ObjectiveTo analyze therapeutic effect of ultrasound-guided vacuum-assisted rotary excision with tube irrigation drainage in treatment of granulomatous mastitis (GM).MethodsThe 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.ResultsThere 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).ConclusionsUltrasound-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.
ObjectiveTo investigate etiology of granulomatous mastitis and it,s conservative treatment method. MethodThe clinical data of 120 patients with granulomatous mastitis given drugs for closed treatment plus massage dredge and ductal lavage from January 2011 to December 2012 in this hospital were analyzed retrospectively. ResultsOne hundred and one cases were cured following conservative treatment for 2 to 8 weeks,19 cases were underwent surgical treatment because of poor outcome.Nine of 101(8.9%) cured patients were relapsed for following-up of 30 to 42 months. ConclusionClosed treatment with drugs,which is effective,could keep patient with granulomatous mastitis from having mastectomy and reduce recurrence.
目的 探討面部燒傷后肉芽創面移植自體大張中厚皮的可行性。 方法 回顧性分析2002年1月－2012年4月收治的27例面部燒傷后肉芽創面進行自體大張中厚皮移植手術患者的臨床資料。術中用手術刀刮除肉芽組織至基底層，用取皮鼓或電動取皮刀取患者大腿或者腹部大張中厚皮，移植于受皮區，術后5 d左右打開敷料半暴露或暴露。 結果 27例手術患者中24例大張中厚皮全部成活，3例大部分成活，再次補植皮后愈合。患者創面愈合后外形豐滿，皮膚彈性較好，表情豐富。20例隨訪1～5年，患者面部外觀良好，2例發生小口畸形，2例眼瞼輕中度外翻，分別行整形手術后改善。 結論 面部燒傷后肉芽創面移植大張中厚皮可獲得較滿意的治療效果，可在臨床推廣使用。
ObjectiveTo summarize the clinical characteristics of idiopathic granulomatous mastitis (IGM) and its experiences of diagnosis and treatment. MethodThe clinical data of 33 patients with IGM from January 2005 to December 2014 were analyzed retrospectively. ResultsThe mean age of the patients was 33 years. The pathological examination showed that 28 patients (85%) were typical granuloma, and 5 patients (15%) were immature granuloma, whom were confirmed after exclusion of other pathogens. Twenty-nine patients were received drugs treatment, among which 21 patients were cured by taking prednisone orally, 6 patients were cured by the combination of prednisone and methotrexate, 2 patients failed to be cured, and 13 patients relapsed after stopping taking medicine. Four patients with abscess ulceration were received surgical treatment, and 2 patients relapsed after the surgery. Fifteen recurrent patients all were took prednisone and methotrexate orally, among which 1 patient stopped taking medicine because of liver function damage, 1 patient was not fully relieved, and other 13 patients were cured again. ConclusionsThe clinical manifestations of IGM have no specificities. The diagnosis mainly relies on pathological examination. In the early phase of this disease, the treatment method of steroid or combined immunosuppressant has good effects. In case of ulceration and protracted course, surgical treatment should be considered as early as possible.
Objective To explore the mechanism of full-thickness burn wound healing with autoskin grafting in fault hypodermis wound of granulation excision and to evaluate its effect.Methods By the techniques of clinical observation, histopathology, immunohistochemistry,TEM and FCM,we observed changes of the activity andstructure of grafted skin and the granulation tissue,collagnous fiber,microvessels,the ultramicrostructure of fibroblasts and the expression of basic fibroblast growth factor(bFGF) in the base of autoskin grafting in fault hypodermis wound in burned adult minipigs(Group A), and compared with traditional method of autoskingrafting on the basilar fibrous tissue wound of scraped partly granulation being(Group B) and control group (Group C, without treatment except de-fur).Results The grafted skin survived after 3 days of operation, and it had less injury and higher proliferative index(PI) in group A than in group B. The hyperplasiaof granulation tissue and vascular endothelial and the expression of bFGF were more evident in group A. After 5 days, the proliferation of endothelial cells and granulation and the protein synthesis of fibroblasts were more active in groupA, and at this moment, fresh collagen appeared and proliferated more actively in group B. After 7-14 days, epidermic structure and dermic microvascular density became normal gradually, the granulation on grafting base matured and transformed into fibrous connective tissue in group A. The same change deferred about 2 days in group B. After 21 days, the above pathologic change in group A was less than that in group B. After 3060 days of operation, Group A achieved much less contraction and transfiguration than Group B, and the grafted skin was tender and movable. Conclusion Autoskin grafting in fault hypodermis wound of granulation excision has a better effect than traditional operation.
ObjectiveTo compare curative effect of catheter drainage following ultrasound-guided vacuum-assisted rotary excision and traditional excision in treatment of granulomatous mastitis in abscess stage. MethodsA total of 38 patients with granulomatous mastitis in abscess phase from December 2016 to March 2017 in the Third People’s Hospital of Chengdu City and from March 2017 to October 2017 in the Sichuan Provincial Hospital for Women and Children were included as a study group, who were received the catheter drainage following ultrasound-guided vacuum-assisted rotary excision. A total of 38 similar cases from July 2015 to November 2016 in the Third People’s Hospital of Chengdu City were collected as a control group according to the 1∶1 matching principle, who were received the traditional excision. The therapeutic period, postoperative appearance of breast, and recurrence rate were compared between these two groups. ResultsCompared with the control group, the therapeutic period was significantly shorter (t=74.000, P<0.001), the postoperative appearance of breast was significantly better (χ2=7.280, P=0.007) in the study group, while the recurrence rate had no significant difference (χ2=0.559, P=0.455) between these two groups. ConclusionsCatheter drainage following ultrasound-guided vacuum-assisted rotary excision shows advantages in postoperative therapeutic period and appearance of breast and doesn’t increase relapse rate as compared with traditional surgery for patients with granulomatous mastitis in abscess stage.
Objective To investigate the operative procedure and the effectiveness of eosinophil ic granuloma (EG) of long bones in children. Methods Between January 2005 and December 2009, 14 patients with EG of long bones were treated. There were 9 boys and 5 girls, aged from 1 to 13 years (mean, 6.5 years). The locations were femur in 5 cases, humerus in 4 cases, tibia in 2 cases, fibula in 1 case, and femur compl icated with tibia in 2 cases. The disease duration was7 days to 10 months (median, 2 months). X-ray films showed that osteolytic destruction had clear boundary, which did notinvolve the epi physeal plate. Of 14 cases, 12 cases of tumor were treated by curettage, autologous il iac bone or combined artificial bone graft repair, and 2 cases were treated by resection, autologous il iac reconstruction, plate and screw fixation. Five cases compl icated with pathological fracture underwent reduction and fixation. Results All cases were diagnosed pathologically as having EG. All incisions healed by first intention. A total of 12 patients were followed up 1 to 4 years (mean, 2 years). The X-ray films showed tumor focus and pathological fracture healed within 3 to 4 months (mean, 3.5 months). Tibial lesion was found in 1 case of femoral tumor after 8 months, and was curred after reoperation. No recurrence occurred in other 11 cases. According to comprehensive assessing standard of X-ray film and joint function, the results of all cases were excellent. Conclusion EG of long bones in children is more common in the femur and humerus. Tumor curettage and autologous il iac bone graft repair is an effective method, and postoperative prognosis is good. There may be multiple lesions, so long-term follow-up is needed.
Granulomatous lobular mastitis (GLM) is a rare mastitis disease, which mainly occurs in childbearing period. The etiology, diagnosis and treatment of GLM are still disputed. In recent years, the role of Corynebacterium infection in the pathogenesis of GLM has attracted more and more attention. Cystic neutrophilic granulomatous mastitis (CNGM) has been proposed, and more and more studies have targeted CNGM as a unique subtype of GLM. This article summarizes the published literature on CNGM so far to discuss the research progress in clinicopathological features, microbiological findings, clinical diagnosis and treatment of CNGM.