Therapeutic evaluation of ultrasound-guided vacuum-assisted rotary excision with tube irrigation drainage in treatment of granulomatous mastitis_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

DUAN Menglian , CHEN Chuang , XU Zhiliang ,  SUN Shengrong

Department of Breast and Thyroid Surgery, Renmin Hospital of Wuhan University, Wuhan 430060, P. R. China;

Corresponding author：

SUN Shengrong, Email: sun137@sina.com

Keywords：

granulomatous mastitis; minimally invasive rotary excision; tube irrigation drainage

DOI：

10.7507/1007-9424.201912114

Video：

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Objective To analyze therapeutic effect of ultrasound-guided vacuum-assisted rotary excision with tube irrigation drainage in treatment of granulomatous mastitis (GM).Methods The clinical data of 120 patients with GM from January 2018 to December 2018 in the Renmin Hospital of Wuhan University were analyzed. Sixty patients were treated with the ultrasound-guided vacuum-assisted rotary excision with tube irrigation drainage (control group), and the other 60 patients were treated with the metronidazole solution combined with dexamethasone on the basis of the control group (observation group). The therapeutic period, total effective rate, postoperative appearance of breast, and recurrence rate were analyzed. While the pathogenic bacteria was analyzed by the microbial culture and the pathogen gene detection.Results There were no significant differences in the baseline data between the two groups (P>0.05). The ultrasound-guided vacuum-assisted rotary excisions were successfully performed in all 120 patients. The therapeutic period of the observation group was shorter than that of the control group (t=–3.633, P<0.001). The total effective rate and rate of excellent and good of postoperative breast appearance had no significant differences between the two groups (total effective rate: 96.7% versus 90.0%, χ²=1.922, P=0.166; rate of excellent and good of postoperative breast appearance: 96.7% versus 88.3%, χ²=1.205, P=0.272). The recurrence rate of the observation group was lower than that of the control group (χ²=5.175, P=0.023). The positive rates of bacteria were 25.8% and 58.8% in the 120 cases by the microbial culture and 52 cases by the pathogen gene detection, respectively, which had a statistical difference (χ²=16.974, P<0.001), the same conclusions were obtained in the observation group and the control group (χ²=6.691, P=0.010; χ²=9.379, P=0.002).Conclusions Ultrasound-guided vacuum-assisted rotary excision with tube irrigation drainage is well applied in treatment of GM. It could maintain a good shape of breast. Use of metronidazole solution combined with dexamethasone after surgery could shorten therapeutic period and reduce recurrence rate.

Citation： DUAN Menglian, CHEN Chuang, XU Zhiliang, SUN Shengrong. Therapeutic evaluation of ultrasound-guided vacuum-assisted rotary excision with tube irrigation drainage in treatment of granulomatous mastitis. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2020, 27(10): 1226-1230. doi: 10.7507/1007-9424.201912114 Copy

1.	中华预防医学会妇女保健分会乳腺保健与乳腺疾病防治学组. 非哺乳期乳腺炎诊治专家共识. 中国实用外科杂, 2016, 36(7): 755-758.
2.	肖敏, 李三荣, 童树红. 穿刺抽脓引流联合局部应用糖皮质激素治疗肉芽肿性小叶性乳腺炎 46 例. 中华普通外科学文献(电子版), 2019, 13(1): 30-33.
3.	Chirappapha P, Thaweepworadej P, Supsamutchai C, <italic>et al</italic>. Idiopathic granulomatous mastitis: A retrospective cohort study between 44 patients with different treatment modalities. Ann Med Surg (Lond), 2018, 36: 162-167.
4.	Harris JR, Levene MB, Hellman S. Primary radiation therapy for early breast cancer. Front Radiat Ther Oncol, 1979, 1(14): 83-89.
5.	张宇, 钟晓捷, 汤鹏. 肉芽肿性乳腺炎 46 例临床诊治分析. 中华普通外科学文献(电子版), 2014, 8(1): 40-42.
6.	Kessler E, Wolloch Y. Granulomatous mastitis: a lesion clinically simulating carcinoma. Am J Clin Pathol, 1972, 58(6): 642-646.
7.	Lin CH, Hsu CW, Tsao TY, <italic>et al</italic>. Idiopathic granulomatous mastitis associated with risperidone-induced hyperprolactinemia. Diagn Pathol, 2012, 7: 2.
8.	Johnstone KJ, Robson J, Cherian SG, <italic>et al</italic>. Cystic neutrophilic granulomatous mastitis associated with <italic>Corynebacterium</italic> including <italic>Corynebacterium</italic> kroppenstedtii. Pathology, 2017, 49(4): 405-412.
9.	DeHertogh DA, Rossof AH, Harris AA, <italic>et al</italic>. Prednisone management of granulomatous mastitis. N Engl J Med, 1980, 303(14): 799-800.
10.	Wang J, Xu H, Li Z, <italic>et al</italic>. Pathogens in patients with granulomatous lobular mastitis. Int J Infect Dis, 2019, 81: 123-127.
11.	周飞, 余之刚. 非哺乳期乳腺炎性疾病的细菌学研究进展. 中华乳腺病杂志(电子版), 2013, 7(3): 44-47.
12.	Fernández-Natal MI, Soriano F, Ariza-Miguel J, <italic>et al</italic>. Draft genome sequences of <italic>Corynebacterium</italic> kroppenstedtii CNM633/14 and CNM632/14, multidrug-resistant and antibiotic-sensitive isolates from nodules of granulomatous mastitis patients. Genome Announc, 2015, 3(3): pii: 525-515.
13.	Yu HJ, Deng H, Ma J, <italic>et al</italic>. Clinical metagenomic analysis of bacterial communities in breast abscesses of granulomatous mastitis. Int J Infect Dis, 2016, 53: 30-33.
14.	Dobinson HC, Anderson TP, Chambers ST, <italic>et al</italic>. Antimicrobial treatment options for granulomatous mastitis caused by <italic>Corynebacterium species</italic>. J Clin Microbiol, 2015, 53(9): 2895-2899.
15.	唐玲玲, 刘成义, 纪存委, 等. 肉芽肿性乳腺炎的病原菌分布及药敏分析. 中国抗生素杂志, 2019, 44(6): 736-740.
16.	于海静, 王颀, 杨剑敏, 等. 抗分枝杆菌药物治疗窦道型导管周围乳腺炎. 中华外科杂志, 2012, 50(11): 971-974.
17.	Farouk O, Abdelkhalek M, Abdallah A, <italic>et al</italic>. Rifampicin for idiopathic granulomatous lobular mastitis: a promising alternative for treatment. World J Surg, 2017, 41(5): 1313-1321.
18.	Chu AN, Seiler SJ, Hayes JC, <italic>et al</italic>. Magnetic resonance imaging characteristics of granulomatous mastitis. Clin Imaging, 2017, 43: 199-201.
19.	刘彦章, 刘皎玲, 陈建安, 等. 超声引导微创旋切术治疗非哺乳期乳腺炎的临床效果. 中华乳腺病杂志(电子版), 2018, 12(6): 360-364.
20.	Troxell ML, Gordon NT, Doggett JS, <italic>et al</italic>. Cystic neutrophilic granulomatous mastitis: association with <italic>Gram-positive bacilli</italic> and <italic>Corynebacterium</italic>. Am J Clin Pathol, 2016, 145(5): 635-645.
21.	Freeman CM, Xia BT, Wilson GC, <italic>et al</italic>. Idiopathic granulomatous mastitis: A diagnostic and therapeutic challenge. Am J Surg, 2017, 214(4): 701-706.

1. 中华预防医学会妇女保健分会乳腺保健与乳腺疾病防治学组. 非哺乳期乳腺炎诊治专家共识. 中国实用外科杂, 2016, 36(7): 755-758.
2. 肖敏, 李三荣, 童树红. 穿刺抽脓引流联合局部应用糖皮质激素治疗肉芽肿性小叶性乳腺炎 46 例. 中华普通外科学文献(电子版), 2019, 13(1): 30-33.
3. Chirappapha P, Thaweepworadej P, Supsamutchai C, <italic>et al</italic>. Idiopathic granulomatous mastitis: A retrospective cohort study between 44 patients with different treatment modalities. Ann Med Surg (Lond), 2018, 36: 162-167.
4. Harris JR, Levene MB, Hellman S. Primary radiation therapy for early breast cancer. Front Radiat Ther Oncol, 1979, 1(14): 83-89.
5. 张宇, 钟晓捷, 汤鹏. 肉芽肿性乳腺炎 46 例临床诊治分析. 中华普通外科学文献(电子版), 2014, 8(1): 40-42.
6. Kessler E, Wolloch Y. Granulomatous mastitis: a lesion clinically simulating carcinoma. Am J Clin Pathol, 1972, 58(6): 642-646.
7. Lin CH, Hsu CW, Tsao TY, <italic>et al</italic>. Idiopathic granulomatous mastitis associated with risperidone-induced hyperprolactinemia. Diagn Pathol, 2012, 7: 2.
8. Johnstone KJ, Robson J, Cherian SG, <italic>et al</italic>. Cystic neutrophilic granulomatous mastitis associated with <italic>Corynebacterium</italic> including <italic>Corynebacterium</italic> kroppenstedtii. Pathology, 2017, 49(4): 405-412.
9. DeHertogh DA, Rossof AH, Harris AA, <italic>et al</italic>. Prednisone management of granulomatous mastitis. N Engl J Med, 1980, 303(14): 799-800.
10. Wang J, Xu H, Li Z, <italic>et al</italic>. Pathogens in patients with granulomatous lobular mastitis. Int J Infect Dis, 2019, 81: 123-127.
11. 周飞, 余之刚. 非哺乳期乳腺炎性疾病的细菌学研究进展. 中华乳腺病杂志(电子版), 2013, 7(3): 44-47.
12. Fernández-Natal MI, Soriano F, Ariza-Miguel J, <italic>et al</italic>. Draft genome sequences of <italic>Corynebacterium</italic> kroppenstedtii CNM633/14 and CNM632/14, multidrug-resistant and antibiotic-sensitive isolates from nodules of granulomatous mastitis patients. Genome Announc, 2015, 3(3): pii: 525-515.
13. Yu HJ, Deng H, Ma J, <italic>et al</italic>. Clinical metagenomic analysis of bacterial communities in breast abscesses of granulomatous mastitis. Int J Infect Dis, 2016, 53: 30-33.
14. Dobinson HC, Anderson TP, Chambers ST, <italic>et al</italic>. Antimicrobial treatment options for granulomatous mastitis caused by <italic>Corynebacterium species</italic>. J Clin Microbiol, 2015, 53(9): 2895-2899.
15. 唐玲玲, 刘成义, 纪存委, 等. 肉芽肿性乳腺炎的病原菌分布及药敏分析. 中国抗生素杂志, 2019, 44(6): 736-740.
16. 于海静, 王颀, 杨剑敏, 等. 抗分枝杆菌药物治疗窦道型导管周围乳腺炎. 中华外科杂志, 2012, 50(11): 971-974.
17. Farouk O, Abdelkhalek M, Abdallah A, <italic>et al</italic>. Rifampicin for idiopathic granulomatous lobular mastitis: a promising alternative for treatment. World J Surg, 2017, 41(5): 1313-1321.
18. Chu AN, Seiler SJ, Hayes JC, <italic>et al</italic>. Magnetic resonance imaging characteristics of granulomatous mastitis. Clin Imaging, 2017, 43: 199-201.
19. 刘彦章, 刘皎玲, 陈建安, 等. 超声引导微创旋切术治疗非哺乳期乳腺炎的临床效果. 中华乳腺病杂志(电子版), 2018, 12(6): 360-364.
20. Troxell ML, Gordon NT, Doggett JS, <italic>et al</italic>. Cystic neutrophilic granulomatous mastitis: association with <italic>Gram-positive bacilli</italic> and <italic>Corynebacterium</italic>. Am J Clin Pathol, 2016, 145(5): 635-645.
21. Freeman CM, Xia BT, Wilson GC, <italic>et al</italic>. Idiopathic granulomatous mastitis: A diagnostic and therapeutic challenge. Am J Surg, 2017, 214(4): 701-706.

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Therapeutic evaluation of ultrasound-guided vacuum-assisted rotary excision with tube irrigation drainage in treatment of granulomatous mastitis

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