特发性肉芽肿性乳腺炎的诊断与治疗(附33例报道)  

Diagnosis and Treatment of Idiopathic Granulomatous Mastitis(Report of 33 Cases)

作　　者：於恩桥[1] 赵柳华[1] 唐祖雄[2] 赵静[2] 刘建夏[2] 

机构地区：[1]南通大学附属吴江医院普外科,江苏苏州215200 [2]苏州大学附属第一医院普外科,江苏苏州215006

出　　处：《中国普外基础与临床杂志》2015年第8期985-988,共4页Chinese Journal of Bases and Clinics In General Surgery

摘　　要：目的总结特发性肉芽肿性乳腺炎的临床特点、诊断及治疗经验。方法回顾性分析苏州大学附属第一医院和南通大学附属吴江医院2005年1月至2014年12月期间收治的33例特发性肉芽肿性乳腺炎的病例资料。结果患者平均年龄33岁,病理检查28例(85%)为典型肉芽肿,5例(15%)为不成熟肉芽肿,均在排除其他病因后确诊。药物治疗29例,其中单纯口服泼尼松治愈21例,泼尼松联合甲氨蝶呤治愈6例,2例无效,停药后有13例复发。手术治疗有脓肿破溃者4例,术后有2例复发。15例复发患者均口服泼尼松加甲氨蝶呤,除1例因肝功能损害而停药及1例不完全缓解外,其余13例再次治愈。结论特发性肉芽肿性乳腺炎的临床表现无特异性,确诊主要依赖于病理检查,该病早期给予糖皮质激素或联合免疫抑制剂治疗效果良好,一旦破溃或迁延不愈需尽早考虑手术治疗。Objective To summarize the clinical characteristics of idiopathic granulomatous mastitis（IGM） and its experiences of diagnosis and treatment. Method The clinical data of 33 patients with IGM from January 2005 to December 2014 were analyzed retrospectively. Results The mean age of the patients was 33 years. The pathological examination showed that 28 patients（85%） were typical granuloma, and 5 patients（15%） were immature granuloma, whom were confirmed after exclusion of other pathogens. Twenty-nine patients were received drugs treatment, among which 21 patients were cured by taking prednisone orally, 6 patients were cured by the combination of prednisone and methotrexate, 2 patients failed to be cured, and 13 patients relapsed after stopping taking medicine. Four patients with abscess ulceration were received surgical treatment, and 2 patients relapsed after the surgery. Fifteen recurrent patients all were took prednisone and methotrexate orally, among which 1 patient stopped taking medicine because of liver function damage, 1 patient was not fully relieved, and other 13 patients were cured again. Conclusions The clinical manifestations of IGM have no specificities. The diagnosis mainly relies on pathological examination. In the early phase of this disease, the treatment method of steroid or combined immunosuppressant has good effects. In case of ulceration and protracted course, surgical treatment should be considered as early as possible.

关 键 词：乳腺炎 肉芽肿 诊断 治疗 糖皮质激素 

分 类 号：R655.8[医药卫生—外科学]