- 期刊
結合超音波與乳房按摩治療乳腺管阻塞：三病例報告
Combining Therapeutic Ultrasound and Breast Massage for Plugged Ducts: Three Case Reports
摘要
乳腺管阻塞是在哺乳過程中一常見的問題，是由於乳汁未能完全排出或有外在壓力擠壓造成。好發在產後三至四週時。臨床症狀包括可在乳房摸到局部壓痛敏感的硬塊，母乳的排出受到阻礙，有時亦可在乳頭處發現塞住乳腺管在乳頭處開口的小白點。若未加以治療，乳腺管阻塞可能演變成乳腺囊腫、乳腺炎或乳房膿瘍。傳統的乳腺管阻塞治療方式包括了更頻繁地哺乳或擠乳、改變哺乳的姿勢、局部熱敷或冰敷、乳房按摩等。當傳統治療方法無效時，有學者提出可以使用治療用高能超音波用作替代療法。超音波的物理作用可分為熱效應與非熱效應，熱效應對於乳房腫大或乳腺管阻塞在止痛上的效果已獲得證實，但非熱效應在臨床應用的意義仍未有結論。 本文敘述三名乳腺管阻塞病患接受我們結合超音波與乳房按摩的治療方法。在前兩名病患，使用超音波配合乳房按摩對於疼痛和局部硬塊有明顯的改善。超音波可降低壓痛的感覺，讓病人較能夠忍受乳房按摩的不適感。治療後乳量增加，病人也感覺在哺乳過程中更順暢。治療中唯一觀察到的副作用是空泡效應。第三名病患在乳腺管阻塞的症狀出現一個月時才就醫，接受了多次超音波與按摩治療皆無效，因此轉介回婦產科接受細針抽吸術。 根據我們的經驗，結合超音波與乳房按摩可作為治療急性乳腺管阻塞的治療方法之一。但超音波的劑量以及非熱效應的意義仍需隨機控制試驗的證明。
並列摘要
Plugged ducts are a common problem during lactation. They often occur when the breast is not emptied properly, or when there is local pressure on the breast. Plugged ducts usually occur three to four weeks postpartum. Symptoms include a sensitive lump with well-defined margins in the breast. There may be pain and tenderness in the affected area, although this is not necessarily accompanied by systemic symptoms such as high-grade fever. Milk flow can be blocked and sometimes a tiny white spot can be seen at the opening of the mammary duct on the nipple. Without treatment, plugged ducts can lead to galactocele, mastitis or breast abscess. Traditional management of plugged ducts includes more frequent feeding or expression of milk, alternating breastfeeding position, using breast compression during feeding, and applying local heat and massage to the affected region. If these methods fail, therapeutic ultrasound has been suggested as an alternative treatment. The therapeutic effects of ultrasound can be divided into thermal and non-thermal. The heating effects have been proven to be of value in pain relief for breast engorgement and plugged ducts. However, the clinical significance of non-thermal effects in treating plugged ducts remains undetermined. We describe our experience combining therapeutic ultrasound and breast massage in the treatment of three patients with plugged ducts. In the first and second patients, after treatment, there were improvements in pain and lump resolve. Therapeutic ultrasound can decrease local pain and tenderness, which makes the patients more comfortable and tolerant to breast massage. Milk output increased, and patients felt they could breastfeed more easily. The only observed side effect was cavitation. In the third patient, who had symptomatic plugged ducts for one month, there was no response to combined ultrasound and massage therapy. She was referred back to her obstetrician and received fine needle aspiration. According to our experience, utilizing ultrasound and breast massage can be an effective alternative treatment for acute plugged ducts. The therapeutic dosage and the role of non-thermal effects, however, need to be determined by further controlled clinical trials.