穿刺冲洗术治疗哺乳期乳腺脓肿182例疗效观察及治疗后哺乳结局分析  

Efficacy of ultrasound-guided aspiration and irrigation in 182 cases of lactational breast abscess patients and lactational outcomes after treatment

作　　者：李帅 张彦武[1] 牛耀东[1] 王璐[1] 王涛[1] LI Shuai;ZHANG Yanwu;NIU Yaodong;WANG Lu;WANG Tao(Department of Breast Surgury,The Third Affiliated Hospital of Zhengzhou University,Zhengzhou,Henan 450052,China)

机构地区：[1]郑州大学第三附属医院乳腺科,河南郑州450052

出　　处：《安徽医药》2023年第3期584-587,共4页Anhui Medical and Pharmaceutical Journal

摘　　要：目的 探讨哺乳期乳腺脓肿经超声引导下穿刺冲洗术治疗效果,并分析影响治疗后病人哺乳结局的相关因素。方法收集2017年1月至2020年12月郑州大学第三附属医院收治经超声引导下穿刺冲洗术治疗的182例哺乳期乳腺脓肿病人的临床资料,哺乳结局根据治疗后是否回奶,分为回奶组27例和继续母乳喂养组155例。从产次、产后时间(产后初次发病时间)、脓肿位置、脓肿长径、致病菌、穿刺次数等方面,采用χ^(2)检验进行单因素分析,采用logistic回归模型进行哺乳结局的多因素分析。结果 本研究纳入182例病人,其中165例经过超声引导下穿刺冲洗术联合抗生素治疗后达到治愈标准,治愈率90.7%,治疗后回奶病人27例,回奶率14.8%(27/182)。单因素分析结果显示,哺乳结局与时间、脓肿位置、穿刺次数有相关性(均P<0.05);多因素分析结果显示,中央区脓肿[OR=11.61,95%CI:(2.70,49.85),P=0.001]、脓腔≥5 cm[OR=3.60,95%CI:(1.12,11.51),P=0.031]和穿刺次数[OR=10.08,95%CI:(2.04,49.60),P=0.004]是影响病人治疗后回奶的独立危险因素,产后时间长[OR=0.08,95%CI:(0.02,0.34),P=0.001]是病人治疗后回奶的保护性因素。结论 超声引导下穿刺冲洗术治疗哺乳期乳腺脓肿效果良好,产后时间≤42 d、中央区脓肿、脓腔≥5 cm、增加穿刺次数更容易导致病人回奶。Objective To investigate the effectiveness of ultrasound aspiration and irrigation in lactational breast abscess patients and to analyze the related factors for lactational outcomes.Methods Clinical data of 182 patients with lactational breast abscess, who were admitted to The Third Affiliated Hospital of Zhengzhou University from January 2017 to December 2020, were retrospectively analyzed. Patients were assigned intoablactation group(n=27) and continuous lactation group(n=155) according to whether the lactation was carried on after treatment. Chi-square test was used to analyze the data including parity, postpartum time(first onset time after childbirth), location of abscess, diameter of abscess, pathogenic bacterium and puncture frequency. Multivariate analysis was made of lactational outcomes by logistic regression model.Results In this study 182 patients were enrolled, among whom 165(90.7%) patients were cured after ultrasound aspiration and irrigation together with antibiotic treatment. Ablactation occurred in 27(14.8%) patients.Single-factor analysis results showed that postpartum time,location of abscess and puncture frequency were correlated with lactational outcomes(all P<0.05). Multivariate analysis results showed that central quadrant abscess [OR=11.61,95%CI:(2.70,49.85),P=0.001], diameter of pus≥5 cm [OR=3.60, 95%CI:(1.12,11.51),P=0.031] and puncture frequency [OR=10.08, 95%CI:(2.04, 49.60),P=0.004] were independent risk factors for ablactation, while long postnatal time [OR=0.08, 95%CI:(0.02,0.34),P=0.001] was an independent protective factor for ablactation.Conclusions Treatment with ultrasound-guided aspiration and irrigation is attended with good results for lactational breast abscess. Postpartum time equal to or shorter than 42 d, central quadrant abscess, diameter of pus≥5 cm and multiple punctures may be more likely to cause ablactation.

关 键 词：乳腺脓肿 超声检查 乳房 穿刺抽液术 母乳泌出 泌乳障碍 哺乳结局 

分 类 号：R655.8[医药卫生—外科学]