Colin Catherine, Delov Ana Gjorgjievska, Peyron-Faure Noémie, Rabilloud Muriel, Charlot Mathilde
Department of Radiology, Breast Imaging, Hospices Civils de Lyon, Centre Hospitalier Femme Mère Enfant, 59 Boulevard Pinel, 69677, Bron, France.
Department of Radiology, Women Imaging, Private clinic Val d'Ouest, Charcot, 53 rue commandant Charcot, 69110, Sainte Foy-lès-Lyon, France.
Emerg Radiol. 2019 Oct;26(5):507-514. doi: 10.1007/s10140-019-01694-z. Epub 2019 Jun 1.
Surgical incision with drainage remains the first-line therapy recommendation for breast abscesses greater than 5 cm.
To determine recovery with ultrasound guided (US-guided) procedures for treatment of lactational breast abscesses without surgical incision for drainage.
Institutional review board approval and written informed patient consent were obtained for this retrospective study. From May 1, 2009, to June 1, 2018, 92 consecutive women (mean age 30 years, range 18-45) with 105 abscesses were treated with oral antibiotics and US-guided percutaneous drainage under local anesthesia. A total number of 202 US-guided procedures were performed. Three techniques were used: needle aspiration (diameter 18 to 14G), pigtail catheter insertion (diameter 5 to 7F), and/or vacuum-assisted biopsy/aspiration (diameter 10G). When using needle aspiration or pigtail catheter, a saline irrigation of the cavity was performed according to pus viscosity.
The median diameter of abscesses was 4.5 cm (range 1-15), 82/105 (78%) were larger than 3 cm and 40/105 (38%) larger than 5 cm. US-guided management was successful for 101/105 (96%; 95% CI, (91-99%)) abscesses regardless the size. After the first round of procedures, 49/105 (47%) abscesses were recovered, 56/105 (53%) needed more than one drainage with a median number drainages of 2.6 (2-6). In 4/105 cases (4%), women underwent additional surgery under general anesthesia. By excluding abscesses which occurred in the weaning phase (n = 17), breastfeeding carried on for 68/75 (91%) women.
Unlike previous studies, US percutaneous guided management of lactational abscesses is effective even for abscesses greater than 5 cm and allows continued breastfeeding.
对于直径大于5厘米的乳腺脓肿，手术切开引流仍是一线治疗推荐方法。
确定超声引导下（US引导）治疗哺乳期乳腺脓肿且无需手术切开引流的恢复情况。
本回顾性研究获得了机构审查委员会的批准以及患者的书面知情同意书。从2009年5月1日至2018年6月1日，92名连续的女性（平均年龄30岁，范围18 - 45岁）共105个脓肿接受了口服抗生素治疗，并在局部麻醉下接受了超声引导下的经皮引流。总共进行了202次超声引导操作。使用了三种技术：针吸（直径18至14G）、猪尾导管插入（直径5至7F）和/或真空辅助活检/抽吸（直径10G）。当使用针吸或猪尾导管时，根据脓液黏稠度对脓腔进行盐水冲洗。
脓肿的中位直径为4.5厘米（范围1 - 15厘米），82/105（78%）大于3厘米，40/105（38%）大于5厘米。无论脓肿大小，超声引导下的治疗对101/105（96%；95%CI，（91 - 99%））个脓肿成功。第一轮操作后，49/105（47%）个脓肿恢复，56/105（53%）个需要不止一次引流，中位引流次数为2.6（2 - 6）。在4/105例（4%）中，女性在全身麻醉下接受了额外手术。排除断奶期发生的脓肿（n = 17）后，75名女性中有68/75（91%）继续进行母乳喂养。
与先前研究不同，超声引导下经皮治疗哺乳期脓肿即使对于大于5厘米的脓肿也有效，并且能使患者继续母乳喂养。
