哺乳期乳腺脓肿临床特点及延误诊断原因分析  

Clinical Features and Causes of Delayed Diagnosis of Breast Abscess during Lactation Period

作　　者：梁琦 黄伟 罗静 LIANG Qi;HUANG Wei;LUO Jing(Department of Breast and Thyroid Surgery,Sichuan Provincial Maternity and Child health Care Hospital,Chengdu 610045,China)

机构地区：[1]四川省妇幼保健院乳腺甲状腺科,成都610045

出　　处：《临床误诊误治》2024年第8期15-19,共5页Clinical Misdiagnosis & Mistherapy

摘　　要：目的探讨哺乳期乳腺脓肿的临床特点及误诊原因,并总结防范误诊措施。方法回顾分析2023年1—6月收治的被误诊为乳管堵塞或积乳囊肿的哺乳期乳腺脓肿10例的临床资料。结果本组10例均以哺乳期乳房发现肿块伴疼痛为主要症状就诊,乳房无表面皮肤红肿及波动感,误诊为乳管堵塞7例,积乳囊肿3例,保守治疗2~5 d无效,后经彩色多普勒超声引导穿刺诊断为乳腺脓肿。10例行1~4次彩色多普勒超声引导下脓肿穿刺冲洗引流术等治疗,7例治愈,2例进一步行全身麻醉下置管引流,1例行小切口置管引流。10例皆治疗过程顺利,预后良好。结论临床上对于哺乳期短时间出现乳房肿块患者不能单纯通过红、肿、热、痛及波动感来评判是否为脓肿,需要通过彩色多普勒超声检查,结合患者发病时间和症状、体征综合分析,对于彩色多普勒超声检查提示的异常声像区域,避免热敷和按摩等刺激,必要时行诊断性穿刺,以明确诊断。Objective To investigate the clinical characteristics and causes of misdiagnosis of breast abscess during lactation period,and to summarize the preventive measures.Methods The clinical data of 10 patients with breast abscess during lactation period,which were misdiagnosed as breast duct obstruction or galactocele from January to June 2023,were retrospectively analyzed.Results All the 10 patients presented with breast mass accompanied by pain during lactation period.There was no surface skin swelling and fluctuation sensation in the breast.Of them,7 patients were misdiagnosed with breast duct obstruction and 3 with galactocele.Conservative treatment for 2-5 d was ineffective,but breast abscess was diagnosed through color Doppler ultrasound-guided puncture.Ten patients were treated with 1 to 4 repetitions of color Doppler ultrasound guided abscess puncture irrigation drainage.Ultimately,7 patients were cured,2 were further treated with catheterization and drainage under general anesthesia,and 1 was treated with catheterization and drainage through a small incision.All the 10 patients were treated successfully and the prognosis was good.Conclusion For patients with breast mass occurring in a short period of time during lactation period,clinicians cannot simply judge whether they are suppurative by redness,swelling,heat,pain and fluctuation.Color Doppler ultrasound examination is required,combined with comprehensive analysis of the patient's onset time,symptoms and signs.For abnormal sound and image areas indicated by color Doppler ultrasound,hot compress and massage should be avoided,and diagnostic puncture should be performed if necessary,to make a clear diagnosis.

关 键 词：脓肿 乳腺疾病 哺乳期 误诊 乳管堵塞 积乳囊肿 超声检查 多普勒 彩色 穿刺抽液术 

分 类 号：R632.5[医药卫生—外科学]