本文選題：漿細胞性乳腺炎 + 治療方式��； 參考：《重慶醫(yī)科大學》2017年碩士論文

【摘要】：目的研究不同臨床分型的漿細胞性乳腺炎(Plasma cell mastitis,PCM)經治療后的治愈率及復發(fā)率,探討漿細胞性乳腺炎治療方式及手術時機的把握。方法采用回顧性分析研究方法,收集我院2006年1月~2015年12月臨床診斷的178例女性PCM患者,所有病例均經術后病理學檢查確診為PCM。按就診時的臨床表現(xiàn)分為四組,分型標準參照耿翠芝所提出的分類標準[1],腫塊型急性炎癥期89例,腫塊型慢性炎癥期47例,膿腫型36例,瘺管型6例。其中對于腫塊型PCM,又可根據(jù)腫塊邊緣與乳暈邊緣的位置關系,分為暈周型(腫塊邊緣距乳暈邊緣2cm)和周圍型(腫塊邊緣距乳暈邊緣2cm)。對于處于急性期、局部炎癥反應明顯的PCM患者,于術前予以靜脈輸注抗生素治療。針對膿腫型PCM患者,用藥前取患者乳腺病灶區(qū)膿液或者分泌物進行培養(yǎng)及藥敏試驗,選用廣譜抗生素,用藥期間根據(jù)臨床癥狀改善情況及藥敏試驗結果更換敏感抗生素。部分PCM患者局部感染癥狀較重、可加用抗厭氧菌藥物及地塞米松,發(fā)揮抗厭氧菌作用及抗炎作用。89例腫塊型急性炎癥期PCM患者,58例腫塊屬于暈周型,視腫塊大小行腫塊切除術或腫塊切除術+局部腺體瓣翻轉整形術,31例腫塊屬周圍型,行腫塊切除術或區(qū)段切除術。47例腫塊型慢性炎癥期PCM患者中,均行病變乳腺區(qū)段切除術或象限切除術;36例膿腫型PCM患者中,14例膿腔直徑較大,行膿腫切開引流術,充分完全引流膿液,22例因膿腫較小,局部炎癥控制后行病灶擴大切除術;6例瘺管型PCM患者行瘺管及周圍部分正常乳腺組織切除術。多個瘺管形成、局部粘連嚴重病例行皮下腺體全切術或者乳房單純切除術,術后行一期假體植入術,所有伴乳頭內陷畸形的PCM患者均予以內陷乳頭畸形矯正術。術后門診或電話隨訪1~3年,中位隨訪時間22個月。記錄每組的治愈率及復發(fā)率。結果(1)89例腫塊型急性炎癥期的PCM患者,治愈87例,治愈率97.75%(87/89),復發(fā)2例,復發(fā)率2.25%(2/89);(2)47例腫塊型慢性炎癥期PCM患者,44例治愈,占93.62%(44/47),復發(fā)3例,占6.38%(3/47);(3)36例膿腫型PCM患者,切開引流組治愈3例,治愈率21.43%(3/14),復發(fā)11例,復發(fā)率78.57%(11/14)。擴大切除組治愈20例,治愈率90.91%(20/22),復發(fā)2例,復發(fā)率9.09%(2/22);(4)6例瘺管型,5例治愈,治愈率83.33%(5/6),復發(fā)1例,復發(fā)率16.67%(1/6)。結論PCM腫塊型急性炎癥期宜予以藥物治療控制局部炎癥反應,炎癥反應消退或局限后的腫塊靜止期宜行手術治療。PCM的治療關鍵在于早期診斷早期治療,針對不同臨床類型的PCM治療方式上建議采取綜合性治療手段。
[Abstract]:Objective to study the cure rate and recurrence rate of plasma cell mastitis (PCM) with different clinical types, and to explore the treatment methods and the timing of operation for plasmacytic mastitis. Methods 178 cases of female PCM diagnosed in our hospital from January 2006 to December 2015 were collected by retrospective analysis. All cases were confirmed as PCM by postoperative pathological examination. According to the clinical manifestations of the patients, they were divided into four groups. According to the classification criteria proposed by Geng Cuizhi, 89 cases of acute inflammatory stage of mass type, 47 cases of chronic inflammatory stage of mass type, 36 cases of abscess type and 6 cases of fistula type were classified. According to the position relationship between the edge of the mass and the edge of the areola, PCM can be divided into two types: the perihalo type (2 cm from the edge of the mass to the edge of the areola) and the peripheral type (2 cm from the edge of the mass to the edge of the areola). Patients with PCM in acute phase with obvious local inflammatory reaction were treated with antibiotics before operation. For the patients with abscess PCM, the abscess or secretion of the patients with breast lesions were taken for culture and drug sensitivity test, and broad-spectrum antibiotics were selected. During the treatment, the sensitive antibiotics were replaced according to the improvement of clinical symptoms and the results of drug sensitivity test. Partial PCM patients with severe local infection symptoms can be added with anti-anaerobe drugs and dexamethasone to play the role of anti-anaerobes and anti-inflammatory effect .89 cases of mass type of acute inflammation of PCM patients 58 cases of mass belong to the halo type. According to the size of the mass, 31 patients were treated with local glandular flap turnover surgery according to the size of the mass, and 47 patients with chronic inflammatory phase PCM were treated with mass resection or segmental resection. Of the 36 patients with PCM with abscess type, 14 patients had large abscess cavity diameter, 22 patients had full and complete drainage of abscess because of the small abscess, 14 patients had large abscess cavity diameter, 22 patients had complete drainage of abscess because of the small abscess. Six patients with fistula PCM were treated with fistula and normal breast tissue resection after local inflammation control. Patients with multiple fistula and severe local adhesion underwent subcutaneous adenectomy or simple mastectomy. All PCM patients with nipple invagination malformation were treated with correction of inverted papillary deformity. Postoperative outpatient or telephone follow-up 1 ~ 3 years, the median follow-up time 22 months. The cure rate and recurrence rate of each group were recorded. Results among 89 patients with PCM in acute inflammatory stage of mass type, 87 cases were cured, the cure rate was 97.75 / 87 / 89, recurrence was 2 cases, recurrence rate was 2.25% / 89%, 44 cases (93.622% / 47) were cured (93.622% 44 / 47), 3 cases (6.38% ~ 347%) with abscess type PCM. In the incision and drainage group, 3 cases were cured, the cure rate was 21.43%, and the recurrence rate was 11 cases. The recurrence rate was 78.57%. In the extended resection group, 20 cases were cured, the cure rate was 90.91% 20 / 22%, the recurrence rate was 2 cases, the recurrence rate was 9.09% / 22%, 4 cases of fistula type were cured in 5 cases, the cure rate was 83.33% / 6%, the recurrence rate was 1 case and the recurrence rate was 16.67%. Conclusion the local inflammatory reaction should be controlled by drug therapy in acute inflammatory stage of PCM. The key to the treatment of PCM is early diagnosis and early treatment. Comprehensive treatment is recommended for different clinical types of PCM.
【學位授予單位】：重慶醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R655.8

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