病理性双侧乳头溢液659例临床分析

目的探讨病理性双侧乳头溢液与乳腺导管内病变的关系。方法对659例病理性双侧乳头溢液患者行乳管镜检查和甲状腺功能、催乳素、雌二醇、孕酮检测,并对催乳素升高及乳汁样双乳多孔溢液的患者行脑垂体MRI检查。定性资料的比较用χ2检验或Fisher确切概率检验。结果659例中328例乳管镜诊断为导管内乳头状瘤,331例诊断为导管扩张症。328例均行手术治疗,术后病理检查证实导管内乳头状瘤307例,导管扩张症21例,病理检查符合率为93.60%(307/328),未见乳腺癌;659例患者中经临床确诊合并甲状腺功能减退94例,垂体瘤128例;导管病变在不同月经状况、不同民族及不同溢液性质的病理性双侧乳头溢液患者间差异有统计学意义(P0.050)。绝经前患者导管扩张症发生率高于绝经后;在不同民族中,汉族与哈萨克族患者之间导管病变的差异有统计学意义(P=0.008),其余民族之间差异无统计学意义(P0.050);合并垂体瘤的乳头溢液多见乳汁样,合并甲状腺功能减退的乳头溢液多见清水样,单纯性乳头溢液多见淡黄色、黄色黏稠样及血性。本组导管内乳头状瘤85.34%(262/307)发生在主导管以下的分支导管。结论乳管镜是发现病理性双侧乳头溢液患者乳腺导管内病变较为适宜的检查方法;合并甲状腺功能减退或垂体瘤的患者发生双侧乳头溢液时要考虑导管内病变的可能。

Pathological bilateral nipple discharge: analysis of 659 cases

Objective To explore the relationship between pathological bilateral nipple discharge and mammal intra-ductal lesions. Methods Six hundred and fifty nine patients with pathological bilateral nipple discharge underwent intra-ductal endoscopy, thyroid function testing and serum prolactin, estradiol and progesterone level testing. Those patients with milk-like nipple discharge and elevated serum prolactin level underwent pituitary MRI scanning. Chi-square test or Fisher＇s exact tese was used for qualitative data analysis. Results Among the 659 patients, 328 were diagnosed as intra-ductal papilloma and 331 as intra-ductal ectasia by ductal endoscopy. The 328 cases underwent surgical treatment, and post-operative pathological test confirmed 307 cases （93. 60%, 307/328） with intraductal papilloma, 21 cases with ectasia and none with breast cancer. Among the 659 cases, 94 were clinically defined as combined hypothyrea and 128 as combined pituitary adenoma. Ductal lesions occurring in bilateral nipple discharge had statistical difference in different menstruate status, ethnic group distribution and the quality of discharge, （P〈0. 050）. The incidence of ductal ectasia was higher in pre-menopausal patients than in post-menopausal patients. Ductal lesions occurred in bilateral nipple discharge were statistically different between Hal and the Kazak peoples（P= 0. 008）, but not statistically different between other nationaties （P 〉 0. 050）. Milk-like discharge mainly occurred in cases with combined pituitary adenoma, water-like discharge in cases with combined hypothyrea. The color of simple nipple discharge was light yellow, yellow and bloody. In this study, 85. 34% （262/307）intraductal papilloma appeared in branch ducts next to the main duct. Conclusion Intra-ductal endoscopy is feasible for detecting pathological bilateral nipple discharge. For patients with bilateral nipple discharge accompanied with hypothyrea and pituitary adenoma, intra-ductal lesions should be taken into consideration.