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.	中華預防醫學會婦女保健分會乳腺保健與乳腺疾病防治學組. 非哺乳期乳腺炎診治專家共識. 中國實用外科雜, 2016, 36(7): 755-758.
2.	肖敏, 李三榮, 童樹紅. 穿刺抽膿引流聯合局部應用糖皮質激素治療肉芽腫性小葉性乳腺炎 46 例. 中華普通外科學文獻(電子版), 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.	張宇, 鐘曉捷, 湯鵬. 肉芽腫性乳腺炎 46 例臨床診治分析. 中華普通外科學文獻(電子版), 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.	周飛, 余之剛. 非哺乳期乳腺炎性疾病的細菌學研究進展. 中華乳腺病雜志(電子版), 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, 劉成義, 紀存委, 等. 肉芽腫性乳腺炎的病原菌分布及藥敏分析. 中國抗生素雜志, 2019, 44(6): 736-740.
16.	于海靜, 王頎, 楊劍敏, 等. 抗分枝桿菌藥物治療竇道型導管周圍乳腺炎. 中華外科雜志, 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.	劉彥章, 劉皎玲, 陳建安, 等. 超聲引導微創旋切術治療非哺乳期乳腺炎的臨床效果. 中華乳腺病雜志(電子版), 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. 中華預防醫學會婦女保健分會乳腺保健與乳腺疾病防治學組. 非哺乳期乳腺炎診治專家共識. 中國實用外科雜, 2016, 36(7): 755-758.
2. 肖敏, 李三榮, 童樹紅. 穿刺抽膿引流聯合局部應用糖皮質激素治療肉芽腫性小葉性乳腺炎 46 例. 中華普通外科學文獻(電子版), 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. 張宇, 鐘曉捷, 湯鵬. 肉芽腫性乳腺炎 46 例臨床診治分析. 中華普通外科學文獻(電子版), 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. 周飛, 余之剛. 非哺乳期乳腺炎性疾病的細菌學研究進展. 中華乳腺病雜志(電子版), 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, 劉成義, 紀存委, 等. 肉芽腫性乳腺炎的病原菌分布及藥敏分析. 中國抗生素雜志, 2019, 44(6): 736-740.
16. 于海靜, 王頎, 楊劍敏, 等. 抗分枝桿菌藥物治療竇道型導管周圍乳腺炎. 中華外科雜志, 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. 劉彥章, 劉皎玲, 陳建安, 等. 超聲引導微創旋切術治療非哺乳期乳腺炎的臨床效果. 中華乳腺病雜志(電子版), 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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