Objective:As a common breast cancer-related complaint, pathological nipple discharge (PND) detected by ductoscopy is often missed diagnosed. Deep learning techniques have enabled great advances in clinical imaging but are rarely applied in breast cancer with PND. This study aimed to design and validate an Intelligent Ductoscopy for Breast Cancer Diagnostic System (IDBCS) for breast cancer diagnosis by analyzing real-time imaging data acquired by ductoscopy.Materials and methods:The present multicenter, case-control trial was carried out in 6 hospitals in China. Images for consecutive patients, aged ≥18 years, with no previous ductoscopy, were obtained from the involved hospitals. All individuals with PND confirmed from breast lesions by ductoscopy were eligible. Images from Beijing Chao-Yang Hospital were randomly assigned (8:2) to the training (IDBCS development) and internal validation (performance evaluation of the IDBCS) datasets. Diagnostic performance was further assessed with internal and prospective validation datasets from Beijing Chao-Yang Hospital; further external validation was carried out with datasets from 5 primary care hospitals. Diagnostic accuracies, sensitivities, specificities, and positive and negative predictive values for IDBCS and endoscopists (expert, competent, or trainee) in the detection of malignant lesions were obtained by the Clopper-Pearson method.Results:Totally 11305 ductoscopy images in 1072 patients were utilized for developing and testing the IDBCS. Area under the curves (AUCs) in breast cancer detection were 0·975 (95%CI 0·899-0·998) and 0·954 (95%CI 0·925-0·975) in the internal validation and prospective datasets, respectively, and ranged between 0·922 (95%CI 0·866-0·960) and 0·965 (95%CI 0·892-0·994) in the 5 external validation datasets. The IDBCS had superior diagnostic accuracy compared with expert (0.912 [95%CI 0.839-0.959] vs 0.726 [0.672-0.775]; p<0.001), competent (0.699 [95%CI 0.645-0.750], p<0.001), and trainee (0.703 [95%CI 0.648-0.753], p<0.001) endoscopists.Conclusions:IDBCS outperforms clinical oncologists, achieving high accuracy in diagnosing breast cancer with PND. The novel system could help endoscopists improve their diagnostic efficacy in breast cancer diagnosis.

目的 探讨超声光散射乳腺诊断系统(简称乳光超)在多中心乳腺癌筛查中对乳房影像报告及数据系统(BI-RADS)3、4级乳腺结节的诊断价值.方法 纳入2017-10-01-2018-05-316家妇幼保健院(广东省妇幼保健院、北京市海淀妇幼保健院、广州市妇女儿童医疗中心、安阳市妇幼保健院、长沙市妇幼保健院、北京市延庆妇幼保健院)36706名女性体检筛查及门诊筛查者,均进行乳光超和超声2种检查,部分进行乳腺X射线检查,均进行BI-RADS分级.任意一种检查方法BI-RADS 4级者进行活检(空芯针、真空辅助微创旋切或手术活检),BI-RADS 3级者至少随机选取20％进行活检.分析乳光超和超声筛查乳腺癌的灵敏度和特异度,探讨2种检查方法区分BI-RADS 3和4级肿块及≤1 cm肿块的能力.采用SPSS 22.0对数据进行统计学分析,构成比比较采用χ2检验.结果 6家研究单位共采集36706名患者数据,有肿块病例为6237例,肿块检出率为16.99％,活检病例为1056例,活检率为2.88％.乳光超灵敏度大于超声(0.932 vs 0.915),差异无统计学意义,P=0.942.乳光超特异度大于超声(0.809 vs 0.737),差异有统计学意义,P<0.001.乳光超与超声检查的BI-RADS 3级恶性率分别为3.39％和6.78％,差异无统计学意义,P=0.316;乳光超与超声BI-RADS 4级良性率分别为17.25％和25.38％,差异有统计学意义,P<0.001.结论 乳光超在乳腺筛查中对BI-RADS 3、4级结节的诊断准确性优于超声,可作为早期乳腺癌筛查的有效方法之一.

Background Approximately 54.8% of patients with breast abscesses discontinue breastfeeding due to the lack of adequate breastfeeding support. Research aims We aimed to (1) examine the difference in milk volume produced by healthy breasts and breasts with abscesses; and (2) to explore the changes in milk volume before and after comprehensive management. Method A prospective, consecutive series study was designed. Lactating patients (N = 50) with breast abscesses were selected from March 2017 to November 2018. The volume and frequency of milk expression of the affected and the unaffected breast were recorded every 24 hr before and after comprehensive management. The difference in the milk volume produced by healthy breasts (control) and breasts with abscesses, as well as the milk volume produced by each breast before and after comprehensive management, was determined. Results There was a significant difference in the milk volume produced by healthy breasts and breasts with abscess before (t = 3.016; p = .004) and after (t = 4.336; p < .001) comprehensive management. The frequency of milk expression was significantly higher after comprehensive management than before it (z = −6.145; p < .001); the milk volume produced by each side significantly increased after comprehensive management (healthy breasts: t = −4.789; p < .001; breasts with abscess: t = 2.555; p = .014). Conclusion The total milk volume produced by breasts with abscesses can be less than that produced by healthy breasts. The management of abscesses by increasing the frequency of milk expression and degree of emptying can help mothers increase their milk volume.

Mastering the correct breastfeeding posture remains a challenge for many new mothers. Generalized pregnancy breastfeeding education plays a role in helping mothers master breastfeeding positions and prevent nipple damage. This study prospectively analyzed the effects of prenatal professional breastfeeding education for the family on mastering the lactation latch and preventing nipple damage. Medical records of pregnant women in the authors' hospital from April 2020 to July 2020 were prospectively analyzed. A total of 342 patients were enrolled and divided into experimental and control groups according to whether or not they had received prenatal professional breastfeeding education for the family by the random number table method. The difference in the mastery rate of the postpartum breastfeeding posture and nipple damage was examined three days postpartum. The mastery rate in the experimental group (88.5%) was significantly higher than that in the control group (63.8%), whereas the rate of nipple damage in the experimental group (23.1%) was significantly lower than that in the control group (46.9%). Prenatal professional breastfeeding education for the family can promote mothers' mastery of breastfeeding latch skills and reduce the risk of nipple damage.

Abstract Introduction Breast massage and manual expression of breast milk are recommended for some breastfeeding problems. Aim This retrospective study evaluated the differences in the clinical characteristics and treatment of lactating mothers with breast abscess involving different breast massage participants. Methods Medical records of 654 women with breast abscess in Haidian Maternal and Child Health Hospital were obtained and analyzed. The women were categorized into the study and control groups based on the person who performed the massage (non-medical vs. medical personnel). The difference in the site of breast abscess, type of abscess cavity, necrotic organization inside the abscess cavity, treatment of abscess, and number of punctures treatment was compared. Results The incidences of breast abscess in the nipple areola area, multicavity, and necrotic tissue in the abscess cavity in the study group were higher than in the control group. The mean number of abscess cavities in the two groups was not significantly different. The puncture treatment rate was lower, while the mean puncture number was higher in the study group. Conclusion Breast massage by non-medical personnel resulted in more complex and difficult to treat abscesses, which underscores the need for mothers to be cautious in choosing breast massage providers.

Background: Lactational mastitis and breast abscess cause trouble for women. It has been shown that oral probiotics can improve breast microecology, thus alleviating inflammatory responses. Our study aims to understand the long-term effect of Lactobacillus fermentum CECT5716 on patients with lactational breast abscess after needle aspiration. Methods: Data continued in a randomized controlled study of 101 subjects with lactational abscess from 12 hospitals were included. They were randomly divided into an experimental group and a control group. After needle aspiration treatment, the experimental group was orally administrated with L fermentum CECT5716 for 4 consecutive weeks, while the control group was treated with maltodextrin in the same way). In the third month after randomized controlled trial, the subjects were followed up by an online questionnaire investigation. The observation indexes included the relief of breast pain, recurrence of mastitis from the end of oral administration to the follow-up, and the effect on continuing breastfeeding. Results: A total of 101 patients were enrolled and 83 valid questionnaires were received during follow-up, including 40 in the experimental group and 43 in the control group. The rate of stop breastfeeding due to recurrence of mastitis was 2.5% (1/40) in the experimental group and 18.6% (8/43) in the control group, with a statistically significant difference (odds ratio = 0.112, 95% confidence interval: 0.013-0.942, P < .05). The rate of stop breastfeeding was 10% (4/40) in the experimental group and 25.6% (11/43) in the control group, without significant difference. The pain relief rate in the experimental group was 80% (32/40), which showed no significant difference from that in the control group, that is, 72.1% (31/43). The recurrence rate of mastitis in the experimental group was 20% (8/40), which was not significantly different from that in the control group, that is, 16.3% (7/43). Conclusions: In lactating women with a history of breast abscess, oral L fermentum CECT5716 may reduce the risk of stop breastfeeding due to recurrence of mastitis.

Treatment strategies for nipple injury are mainly based on aetiology. However, some damaged nipples do not heal after the aetiology was corrected. This study retrospectively analyses the effect of debridement for treating chronic injury of lactating nipples. The medical records on nipple injury management in the authors’ department from December 2015 to January 2020 were retrospectively analysed. A total of 167 patients were enrolled and grouped based on the presence or absence of nipple debridement. The difference in the healing effect, pain relief rate and recurrence rate of nipple injury between the two groups after 1 week was examined. The cure rate of nipple injury in the intervention group (54.3%) was significantly higher than in the control group (26.7%). In addition, the complete pain relief rate in the intervention group (48.1%) was significantly higher than in the control group (23.3%). However, the recurrence rates between the two groups (36.4% (16/44) vs. 34.8% (8/23)) had no statistically significant differences. For patients with no improvement after correction of the aetiology of the in the nipple damage, debridement can improve the healing environment of nipple breakage and thus relieve nipple pain.

目的 探讨真空辅助微创旋切术后不放置引流管治疗坏死型乳腺脓肿的临床效果.方法 依据纳入、排除标准,选取北京市海淀区妇幼保健院2015年1月至2018年7月收治的73例哺乳期坏死型乳腺脓肿患者进行前瞻性研究.采用随机数字表法将患者分为研究组(35例)和对照组(38例).研究组采用真空辅助微创旋切术治疗,术后不放置引流管;对照组采用脓肿置管冲洗引流术治疗.比较2组间治疗指标(术后住院时间、复诊次数)、并发症(乳瘘)及预后(回乳、复发)的差异.偏态分布的计量资料用M(P25～P75)表示.术后住院时间、复诊次数的比较采用Mann-Whitney U检验;回乳率、复发率及乳瘘发生率的比较采用χ2检验及Fisher确切概率检验.结果 研究组与对照组患者术后住院时间分别为5.0(3.0～7.0)d和10.5(8.0～13.3)d,复诊次数分别为3.0(2.0～6.0)次和7.5(3.0～10.0)次,乳瘘发生率分别为2.9％(1/35)和21.1％(8/38),组间比较,差异均有统计学意义(Z=-5.704,P<0.001;Z=-3.626,P<0.001;P=0.029),而回乳率、复发率比较,差异均无统计学意义[回乳率:20.0％(7/35)比39.5％(15/38),χ2=3.282,P=0.070;复发率:8.6％(3/35)比7.9％(3/38),P=1.000].结论 对于脓腔内充满坏死组织的复杂乳腺脓肿,真空辅助微创旋切术后不放置引流管,患者不需特殊护理,术后住院时间短,复诊次数少,可提高母亲患病期间的生活质量.

目的:探讨超声光散射技术与超声、X光钼靶在乳腺癌筛查中作用.方法:选取2013年10月-2014年6月我院筛查的2000例(其中85例进行活检)进行乳腺癌筛查乳腺肿块患者作为研究对象,分别给予乳腺超声检查、乳腺X光检查(对照组)及超声光散射乳腺成像技术检查(研究组),并分析两组影像学检查方式诊断的灵敏性、特异性、漏诊率、误诊率、诊断正确率以及不典型增生诊断正确性.结果:超声光散射的敏感度为0.83,低于乳腺超声检查,高于乳腺X光检查;特异度为0.91,高于乳腺超声检查和乳腺X光检查;符合率为0.91,阳性预测值为0.42,均高于乳腺超声和乳腺X光检查;超声光散射与病理结果的一致性比较,Kappa值为0.51,高于乳腺超声和乳腺X光检查.结论:与乳腺超声检查、乳腺X光检查相比,超声光散射乳腺成像技术对不典型增生具有预警价值.同时,与乳腺超声检查及乳腺X光检查联合应用可提高乳腺癌筛查效果.

目的 探讨乳头修复术治疗哺乳期慢性乳头损伤的应用价值.方法 根据纳入及排除标准,纳入2015年11月至2020年6月于北京市海淀区妇幼保健院就诊的哺乳期慢性乳头损伤患者274例进行回顾性分析.根据治疗方案不同,分为3组:修复组87例,全部进行乳头修复术;敷药组92例,外敷重组人碱性成纤维细胞生长因子(rh-bFGF)药物;联合组95例,先行乳头修复术,术后外敷rh-bFGF药物.采用非参数Kruskal-Wallis H检验比较3组患者乳头损伤愈合程度及疼痛改善程度,其两两比较采用Dunn-Bonferroni检验;采用χ2检验比较治愈率和复发率的差异,两两比较采用Bonferroni校正的χ2检验.结果 修复组中45例患者乳头损伤完全愈合,22例好转,20例无效;敷药组中33例完全愈合,17例好转,42例无效;联合组中70例完全愈合,14例好转,11例无效,3组比较,差异有统计学意义(χ2=32.252,P<0.001).联合组乳头损伤愈合程度优于修复组,联合组与修复组均优于敷药组(Bonferroni校正P=0.018、<0.001、0.014).修复组中40例患者乳头疼痛完全消失,25例好转,22例无效;敷药组中26例疼痛完全消失,29例好转,37例无效;联合组中61例疼痛完全消失,21例好转,13例无效,3组比较,差异有统计学意义(χ2=26.907,P<0.001).联合组疼痛改善程度优于修复组,联合组与修复组均优于敷药组(Bonferroni校正P=0.041、<0.001、0.026).修复组、敷药组、联合组患者治愈率分别为44.8％(39/87),26.1％(24/92)55.8％(53/95),3组比较,差异有统计学意义(χ2=17.688,P<0.001).修复组与联合组的治愈率均高于敷药组(χ2=17.470、7.149,Bonferroni校正P=0.008、<0.001),联合组与修复组比较,差异无统计学意义(χ2=2.183,Bonferroni校正P=0.140).在乳头损伤治愈患者中,修复组乳头损伤复发率为28.2％(11/39),敷药组为29.2％(7/24),联合组为24.5％(13/53),3组比较,差异无统计学意义(χ2=0.247,P=0.884).结论 对于哺乳期慢性乳头损伤的患者,乳头修复术不仅可以改善乳头损伤的愈合环境,缓解乳头疼痛,还有助于外用药rh-bFGF在损伤局部发挥促进上皮、组织、神经修复的作用.

Abstract Objective To explore the effect of nipple repair in the treatment of lactating nipple injury.Methods Patients with nipple lesions admitted to the Maternal and Child Health Hospital of Haidian District from December 2015 to January 2020 were retrospective control study. The patients received nipple repair was the study group, the patients did not treated with medicine or surgery was the control group. Patients in both groups continued to be exclusively breastfeed with good sucking, The method of chi-square test was adopted by using SPSS24.0 statistical software to compare the difference of healing effect of nipple injury, pain relief rate, and recurrence rate of nipple injury.Results A total of 167 patients were enrolled, including in the 81 study group and 86 in the control group. The cure rates of the nipple injury in the study group and in the control group were 54.3% (44/81) and 26.7% (23/86) (χ2 = 13.451, P = 0.001). The complete pain relief rate was 48.1% (39/81) and 23.3% (20/86) (χ2 = 14.170, P = 0.001). The recurrence rate was 36.4% (16/44) and 34.8% (8/23) (χ2 = 0.016, P = 0.898).Conclusion For patients with no improvement in nipple damage after correction of etiology, nipple repair can improve the healing environment of nipple breakage, relieve nipple pain.

Background: Several Chinese mothers experience problems related to their breasts during breastfeeding and are referred to hospitals for treatment after a massage by a "cuirushi." Some of these patients develop large breast abscesses. Notably, the treatment of residual milk cavities is difficult after pus aspiration. Lactational residual milk cavities in the breast hinder effortless breastfeeding, but no solution has been reported thus far. This study aims to explore the use of a simple and minimally invasive method for treating lactational residual milk cavities and enabling mothers to breastfeed effortlessly. Materials and Methods: We retrospectively analyzed clinical data of 28 patients with lactational residual milk cavities treated using negative-pressure suction cannula and drainage at our department from December 2016 to May 2019. The success rate, safety, and feasibility of this technique are summarized. Results: Among the 28 patients, the first catheterization was successful in 7 (25%) patients, the second in 13 (46.4%) patients, and the third or subsequent catheterizations in 8 (28.6%) patients. The intubation time was <10 days in 3 patients, between 10 and 20 days in 12 patients, and >20 days in 13 patients. During and after treatment, 21 patients (75%) continued breastfeeding with the affected breast. Conclusions: Ultrasound-guided negative-pressure suction cannula is a new method to treat lactational residual milk cavities that may remain after initial therapy for lactational breast abscess. The treatment of lactational residual milk cavities offers significant advantages in supporting mothers during breastfeeding.

Objective To discuss the efficacy of ultrasound-guided aspiration and irrigation in lactational breast abscess patients and analyze the related factors of delactation.Methods The clinical data of 799 patients with lactational breast abscess treated by ultrasound-guided aspiration and irrigation in the Center for Prevention and Treatment of Breast Diseases,Maternal and Child Health Hospital of Haidian District from January to December 2016 were retrospectively analyzed.x2 test was used to analyze the data such as puncture frequency,postpartum time,antibiotics use and location of abscess.The unconditional logistic regression model was used to analyze the relationship between various factors and delactation.Results All 799 cases were followed up and 753 cases were cured.The cure rate was 94.2％ (753/799).Delactation occurred in 75 cases and the delectation rate was 9.4％ (75/799).Single-factor analysis showed that postnatal time,use of antibiotics,number of puncture and location of abscess were associated with delactation (x2 =7.159,7.794,39.394,21.243,P=0.007,0.005,P ＜0.001).Multivariate Logistic regression analysis showed that number of puncture (OR =6.442,95％ CI:1.851-22.420,P =0.003) and abscess in central area (OR =2.643,95％CI:1.480-4.721,P=0.001)were the risk factors for delactation,while long postnatal time was a protective factor for delactation (OR=0.540,95％ CI:0.315-0.927,P=0.025).Conclusions Ultrasoundguided aspiration and irrigation is effective for the treatment of lactational breast abscess,with a high cure rate and low delactation rate.The disease in puerperium,multiple punctures and the abscess in the central area are more likely to cause delectation.

目的:分析探讨综合护理干预在早期急性乳腺炎护理中的应用分析.方法:选取在本院治疗的80例早期急性乳腺炎患者作为研究对象,随机分成对照组和观察组,每组40例患者.针对对照组患者采用一般的常规护理方法,观察组采用综合护理干预模式,比较两种护理方式的临床应用结果.结果:观察组患者治疗有效率明显高于对照组患者的治疗有效率,且对照组和观察组治疗有效率差异显著(P<0.05).结论:早期急性乳腺炎患者进行临床治疗期间,对其采取综合性护理干预方式,可以有效提高早期急性乳腺炎患者的疗效,减少并发症的发生率,有效提升患者对医院护理质量的满意度,减短了患者的住院时间,在一定程度上减轻了患者的经济压力,值得在临床上推广使用.

Objective To evaluate the efficacy of ductal probing in treating milk stasis and the possible influencing factors. Methods A total of 2 544 patients with milk stasis in Haidian Maternal and Child Health Hospital from January 2012 to May 2016 were enrolled in this prospective study. They were divided into the study group (n=1 159) and the control group ( n=1 385) using a random number table method. The patients in study group were treated by ductal probing and the patients in control group received comprehensive physiotherapy(including local massage, semiconductor laser physical therapy, electric breast pump sucking and external application with 50% magnesium sulfate for 30 min). The patients were followed up for 1 month. The efficacy and recurrence rate were compared between two groups. According to the course of milk stasis, the distance from the nipple to the lump and the lump diameter, all patients in study group were subdivided to compare the efficacy of ductal probing among subgroups. The recurrence rate was compared between two groups using x2test. The non-parametric test was used to compare the treatment outcome. Two groups were compared using the Wilcoxon test, and three groups were compared using the Kruskal-Wallis test. Results After the treatment, there were 847 patients cured, 156 improved, 73 with clinical response, 65 with no response, and 18 with disease progression in the study group, 441, 312, 291, 308 and 33 in control group. The efficacy of ductal probing showed a significant difference (Z=-20. 75, P<0. 001). The difference in the recurrence rate between two groups was not statistically significant [14. 6% (169/1 159) vs 14. 0% (194/1 385), x2=0. 17, P=0. 680]. Subgroup analysis showed that the efficacy of ductal probing was significantly different among the subgroups with different courses (<2 d,2~3 d and >3 d) and different distance from the nipple to the lump (< 3 cm,3 ~5 cm and >5 cm) (Z=116. 14, P<0. 001; Z=198. 77, P<0. 001). The efficacy of ductal probing showed no significant difference between the patients with the lump ≤5 cm and the patients with the lump >5 cm (Z=-1. 00, P=0. 317). Conclusions Compared with mammary physiotherapy, ductal probing is effective in patients with milk stasis, worthy of clinical application. The outcome of this operation is related to the disease course and the distance from the nipple to the lump, irrelevant of the lump diameter.

目的:观察夏枯草口服液治疗慢性乳腺炎患者的疗效,探讨其对患者的炎症水平、VAS评分以及肿块大小的影响.方法:选取2015年1月至2017年12月于我院治疗的102例慢性乳腺炎患者为研究对象,按照随机数表法平均分为实验组与参照组(各51例),参照组患者给予常规方法治疗,实验组患者在常规方法基础上加用夏枯草口服液治疗,两组均持续治疗3周.观察比较两组患者临床疗效、炎症水平、各临床指标、视觉模拟评分(VAS)以及肿块大小情况.结果:实验组患者总有效率为94.12％,明显高于参照组患者的78.43％ (P ＜0.05).两组患者治疗前肿瘤坏死因子α(TNF-α)水平、C反应蛋白(CRP)和白细胞(WBC)正常比例、肿块最大直径及VAS评分比较无明显差异(P＞0.05);经治疗干预后,两组患者TNF-α、CRP、WBC正常比例、肿块最大直径及VAS评分均有所改善,且实验组患者改善程度明显优于参照组(P＜0.05).治疗后实验组患者乳房红肿消退时间、乳房压痛消失时间及退热时间均比参照组的短(P＜0.05);一年内实验组复发率为7.84％,明显低于参照组的25.49％ (P ＜0.05).治疗后两组不良反应均较轻,两组发生率比较无明显差异(P＞0.05).结论:利用夏枯草口服液辅助治疗慢性乳腺炎患者可以明显提高治疗有效率,缓解患者的炎症反应和疼痛情况,改善临床症状并降低复发率,且无明显不良反应.

Objective To investigate the therapeutic effects of ultrasound-guided aspiration in patients with lactational breast abscess and explore the factors affecting the times of aspirations for healing the breast abscess.Methods The clinical data of 108 patients with lactational breast abscess treated by ultrasound-guided aspiration and irrigation in the Center for Prevention and Treatment of Breast Diseases, Maternal and Child Health Hospital of Haidian District from May 2014 to October 2014 were retrospectively analyzed. According to the times of aspirations, the patients were dived into two groups: group A (≤5 times) and group B (>5 times). χ2 test was used for single-factor analysis of the following factors: patients’ age, time after childbirth, duration, fever, use of antibiotics, position of abscess, number of abscesses, maximum diameter of abscess, pus volume in the first aspiration, pus feature in the first aspiration and milk regurgitation. The factors with statistical significance were enrolled into stepwise Logistic regression analysis.Results In 108 cases, 105 cases were cured and 3 cases underwent surgery because of unsatisfactory outcome after aspiration. The cure rate was about 97.2%(105/108).They were followed up for one month. One case had recurrence, with the recurrence rate of about 1.0% (1/105). In 105 cured cases, 78 cases (74.3%) had the aspirations ≤5 times and 27 cases (25.7%) had the aspirations >5 times for healing the breast abscess. Single-factor analysis showed that the position of breast abscess, maximum diameter of abscess and pus volume in the first aspiration were related to the times of aspirations for healing the breast abscess (χ2=4.396,3.993,16.646; P=0.036,0.046, P<0.001). Logistic regression analysis showed that pus volume in the first aspiration was an independent factor affecting the times of aspirations (OR=15.665,95%CI:3.423-71.697,P<0.001).Conclusions Ultrasound-guided aspiration is feasible for lactational breast abscess, worthy of clinical application. The pus volume in the first aspiration may be an important factor to predict the times of aspirations for healing lactational breast abscess.

目的 分析哺乳期乳腺脓肿患者行超声引导下穿刺冲洗治疗后出现治疗失败的相关因素.方法 回顾性分析北京市海淀区妇幼保健院2012年1月至2014年12月收住院的359例行超声引导下穿刺冲洗治疗的哺乳期乳腺脓肿患者临床资料,根据治疗结果分为治疗痊愈组(329例)和治疗失败组(30例).采用x2检验比较两组患者在产后时间、年龄、脓腔位置、脓腔数量等方面的差异,多因素Logistic回归分析治疗失败患者的危险因素.结果 仅脓肿位置是否位于中央区这个因素,两组差异有统计学意义(x2=10.298,P=0.001).产后时间、年龄、脓腔数量、最大穿刺脓液量、感染细菌、白细胞计数情况以及初次穿刺前是否应用抗生素等因素,组间差异无统计学意义(x2 =0.186,P=0.666;x2=1.006,P=0.316;x2 =0.113,P=0.737;x2=0.677,P=0.410;x2=0.123,P=0.726;x2=0.017,P=0.897;x2=1.097,P=0.295).多因素Logistic回归分析显示,脓肿位于中央区是引起穿刺治疗失败的危险因素(OR=3.607,95％ CI:1.606 ～8.103,P=0.002).结论 对于脓肿位于中央区的哺乳期乳腺脓肿患者,通过超声引导下穿刺冲洗治疗后出现治疗失败的概率较高,临床工作中对于这部分患者是否首选穿刺抽脓治疗应慎重考虑.

哺乳期乳腺脓肿是哺乳期女性的常见病。脓肿切开引流术仍是主要的治疗方法，但手术创伤大，术后恢复时间长[1]。我院于2012年1月~2014年12月收治哺乳期乳腺脓肿患者359例，经超声引导下脓肿穿刺冲洗治疗，取得较好效果，现报道如下。

Objective To explore the related factors in the development from acute lactation mastitis to breast abscess. Methods The clinical data of 111 patients who had lactation mastitis or breast abscess in our department from January 2013 to March 2014, including 92 cases of lactation mastitis and 19 cases of breast abscess, were analyzed retrospectively. Single factor analysis and unconditional logistic regression analysis were used from the following aspects: fever or not, duration of fever, infection site, massage history given by non-medical staff, use of antibiotics, switching to sensitive antibiotics or not, bacterial culture of breast milk, mass, age, and routine blood test. Results Single factor analysis showed that in breast abscess group, the proportion of the patients with duration of fever >2 d, lesions in nipple-areola area and massage history given by non-medical staff were 12/19, 9/19 and 5/19, significantly higher than 27. 2% (25/92), 15. 2% (14/92) and 4. 3% (4/92) in non-abscess group (χ2=9. 176,9. 909,7. 465, P=0. 002,0. 002,0. 006). Multiple factor logistic regression analysis showed that duration of fever>2 d, lesions in nipple-areola area and massage history given by non-medical staff were risk factors in breast abscess during lactation ( OR=4. 171, 95%CI:1. 325-13. 135,P=0. 015;OR=5. 153, 95%CI:1. 564-16. 972,P=0. 007;OR=10. 184, 95%CI:2. 017-51. 428,P=0. 005). Conclusion The patients with duration of fever >2 d, lesions in nipple-areola area and massage history given by non-medical staff are prone to develop breast abscess and the physicians should pay more attention to their treatment.