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。     

男性乳腺导管扩张症2例

例 1　男, 4 0岁。 2 0 0 3年 3月 7日入院。患者于 2年前无意中发现左乳头后方有一肿块,乒乓球样大小,无不适,无乳头溢液。 2年来,肿块略有增大,并出现胀痛感。有高血压病史2 0余年,体查:左乳头内陷,乳晕后方偏上可触及一肿块, 约 5cm×4cm大小,质硬、无痛, 表面欠光滑, 境界不清,局部皮肤桔皮样变明显,与胸肌无粘连,左腋窝及锁骨上未触及肿大淋巴结。右乳正常。钼钯摄片诊断为:左乳腺癌。胸透正常。入院诊断: 左乳腺癌。硬膜外麻醉下行左乳腺皮下切除术。术中见肿块位于左乳头后上方,约4. 5cm×4cm,质硬与乳头关系紧密,有管道相连,切…     

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273例临床分析

乳腺导管扩张症是一种较少邮的无菌性炎症样特殊类型的乳腺病变。临床上主要表现为乳房肿愉或／和乳头溢液，极易误诊误治。作者报告了１９７１－１９９４年２３年间收治的经手术病理证实的乳腺导管扩张症２７３例。术后临床误诊率高达６７．４％，因误诊为乳腺癌而行乳腺癌根治要６例，改良根治术９例，１５例由于误诊误治而造成经久难愈的乳腺瘘。     

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30例临床报告

目的 探讨乳腺导管扩张症的临床特点、诊断、鉴别诊断及治疗。方法 对我院１９９０年至１９９９年收治的３０例乳腺志管扩张症患者进行一般情况,治疗及预后的回顾性分析和总结。结果 本组病例平均发病年龄４２岁,首发症状以乳腺肿块和乳头溢液多见,病变多位于乳晕周围,所有患者均行手术治疗。结论 乳腺导管扩张症为非感染性炎症,病史长,易反复,鉴别诊断有一定困难,均需外科治疗。     

乳腺导管扩张症（附187例报告）

１９５４－１９９３年我院手术治疗乳腺导管扩张症１８７例，主要表现为乳头溢液，乳房肿块，临床表现酷似乳腺癌。本病术前误诊率８８．８％，其中６１例，误诊为乳腺癌。本文对发病机理、病理改变、临床鉴别诊断及治疗进行了讨论。     

乳腺导管扩张症

目的　探讨乳腺导管扩张症的诊断和治疗。方法　对７６ 例乳腺导管扩张症的临床资料进行回顾性分析。结果　该病主要临床表现为乳房肿块（３１ 例,４０．７８ ％ ） ,脓肿（２４ 例,３１．５８ ％ ） ,乳头内陷（５２ 例,６８．４２ ％ ） ,乳头溢液（２１ 例,２７．６３ ％ ） ,乳瘘（２１ 例,２７．６３ ％ ） 。术前误诊率５５．２６ ％ （４２／７６） ,其中２０ 例（２６．３２ ％ ） 误诊为乳癌。本组均经手术治疗,治愈率为９２．１１ ％ （７０／７６） 。结论　乳腺导管扩张症易误诊,术中病理检查是确诊的可靠方法;彻底切除或切开病变的乳管是手术成功的关键。     

Mammary duct ectasia and pituitary adenomas

Mammary duct ectasia developed in three postmenopausal patients who had had pituitary chromophobe adenomas. The first patient had bilateral duct ectasia that developed 8 and 11 years after hypophysectomy. The second patient, who also had bilateral ectasia, had a prolactin-producing pituitary adenoma for which bromocriptine was prescribed. The ectasia developed in one breast before commencing bromocriptine therapy, and in the other breast 2 years later. The third patient also had a prolactin-producing pituitary adenoma. Unilateral duct ectasia developed while bromocriptine was taken. The ectasia in all patients was very marked and affected all excised ducts. Cholesterol granulomas were sometimes very extensive. These cases suggest a relationship between certain hypothalamic/pituitary disorders, possibly related to prolactin secretion and the development of mammary duct ectasia in postmenopausal patients.     

乳腺导管扩张症（附96例报告）

目的 探讨乳腺导管扩张症的诊断及治疗。方法 分析1961－2000年经手术及病理证实的乳腺导管扩张症96例的临床资料。结果 术前误诊72例（75．0％）。根据临床表现的不同采用相应的手术方式：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、乳癌根治术。治愈88例（91．7％），另18例术后症状无明显减轻或复发。结论 乳腺导管扩张症易误诊，手术是治疗的主要手段。     

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.     

Mammary duct ectasia in children presenting bloody nipple discharge: a case in a pubertal girl

Mammary duct ectasia occurs rarely in childhood. The authors report on the case of a pubertal girl who was operated on for duct ectasia with bloody nipple discharge. Duct ectasia is regarded as a primary lesion; it is considered to be a cause of bloody secretion, and it has a mechanism similar to that of mammary duct papilloma.     

Periductal mastitis/duct ectasia

Periductal mastitis/duct ectasia affects major breast ducts and is poorly understood. A variety of different terms have been used for this condition and these probably reflect different stages in one disease process.It appears to be responsible for 1–2% of all symptomatic breast conditions. Although the incidence is higher in postmortem studies, much of what is included as so-called periductal mastitis orduct ectasia in these studies is duct dilatation, which occurs as part of normal breast involution.Periductal mastitis appears to be the primary condition with duct ectasia being the outcome. The cause of this periductal mastitis is uncertain, although bacteria, particularly anaerobic organisms, appear to play some role. Clinically, this condition can present with noncyclical mastalgia, nipple discharge, nipple retraction, a subareolar breast mass with or without overlying breast inflammation, a periareolar abscess, or a mammillary fistula.Antibiotics effective against the organisms isolated from this condition are effective in resolving periareolar inflammation and are useful when combined with surgery in mammillary fistula.

---

Resumen La mastitis periductal/ectasia ductal que afecta a los ductos o canalículos mamarios principales es una entidad poco conocida. Una variedad de términos ha sido utilizada para designarla, términos que probablemente reflejan diferentes estadios de un mismo proceso patológico.La entidad parece ser responsable del 1–2% de todas las entidades sintomáticas que se presentan en los senos. Aunque la incidencia más alta se presenta en exámenes postmortem, mucho de lo que se incluye comomastitis periductal o ectasia ductal en estos estudios corresponde realmente a la dilatación ductal que ocurre como parte de la involución mamaria normal.La mastitis periductal parece ser la condición primaria y la ectasia ductal el resultado final. La causa de esta mastitis periductal no aparece clara, aunque las bacterias, especialmente los organismos anaeróbicos, parecen jugar algun papel. Clínicamente esta condición puede presentarse con mastalgia no cíclica, secreción por el pezón, retracción del pezón, masa subareolar con o sin inflamación concomitante del seno, absceso periareolar, o fístula mamilar.Los antibióticos de demostrada eficacia contra los microorganismos que han sido aislados de cultivos en esta condición clínica son efectivos en cuanto a lograr la resolución de la inflamación periareolar y son de utilidad cuando se combinan con cirugía en casos de fístula mamilar.

---

Résumé La mastite péricanalaire ou ectasie canalaire est une maladie peu connue des canals galactophores majeurs. La variété de termes utilisés pour désigner cette affection témoigne probablement des stades évolutifs de la même maladie.Cette affection serait responsable de 1 à 2% des toutes les maladies symptomatiques du sein. Bien que l'incidence soit plus élevée dans les études postmortem, bien des cas étiquetés mastite péricanalaire ou ectasie canalaire semblent en fait être une dilatation canalaire qui se voit dans l'involution normale du sein.La mastite péricanalaire apparaît comme le primans movens; l'ectasie en est le résultat. La cause de la mastite péricanalaire n'est pas connue avec certitude mais il semble que les bactéries, et notamment des anaérobies, jouent un rôle. Cliniquement, cette affection se présente comme des mastalgies non-cycliques, avec écoulements ou rétraction mammelonnaires, masse sousaréolaire avec ou sans inflammation du sein avoisinant, abcès périaréolaire ou fistule mamillaire.Les antibiotiques adaptés aux organismes retrouvés dans cette affection sont efficaces dans la résolution de l'inflammation périaréolaire et sont également utiles combinés à la chirurgie en cas de fistule mamillaire.

     

Are the lesions of duct ectasia sterile?

A prospective study was established to determine whether, using suitable transport media, bacteria could be isolated from the lesions of mammary duct ectasia. The results indicate that both aerobic and anaerobic organisms are present in a high proportion of patients with nipple discharge associated with this condition and in all patients who develop peri-areolar sepsis (abscess and mammillary fistulae) as part of the syndrome. The lesions of duct ectasia are therefore not sterile and the possibility exists that bacteria have a role in the aetiology and pathogenesis of this condition.