外科治疗肉芽肿性小叶性乳腺炎32例疗效分析  

Surgical Treatment of Granulomatous Lobular Mastitis:An Analysis of 32 Cases

作　　者：岑延增[1] 张嘉越[1] 闫威[1] 

机构地区：[1]中国人民解放军第303医院普通外科,南宁530021

出　　处：《中国现代手术学杂志》2017年第5期354-356,共3页Chinese Journal of Modern Operative Surgery

摘　　要：目的探讨肉芽肿性小叶性乳腺炎(granulomatous lobular mastitis,GLM)的临床表现、诊断及治疗方法。方法回顾性分析我院2014年1月~2015年12月收治的32例经病理证实的GLM患者的临床资料。32例患者均为女性,其中31已育并有哺乳史,1例未育无哺乳史,均为单侧发病,年龄23~51岁,平均年龄31.8岁,治疗前有3例因外院行局部切除而行病理学检查;22例入院后行空芯针穿刺活检,空芯针进针后沿不同方向取4条组织送病理,均诊断为肉芽肿性乳腺炎;7例形成脓肿者行脓肿切开引流并取脓液做细菌培养加药敏试验,同时取组织病理学检查确诊。均经7 d地塞米松、广谱抗菌素治疗后手术治疗,18例行肿块局部扩大切除,13例行乳腺区段切除,1例因病变广泛行乳腺皮下腺体切除;乳头内陷加做乳头乳晕成形术。创面放置双套管以便术后冲洗引流,术后上述应用抗菌素2~3 d,3~7 d拔除引流管。结果术后随访10~21个月,31例无复发,1例复发,再次扩大手术治疗后未复发。2例乳房明显变形,其中1例因行保留乳头乳晕皮下腺体全切除而变形,另一例因切除下象限腺体而变形。结论 GLM临床表现缺乏特异性,影像学特征不典型,容易误诊,确诊必须依靠组织病理学检查;经短程地塞米松治疗后手术治疗是肉芽肿性乳腺炎的有效治疗方法。Objective To explore the clinical manifestations,diagnosis and treatments of granulomatous lobular mastitis（GLM）. Methods A retrospective study was carried out in 32 cases confirmed GLM by pathology in our hospital from January 2014 to December 2014. In all the 32 reproductive aged female cases,there were 31 parous and 1 un-parous. All the lesions was unilateral. The patients aged 23 ~ 51 years,with an average of 31. 8 years. Before the operation,there were 3 cases got pathology examination by previous resection,22 cases by needle biopsy after admission,and 7 cases of cell collection of abscess drainage. After 7 days＇ dexamethasone and broad spectrum antibiotic therapy,they all underwent resection of the lesions,including 18 cases of local expanded resection,13 cases of segmental resection and 1 case of nipple-preserving mastectomy. Nipple areola keratoplasty was done in 1 case with nipple retraction. Double pipes for washing drainage was used for 3 ~ 7 days after surgery. Results During 10 to 21 months postoperative follow-up,there were 31 cases cured,except 1 case of recurrence. And she got cured after a secondary local expanded resection. 2 cases appeared obvious breast deformation,including 1 case for nipple-preserving mastectomy,another for lower quadrant mastectomy. Conclusion It is easy to be misdiagnosed of the GLM because of the non-specific clinical characteristics and imaging features. The diagnosis must rely on the histopathological examination. Surgical treatment after short term use of dexamethasone is an effective treatment for granulomatous mastitis patients.

关 键 词：肉芽肿性小叶性乳腺炎 手术 

分 类 号：R655.8[医药卫生—外科学]