乳房膿瘍治療之回溯性探討

Treatment of Breast Abscess-A Retrospective Study

陳火木(Huo-Mu Chen) ； 吳淑娟(Shu-Chuan Wu)

《北市醫學雜誌》 12卷1期 (2015/03) Pp. 57-66

https://doi.org/10.6200/TCMJ.2015.12.1.05

摘要

目的：乳房膿瘍最常見的原因為哺乳，正確的指導與教育則可減輕乳房發炎避免進一步的產生乳房膿瘍。乳腺炎及乳房膿瘍常見於哺乳婦女，其它非哺乳性因素也可能導致，其中的乳房膿瘍可能導致乳房皮膚實際組織受損，加上感染菌株改變（CA-MRSA），早期診斷加上抗生素治療，預防乳腺炎變成乳房膿瘍。傳統治療乳房膿瘍方式為切開引流，要麻醉且可能須要住院每天換藥；常見使傷口癒合延長且對傷口外觀也不滿意，也會終止哺餵嬰兒。收集本院在乳房膿瘍婦女的處置，瞭解適合的治療方式，提供病患更大的幫助，是本研究主要探討的目的。方法：病歷回溯性，篩選國際疾病分類碼611.0與乳房超音波診斷符合乳房膿瘍和細菌學檢查佐證之女性個案。結果：統計收錄190位病人，平均年齡32.8歲，哺乳性乳房膿瘍佔65%，其中123位使用超音波導引下乳房抽吸；22位行切開排膿；28位進行乳房穿刺及切開排膿，15位只使用抗生素治療，感染CA-MRSA者90位，佔54%。每位病人使用amoxicillin+clavulanate（augmentinR）治療，culture培養確定為MRSA，更改為ciprofloxacin。結論：乳房膿瘍最常見的原因為哺乳，正確的指導與教育可減輕發炎，一旦確定是乳房膿瘍，超音波導引下乳房抽吸在目前臨床應為可採用之有效處置，至於有recurrence abscesses的病人，可能還是須使用傳統的incision and drainage。

關鍵字

哺乳 ； 乳房膿瘍

並列摘要

Objective: One of the most common causes of breast abscess is breastfeeding. Proper guidance and education on prevention of breast inflammation may avoid further breast abscess among breastfeeding mothers. Mastitis and breast abscess can be prevented if these conditions are diagnosed earlier and antibiotic treatments are administered. Traditional treatment of breast abscess requires surgical incision and drainage in which patients need to be hospitalized and be given local anaesthetic; daily dressing changes and prolonged wound healing time may cause dissatisfied scare and interrupt, or worse, terminate breastfeeding. The primary goal of this study was to collect data on the treatment options offered to affected women and compare their treatment outcomes in order to determine the best possible treatment possible for the patients. Methods: Data were collected by screening hospital medical records for female patients with a confirmed ICD 611.0 diagnosis, record of breast ultrasound confirming breast abscess, and confirmed lab result indicating breast infection. Result: Data were collected from 190 qualified patient records. The mean age of the patients was 32.8 years old and 65% of the breast abscess were related to breastfeeding. A total of 123 patients went through ultrasoundguided abscess aspiration; 22 patients had surgical incision and drainage; 28 had both breast aspiration and incision and drainage, and 15 were treated with antibiotics alone. Ninety cases were with confirmed CA-MRSA, accounted for 54% of all infected cases. All patients initially treated with amoxicillin+clavulanate (augmentinR) were switched to ciprofloxacin when culture and sensitivity result confirmed the MRSA infection. Conclusion: The most common cause of breast abscess is breastfeeding and prompt patient education and guidance on breastfeeding techniques may help to reduce the severity of inflammation. In the case of confirmed breast abscess, ultrasound-guided abscess aspiration is the current recommended clinical procedure. Traditional surgical incision and drainage are still the standard treatments for patients with recurrent infections.

並列關鍵字

breastfeeding ； breast abscess ； CA-MRSA