临床研究

穿刺抽脓治疗哺乳期乳腺脓肿的临床分析

冯艳玉 贾兴东 刘建* 王继 宿士智

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【摘要】  【摘要】目的 评价穿刺抽脓治疗哺乳期乳腺脓肿的临床效果。方法 前瞻性收集2018年5月至2019年8月在我院乳腺外科门诊因哺乳期乳腺脓肿行穿刺抽脓患者的临床资料,与同期行传统切开引流术的患者进行对比。记录两组患者一般情况(包括脓肿特征)、治疗情况,并进行统计分析。

【关键字】  乳腺脓肿,微创治疗,穿刺抽脓,传统切开引流术,疼痛

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[Abstract] Objective To evaluate the clinical effect of puncture suction in treating lactational breast abscess. Methods The clinical data of lactational breast abscess patients undergoing puncture suctionin breast surgery clinic was collected prospectively between May 2018 and August 2019, and patients undergoing traditional incision and drainage at the same time were classified as contrast group. The general characteristics of the patients(including abscess characteristics), treatment effectwere recorded; and statistical analysis was made. Results 54 patients were analyzed. Puncture suction and traditional incision and drainage were all safe and effective. Patients accepting puncture suction acquired less painful, less treatment times, shorter recovery time, shorter scar, less breastfeeding rate compared with patients accepting traditional incision and drainage; and the difference was statistically significant(P<0.05). The cure rate of puncture suction was lower, but the difference wasn’t statistically significant. The risk factors of puncture suction treatment failure included larger abscess diameter and shorter time after childbirth. Conclusion Most small abscess can be cured by puncture suction, and it’s clinical effect is better than traditional incision and drainage.

乳腺脓肿是哺乳期女性常见疾病,好发于初产妇,主要病因为细菌入侵及乳汁淤积。乳腺脓肿传统治疗方法是切开脓肿、放置引流、定期换药。但该术式创伤大,给患者带来巨大痛苦,愈合时间较长,且伴有过高的非计划性停止哺乳率[1]。近年来,穿刺抽脓(盲抽或超声引导)被部分医院用于乳腺脓肿的治疗,但既往报道主要为回顾性研究,证据强度稍低。我院近年来也开展了穿刺抽脓治疗,并将其作为多数乳腺脓肿的首选治疗方式,为评估穿刺抽脓的治疗效果,我们设计了该前瞻性队列研究,现将研究过程及结果报道如下。 1 资料与方法 1.1 研究对象:研究对象为2018年5月至2019年8月在大兴区人民医院乳腺门诊接受外科治疗的哺乳期乳腺脓肿患者,入组患者需满足以下条件:①符合乳腺脓肿的诊断标准,包括具备相应临床表现,辅助检查证实,且志愿入组;②初始外科治疗方法为穿刺抽脓术或传统切开引流术。如治疗过程中不能配合治疗、失访、重要资料缺失则予以剔除。 1.2 治疗方法的选择:确诊哺乳期乳腺脓肿后,向患者交代可选的治疗方法及其利弊,由患者决定选择何种治疗方法,临床医生不强制规定患者必须采取何种治疗。 1.3 资料的收集:记录入组患者一般情况,包括患者年龄、产后时间、脓腔最大径、起病时间、脓肿位置、脓肿距离皮肤深度、麻醉情况、操作次数(抽吸或换药次数)、疼痛情况(视觉模拟频分,满分10分)、痊愈时间、遗留瘢痕;为评估治疗方法的安全性,同时记录可能的并发症,比如创面出血、血肿、感染、乳漏、穿刺损伤等。 1.4 疗效的评估:如采取某种治疗方法后治疗有效,脓肿逐渐缩小、消失,则认为该治疗成功。如治疗3 d后病情无明显缓解或者需要采取其他治疗方式则认为治疗失败。 1.5 统计学处理:采用SPSS 17统计软件进行数据分析,计量资料采用t检验(正态分布资料)或秩和检验(非正态分资料布)进行统计分析。计数资料采用卡方检验进行统计分析。P<0.05认为差异有统计学意义。

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