| Background:Granulomatous lobular mastitis(GLM),also known as idiopathic granulomatous mastitis,is a rare benign inflammation of the breast and a typical non-lactation mastitis.GLM usually presents with clinical symptoms of breast lumps,abscesses,inflammation and breast fistula,especially in women of childbearing age in their thirties and forties with a history of lactation.With the incidence increasing year by year,GLM has become a hot topic in the medical field.Current studies have shown that the causes of GLM include autoimmune diseases or inflammation caused by hypersensitivity to milk secretion,which are closely related to pregnancy history,smoking history,oral contraceptive history,α1-antitrypsin deficiency and other factors.Its pathogenesis is very complex and has not been fully elucidated at present.Modern medicine is mainly treated by surgery,anti-tuberculosis,hormone and so on,but it has a high recurrence rate and great damage to the appearance and function of the breast,which brings heavy psychological and economic burden to patients and families.Therefore,there is an urgent need for a treatment method with better curative effect,less trauma and lower recurrence rate.After decades of clinical experience,Professor Zhu Dongsheng believes that the treatment of traditional Chinese medicine combined with western medicine is effective in the treatment of this disease,and the recurrence rate is low,and it combines the concept of plastic surgery,which can protect the appearance of the breast and restore the function of the breast to the greatest extent,so it is one of the ideal schemes for clinical treatment of GLM at present.The purpose of this study is to evaluate the efficacy and safety of traditional Chinese medicine combined with western medicine in the treatment of GLM,and to provide some guidance and reference for the clinical treatment of GLM through a retrospective analysis of 162 cases,with the improved operation methods and the prescription of Professor Zhu Dongsheng,combined with the general law of the incidence of GLM,the therapeutic effect and recurrence of the disease were analyzed.Objective:Through a retrospective analysis of the general data and treatment of inpatients with GLM in the Breast Department of Oriental Hospital of Beijing University of traditional Chinese Medicine,to study the clinical characteristics of GLM,and through the treatment effect and analysis of GLM patients in our hospital,to provide reasonable suggestions for the current treatment of GLM.Methods:Collected GLM cases treated in our hospital from January 1,2015 to December 31,2018,and met the inclusion criteria.Collect and collate the original case information,including general data,clinical conditions and treatment,and the data were statistically analyzed by spss23.0.According to the case arrangement,the improved treatment program wasimplemented from May 23,2017 as the boundary,The patients who had been hospitalized before this period were treated as the treatment group,and the first-stage operation in this group was performed with ’breast abscess incision and debridement drainage’;After that,the hospitalized cases were treated as the improved group,and the one-stage operation inthis group was performed with "acute breast abscess debridement".Treatment combined with traditional Chinese medicine treatment.The study ends at the end of follow-up.Results:1.According to the statistics,it was found that there were 154 cases in accordance with the inclusion criteria,during the treatment of unilateral breast 146 people,treatment of bilateral 8 people,treatment of unilateral breast a total of 162 cases(treatment group 80 cases,improved group 82 cases).2.GLM mainly occurred in women of childbearing age,mostly in married women with a history of childbearing,only 4 cases had no history of pregnancy,the oldest was 48 years old,the youngest was 20 years old,and the average age was 32.81±4.673years old.3.The disease can occur in all four seasons,including the peripheral quadrant of the breast and the glands under the areola,and most of the lesions involve the peripheral quadrant.The most common manifestations of this disease were mass and sinus.In this study,multiple masses were the main symptoms,a total of 155 cases,only 2 cases showed no mass,which had a recent history of out-of-hospital surgery.74 cases were accompanied by sinus,72cases were accompanied by mass and sinus,accounting for 44.4%of the total.Before admission,the duration of the disease varied from 7 days to 3 years,with an average course of 3.00±3.506 months,with a median of 2 months.In the past history,there were 79 cases of cesarean section,69 cases of abortion,104 cases of ipsilateral nipple deformity and 61 cases of lactation disorder.94 cases were treated by invasive surgery in other hospital.4.Of the 154 patients treated in our hospital,8 had double breast disease and 2 were treated with double breast disease at the same time.Most of them take breast swelling and pain as the first symptom.The total number of treatment person-times was 162.After the comprehensive treatment of traditional Chinese and western medicine in our hospital,162 person-times were cured,the cure rate was 100%,and the recurrence rate of the improved treatment scheme was 3.7%.5.Most of the patients treated in our hospital were liver depression and phlegm coagulation.in the staging treatment plan,liver depression and phlegm coagulation were 107 and 51 respectively.In the treatment group,the top 16 frequency of traditional Chinese medicine were Bupleurum,Prunella vulgaris,Radix Arnebiae,dandelion,Angelica dahurica,Bletilla hyacinthina Reichb,seaweed,Hawthorn,Platycodon grandiflorum,Poria cocos,turmeric,trichosanthin,honeysuckle,Atractylodes macrocephala,Coix seed,Hedyotis diffusa.The top 16 drugs in the improved group were Bupleurum,Poria,Bletilla hyacinthina Reichb,Angelica,Radix Astragali,Angelica dahurica,honeysuckle,dandelion,elm,licorice,Radix Rehmanniae,Prunella vulgaris,Scutellaria baicalensis,Radix Paeoniae Rubra,corrugated seed,Cortex moutan.6.In this study,the days of dressing change in the improved group were significantly shorter than those in the treatment group,and the difference was statistically significant·The situation of multiple debridement in the improved group was also better than that in the treatment group,and the difference was statistically significant.There was no significant difference in recurrence rate between treatment group and improvement group.Conclusions:1.Most of the cases of this disease are married postpartum women.2.Galactostasis,nipple deformities,and autoimmune reactions are important factors in the onset of granulomatous mastitis in this study.3.Clinical manifestations:mostly manifested as the onset of the disease with no obvious predisposing mass,the systemic response is not obvious,as the disease progresses,the mass forms abscesses and ruptures and sinuses appear.Asking about the medical history often has a history of lactation disorder and allergies on the affected side.Physical examination showed malformation of the ipsilateral nipple,and most of the lesions involved the periphery of the breast.4.Treatment plan:The improved treatment plan can reduce the number of days for patients to change dressings,reduce the probability of re-debridement,and the effect is significantly better than the previous treatment plan.The overall clinical cure rate under the improved treatment plan was 100%,the overall recurrence rate was 3.7%,and the overall curative effect was significant.5.The complete elimination of necrotic tissue,increasing the ratio of invigorating qi and nourishing blood and reinvigorating sore muscles in oral traditional Chinese medicine can promote faster wound healing.With external medicine,it can promote wound healing,reduce postoperative breast shape loss and reduce recurrence rate.6.The improved treatment plan is better than before.It can be inferred that the organic combination of Chinese and Western medicine can further enhance the efficacy and reduce side effects. |
PDF Full Text Request