乳头溢液患者乳管镜检查操作要点解读与诊疗决策的制定  

Interpretation of operative points and the decisions making of diagnosis and treatment in the examination of Fiberoptic Ductal Endoscope in patients with nipple discharge

作　　者：马成权[1] 陈洁 张兴海[1] 任梅[1] Ma Chengquan;Chen Jie;Zhang Xinghai;Ren Mei(Department of Thyroid and Breast Surgery,AnhuiWanbei Coal-electricity Group General Hospital,Suzhou,Anhui,234300,China)

机构地区：[1]皖北煤电集团总医院甲乳外科

出　　处：《当代医学》2020年第6期120-123,共4页Contemporary Medicine

摘　　要：目的探讨乳头溢液患者纤维乳管镜检查中的操作要点及诊疗决策的制定。方法本研究通过分析2017年1月至2018年1月因乳头溢液于本院就诊并行纤维乳管镜检查的128例患者的镜检操作过程和治疗决策制定后临床病理资料及随访情况,进一步精细化乳管镜操作技巧,提供更多的临床数据帮助医师制定更完善的诊疗方案。结果128例患者行FDS得出乳管炎症49例、乳管扩张症17例、乳腺囊性增生5例、浆细胞性乳腺炎3例、外伤3例、乳管占位28例、积乳23例。所有检查患者耐受可。29例即刻确立诊疗方案建议其行手术活检,病理示炎症5例、浆细胞性乳腺炎3例、不典型增生1例、导管内乳头状瘤19例、导管内癌4例。另有3例行多次灌洗后建议行活检,病理示:1例为慢性炎症,1例为浆细胞性乳腺炎,1例为导管内乳头状瘤。余患者随访未见特殊异常。非手术患者FDS检查准确率可达92.55%,手术组患者诊断准确率可达93.75%。63例患者行乳腺灌洗后症状均明显改善,其中4例患者灌洗后乳管病变显示更清晰,建议行活检手术。结论乳管镜为1种安全、精细的直观内镜检查方法,并可同期行乳腺灌洗治疗,准确性较高,不良反应较低,临床效能明显。临床医师根据患者病情制定正确的诊疗决策可以帮助患者简化就医流程。Objective To explore the operation points and the decision making of diagnosis and treatment in the examination of Fiberoptic Ductal Endoscope in patients with nipple discharge.Methods The operation process,clinicopathological data and follow-up of 128 patients who had been treated with Fiberoptic Ductal Endoscope(FDS)for nipple discharge from January 2017 to January 2018 were analyzed to provide more clinical data to refine the operation techniques and to help physicians develop better diagnosis and treatment programs.Results There were 49 cases of ducts’inflammation,17 cases of dilation of mammary duct,5 cases of hyperplasia of mammary glands,3 cases of plasma cell mastitis,3 cases of trauma,28 cases of milk tube position and 23 cases of milk spillage among 128 patients who undertook FDS.All patients can be tolerated well.29 cases were recommended surgery for immediate diagnosis and treatment,5 cases of inflammation,3 cases of plasma cell mastitis,1 case of atypical hyperplasia,19 cases of intraductal papilloma,and 4 cases of intraductal carcinoma.The remaining 3 cases were recommended for biopsy after repeated lavage.The pathology showed that 1 case was chronic inflammation,1 case was hyperplasia of mammary glands,and 1 case was intraductal papilloma.No special abnormalities were observed in the follow-up of the remaining patients.The diagnostic accuracy of FDS examination in nonsurgical patients can reach 92.55%,and the diagnostic accuracy of patients in the surgical group can reach 93.75%.The symptoms of 63 patients after breast lavage were all significantly improved,of which 4 patients showed clearer lesions after infusion,and biopsy surgery was recommended.Conclusion Fiberoptic Ductal Endoscope is a safe and fine intuitive endoscopic examination method with high accuracy,low side effects and obvious clinical efficacy,and can be treated with breast lavage at the same time.Making the right decision according to the results of FDS can help the patients simplify the process of treatment.

关 键 词：纤维乳管镜 乳头溢液 乳腺肿瘤 操作 诊疗决策 

分 类 号：R655.8[医药卫生—外科学]