目的

探讨超声引导下穿刺灌洗术在治疗哺乳期乳腺脓肿中的临床应用价值。

方法

回顾分析2012 年5 月至2015 年10 月成都市妇女儿童中心医院收治的99 例脓腔≥2 个的哺乳期乳腺脓肿患者临床资料,其中超声引导下脓肿穿刺灌洗组51 例,脓肿切开置管引流(切开引流组)48 例。 比较2 组患者的穿刺/换药次数、住院时间、住院费用、回乳率和乳瘘发生率,其中,组间穿刺/换药次数比较采用t 检验,住院时间和住院费用呈偏态分布,且方差不齐,因此用M(P₂₅ ～P₇₅)表示,组间比较采用秩和检验,率的比较采用χ²检验。

结果

穿刺灌洗组患者穿刺/换药次数、住院时间和住院费用均低于切开引流组[(2.1±1.0)次比(4.1±1.0)次,t=-10.003, P＜0.001; 7(6 ～8) d 比10(8 ～12) d,Z=-6.026,P＜0.001;3 808.0(3 381.7 ～4 328.1)元比5 824.9(4 937.1 ～8 329.0)元,Z=-6.872, P＜0.001]。 穿刺灌洗组患者回乳率和乳瘘发生率也均低于切开引流组[58.8% (30/51)比95.8% (46/48),χ² =18.991, P＜0.001;0 比37.5%(18/48),χ²=23.375, P＜0.001]。

结论

超声引导下穿刺灌洗术具有操作次数少、住院时间短、住院费用低、回乳率和乳瘘发生率低等优点,在哺乳期乳腺脓肿的治疗中较脓肿切开引流术具有明显的优势,在临床上具有很好的应用价值。

Objective

To investigate the clinical application value of ultrasound-guided needle aspiration for lactational breast abscess.

Methods

A total of 99 patients with lactational breast abscess(≥2 pus cavities) admitted in Chengdu Women and Children's Central Hospital between May 2012 and October 2015 were retrospectively analyzed. Fifty-one patients received ultrasound-guided needle aspiration(needle aspiration group), while 48 received incision and drainage (incision and drainage group). The times of aspiration/dressing change, hospital stay and hospitalization expense, rate of milk withdrawal and rate of breast fistula were compared between these two groups. χ² test was used for comparison on rates, and t test was used for comparison on times of aspiration/dressing change. Because of the skewed distribution and heterogeneous variance, the data on hospital stay and hospitalization expense were expressed as M(P₂₅ ～P₇₅)and compared by rank sum test.

Results

The detected indexes in needle aspiration group were all significantly lower than those in incision and drainage group, including times of aspiration/dressing change (2.1±1.0 vs 4.1±1.0, t=-10.003, P＜0.001), hospital stay [ 7(6-8) d vs 10(8-12) d, Z=-6.026, P＜0.001],hospitalization expense [3 808.0(3 381.7-4 328.1) yuan vs 5 824.9(4 937.1-8 329.0) yuan, Z=-6.872,P＜0.001], rate of milk withdrawal [58.8%(30/51) vs 95.8%(46/48),χ²=18.991, P＜0.001] and rate of breast fistula [0 vs 37.5% (18/48), χ² = 23.375, P ＜0.001].

Conclusion

Ultrasound-guided needle aspiration has significant advantages over incision and drainage for the treatment of lactational breast abscess,including fewer times of aspiration/dressing change, shorter hospital stay, lower hospitalization expense,decreased rate of milk withdrawal and breast fistula, regarded as an effective method for clinical application.