无引流微创旋切术治疗坏死型乳腺脓肿的临床研究

doi:10.3877/cma.j.issn.1674-0807.2020.03.004

目的

探讨真空辅助微创旋切术后不放置引流管治疗坏死型乳腺脓肿的临床效果。

方法

依据纳入、排除标准，选取北京市海淀区妇幼保健院2015年1月至2018年7月收治的73例哺乳期坏死型乳腺脓肿患者进行前瞻性研究。采用随机数字表法将患者分为研究组(35例)和对照组(38例)。研究组采用真空辅助微创旋切术治疗，术后不放置引流管；对照组采用脓肿置管冲洗引流术治疗。比较2组间治疗指标(术后住院时间、复诊次数)、并发症(乳瘘)及预后(回乳、复发)的差异。偏态分布的计量资料用M(P₂₅～P₇₅)表示。术后住院时间、复诊次数的比较采用Mann-Whitney U检验；回乳率、复发率及乳瘘发生率的比较采用χ²检验及Fisher确切概率检验。

结果

研究组与对照组患者术后住院时间分别为5.0(3.0～7.0) d和10.5(8.0～13.3) d，复诊次数分别为3.0(2.0～6.0)次和7.5(3.0～10.0)次，乳瘘发生率分别为2.9%(1/35)和21.1%(8/38)，组间比较，差异均有统计学意义(Z＝－5.704，P<0.001；Z＝－3.626，P<0.001；P＝0.029)，而回乳率、复发率比较，差异均无统计学意义[回乳率：20.0%(7/35)比39.5%(15/38)，χ²＝3.282, P＝0.070；复发率：8.6%(3/35)比7.9%(3/38)，P＝1.000]。

结论

对于脓腔内充满坏死组织的复杂乳腺脓肿，真空辅助微创旋切术后不放置引流管，患者不需特殊护理，术后住院时间短，复诊次数少，可提高母亲患病期间的生活质量。

关键词: 乳腺疾病, 脓肿, 外科手术，微创性, 穿刺术

Objective

To explore the clinical effect of vacuum-assisted minimally invasive resection without catheter drainage for necrotic breast abscess.

Methods

According to the inclusion and exclusion criteria, 73 patients with puerperal necrotic mammary abscess in the Haidian Maternal and Child Health Hospital from January 2015 to July 2018 were enrolled for a prospective study. The patients were divided into study group (35 cases) and control group (38 cases) by random number table method. The study group was treated with vacuum-assisted minimally invasive resection without catheter drainage, and the control group was treated by catheter flushing and drainage. The differences of treatment indicators (length of postoperative hospital stay, times of subsequent visits), complications (breast fistula) and prognosis (weaning, recurrence) were compared between the two groups. The quantitative data with skewed distribution were expressed as M(P₂₅-P₇₅), and Mann-Whitney U test was used to compare length of postoperative hospital stay and times of subsequent visits. The χ² test and Fisher’s exact test were used to compare the weaning rate, recurrence rate and incidence of breast fistula.

Results

The length of postoperative hospital stay, times of subsequent visits after discharge and the incidence of breast fistula in the study group and control group were 5.0(3.0-7.0) d and 10.5(8.0-13.3) d, 3.0(2.0-6.0) and 7.5(3.0-10.0), 2.9% (1/35) and 21.1% (8/38), respectively, indicating a significant difference (Z=-5.704, P<0.001; Z=-3.626, P<0.001; P=0.029). There was no significant difference in the weaning rate and recurrence rate [weaning rate: 20.0% (7/35) vs 39.5% (15/38), χ²=3.282, P=0.070; recurrence rate: 8.6% (3/35) vs 7.9% (3/38), P=1.000].

Conclusion

For the breast abscess with necrotic tissues in the cavity, vacuum-assisted minimally invasive resection without catheter drainage is feasible, with the advantages of no special nursing, short length of hospital stay, reduced subsequent visits and improved quality of life for puerperal women.

Key words: Breast diseases, Abscess, Surgical procedures, minimally invasive, Punctures

图1 乳腺脓肿患者行微创旋切术前局部表现

图2 乳腺脓肿患者行微创旋切术前超声表现

图3 乳腺脓肿患者行微创旋切术中超声表现

图4 乳腺脓肿患者行微创旋切术后3 d乳房表现

图5 乳腺脓肿患者行微创旋切术后7 d乳房表现

图6 乳腺脓肿患者行微创旋切术后10 d乳房表现

表1 研究组与对照组乳腺脓肿患者基线资料比较

组别	例数	发病年龄	产后发病时间	病程	最高体温	脓腔最大径	脓腔位置(例)
组别	例数	(岁，±s)	(d，±s)	(d，±s)	(℃，±s)	(cm，±s)	中央区	非中央区
研究组	35	29.3±3.4	49.7±15.3	9.8±3.0	38.4±1.0	9.4±2.6	6	29
对照组	38	30.5±2.9	46.3±21.6	10.5±2.8	38.5±0.8	8.8±2.7	13	25
检验值	?	t＝1.578	t＝－0.774	t＝0.918	t＝0.238	t＝1.038	χ²＝2.757
P值	?	0.431	0.084	0.885	0.098	0.303	0.097

表1 研究组与对照组乳腺脓肿患者基线资料比较

组别	例数	发病年龄	产后发病时间	病程	最高体温	脓腔最大径	脓腔位置(例)
组别	例数	(岁，±s)	(d，±s)	(d，±s)	(℃，±s)	(cm，±s)	中央区	非中央区
研究组	35	29.3±3.4	49.7±15.3	9.8±3.0	38.4±1.0	9.4±2.6	6	29
对照组	38	30.5±2.9	46.3±21.6	10.5±2.8	38.5±0.8	8.8±2.7	13	25
检验值	?	t＝1.578	t＝－0.774	t＝0.918	t＝0.238	t＝1.038	χ²＝2.757
P值	?	0.431	0.084	0.885	0.098	0.303	0.097

表2 研究组与对照组乳腺脓肿患者治疗指标比较[M(P₂₅～P₇₅)]

组别	例数	术后住院时间(d)	复诊次数(次)
研究组	35	5.0(3.0～7.0)	3.0(2.0～6.0)
对照组	38	10.5(8.0～13.3)	7.5(3.0～10.0)
Z值	?	－5.704	－3.626
P值	?	<0.001	<0.001

表2 研究组与对照组乳腺脓肿患者治疗指标比较[M(P₂₅～P₇₅)]

组别	例数	术后住院时间(d)	复诊次数(次)
研究组	35	5.0(3.0～7.0)	3.0(2.0～6.0)
对照组	38	10.5(8.0～13.3)	7.5(3.0～10.0)
Z值	?	－5.704	－3.626
P值	?	<0.001	<0.001

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Vacuum-assisted minimally invasive resection without catheter drainage for necrotic breast abscess

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Vacuum-assisted minimally invasive resection without catheter drainage for necrotic breast abscess