Mastitis and Breast Abscess: A Retrospective Review of 170 Cases

乳房炎和乳房膿腫170例回顧性分析

林偉烈(Wee-Liat Lim) ； 陸幼琴(Mary Ann Yiu-Chin Lou) ； 周少鈞(Shao-Jin Chou) ； 冉祥俊(Hsiang-Chun Jan) ； 陳之凱(Victor Tk. Chen)

《Formosan Journal of Surgery》 40卷1期 (2007/02) Pp. 16-24

https://doi.org/10.29833/FJS.200702.0003

摘要

因為乳房感染（乳腺炎和乳房膿腫）是一種良性乳房疾病，少被重視，但是一樣會給婦女帶來許多痛苦與不安，不但影響日常生活，也影響母乳育嬰宣導。有鑑於此，本院就1989-2005年間170病例做了回顧性分析。
資料搜集來自住院和門診病歷記載。在17年間有170例乳房感染病人住院治療186次。其中確診為乳房膿腫者有128例，乳腺炎42例，乳房膿腫採用切開引流清創手術合併抗生素治療，乳腺炎以靜脈注射抗生素為主，膿腫復發者有16例(12.5%)，其中10例(62.5%)在乳暈下(sub-areolar)，接續做感染乳管切除清創手術，效果滿意。所有住院病人平均住院天數為6.5天。雖有文獻報告抽煙與乳房感染有關，本研究中僅有四位病人有抽煙習慣。引起感染的因素很多，本組病例以下列四種為最常見：(1)乳房纖維囊腫病變(24.0%)，(2)哺乳中(21.2%)，(3)乳頭凹陷(5.2%)，(4)糖尿病(4.7%)。金黃葡萄球菌是培養出來的主要病菌(56.9%)。
我們認為善用超音波早期診斷，積極由靜脈給以抗生素，在預防乳腺炎演變成乳房膿腫及縮短治療天數上是有效方法。對乳房膿腫做切開引流清創手術，雖然是一種傳統方法，仍然不失為可以繼續採用之有效處置。積極宣導，消除恐懼，有助於早期診斷，早日治療，也有助於提倡母乳育嬰。乳房感染雖是良性疾患，也有隱藏惡性病變的可能，病理檢驗不可輕忽。

並列摘要

Introduction: Breast infections, both mastitis and abscess, are among the most painful and annoying benign diseases in women. This study was undertaken hoping to stimulate the interest of the concerned medical specialists. Perhaps more attention to prompt diagnosis and early intervention could better alleviate the pain and anxiety suffered by these patients.
Methods: This retrospective study includes 170 female patients diagnosed with breast infections between January 1989 and December 2005. These patients had in total 186 admissions into this regional hospital. Surgical incision and drainage (I & D) were performed 142 times in 128 patients with breast abscess.
Results: Pre-operative symptom duration averaged 10.8 days and total recovery time averaged 24.1 days. Recurrence occurred in 16 of the 128 cases of abscess and ten of the recurrent abscesses (62.5%) were located in the sub-areolar area. One hundred and eight out of the 170 patients received sonographic examination. Mastitis was treated aggressively by using intravenous antibiotics, most commonly cephalosporins. Though there were many factors related to breast infection, in this series the possible contributory factors were fibrocystic disease (24.0%), lactation (21.2%), nipple inversion (5.2%) and diabetes (4.7%). The exact cause was unknown in nearly half (44.9%) of the patients, most of whom (78.8%) were non-lactational, and only four patients were smokers, contrary to statements in many published papers and textbooks. The predominant known causative agent was staphylococcus aureus.
Conclusions: This study suggests that the early use of aggressive anti-staphylococcal antibiotics may prevent mastitis from developing into abscess, and that timely surgical drainage combined with antibiotics would decrease the lengthy recovery and reduce the pain and suffering of the patients so affected. Skilled breast ultrasonography is a very useful adjunct to needle aspiration in differentiating clinical mastitis from abscess.

並列關鍵字

breast infection ； mastitis ； breast abscess