本文選題：重癥肉芽腫性乳腺炎 + 術(shù)前輔助治療�。� 參考：《鄭州大學(xué)》2016年碩士論文

【摘要】：背景:肉芽腫性小葉性乳腺炎(granulomatous mastitis,GLM)是在以往的乳腺炎癥中發(fā)病率較低的一種疾病,但近幾年此種類(lèi)型的乳腺炎癥的患者逐漸增多,在臨床工作中已成為較常見(jiàn)的一種乳腺良性疾病,且此病病程較長(zhǎng),患者偏年輕化。此病的臨床初始表現(xiàn)為乳腺腫塊,隨病情進(jìn)展可出現(xiàn)乳房膿腫、皮損、形成竇道,然后遷延不愈,且最終需行手術(shù)治療,極有可能導(dǎo)致全乳切除,給患者及家人帶來(lái)嚴(yán)重的心理負(fù)擔(dān)及經(jīng)濟(jì)壓力,尤其是重癥肉芽腫性小葉性乳腺炎,因病變范圍廣、皮損嚴(yán)重,治療的最終可能會(huì)導(dǎo)致全乳的切除,給患者及家人帶來(lái)巨大的身心痛苦。且因此病的病因、發(fā)病機(jī)制等尚不明確,臨床對(duì)其的治療仍在探索中,方案多種多樣,尋找一套合理、有效的治療方案是所有臨床工作者的最終目標(biāo)。目的:本研究為前瞻性臨床試驗(yàn)性研究,通過(guò)對(duì)比觀察術(shù)前使用抗結(jié)核三聯(lián)藥物治療重癥GLM與術(shù)前使用激素治療重癥GLM患者的治療效果、術(shù)后乳房外形以及術(shù)后復(fù)發(fā)率等,尋找一種更加有效的用于術(shù)前輔助治療重癥GLM的方案,目的在于治愈患者疾病的同時(shí),可以最大程度的滿(mǎn)足患者對(duì)于術(shù)后乳房外形的要求。方法:收集2013年6月至2015年6月就診于鄭州大學(xué)第一附屬醫(yī)院乳腺外二科的98例重癥GLM患者,隨機(jī)分為A、B兩組,A組為實(shí)驗(yàn)組,49人,患者術(shù)前給予每天口服三聯(lián)抗結(jié)核藥物(異煙肼,利福平,乙胺丁醇)輔助治療,B組為對(duì)照組,49人,給予口服激素藥物(甲潑尼龍)輔助治療,若伴有原發(fā)性泌乳素升高的重癥GLM患者,同時(shí)給予口服溴隱亭治療,密切觀察患者病情變化,待病情達(dá)到藥物治療有效并可行手術(shù)治療的判定標(biāo)準(zhǔn)后,即行手術(shù)治療。統(tǒng)計(jì)三聯(lián)抗結(jié)核藥物治療重癥GLM患者的有效率及激素治療GLM的有效率;參照波士頓哈佛放射治療聯(lián)合中心的乳房術(shù)后外形評(píng)估標(biāo)準(zhǔn),隨訪統(tǒng)計(jì)抗結(jié)核三聯(lián)藥治療的患者術(shù)后乳房外形優(yōu)良率及術(shù)前輔助激素藥物治療的患者術(shù)后乳房外形優(yōu)良率;對(duì)所有患者術(shù)后6個(gè)月隨訪統(tǒng)計(jì)其術(shù)后復(fù)發(fā)率。采用SPSS18.0統(tǒng)計(jì)軟件對(duì)數(shù)據(jù)進(jìn)行分析,檢驗(yàn)標(biāo)準(zhǔn)p0.05,分析:1.兩組藥物治療有效率是否存在差異;2.兩組術(shù)后乳房外形優(yōu)良率是否存在差異?結(jié)果:實(shí)驗(yàn)組(A組)49例患者,于治療過(guò)程中失訪2例,最終可評(píng)價(jià)病例:47例,3例患者經(jīng)藥物治療1個(gè)月后病情未緩解,遂停藥行患乳擴(kuò)大切除術(shù),44例患者口服三聯(lián)藥物治療2至4個(gè)月不等,達(dá)到臨床評(píng)判有效及可行手術(shù)的標(biāo)準(zhǔn),有效率達(dá)93.6%,最終有7例患者口服藥物治療達(dá)到臨床及影像學(xué)上的痊愈而未術(shù),共40例患者行手術(shù)治療,術(shù)后乳房外形滿(mǎn)意度評(píng)估:優(yōu)秀5/40個(gè)(12.5%),良好25/40個(gè)(62.5%),總優(yōu)良率75%。對(duì)照組(B組)49例患者,治療過(guò)程中失訪1例,最終可評(píng)價(jià)病例:48例,7例患者口服激素治療10天以上病情未見(jiàn)穩(wěn)定或緩解,4例患者病情繼續(xù)進(jìn)展,6例患者初始口服藥物治療有效,于藥物減量過(guò)程中病情突然爆發(fā),遂共17例患者藥物治療無(wú)效后直行手術(shù)治療,31例患者經(jīng)激素治療一個(gè)月至兩個(gè)月不等,皮膚表面紅腫減退、范圍縮小,腫塊變軟,或竇道部分閉合,有效率達(dá)64.6%,最終共48例患者行手術(shù)治療,術(shù)后乳房外形滿(mǎn)意度評(píng)估:優(yōu)秀2/48個(gè)(4.1%),良好18/48個(gè)(37.5%),總優(yōu)良率41.7%。兩組之間藥物治療有效率及術(shù)后乳房?jī)?yōu)良率的差別具有統(tǒng)計(jì)學(xué)差異(p0.05)。術(shù)后6個(gè)月再次隨訪所有患者,無(wú)復(fù)發(fā)者。結(jié)論:1.術(shù)前輔助三聯(lián)藥物或激素對(duì)于治療重癥GLM均有一定的臨床療效。2.術(shù)前輔助三聯(lián)藥物治療重癥GLM的療效相對(duì)更好。3.術(shù)前輔助三聯(lián)藥物組可達(dá)較高的術(shù)后乳房外形優(yōu)良率
[Abstract]:Background: granulomatous lobular mastitis (granulomatous mastitis, GLM) is a disease with a low incidence of mastitis in the past, but in recent years, this type of breast inflammation has gradually increased. In clinical work, it has become a common kind of breast benign disease, and the course of this disease is longer and the patient is younger. The initial clinical manifestation of the breast is the breast lump. With the progress of the disease, the breast abscess, the skin lesion, the formation of the sinus, and the continuation of the disease are not healed, and the surgical treatment is necessary. It is very possible to cause total breast resection and bring serious psychological burden and economic pressure to the patients and family, especially the severe granulomatous lobular mastitis, because of the wide range of lesions. The skin lesions are serious. The treatment may eventually lead to the resection of whole milk and bring great physical and mental pain to the patients and their families. Therefore, the etiology and pathogenesis of the disease are not clear. The treatment of the disease is still in the exploration, the scheme is varied, and the final goal of all clinical workers is to find a set of reasonable and effective treatment programs. The purpose of this study is to find a more effective scheme for the treatment of severe GLM in the treatment of severe GLM with preoperative use of antituberculous triad drugs and preoperative hormone treatment for severe GLM patients, and to find a more effective scheme for preoperative adjuvant treatment of severe GLM. At the same time, patients can meet the patients' requirements for postoperative breast shape to the maximum degree. Methods: 98 patients with severe GLM from June 2013 to June 2015 at the First Affiliated Hospital of Zhengzhou University were collected and divided into groups of A, B two, group A as experimental group and 49 people. The patients were given three anti tuberculosis drugs every day before operation. The adjuvant therapy (isoniazid, rifampicin, ethambutol) was used in the group B as the control group and 49 people were treated with oral hormone drugs (methylprednisolone). If the patients with severe GLM with higher prolactin were treated with oral bromocriptine, the patient's disease changes were observed closely, and the treatment was effective and operative treatment was practiced. The effectiveness of the triple antituberculous drugs for severe GLM patients and the efficiency of hormone therapy for GLM were statistically analyzed after the criteria were performed. The rate of good breast shape after the drug treatment; the postoperative recurrence rate of all the patients after 6 months of operation was analyzed. The data were analyzed by SPSS18.0 software, and the standard P0.05 was tested. The difference in the effective rate of the 1. two groups was analyzed. Whether there was a difference in the good rate of breast shape after operation in the 2. two groups? Results: experimental group (group A) 49 cases, 2 cases were lost during the treatment, 47 cases were evaluated, 3 cases were not relieved after 1 months of drug treatment, 3 patients were treated with extended excision of milk, 44 cases were treated with triple drugs for 2 to 4 months, to reach the standard of clinical evaluation and operation, the effective rate was 93.6%, and 7 patients finally were. A total of 40 patients were treated by oral medicine for clinical and imaging treatment. 40 patients were treated with surgical treatment. The postoperative satisfaction of the breast was evaluated: excellent 5/40 (12.5%), good 25/40 (62.5%), 49 patients with total excellent rate 75%. control group (group B), 1 cases in the treatment process, 48 cases, 7 patients with oral hormone treatment 10. No stable or relieved condition above, 4 cases of patients continued to progress, 6 cases of initial oral drug treatment effective, in the process of drug reduction in the process of sudden onset, then 17 cases of patients after the treatment of invalid direct operation, 31 patients with hormone treatment for one month to two months, the skin surface redness and swelling decreased, the scope narrowed, The swelling was soft, or the sinus tract was partially closed, the effective rate was 64.6%. A total of 48 patients were finally operated on. The postoperative satisfaction of the breast was evaluated: excellent 2/48 (4.1%), good 18/48 (37.5%), and the total good rate of 41.7%. two groups had statistical difference between the effective rate of drug treatment and the postoperative breast good rate (P0.05). 6 months after the operation again. All patients were followed up with no recurrence. Conclusion: 1. combined drugs or hormones had a certain clinical effect on the treatment of severe GLM before operation. The curative effect of.2. before operation was better than that of the triple drug treatment of severe GLM, and the higher rate of postoperative breast shape after operation was higher than that of the adjuvant triple drug group.
【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類(lèi)號(hào)】：R655.8

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本文編號(hào)：1901111