275例乳管内镜的临床应用

目的评价纤维乳管镜对乳头溢液的诊治作用。方法应用MF2-707型乳管内镜对275例乳头溢液患者进行诊治。结果275例病例中,乳腺导管内癌有10例,乳头状瘤病有15例,导管内乳头状瘤有80例,乳腺导管炎有54例,乳管扩张症有113例,3例诊断为正常乳管。部分乳腺导管炎及乳管扩张症患者经药物冲洗后症状消失。结论乳管内镜检查是一种对乳头溢液患者安全、有效的检查及治疗方法。     

89例乳头溢液的外科治疗

目的探讨89例乳头溢液患者的外科治疗效果。方法对我院于2004年1月至2009年9月收治89例乳头溢液患者,分别采用乳腺区段切除,单纯乳房切除或者改良根治术进行回顾性分析。结果术后病理类型：乳腺导管内乳头状瘤57例,乳腺增生21例,导管扩张5例．导管癌4例,浸润性导管癌2例。结论乳头溢液最常见的原因是乳管内乳头状瘤,其次是乳腺增生。乳腺导管扩张及导管癌。乳头溢液以手术治疗为主,术式应根据病理决定。行术中冰冻切片病理活检可以确定病理类型。     

乳腺导管镜的临床应用

目的 评价乳腺导管镜在乳头溢液诊疗中的临床意义。方法 用FV—3000型MS—611E乳腺导管镜对31例乳头溢液病人进行检查，并对检查情况加以分析。结果 乳腺导管镜诊断为乳腺增生及导管扩张13例，导管内乳头状瘤17例，乳腺癌1例。乳腺导管镜检查与术后病理的诊断符合率为91．6％(22／24)。结论 乳腺导管镜可以对乳头溢液病人作出明确的诊断和定位，是乳腺疾病诊治中的一种有效手段。     

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.     

Postlactational tumoral granulomatous mastitis: a localized immune phenomenon.

Recurrent, nodular necrotizing granulomatous mastitis in two patients is reported in detail. Pathologic, immunologic, and bacteriologic studies in one patient indicate that this entity is different from plasmas cell mastitis, fat necrosis, mammary ductal ectasia, and the usual infectious and puerperal mastitis. Systemic antibreast autoimmune mastitis and vasculitis are also ruled out. Its pathogenesis, differential diagnosis, surgical treatment, and prognosis are discussed.     

Infantile mammary duct ectasia: a cause of bloody nipple discharge

Bloody nipple discharge in infancy has been rarely reported in the medical literature. Its cause is unknown. We report a three-year-old male infant and a five-month-old female infant with bloody nipple discharge. Because of persistent bloody discharge, a subcutaneous mastectomy was performed in the boy; the problem resolved in the girl after a period of observation. The specimen showed histologic changes identical to those seen in adult mammary duct ectasia. All the endocrinologic work-up was normal. We suspect that bloody nipple discharge in infancy is underreported. This is a benign condition with histologic changes similar to adult mammary duct ectasia and if persistent, should be properly investigated; biopsy or excision are not indicated.     

纤维乳腺导管镜对乳腺非肿瘤性良性病变的诊断及治疗价值(附120例报告)

目的 总结纤维乳腺导管镜在乳管炎及乳管扩张症等非肿瘤性良性病变中的诊断及治疗价值.方法 2005年11月至2008年3月,对120例乳头溢液病例行FDS检查,并对其中95例非肿瘤性良性病变疾病者行术中乳管冲洗,给予庆大霉素及地塞米松灌注治疗.结果 95例非肿瘤性良性病变中,单侧81例,双侧14例,溢液为血性者21例,乳白色者17例,淡黄色者57.FDS拟诊为乳管扩张症17例,乳管炎53例,乳管炎合并乳管扩张症25例.95例经乳管冲洗,庆大霉素及地塞米松灌注治疗后81例溢液减少或消失,有效率为85.3%.结论 FDS检查乳头溢液安全、有效、准确、可靠.对非肿瘤性良性疾病诊断准确,并有明确治疗效果.     

乳腺导管扩张症临床病理特征与治疗对策

乳腺导管扩张症是临床较常见的乳腺炎性疾病,还被称为浆细胞性乳腺炎、粉刺性乳腺炎、导管周围乳腺炎、肉芽肿性乳腺炎等。从该病的病理发展过程看,这些命名只是反映了该病不同阶段的病理表现,最根本的病理变化是乳腺导管扩张,因此以乳腺导管扩张症命名最合理。乳腺导管扩张症随着病理过程的进展,不同时期常有不同的临床表现,可分为：导管扩张期、炎块期、脓肿期和瘘管期。不同的病期可采用不同的治疗对策。     

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??Clinicopathologic features and treatment of mammary duct ectasia MA Rong. Department of Breast Surgery?? Qilu Hospital of Shandong University, Jinan 250012, China Abstract Mammary duct ectasia is of common inflammatory disease of breast. It is also called plasma cell mastitis, comedo mastitis, periductal mastitis, granulomatous mastitis and so on. Its primary basic pathologic change is mammary duct dilation. So it is called mammary duct ectasia is more rational. According to its different clinicopathologic features, it can be divided into four stages: duct dilation, inflammatory mass, abscess and fistula. We may treat this disease with different strategy in different stage.     

Mammary duct fistulae: classification and management

BACKGROUND: The aim of the present study was to review the management of mammary duct fistulae and propose a classification that could be useful in planning the management of mammary duct fistulae. METHODS: Sixteen women presented with a mammary duct fistula, two of whom had two fistulae. The data analysed included age, smoking habit, previous abscesses, nipple abnormalities, imaging, culture, operative technique and histopathological findings. RESULTS: The average follow up was 28 months, the mean age was 36.5 years and two women were heavy smokers. Nipple abnormalities were found in five (32%) patients, the average number of abscesses before the presentation was 1.8 and Staphylococcus coagulase negative predominated the culture. Eleven (69%) patients underwent total excision of the ductal system and fistulous tract using a technique modified by the author. Five patients were offered conservative treatment; however, one of the patients refused surgical treatment, but was still followed up in the present study. Histopathological results revealed periductal mastitis in 10 patients, idiopathic granulomatous mastitis in five patients and tuberculous mastitis in one patient. CONCLUSION: Deep mammary duct fistulae are directly related to a diseased ductal system and should be differentiated from superficial fistulae, which result from the infection of the subepidermal mammary glands. Deep fistulae that result from periductal mastitis should be treated by total excision of the ductal system in conjunction with the fistulous tract under antibiotics to ensure the lowest rate of recurrence. The technique used in the present study resulted in negligible morbidity and good cosmetic appearance. A trial of conservative treatment should be recommended for fistulae resulting from idiopathic granulomatous mastitis; however, further studies are required to establish the best treatment.     

少见乳腺炎的影像学诊断

目的 总结分析少见乳腺炎的B超、钼靶及磁共振的影像学特点,结合病理结果及文献复习探讨这三种影像学检查的诊断价值.方法 回顾性分析第三军医大学第三附属医院2000年1月至2009年6月所有经病理检查确诊并行影像学检查的24例少见乳腺炎,包括一般资料、影像学检查特点、病理结果、诊断符合率.结果 24例中乳腺导管扩张并慢性炎14例,肉芽肿性小叶炎3例,慢性化脓性炎6例,乳腺结核1例;行B超检查13例,诊断符合率为77%,行钼靶检查12例,诊断符合率25%,行MRI检查3例,诊断符合率100%.结论 少见乳腺炎大多在影像学上无特异性表现,但仍有其异于其他乳腺肿块的特点,MRI检查较B超及钼靶检查更准确,联合多种检查手段可以提高诊断符合率.     

乳腺癌改良根治术后的缺损再造

目的：介绍对早期乳腺癌既达到肿瘤根治性切除,又保留乳房美观外形的一种手术方法。方法：对早期乳腺癌患者在保留乳头的基础上,经腋下切口行肿瘤根治切除术,同时切除肿瘤表面皮肤,用背阔肌肌瓣（或背阔肌岛状皮瓣）行一期乳房再造。结果：1995－1997年共治疗10例,术后随访2年以上6例,3年以上4例,均无肿瘤复发及转移,外观效果优7例,良3例。结论：本手术方法简单,损伤小,达到了肿瘤根治性切除,且切口隐蔽,保留了乳头、乳晕,使再造乳房外形美观逼真,手感良好。手术适应证较宽,对I、Ⅱ期乳腺癌除肿瘤侵犯乳头、乳晕或胸肌、皮肤等外均可采用。     

乳管内窥镜在合并甲状腺功能低下或垂体瘤的双侧乳头溢液中的应用

目的 探讨合并甲状腺功能低下或垂体瘤的双侧乳头溢液与乳腺导管内病变的关系.方法 对222例临床确诊的甲状腺功能低下(94例)和垂体瘤(128例)患者行乳管镜检查.结果 222例患者中有64例乳管镜诊断为乳腺导管内乳头状瘤,158例诊断为导管扩张炎症.64例均行手术治疗,术后病理证实59例为导管内乳头状瘤,5例为导管扩张性炎症,病理符合率为92.18%(59/64),未见乳腺癌.合并甲状腺功能低下或垂体瘤的双侧乳头溢液患者各民族之间分布差异无统计学意义(P>0.05);绝经前的合并垂体瘤的患者发生导管病变的概率高于甲状腺功能低下患者,而绝经后甲状腺功能低下患者发生导管病变的概率高于垂体瘤患者(P<0.05);合并垂体瘤的乳头溢液多为乳汁样,而合并甲状腺功能低下的乳头溢液多为清水样.本组乳管内乳头状瘤约71.19%发生在主导管以下的分支导管.结论 合并甲状腺功能低下或垂体瘤的双侧乳头溢液患者要考虑到发生导管内病变的可能.乳管镜是较为适宜的检查方法.     

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.     

Viability and sensation of the nipple-areolar complex after reduction mammaplasty

Reduction mammaplasty with nipple-areolar transposition on a medial pedicle was designed as an alternative to amputation and free nipple graft for women with severe mammary hypertrophy. The purpose of this study was to review the viability and sensory outcome of the nipple-areolar complex (NAC) in 72 women (133 breasts) after medial pedicle and inferior pedicle reduction mammaplasty between 1996 and 2000. The medial pedicle was used for 41 women (79 breasts) with moderate to severe mammary hypertrophy. An inferior pedicle was used for 31 women (54 breasts) with mild to moderate mammary hypertrophy. Mean follow-up for all patients was 25 months. Total sensation of the NAC was obtained in 68 of 79 breasts (86%) after medial pedicle reduction mammaplasty and in 50 of 54 breasts (92%) after inferior pedicle reduction mammaplasty. Total viability of the NAC occurred in 74 of 79 breasts (94%) after medial pedicle reduction mammaplasty and in 53 of 54 breasts (98%) after inferior pedicle reduction mammaplasty. Quantitative sensory testing of the NAC using the pressure-specified sensory device demonstrated that static and moving sensory thresholds of the NAC are lowest in the inferior pedicle group followed by the control group and the medial pedicle group. It can be concluded from this study that the medial and inferior pedicle techniques are capable of supporting vascularity and innervation to the NAC. The medial pedicle technique for severe mammary hypertrophy is a good alternative to free nipple grafting. The amount of breast tissue removed does not correlate with sensory outcome for both inferior and medial pedicle techniques. The pressure-specified sensory device is an excellent means of assessing sensory outcome.     

乳腺基底部纤维组织松解矫正原发性乳头内陷

目的探索一种避免乳腺管损伤,矫正原发性乳头内陷的新术式。方法通过对乳晕切口胸大肌前假体置入隆乳术的患者,术后乳头内陷自动治愈的观察所得启示,笔者采用了在乳腺基底部松解挛缩牵拉乳头的纤维结缔组织的方法矫正原发性乳头内陷。手术操作部位远离乳腺管集中的部位,避免了乳腺管损伤,使乳头内陷矫正后保留其乳管功能。结果本组患者8例15侧,均为原发性乳头内陷且未生育的女性。术后乳头外形美观,感觉与勃起功能正常,随访5例已生育的受术者,均能正常哺乳。结论采用乳腺基底部纤维组织松解矫正原发性乳头内陷,手术操作简单、安全,效果明显,并保留其乳腺管功能,降低了乳头内陷矫正手术的复发率。     

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。     

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.     

Spontaneous unilateral nipple discharge: when screening tests are negative--a case report and review of current diagnostic management of a pathologic nipple discharge

We describe a 45-year-old woman who presented with a spontaneous unilateral nipple discharge. With a negative breast examination and screening tests (mammography and ultrasonography) she underwent mammary ductography, which revealed a small 3-4 mm intraluminal filling defect. A core biopsy showed high-grade ductal carcinoma in situ (DCIS). An attempted wide local excision was unsuccessful, and the patient underwent a mastectomy. Pathologic assessment revealed high-grade DCIS and multiple foci of invasive mucinous ductal adenocarcinoma. Rare tumor cells were identified in the subcapsular sinuses in both sentinel lymph nodes. We report this case to point out the importance of the diagnostic examination for patients with a pathologic nipple discharge and review current and possible future diagnostic management.