导管周围乳腺炎与肉芽肿性乳腺炎的临床鉴别与处理

目的探讨导管周围乳腺炎与肉芽肿性乳腺炎的临床特点及处理方法。方法 2006年5月至2010年1月本院收治了36例经病理证实的导管周围乳腺炎或肉芽肿性乳腺炎患者,对该36例患者的临床资料进行回顾性分析。结果 病理结果显示导管周围乳腺炎25例,肉芽肿性乳腺炎11例。两种疾病均以反复脓肿、乳房肿块及乳腺窦道或瘘管为表现。25例导管周围乳腺炎患者病变均位于乳晕2cm环内,其中14例合并乳头内陷;治疗包括,手术治愈4例（肿块型局限者）占16%,药物加手术治愈10例（肿块并乳头内陷者8例及合并窦道及乳头内陷者2例）,占40%;仅用药物治疗痊愈6例（脓肿型4例和肿块并窦道2例）,占24%,随访2～27个月未见复发,另有5例（肿块型1例和肿块并乳头内陷者4例）仍接受三联抗菌药物治疗。11例肉芽肿性乳腺炎患者中9例病变位于乳晕2cm环外,未见合并乳头内陷;治疗包括,7例三联抗菌药物治疗后肿块缩小至1～2cm后手术切除病变,其中1例合并多发窦道者术后3个月复发,予三联抗菌药物治疗2个月后范围缩小,再次行手术治疗,术后12个月未见异常,余6例随访6～24个月,未见复发;2例仍在行三联抗菌药物治疗,待病变缩小手术;2例皮质激素治疗停药后复发,再用激素治疗2周病变缩小,手术切除病变,未见复发。两组患者无一例行全乳房切除。结论 导管周围乳腺炎和肉芽肿性乳腺炎临床表现相近,需临床与病理检查结合确诊,手术是该病的主要治疗手段,病变复杂广泛者可先行三联抗菌药物治疗,待病变缩小至1～2cm、病情稳定后,手术治疗效果更好

Identification and treatment of periductal mastitis and granulomatous mastitis

Objective To explore and summarize the clinical features and treatment of periductal mastitis and granulomatous mastitis. Methods From May 2005 to January 2010 a total of 36 patients with periductal mastitis or granulomatous mastitis were treated in our hospital. The clinical data of the 36 patients were retrospectively analyzed. Results The pathological examination result showed periductal mastitis in 25 patients and granulomatous mastitis in 11. The two diseases manifested mainly as repeated abscess, breast lump and sinus or fistula cannulas. In all the 25 patients with periductal mastitis the lesions were located in 2 cm area within the areola, and 14 of them were combined with mammary papilla invagination. Four patients (16%) were treated with operation and cured, ten patients (40%) were treated with anti-nontuberculosis mycobacteria drugs plus operation and cured, six patients (24%) were treated with the drugs only and cured. The follow-up of 2-27 months demonstrated no recurrence. The rest 5 patients were still receiving anti-nontuberculosis mycobacteria therapy, when their conditions would permit operation would be performed. In the 11 patients with granulomatous mastitis nine had their lesions located in the 2 cm area outside the areola, without mammary papilla invagination. Seven patients received anti-nontuberculosis mycobacteria drugs therapy first till the mass became smaller about1-2 cm in size and their disease condition was stable the masses were resected. Six of them were cured and no recurrence happened by 6-24 months of follow-up, and one patient had recurrence three months after operation, received the drug therapy again for two months, reoperated on and cured, and 12-month follow-up showed no recurrence. Tow patients had recurrence after cortical hormone treatment, were retreated with the same drugs for two weeks, then the lesions were resected, and no recurrence was found. Two patients were still having anti-nontuberculosis mycobacteria therapy and when their masses would decrease in size operation would be done. In the two groups no patients had excision of the whole breast. Conclusions The clinical features of periductal mastitis and granulomatous mastitis are similar. Pathological examination is the key method for diagnosis. Operation is the main treatment for the two diseases. If a patient has complex lesion, anti-nontuberculosis mycobacteria therapy is given first till the lesion becomes smaller and disease condition is stable operation is performed. In this way better result can be obtained.