乳腺导管扩张症的临床特点与治疗

文中报告５４例乳腺导管扩张症，并根据症状特点将其分为溢液型、包块型、炎症型和混合型。较年长患者常以乳头溢液为主要表现（溢液型和混合型），其病理主要改变为导管扩张。而较年轻者常以包块为主要表现（包块型和炎症型），病理的主要改变为浆细胞乳腺炎。临床上前者常误为管内乳头状瘤，后者易诊为乳腺癌。针吸细胞学检查是一简单有效的诊断方法，凡属有乳房包块者均应列为常规，本组诊断符合率为８５．７１％。外科治疗主要针对扩张的导管及导管周围炎程度选择不同的治疗方法。     

乳腺导管扩张症243例临床分析

目的提高乳腺导管扩张症的诊断与治疗方法。方法回顾性分析1970年至2005年经手术和病理证实的乳腺导管扩张症243例的临床资料。结果243例乳腺导管扩张症患者包括五种类型,即隐匿型33例(13.6%),肿块型169例(69.5%),脓肿型15例(6.2%),瘘管型14例(5.8%),共存型7例(2.9%)。根据临床分型可分别采用不同的术式:乳管切除术,肿块局部切除术,乳腺区段切除术,单纯乳房切除术,切开引流术,瘘管切除术,乳房简化根治术,乳房根治术。本组243例患者均手术治愈。结论根据临床表现特点,可作出初步诊断,术中冷冻切片病理检查可确定诊断。手术切除病灶是治疗乳腺导管扩张症比较彻底的有效方法。     

乳腺导管扩张症和浆细胞性乳腺炎差异的探讨

目的：分析乳腺导管扩张症和浆细胞性乳腺炎临床上的差异。提出各自独立诊断的论据。方法：结合24例乳腺导管扩张症和28例浆细胞性乳腺炎对两病的临床症状、鉴别诊断、手术治疗、病理结果进行比较分析。结果：乳腺导管扩张症临床表现为乳头溢液和乳腺肿物，主要与乳腺肿物和早期乳腺癌鉴别诊断，手术以局部切除多见，病理表现为导管扩张及导管周围明显炎性改变。浆细胞性乳腺炎临床表现为乳腺肿物和炎性改变，主要与晚期乳腺癌和炎性乳腺癌鉴别诊断，手术切除的范围较大。病理变化以乳腺组织的炎性反应和多发性脓肿为主。结论：乳腺导管扩张症和浆细胞性乳腺炎有明显的差异，应作为这两种疾病独立诊断。     

乳腺导管扩张症48例诊治体会

乳腺导管扩张症为常见的乳腺良性疾病,因病灶常有浆细胞浸润,故亦称为浆细胞性乳腺炎[1].主要体征为乳头溢血、溢液或伴有乳腺肿块.因其药物治疗效果欠佳,且可发生药物难以治愈的小脓肿,故需要完全切除.包括病灶在内的部分乳腺组织.我院自1998年元月至2007年元月共收治48例病人,现将诊治体会介绍如下:     

乳腺导管扩张症

乳腺导管扩张症(maary duct ectasia,MDE)最初由Bloodgood[1]于1923年提出,文献报道中,MDE有许多名称,如浆细胞性乳腺炎、粉刺性乳腺炎、导管周围乳腺炎、乳腺分泌性疾病、乳腺静脉曲张样瘤等.Dixon[2]认为这些命名只是反映了该病不同阶段的表现,将其命名为导管周围乳腺炎/乳管扩张症较为合理.     

82例乳腺导管扩张症临床诊治分析

乳腺导管扩张症又称浆细胞性乳腺炎,是一种好发于非哺乳期、以乳腺导管扩张和浆细胞浸润为病变基础的慢性非细菌性乳腺炎症,其病因不明确,临床表现复杂多样,易误诊误治,应引起临床重视。我院2004年1月至2008年12月共收治82例,报告如下。     

乳腺导管扩张症18例临床分析

乳腺导管扩张症（mammary duct ectasia，MDE），亦称浆细胞性乳腺炎或闭塞性乳腺炎．是一种以非周期性乳房疼痛、乳头溢液、乳晕区肿块、乳头凹陷、非哺乳期乳房脓肿、乳头部瘘管为主要表现的良性乳房疾患。临床比较少见，其发病率约占同期乳房疾病的1_41％～5．36％。因临床表现缺乏特异性，极易误诊误治。本院自2000年以来共收治乳腺导管扩张症18例，现就本院临床资料及诊治问题进行分析。     

乳腺导管扩张症的治疗

乳腺导管扩张症（mammaryductectasia,MDE）最早由Bloodgood在1923年提出。在对该病的不断研究中,“浆细胞性乳腺炎（plasmacellmastiffs）”、“导管周围性乳腺炎（periductalmastitis）”等也被用于描述MDE。目前,学者们对以上疾病之间的关系尚未达成共识。     

乳腺导管扩张症的外科治疗

目的探讨乳腺导管扩张症的外科治疗。方法收集我院1991年9月~2006年5月乳头溢液或乳房肿块就诊病例,经手术后证实为乳腺导管扩张症者58例,行病变导管切除或乳房区段切除术。结果经手术治疗,病人乳房无变形,随访观察无复发。结论手术治疗乳腺导管扩张症效果较好。     

乳腺导管扩张症的诊治(附32例报告)

目的探讨乳腺导管扩张症的诊断与治疗。方法回顾性分析本院1993年1月至2004年12月经手术和病理证实的乳腺导管扩张症32例临床资料。结果本组32例均行手术治疗,随访6个月以上,无一例复发。结论乳腺导管扩张症好发于30～40岁年龄组。临床上易误诊为乳腺癌。术中冰冻切片检查可确诊,手术切除为最有效的治疗方法。     

Risk factors for duct ectasia

Duct ectasia consists of dilation of the mammary ducts and is clinically manifested as nipple discharge, which is more commonly multiductal, bilateral, and colored. To identify clinical factors that might be related to duct ectasia. A case-control study was carried out on a population of 150 patients divided into two groups. Group 1 (the experimental group) comprised 100 patients with multiductal, bilateral, and colored nipple discharge, clinically representing the nipple secretion of duct ectasia. Group 2 (the control group) was composed of 50 patients without nipple discharge. The odds ratio of duct ectasia was three times higher for current smokers (p=0.04). Likewise, smokers from the duct ectasia group had smoked for a longer time (median 25 months) compared to smokers from the control group (median 15 months) (p=0.02). Parity, history of abortion or termination, breast-feeding, hormonal contraceptive use, and history of breast abscess did not increase the risk for duct ectasia. The group of women with duct ectasia was associated with current tobacco smoking.     

Nipple hypersensitivty—An unusual symptom of duct ectasia

Mammary duct ectasia (MDE) is a benign and often troublesome breast condition. The usual presentation includes colored nipple discharge and mastalgia. Nipple hypersensitivity has never before been described as a presenting complaint for MDE. This case report looks into such an unusual case.     

Classification of Inflammatory Breast Disorders and Step by Step Diagnosis

Abstract: In this study, the authors proposed a classification of inflammatory breast disorders based on which a practical systematic scheme in diagnosis was applied aiming to differentiate simple forms of mastitis from more complicated and malignant forms. The study population included 197 female patients who were clinically or pathologically diagnosed as having mastitis. All patients underwent Ultrasound examination. Mammography was performed for 133/197 cases. Cases of simple mastitis and periductal mastitis were followed up to ensure complete resolution. Abscess cavities and postoperative collections were drained. Other cases were biopsied to confirm diagnosis and were managed accordingly by their treating physicians. Statistical analysis was performed by the Statistical Package for Social Science. Nominal Data were expressed as frequency and relative frequencies (percentage). Ultrasound and Mammography categorical results were compared using the Pearson Chi Square and Fisher’s exact test. Patients were classified into three groups; infectious, noninfectious and malignant mastitis. Simple and malignant forms of mastitis showed many signs in common. The presence of ill defined collections and abscess cavities on ultrasound favored simple over malignant forms of mastitis while extensive skin thickening and infiltrated malignant nodes favored malignant forms. Interstitial edema, edematous fat lobules, abscess cavities, skin thickening seen on ultrasound examination were significantly lower in noninfectious than simple and malignant mastitis. Mammography signs were less discriminating. Diffuse skin thickening and increased density favored malignant mastitis while dilated retro areolar ducts and characteristic calcification patterns favored noninfectious forms. Simple mastitis showed nonspecific signs. Ultrasound examination in mastitis cases shows more specific signs in differentiating between the three forms of mastitis and is useful in monitoring treatment, excluding complications and guide for interventional procedures. Mammography should be performed whenever complicated, malignant and uncommon forms of mastitis are suspected.     

浆细胞性乳腺炎的诊治进展

浆细胞性乳腺炎又称导管周围乳腺炎或乳腺导管扩张症,好发于中青年女性,病因尚不明确,临床表现复杂多变,易误诊为乳腺癌.早期诊断和分期有助于避免不必要的手术.目前对该病的治疗方法尚无一致认识,现代医学仍以手术治疗为主,中医主张内外兼治,彻底切除病灶同时保证美容效果是当前研究的重点,本文主要综述浆细胞性乳腺炎的病因、病理、诊断和治疗的研究进展.     

肾集合管癌8例临床病理分析

目的探究肾集合管癌的临床及病理特征。方法回顾性研究我院收治的8例肾集合管癌患者的临床、病理资料并进行随访。结果 8例患者均施行肾根治性切除术,术中见肿瘤直径5~12cm。肿瘤主要位于肾髓质,呈侵袭性生长,以腺管或腺管乳头状结构为主,部分表现为片状生长,间质内含较多淋巴细胞,并伴有集合管上皮的异型增生。免疫组化显示肿瘤细胞均表达CK7、CK19、上皮膜抗原(EMA)、34βE12、PNA,UEA-1、vimentin呈部分阳性表达,而HMB45和S-100为阴性。随访患者中4例患者发生转移,2例死于肾癌转移,2例带瘤生存。平均生存时间为12.8个月。结论肾集合管癌较罕见,恶性程度高,侵袭性强,预后差。根治性手术为主要治疗手段,术后靶向治疗可能改善患者预后,但仍需临床试验进一步验证。     

非哺乳期乳腺炎临床特征及危险因素分析

目的 探讨非哺乳期乳腺炎（NPM）的临床特征及发病危险因素。方法 回顾性分析2011年1月至2015年3月山东大学第二医院乳腺外科经病理学检查确诊的NPM病人120例（病例组）资料,选取山东大学第二医院查体中心的健康人群111名作为对照组。比较两组病人临床特征,并进行单因素及多因素分析。结果 病例组病人年龄为33（20～62）岁,病变常见于乳腺外上象限（21.7%）、内上象限（20.0%）及乳头乳晕区（30.8%）,临床分型以肿块型（45.8%）为主。两组在超重/肥胖、生育次数、初育年龄、哺乳时间、初潮年龄、乳头内陷、既往哺乳史方面比较差异有统计学意义（P<0.05）。多因素分析显示生育次数（OR=5.02,95%CI 1.06～23.86,P=0.042）、初潮年龄（OR=1.97,95%CI 1.45～2.68,P＜0.001）及超重/肥胖（OR=1.25,95%CI 1.08～1.44,P=0.002）为NPM的危险因素,而初育年龄（OR=0.85,95%CI 0.74～0.98,P=0.025）为该病的保护因素。结论 NPM有其特定临床特征,生育次数多、初潮年龄晚、超重/肥胖可增加该病发病风险,初育年龄晚可降低该病的发病风险。