| Research background:Granulomatous lobular mastit is is a chronic breast inflammation characterized by non-caseous granuloma in the lobule of the bre ast,which often occurs in postpartum and non-lactating women.With the incidence increas ing year by year,it has attracted the a ttention of clinical physici ans,with the formation of breast masse s,abscesses and sinuses as the main manifestations.Modern medical research believes that the disease is caused by abnormal autoimmunity and belongs to a kind of aseptic inflammatory react ion.The etiology and pathogenesis of the disease are unclear,and there is no unified standard for diagnosis.in clinic,it ma inly depends on clinical manifestations,medical history and the experience of doctors to make exclusive diagnosis.histopathology is the "gold standard" of diagnosis.There are a variety of treatment methods for this disease,and no guidelines have been f ormed.The conservative treatment drugs in western medicine are mainly steroids and antibiotics,including immunosuppressants and triple anti-tuberculosis therapy.Antibiotics can obviously reduce local redness and swelling.Hormone can quickly reduce the mass,causing a "false appearance" to patients,but it can not be cured completely,and s urgery is still the main treatment metho d.At present,the commonly used surgical methods include mass lesi on resection,extended mass resection,simple mastectomy,br east gland valve plasty and so on.There is no obvious dispute in clinic and the curative effect is good,but the lesions of GLM are not limited to one quadr ant,most of them are sporadic,multipl e,or even spread throughout the breast,which greatly incre ases the difficulty of operation and is easy to remain lesions.If the amount of glands r emoved is too much,the defect reaches 20%,and the breast shape is seriously damaged.Therefore,I think it is a difficult point in clinical treatment for severe GLM patients with large breast mass,insensitive hormone therapy,non-red,non-swollen,diffi cult to collapse stiff mass formed after long-term use of antibiotic s,focus involving multiple quadrants,formation of large area abscess,abscess ulceration or incis ion and drainage wound that does not heal for a long time to form multiple sinuses.Granulomatous lobular mastitis is a difficult and complicated disease in breast diseases.The tutor believes tha t surgery is the best way to treat the disease.Only by thoroughly eliminating the root cause of the disease-focus,can the recurrence rate be greatl y reduced.Whether the treatment is succ essful or not is closely related to the mode of operation and the t iming of operation,and it is not a generalization to adopt "one-size-fits-all" and "one-pot end".After years of clinical experience,the tutor summ ed up a comprehensive treatment model of integrated traditional Chin ese and western medicine for the treatm ent of the disease.Traditional Chinese medicine surgical wo und treatment techniques such as nibbling and debridement,curetting,cotton twisting and removing rot,hoop penetration medicine and other characteristic tr eatments of traditional Chinese medicine are combined with surgical debridement and breast tissue f lap plastic surgery to achieve complete debridement and maximum preservation of glandular tissue,according to disease stages,co mbined with local dialectica l theory of traditional Chinese medicin e surgery.From the five aspects of distinguishing yin and yang,abscess,collapse,sore shape and color,light decay and severe decay,as well as the selection of different surgical method s by ultrasonic examination,starting from the overall concept of t raditional Chinese medicine,the whole process is combined with oral traditional Chinese medicine decoction.Satisfactory curative effect has been ob tained in improving clinical curative ef fect,maintaining breast app earance,reducing recurrence rate and s o on,which is worthy of clinical promotion and reference.Purpose of the study:Through a retrospective study of the incidence and clinical characte ristics of patients with granulomatous l obular mastitis diagnosed an d treated by First Affiliated Doctor of Tianjin University of Traditional Chinese Medicine(hereinafter referred to as "our department"),the pathogenesis of GLM was summarized,the etiology and pathogenesis of GLM were discussed,and the clinical effects of GLM patients treated by diffe rent surgical methods were analyzed in order to provide a more reasonable treatment for the disease.Research methods:The patients who met the inclusion and exclusion criteria were collected from January 2019 to Dec ember 2020.According to the disease sta ge and local syndrome differ entiation,the patients were treated with one-time debridement and staged operation respectively.O ne-time debridement is to thoroughly remove the focus and denatured glandular tissue,sut ure the wound in one stage,perform loca l relaxation,scratching,ni bbling and debridement by stages,fully explo re the concealed focus,retain reversible glandular ti ssue,VS D continuous negative pressure irrigation and drainage after operation,cooperate with traditional Chinese medicine gauze to fill the wound cavity and accelerate the decay,when the surrounding inflammatory reaction is obviously alleviated,the swe lling subsided,and the rot is reborn.Elective two-stage complete debridement and plastic repair of adjacent tissue flap were pe rformed.The clinical data of patients were selected and collected and so rted out.SPSS21.0 software was used for statistical treatment,and the clinical effect was evaluated from three aspects:treatment time,recur rence rate and breast appearance.The results of the study are as follows:1.A total of 56 patients with GLM were included in this study,all female,the age of onset was between 25 and 42 years old,the average age of onset was32.60 ±3.84 years old,the high incidence age was 30-40 years old(69.64%),47 cases had regul ar menstruation(89.47%),9 cases(16.07%)ha d delayed menstruation or advanced menstruation.94.64 % of the patients had a history of childbearing,1 case was unmarried and infertile,2 ca ses occurred during pregnancy,and the i ncidence was the highest in 1-3 years after delivery(41.07%);BMI normal 24 cases(42.86%),overweight 16 cases(28.57%),obes e 16 cases(28.57%).2 cases(3.57%)had a history of breast trauma,only 1 case(1.79%)had a history of taking antipsychotic dr ugs,1 case(1.79%)had a history of pituitary adenomas,1 case(1.79%)h ad immune system diseases,and 22 cases(39.29)had a history of nipple depression.2.In this study,the course of disease varied before admis sion,focusing on about 3 months,and th e treatment was mainly oral antibiotics and traditional Chinese patent medicine.Unilateral breast disease occurred in 54 cases(96.42%),including red skin color and high skin temperature in 39 cases(51.76%),absce ss in 36 cases(64.29%),abscess rupture or incision and drainage in 21 cases(27.37%),nodular erythema in both lower limbs in 1 case(0.02%).The mass mostly occurred in the periphery of the breast,mainly outside the upper quadrant in 33 cases(58.93%),nipple areola in 17 cases(33.36%),and more than 2quadrants were involved in the mass(82.Laboratory examinati on showed leukocytosis in 24 cases(42.86%),prolactin elevation in 15 cases(26.79%),bacterial culture positive in 18 cases(32.14%),and Sta phylococcus epidermidis was the most common.3.Most of the 56 patients had a medical history outside the hospita l.according to the clinical manifestations and diseas e stages in our hospital,there were 14 cases in mass stage,19 cases in abscess stage an d 23 cases in late ulceration stage.4.There was no significant difference in general data between the two group s,including age,body mass index,course of disease b efore admission,mass size,distribution of involved quadrant,clinical manifestation and so on(P > 0.05).After two different s urgical treatments,there we re significant differences in treatment time and recurrence rate between the two groups(P < 0.05).The treatment time in the one-time debridement group was significantly shorter than that in the staging operation group,but the recurrence rate was higher than that in the staging operation group.the re was no significant difference in breast appearance(P > 0.05).Research conclusion:1.The treatment time of one-time debridement is shorter than that of staged operation,but the recurrence rate is high.the two methods can maintain the appearance of t he breast better,and there is no significant differen ce.2.According to the disease stages and local syndrome differentiation of traditional Chinese medicine,treatment based on syn drome differentiation,internal and external treatment of traditional Chi nese medicine combined with surgical treatment,the to tal recurrence rate of patients in this study is 17.86%,which is lower than that reporte d in the general literature.3.Surgical treatment should consider t wo factors: complete debridement and prevention of glandular defects,combined with breast gland fl ap plastic technique can better maintain the appearance of the breast;the control of loc al acute inflammation of GLM is the premise of debridement.4.Body mass index(BMI)≥ 24 accounted for 52.14% in this study,suggesting that GLM may be related to obe sity. |
PDF Full Text Request