乳腺Paget’s病诊治体会  

Experience from diagnosis and treatment of breast paget's disease

作　　者：李鹤成[1] 杨越[2] 温险峰[1] 吴炅[1] 陆劲松[1] 沈坤炜[1] 邵志敏[1] 沈镇宙[1] 

机构地区：[1]复旦大学附属肿瘤医院乳腺外科,上海200032 [2]昆明医学院第一附属医院普外科,昆明650032

出　　处：《肿瘤》2003年第5期404-405,共2页Tumor

摘　　要：目的　分析乳腺Paget’s病的临床、病理、预后 ,使该病的诊治进一步合理化。 方法　结合术后随访 ,回顾分析我院 195 6～ 1999年病理证实的Paget’s病 5 6例。 结果　 5 6例患者平均年龄 6 1.5 (2 9～ 76 )岁 ;在明确诊断前 ,病程 6月以上者 2 0例 ,占 35 .7% ;临床可触及乳房肿块者 4 0例 (71.4 % ) ,未触及肿块者 16例 (2 8.6 % ) ,临床可触及乳房肿块者有较高的浸润性癌发生率 ,且和淋巴结、病理分级等预后因素密切相关 ;5 6例患者根治术 30例 ,改良根治术 16例 ,单纯切除术 10例 ,应用辅助化疗者 2 9例 ,应用辅助内分泌治疗者 2 1例 ,术后放疗 7例。平均随访 4 6 .5 (12～ 12 0 )月 ,临床可触及乳房肿块者及未触及肿块者总生存率分别为 6 7.5 %、81.3% ,log rank检验其差别有统计学意义 (P =0 .0 3)。 结论　乳腺Paget’s病较易引起患者忽视或临床误诊 ,应重视该病的临床表现作到早期诊断 ;乳腺Paget’s病有较高的浸润性癌发生率 ,特别对于临床可触及乳房肿块者应采取以全乳切除术为主的综合治疗 ,慎行保乳手术。Objective To explore an appropriate management for Paget's disease of the breast through analyzing clinical and pathological characteristics of this disease. Methods From January 1956 to December 1999,56 patients in our hospital were pathologically diagnosed as breast Paget's disease; the clinical data were retrospectively studied. Results Symptoms lasted more than 6 months before definitive diagnosis in 20 patients(35.71%). 40 patients (71.4%) had palpable mass while other 16(28.6%) had none The palpable cases were related to a significantly higher incidence of invasive ductal cancer(IDC) and a worse prognosis. In the 56 patients, 30 patients were treated with radical mastectomy ; 16 patients were treated with modified radical mastectomy;10 patients were treated with simple mastectomy .Chemotherapy was given to 29 of these patients;endocrinetherapy was given to 21 of them. With a mean follow up of 46.5 months, patients with no palpable mass had a significantly higher disease free survival than that of the patients with papable mass. Conclusion Paget's disease of the breast is easily to be delayed; any suspected sign or symptom should be considered seriously in order to get an early diagnosis. Since Paget's disease is related to a significantly higher incidence of IDC,especially for palpable cases,conservative surgery should be cautiously selected while mastectomy followed by adjuvant therapy should be performed.

关 键 词：乳腺Paget’s病 诊断 治疗 乳房肿块 

分 类 号：R737.9[医药卫生—肿瘤]