目的

探讨采用超声引导下脓肿穿刺术治疗哺乳期乳腺脓肿的效果,分析影响治愈所需穿刺次数的因素。

方法

回顾性分析2014 年5 ～10 月北京市海淀区妇幼保健院乳腺病防治中心应用超声引导下穿刺冲洗术治疗的108 例哺乳期乳腺脓肿患者的临床资料。 根据治愈乳腺脓肿所需的穿刺次数,将患者分为≤5 次和＞5 次2 组。 从患者年龄、产后时间、病程、发热与否、是否使用抗生素、脓肿位置、脓肿数量、脓肿最大径、首次穿刺脓液量、首次穿刺脓液性状及是否回乳等方面,采用χ² 检验进行单因素分析,将有意义的数据应用逐步Logistic 回归方法进行统计学分析。

结果

在108 例患者中,除3 例因穿刺效果不佳而中转手术外,其余105 例均获治愈,治愈率为97.2%(105/108)。 随访1 个月,复发1 例,复发率约为1.0%(1/105)。 在105 例患者中,治愈脓肿所需穿刺次数≤5 次者共78 例(占74.3%),＞5 次者27 例(占25.7%)。 单因素分析显示,脓肿位置、脓肿最大径及首次穿刺脓液量与治愈脓肿所需的穿刺次数有关(χ²=4.396、3.993、16.646,P=0.036、0.046 和P＜0.001)。 Logistic 回归分析显示,首次穿刺脓液量是穿刺次数的独立影响因素(OR=15.665,95%CI:3.423 ～71.697,P＜0.001)。

结论

应用超声引导下脓肿穿刺术治疗哺乳期乳腺脓肿的方法值得推广。 根据首次穿刺的脓液量或许可以预测治愈哺乳期乳腺脓肿所需要的穿刺次数。

Objective

To investigate the therapeutic effects of ultrasound-guided aspiration in patients with lactational breast abscess and explore the factors affecting the times of aspirations for healing the breast abscess.

Methods

The clinical data of 108 patients with lactational breast abscess treated by ultrasoundguided aspiration and irrigation in the Center for Prevention and Treatment of Breast Diseases, Maternal and Child Health Hospital of Haidian District from May 2014 to October 2014 were retrospectively analyzed.According to the times of aspirations,the patients were dived into two groups:group A (≤5 times) and group B(＞5 times). χ² test was used for single-factor analysis of the following factors: patients' age, time after childbirth, duration, fever, use of antibiotics, position of abscess, number of abscesses, maximum diameter of abscess,pus volume in the first aspiration,pus feature in the first aspiration and milk regurgitation. The factors with statistical significance were enrolled into stepwise Logistic regression analysis.

Results

In 108 cases,105 cases were cured and 3 cases underwent surgery because of unsatisfactory outcome after aspiration. The cure rate was about 97.2%(105/108). They were followed up for one month. One case had recurrence, with the recurrence rate of about 1.0% (1/105). In 105 cured cases, 78 cases (74.3%) had the aspirations ≤5 times and 27 cases (25.7%) had the aspirations ＞5 times for healing the breast abscess. Single-factor analysis showed that the position of breast abscess, maximum diameter of abscess and pus volume in the first aspiration were related to the times of aspirations for healing the breast abscess (χ²=4.396,3.993,16.646;P=0.036,0.046, P＜0.001). Logistic regression analysis showed that pus volume in the first aspiration was an independent factor affecting the times of aspirations (OR=15.665,95%CI:3.423-71.697,P＜0.001).

Conclusions

Ultrasound-guided aspiration is feasible for lactational breast abscess, worthy of clinical application. The pus volume in the first aspiration may be an important factor to predict the times of aspirations for healing lactational breast abscess.