肉芽肿性乳腺炎的治疗分析

Analysis of the Treatment of Granulomatous Mastitis

摘要: 肉芽肿性小叶性乳腺炎(granulomatous lobular mastitis, GLM)是指在病理为以乳腺终末导管小叶单位为中心的非坏死性肉芽肿性炎，属于非哺乳期乳腺炎。近年来该病发病率逐步攀升，常发生在育龄期女性中，且病程长、易复发。治疗方法并无统一标准，可简单分为手术、糖皮质激素两种方式；手术方式一般首选广泛局部切除，糖皮质激素则是最主要的药物治疗手段，常被推荐为GLM一线的初始治疗，或作为手术后的辅助治疗。回顾性分析2017年1月至2023年12月南昌大学第一附属医院收治的79例病理确诊肉芽肿性乳腺炎患者的临床资料，分为非手术组和手术组，两组基本资料无统计学差异(P > 0.05)。对两组复发率进行对比，非手术组对比手术组复发率为34.21%比7.32% (P值 = 0.0071)，研究表明术前、术后均短期抗生素联合小剂量激素治疗肉芽肿性乳腺炎对比激素维持治疗复发率更低，效果更好，在临床工作中值得参考。

Abstract: Granulomatous lobular mastitis refers to a non-necrotizing granulomatous inflammation centered on the terminal duct-lobular unit of the breast, according to pathology, and is classified as non-lactational mastitis. In recent years, the incidence of this disease has gradually increased, commonly occurring in women of reproductive age, with a long disease course and a tendency to recur. There is no unified standard for treatment, which can be simply divided into surgery and glucocorticoid therapy. The preferred surgical method is generally extensive local excision, while glucocorticoids are the main pharmaceutical treatment and are often recommended as the initial first-line treatment for GLM or as adjuvant therapy after surgery. A retrospective analysis was conducted on the clinical data of 79 pathologically confirmed patients with granulomatous mastitis admitted to the First Affiliated Hospital of Nanchang University from January 2017 to December 2023, dividing them into non-surgical and surgical groups. There were no statistically significant differences in baseline characteristics between the two groups (P > 0.05). Comparing the recurrence rates between the two groups, the recurrence rate in the non-surgical group was 34.21% compared to 7.32% in the surgical group (P = 0.0071). The study indicates that short-term antibiotic therapy combined with low-dose glucocorticoids before and after surgery results in lower recurrence rates for granulomatous mastitis compared to maintenance glucocorticoid therapy, and shows better outcomes, which is worth considering in clinical practice.