乳腺结核文献综合分析

目的了解我国乳腺结核的临床特点和误诊现状,提高对乳腺结核的诊治意识。方法检索中国知识资源总库1978年～2008年的相关文献,分析乳腺结核的临床特点及误诊原因。结果近30年国内有关乳腺结核文献174篇,可供分析的97篇1256例。乳腺结核发病率1.3%,20～40岁发病占93.2%,已婚妇女占95.4%,有生育哺乳史者占95.8%,乳腺外结核占50.8%,无痛性边界不清质硬肿块占86.7%～94.9%,单侧发病占91.7%,结节型占82.2%,误诊乳腺癌占51.6%,药物加手术治疗切口一期愈合占98.3%。结论乳腺结核发病率低、20～40岁女性多见、单侧多见、单侧乳腺无痛性边界不清质硬肿块多见、易误诊乳腺癌、药物加手术治疗安全有效。     

乳腺结核文献综合分析

目的 了解我国乳腺结核的临床特点和误诊现状,提高对乳腺结核的诊治意识.方法 检索中国知识资源总库1978年～2008年的相关文献,分析乳腺结核的临床特点及误诊原因.结果 近30年国内有关乳腺结核文献174篇,可供分析的97篇1256例.乳腺结核发病率1.3%,20～40岁发病占93.2%,已婚妇女占95.4%,有生育哺乳史者占95.8%,乳腺外结核占50.8%,无痛性边界不清质硬肿块占86.7%～94.9%,单侧发病占91.7%,结节型占82.2%,误诊乳腺癌占51.6%,药物加手术治疗切口一期愈合占98.3%.结论 乳腺结核发病率低、20～40岁女性多见、单侧多见、单侧乳腺无痛性边界不清质硬肿块多见、易误诊乳腺癌、药物加手术治疗安全有效.     

乳腺结核27例诊治体会

目的探讨乳腺结核的诊断及临床病理特点。方法回顾性分析27例乳腺结核临床资料。结果 167例包块性质待定患者中27例病检确诊为结核（14.4%）,主要表现单侧乳腺包块伴隐痛、乳头脓性溢液。结论在结核病高发地区要重视乳腺结核的发生。     

乳腺结核的高频超声误诊分析与联合超声造影应用的诊断价值

目的：探讨高频超声在乳腺结核中诊断准确情况及联合超声造影的诊断价值。方法：分析34例经穿刺及病理最终证实为乳腺结核的声像图,总结其高频超声及超声造影表现,统计分析其诊断符合率,分析其误诊原因。结果：34例患者高频超声表现分为三型：低回声型13例、混合回声型14例、窦道型7例,超声造影表现分为环状增强型19例、均匀增强型11例、均匀增强型4例。病理诊断分为硬化型9例、结节型14例、融合型11例。单纯高频超声诊断符合率47%,高频超声联合超声造影诊断符合率88.2%,差异具有统计学意义（P<0.01）。其中高频超声及超声造影最易误诊的病理类型为结节型。结论：高频超声联合超声造影联合能够显示不同病理分型乳腺结核的声像图特点差异,具有一定特异性,对临床诊断乳腺结核具有较高的参考价值。     

多发性溃疡型乳腺结核的外科治疗（附10例报告）

目的 探索多发性溃疡型乳腺结核治疗的新途径.方法 回顾性分析总结10例多发性溃疡型乳腺结核的保乳手术与传统单纯乳腺切除手术异同.结果 10例患者手术切口均Ⅰ期愈合,有2例患者入院前外院行脓肿切开引流切口局部愈合欠佳,经门诊换药均愈合,皮肤无缺血坏死,患乳外形良好,随访3～26个月,无复发,患者及家属满意度100%.结论 保乳手术联合规则抗结核是治疗多发性溃疡型乳腺结棱的新途径,它具有微创、疗效确切、安全、并发症少、经济实用等优点,值得推广应用.     

超声诊断乳腺结核的临床价值

目的探讨乳腺结核的超声表现及超声诊断乳腺结核的临床价值。方法回顾性分析我院近十年超声检查发现19例乳腺结核患者的超声影像资料并与临床诊断进行对比。结果本组的19例,男3例,女16例。根据声像图表现可分为3型：①囊实混合性回声9例,超声均正确提示;②实性回声4例,超声均误诊;③钙化型回声6例,其中4例符合,2例误诊。结论超声检查对乳腺结核的诊断无特异性,但结合临床表现对其有一定诊断价值。     

双侧原发性乳腺癌13例临床分析

目的 探讨双侧原发性乳腺癌发病因素、分子分型、手术方式等,并对其预后进行评估.方法 分析双侧原发性乳腺癌和同期单侧乳腺癌患者的发病年龄;分析双侧原发性乳腺癌临床病理资料,根据雌激素受体(estrogen receptor,ER)、孕激素受体(progesterone receptor,PR)和人表皮生长因子受体-2(human epidermal growth factor receptor 2,HER-2)的表达情况将双侧乳腺癌分为4种分子亚型,即Luminal A型、Luminal B型、HER-2型和三阴性乳腺癌.分析各分子亚型的临床病理特征;分析双侧原发性乳腺癌和同期单侧乳腺癌治疗方式.结果 双侧原发性乳腺癌比同期单侧乳腺癌的患者年轻.双侧原发性乳腺癌的三阴性乳腺癌组织学Ⅲ级患者明显多于其他亚型(P＜0.05),各分子亚型在淋巴结转移上差异无统计学意义(P＞0.05).双侧原发性乳腺癌保乳手术比例与同期单侧乳腺癌保乳手术比例差异有统计学意义(P＜0.01),预后生存率差异无统计学意义(P＞0.05).结论 发病年轻是双侧原发性乳腺癌发生的危险因素,双侧原发性乳腺癌各分子亚型的三阴性乳腺癌组织学Ⅲ级患者明显多于其他亚型,双侧原发性乳腺癌保乳术与同期单侧乳腺癌相比,其无瘤生存率差异无统计学意义(P＞0.05).     

高频超声声像图对乳腺结构不良的诊断价值

目的探讨高频超声声像图对乳腺结构不良的诊断效果。方法对我院收治的102例患者采用高频超声进行诊断,并对其中65例患者进行病理活检。结果 96例患者为双侧乳腺结构不良,6例患者为单侧乳腺异常。小叶增生型43例,囊肿型11例,局灶性纤维化型21例,纤维腺瘤样增生型15例,导管增生型3例以及混合型9例。102例患者中有65例进行手术病理活检,均诊断为乳腺结构不良,其中局灶性纤维化型16例,小叶增生型21例,囊肿型9例,纤维腺瘤样增生12例以及混合型7例。结论采用高频超声对乳腺结构不良进行诊断具有良好的检出率及准确性,可为临床治疗提供依据。     

乳腺结核12例

现将我院自1976～1987年收治的12例乳腺结核报告如下: 临床资料 1.一般情况 12例中男1例,女11例。年龄最小19岁,最大65岁,30～45岁者6例。已婚10例,未婚2例。未生育者3例,哺乳期1例。病程最短半个月,最长8年。半个月1例,2～3个月4例,6     

颈部淋巴结结核的MRI表现(附26例分析)

目的 分析不同病理阶段颈部结核的MRI表现特点。方法 回顾性分析26例手术证实的颈淋巴结结核患者的临床、MRI及病理学资料。结果 累及单侧颈部10例(其中单发4例),双侧16例(均为多发)。根据病理颈部淋巴结结核MRI表现可分为4型:Ⅰ型(n=9)为结核结节及肉芽肿形成;Ⅱ型(n=12)为淋巴结干酪样坏死;Ⅲ型(n=17)为淋巴结包膜坏死;Ⅳ型(n=19)为淋巴结干酪样坏死破溃并向周围侵犯。22例同时具有多个病理阶段表现。结论 MRI能准确反映颈部淋巴结结核不同病理阶段的特征,值得应用。     

乳腺叶状囊肉瘤(附12例报告)

本文报道乳腺叶状囊肉瘤12例,占同期乳腺恶性肿瘤的0.68％(12/1760)。全部为女性,平均年龄34.2岁。均为单乳发病,局限于乳腺-象限内,其中外上象限8例、中央区3例、内下象限1例。肿瘤直径最小3cm,最大12cm。病程长短不一,但均有近期生长迅速史。12例患者有腋淋巴结肿大2例。行乳腺根治切除术2例,改良根治术1例,乳腺单纯切除术7例,局部切除术2例,12例分别为术后1 ～16年健在。术后腋淋巴结病理检查均未见转移。     

超声引导下乳腺良性病灶微创旋切治疗的临床效果

［摘要］目的　研究超声引导下微创旋切术治疗乳腺良性病灶的安全性及有效性．方法　采用单中心、随机、对照、前瞻性研究方法,将84例乳腺良性患者随机分为观察组和对照组,每组患者42例,观察组患者采用超声引导下微创旋切术治疗,对照组采用传统手术治疗,对比2组术中、术后相关指标．结果　观察组术中出血量、切口长度、手术时间在乳腺良性单侧单发、单侧多发和双侧均明显小于对照组,差异有统计学意义（P＜0.01）;观察组术后愈合时间、疼痛评分、并发症在乳腺良性单侧单发、单侧多发和双侧均小于对照组,差异有统计学意义（P＜0.01）;并且术后满意度、美容优良率在乳腺良性单侧单发、单侧多发和双侧均优于对照组,差异有统计学意义（P＜0.01）;观察组治疗后未发生乳房变形,对照组发生3例,占7.14%．结论　超声引导下微创旋切术治疗乳腺良性病灶在单侧单发、单侧多发以及双侧安全性及有效性均明显优于传统治疗．     

双侧原发性乳腺癌雌激素与孕激素受体的表达及病理分析

目的 探讨双侧原发性乳腺癌中临床特点与病理学特征的关系及了解双侧原发性乳腺癌中雌激素受体(Estrogan receptor，ER)、孕激素受体(Progestin recetor，PR)表达情况。方法 回顾性分析了29例双侧原发性乳腺癌ER、PR表达情况，分析其病理学特征及临床特点。结果 双侧乳腺癌发生率为3．2％，单侧乳腺癌ER、PR阳性表达分别为53．2％和41．2％，双侧乳腺癌中第一原发癌中ER、PR阳性表达分别为69％和5l％，第二原发癌中分别为65％，和48％，浸润性小叶癌在单侧乳腺癌中占11．6%，在双侧乳腺癌第一、二原发癌中分别占34．4％和41．3％，单侧乳腺癌与双侧乳腺癌第一原发癌腋淋巴结状况相似。结论 双侧原发性乳腺癌有较高的ER表达，浸润性小叶癌与双原发癌发生有明显相关。淋巴结状况与双侧乳腺癌发生无关。     

乳腺错构瘤的病理基础及X线表现分析

目的：分析讨论乳腺错构瘤的病理基础及X线表现。方法：收集本院近5年经手术病理证实的乳腺错构瘤患者9例,分析其病理及X线表现,所有病例采用意大利GITTO乳腺机摄影,用AGFA CR系统处理。结果：9例患者均显示为单侧肿块影,其中4例诊断乳腺错构瘤,3例误诊为腺瘤,1例误诊为积乳囊肿,1例误诊为脂肪瘤。病理表现肉眼观察所有肿块均有完整纤维包膜,镜下可见数量不等,杂乱的乳腺导管、小叶、脂肪组织和纤维组织混合构成。结论：乳腺错构瘤因组织成分的不同,会有不同的X线表现,无论哪种类型的错构瘤均不会以单一形式出现,密度混杂的X线征象是本病的特征性表现。     

Umbilical necrosis post unilateral pedicled transverse rectus abdominis myocutaneous flap

We report a case of umbilical necrosis after a unilateral pedicled transverse rectus abdominis myocutaneous flap in a patient post mastectomy. This uncommon complication of breast reconstruction is highlighted.     

超声自由扩展成像技术在诊断副乳中的价值

目的探讨超声自由扩展成像技术在诊断较大副乳方面的价值。方法对43例经穿刺、手术、病理证实的较大副乳进行超声自由扩展成像技术及高频超声检查,并对二者图像进行分析对比。结果超声自由扩展成像技术不仅能完整显示较大副乳的全貌、病变的大小和特征及与周围组织的关系,而且能准确测量病变的大小。43例较大副乳患者,单侧13例,双侧30例,共73个副乳;其声像图表现为：①混合回声型（共26个）;②不均质实性回声型（共47个）。结论超声自由扩展成像技术对诊断较大副乳具有较大的价值。     

Bilateral breast cancer in northern Alberta: risk factors and survival patterns.

Of 2231 women with stage I, II or III breast cancer who were registered and seen between 1971 and 1979 and followed to the end of 1981, 48 (2.2%) had synchronous and 58 (2.6%) asynchronous bilateral breast cancer. The unadjusted incidence rate for a second breast cancer was 6.4/1000 breast-years at risk, compared with a rate of 0.70 for the risk of a first breast cancer in women. When calculated from the date of diagnosis of the first breast cancer the survival rate was better for the group with asynchronous disease than for the group with synchronous disease or for a group with unilateral disease, but when calculated from the date of diagnosis of the second cancer the rate was the same in all three groups. Comparison of known risk factors showed a significant association between the development of bilateral cancer and a later age at the birth of the first child and a longer interval between menarche and that birth. There was a trend towards greater age and more stage III cancer in the group with synchronous disease. There was no correlation between receiving radiotherapy for the first breast cancer and development of the second cancer. Annual mammography and clinical examination of asymptomatic women at a cancer centre resulted in the detection of a significantly higher proportion of minimal breast cancers in the second breast compared with the first. Such screening practices should be even more valuable in the earlier detection of unilateral breast cancer in asymptomatic women who have not had breast cancer.     

Angiomatosis of the breast in a male child. A case report with immunohistochemical analysis

Angiomatosis is a benign vascular lesion that has been described rarely in the breast. We describe a case in a seven-year-old boy of African descent who presented with progressively increasing, unilateral breast enlargement, the first such report in a male child. The patient underwent excisional biopsy of the breast mass followed by mastectomy. Pathologic examination revealed a diffuse proliferation of variably-sized, thin-walled vascular channels lined by flattened endothelium that showed negative immunohistochemical staining for von Willebrand factor, factor VIII-related antigen, CD34 and S-100 protein. There is no evidence of recurrence after 24 months of follow-up.     

7例原发性乳腺鳞形细胞癌的角蛋白免疫组织化学与雌激素受体检测

乳腺鳞癌是一种少见的乳癌类塑,其发病率为0.05～0.2％。本教研室从1959～1986年共收集得原发乳腺鳞癌7例,占同期女性乳腺癌的0.24％、发病年龄为35～73岁不等。其中5例分化好有明显角化珠,2例分化较差。7例角蛋白组化染色均里阳性结果,其中3例同时作电镜超微结构观察并作雌激素受体检测,结果为阴性。2例癌旁组织显示乳腺导管扩张伴鳞化,其中1例在癌组织中见到内衬鳞形上皮的小囊腔,支持了乳腺鳞癌可能来源于导管上皮的论点。     

Variation in breast cancer surgery in Ontario.

OBJECTIVES: To analyse the extent of variation by county and hospital in the use of breast-conserving surgery in the initial management of breast cancer and to assess some factors that might explain the observed variation. DESIGN: Population-based retrospective cohort study. SETTING: Ontario. PATIENTS: All women with breast cancer newly diagnosed from Jan. 1, 1989, to Dec. 31, 1991. MAIN OUTCOME MEASURE: Proportion of women undergoing unilateral breast cancer surgery who had breast-conserving surgery in each hospital and county. RESULTS: Of the 14,570 women with newly diagnosed breast cancer 12,815 (88.0%) underwent unilateral breast cancer surgery. The mean proportion of breast-conserving procedures by county was 52% and ranged from 11% to 84%. The proportion of breast-conserving procedures in individual hospitals with one or more cases of breast cancer per month ranged from 6% to 84%. The variations in the rates between hospitals was greater than that expected by chance alone (p < 0.0001). CONCLUSIONS: There was marked variation at the hospital and county level in the use of breast-conserving surgery in the initial management of breast cancer. This variation was strongly associated with the hospital where the surgery was performed.