糖皮质激素在乳腺肉芽肿性小叶炎治疗中应用时机的探讨  

Study on applied timing of glucocorticoids in the treatment of granulomatous lobular mastitis

作　　者：刘岩松[1] 李娟[2] 李莹杰[2] 仲雷[1] 郭宝良[1] 

机构地区：[1]哈尔滨医科大学附属第二医院乳腺外科,150086 [2]哈尔滨医科大学附属第二医院病理科,150086

出　　处：《中国医师进修杂志》2015年第11期830-833,共4页Chinese Journal of Postgraduates of Medicine

基　　金：黑龙江省卫生计生委科研课题（2014-326）;黑龙江中医药中青年科技攻关课题（黑中科教发ZQG-051）

摘　　要：目的探讨糖皮质激素在乳腺肉芽肿性小叶炎（GLM）治疗中的地位和最佳应用时机。方法选取24例临床疑似GLM患者，入院后均行粗针穿刺活检。其中10例穿刺病理诊断明确GLM者，术前均给予糖皮质激素辅助治疗，病情缓解后再行区段切除；另14例穿刺病理诊断不明确者，采用单纯区段切除治疗方法，术后病理明确诊断为GLM。首先接受手术治疗的14例患者中有8例术后接受糖皮质激素术后辅助治疗，另6例仅手术治疗后进行随访。收集以上全部患者的临床和病理学资料，进行统计分析。结果全部患者术后均在门诊随访，随访时间6～36个月，平均18个月。其中10例术前糖皮质激素辅助治疗患者中仅1例复发（1／10）；8例术后糖皮质激素辅助治疗患者中1例复发（1／8）；6例单纯手术治疗患者中有3例复发（3／6）。术前和术后接受糖皮质激素治疗的患者复发率比较差异无统计学意义（P〉0．05），但与单纯接受手术治疗患者比较差异有统计学意义（P〈0．05）。结论GLM临床和影像表现均不具有特异性，及时正确诊断有难度，治疗尚无统一共识；糖皮质激素治疗无论在术前或术后，对GLM都可能是必要的；对于术前穿刺病理诊断明确者，术前糖皮质激素辅助治疗可能是更好的选择。Objective To investigate the effectiveness of glucocorticoids in the treatment of granulomatous lobular mastitis （GLM）, and to discuss the optimal stage to add glucocorticoids during the treatment. Methods Twenty-four patients having received the core needle biopsy were involved. Ten cases with the explicit pathological diagnosis received the glueoeorticoids therapy following the subtotal excision after remission. Pathological diagnoses of the rest 14 patients were undefined. For these 14 patients, simple partial excisions were given and the postoperative pathological diagnoses were presented as the GLM. Of all the 14 patients who accepted the surgical treatment firstly, 8 patients received the postoperative glucocortieoids adjuvant therapy. For the rest 6 patients, steroid hormone therapy was not used after surgery, and they were followed up postoperatively. All patients＇ clinical and pathological information were collected and analyzed. Results All patients were followed up for 6 -36 months （average 18） by the outpatient service. Of all the 10 patients who received the glucocortieoids therapy before surgery, only 1 patient of them got the GLM recurrence. For the 8 patients who received the postoperative glucocorticoids treatment, only 1 patient got the recurrence. For the 6 patients who received simple partial excision, the recurrence of the GLM may be up to 3. There was no statistical difference between the two groups who both received the glucoeorticoids therapy preoperatively and postoperatively （P 〉 0.05）. But compared with the pttre surgery treatment, the differenee was obviously （P 〈 0.05）. Conclusions The clinical p,＇esentation and imaging performance of GLM are unspecific, so the diagnosis of the G1,M is difficult. There is no consensus regarding the optimal treatment for GLM. The glueocortieoids therapy may be necessary preoperatively or postoperatively. For the patient with clear preoperative hiopsy diagnosis, preoperative glucocortieoids adjuvant ehemotherapy followed by the w

关 键 词：肉芽肿性小叶性乳腺炎 诊断 糖皮质激素类 手术 

分 类 号：R655.8[医药卫生—外科学]