;b 图示多向式负压引流联合敏感抗生素冲洗治疗患者乳腺脓肿部位局部的愈合面
表2 两组乳腺脓肿患者疼痛级别比较[n(%)]
分组 例数 疼痛级别
0级 1～3级 4～6级 7～9级
试验组 44 2(4.6) 35(79.5) 6(13.6) 1(2.3)
对照组 44 1(2.3) 17(38.6) 20(45.5) 6(13.6)
χ2值 17.634
P值 ＜0.001
图2 患者乳腺脓肿治疗前后的超声形态图 注:a 图所示,超声下乳腺脓腔的原始形态,显示为4.9 cm×1.9 cm 的不均质无回声区,边界增厚,内见密集光点回声,腔内分隔形成;b 图所示,超声下微创治疗后负压引流管残存的窦道形态,显示为1.3 cm×0.4 cm 的无回声区,内透声好
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