非哺乳期乳腺炎的临床特点分析  

Clinical Characteristics of Non-lactational Mastitis

作　　者：李斌[1] 杨学伟[1] 

机构地区：[1]哈尔滨医科大学附属第二医院乳腺外科,黑龙江省哈尔滨市150081

出　　处：《中国全科医学》2017年第36期4576-4580,共5页Chinese General Practice

摘　　要：目的总结非哺乳期乳腺炎的临床表现、临床分型、影像学表现、治疗方法及治疗效果、病理特点,以为临床提供参考。方法选取2013年1月—2015年12月就诊于哈尔滨医科大学附属第二医院乳腺外科的非哺乳期乳腺炎患者263例,均以术后病理结果为确诊依据,均行血细胞分析及三维乳腺超声检查,其中38例行乳腺X线检查,分析患者的临床表现、临床分型、影像学表现、治疗方法及治疗效果、病理特点。结果本组非哺乳期乳腺炎患者临床表现以乳腺肿块、脓肿形成、慢性疼痛为主,临床分型以乳腺肿块型为主。血细胞分析示白细胞计数、中性粒细胞分数增高者47例,其中两项指标均升高者26例,仅白细胞计数升高者9例,仅中性粒细胞分数升高者12例。以乳腺肿块为主的非哺乳期乳腺炎患者三维乳腺超声常表现为乳房局部低回声或混合回声团块,边界模糊,且内部回声不均匀,部分患者肿块内还可见细密悬浮光点,在按压超声探头后可见液体流动;乳腺脓肿患者常表现为大小不等的无回声区。弹性成像(EI):以蓝绿色混合渲染或绿色为主,弹性评分为2~3分。彩色多普勒血流成像(CDFI)示:内部及周边可见血流信号,部分患者可见腋窝淋巴结增大,表现为边界清、包膜完整、淋巴门结构清晰、内部回声均匀。乳腺影像报告与传输系统(BI-RADS)分级为2级或3级,少数以乳腺肿块为主要临床表现的患者三维乳腺超声回报为4a或4b级。治疗以行单侧乳腺区段切除术+引流管引流术+一期缝合术为主。行单侧及双侧乳腺区段切除术+引流管引流术患者,引流管拔除的平均时间为15 d。本组患者以慢性化脓性乳腺炎为主。结论非哺乳期乳腺炎的主要临床表现多样,常规辅助检查为三维乳腺超声检查,病理检查为确诊的主要依据,手术治疗是不同临床分型的非哺乳期乳腺炎的有效措施。Objective To summarize the clinical manifestations,clinical types,imaging features,treatment methods and effects, pathological characteristics of non-lactational mastitis, in order to provide a reference for clinical practice. Methods We enrolled 263 cases of non-lactational mastitis who received treatment in Breast Surgery of the 2nd Affiliated Hospital of Harbin Medical University from January 2013 to December 2015. All of them were diagnosed based on the postoperative pathological results of the surgical biopsy specimens. Blood cell analysis and 3D breast ultrasonography were performed in all cases,and mammogram was performed in 38 cases. The clinical manifestations,clinical types of breast lesions,imaging features,treatment methods and effects,and pathological features of these cases were analyzed. Results Mainly clinical manifestations： breast mass,abscess formation and chronic pain. Major type of breast lesion： breast mass. Results of blood cell analysis： 47 cases were found with abnormal results. Concretely,26 cases had both elevated white blood cell count and neutrophil fraction,9 cases had elevated white blood cell count, and 12 cases had elevated neutrophil fraction. Findings of 3D breast ultrasonography： Non-lactational mastitis cases with breast mass were found with local hypoechoic or mixed echogenic mass with fuzzy boundaries and uneven internal echoes,and some of them were also identified with super fine suspension spots,with visible liquid flows when pressing the acoustic probe. Non-lactational mastitis cases with breast abscesses presented non-echo area ranging in different sizes. Results of breast elasticity imaging： the images were mainly hybrid rendering of blue-green or solely green,breast elasticity score ranged from 2 to 3. Results of color Doppler flow imaging for breast： Blood-flow signals from the periphery and interior of breast were detected in all cases. Some cases were also found with enlarged axillary lymph nodes with clear boundary,integrated capsules and clear hilum,as

关 键 词：乳腺炎 诊断 治疗 

分 类 号：R655.8[医药卫生—外科学]