·临床研究·导管周围乳腺炎与肉芽肿性乳腺炎的临床鉴别与处理杨剑敏王颀张安秦许娟郜红艺李文萍于海静作者单位:510010广州,广东省妇幼保健院暨广州医学院附属省妇儿医院乳腺病中心(杨剑敏、王颀、张安秦、许娟、李文萍、于海静),病理科(郜红艺)通信作者:王颀,E2mail:wangqigz@21cn.com【摘要】目的探讨导管周围乳腺炎与肉芽肿性乳腺炎的临床特点及处理方法。方法2006年5月至2010年1月本院收治了36例经病理证实的导管周围乳腺炎或肉芽肿性乳腺炎患者,对该36例患者的临床资料进行回顾性分析。结果病理结果显示导管周围乳腺炎25例,肉芽肿性乳腺炎11例。两种疾病均以反复脓肿、乳房肿块及乳腺窦道或瘘管为表现。25例导管周围乳腺炎患者病变均位于乳晕2cm环内,其中14例合并乳头内陷;治疗包括,手术治愈4例(肿块型局限者)占16%,药物加手术治愈10例(肿块并乳头内陷者8例及合并窦道及乳头内陷者2例),占40%;仅用药物治疗痊愈6例(脓肿型4例和肿块并窦道2例),占24%,随访2～27个月未见复发,另有5例(肿块型1例和肿块并乳头内陷者4例)仍接受三联抗菌药物治疗。11例肉芽肿性乳腺炎患者中9例病变位于乳晕2cm环外,未见合并乳头内陷;治疗包括,7例三联抗菌药物治疗后肿块缩小至1～2cm后手术切除病变,其中1例合并多发窦道者术后3个月复发,予三联抗菌药物治疗2个月后范围缩小,再次行手术治疗,术后12个月未见异常,余6例随访6～24个月,未见复发;2例仍在行三联抗菌药物治疗,待病变缩小手术;2例皮质激素治疗停药后复发,再用激素治疗2周病变缩小,手术切除病变,未见复发。两组患者无一例行全乳房切除。结论导管周围乳腺炎和肉芽肿性乳腺炎临床表现相近,需临床与病理检查结合确诊,手术是该病的主要治疗手段,病变复杂广泛者可先行三联抗菌药物治疗,待病变缩小至1～2cm、病情稳定后,手术治疗效果更好。【关键词】导管周围乳腺炎;肉芽肿性乳腺炎;诊断;治疗【中图法分类号】R655.8【文献标识码】AIdentificationandtreatmentofperiductalmastitisandgranulomatousmastitisYANGJian2min,WANGQi,ZHANGAn2qin,XUJuan,GAOHong2yi,LIWen2ping,YUHai2jing.BreastDiseaseCenter,GuangdongWomenandChildrenHospital,Guangzhou510010,ChinaCorrespondingauthor,WangQi,E2mail:wangqigz@21cn.com【Abstract】ObjectiveToexploreandsummarizetheclinicalfeaturesandtreatmentofperiductalmastitisandgranulomatousmastitis.MethodsFromMay2005toJanuary2010atotalof36patientswithperiductalmastitisorgranulomatousmastitisweretreatedinourhospital.Theclinicaldataofthe36patientswereretrospectivelyanalyzed.ResultsThepathologicalexaminationresultshowedperiductalmastitisin25patientsandgranulomatousmastitisin11.Thetwodiseasesmanifestedmainlyasrepeatedabscess,breastlumpandsinusorfistulacannulas.Inallthe25patientswithperiductalmastitisthelesionswerelocatedin2cmareawithintheareola,and14ofthemwerecombinedwithmammarypapillainvagination.Four·603·中华乳腺病杂志(电子版)2011年6月第5卷第3期ChinJBreastDis(ElectronicEdition),June2011,Vol.5,No.3patients(16%)weretreatedwithoperationandcured,tenpatients(40%)weretreatedwithanti2nontuberculosismycobacteriadrugsplusoperationandcured,sixpatients(24%)weretreatedwiththedrugsonlyandcured.Thefollow2upof2227monthsdemonstratednorecurrence.Therest5patientswerestillreceivinganti2nontuberculosismycobacteriatherapy,whentheirconditionswouldpermitoperationwouldbeperformed.Inthe11patientswithgranulomatousmastitisninehadtheirlesionslocatedinthe2cmareaoutsidetheareola,withoutmammarypapillainvagination.Sevenpatientsreceivedanti2nontuberculosismycobacteriadrugstherapyfirsttillthemassbecamesmallerabout122cminsizeandtheirdiseaseconditionwasstablethemasseswereresected.Sixofthemwerecuredandnorecurrencehappenedby6224monthsoffollow2up,andonepatienthadrecurrencethreemonthsafteroperation,receivedthe...
