乳腺导管镜在乳腺囊性增生症中的临床应用

The clinical application of fiberoptic ductoscopy in cystic cyclomastopathy

目的通过乳腺导管镜对无乳头溢液的乳腺囊性增生症者的检查和药物介入冲洗治疗，探索无乳头溢液病人导管镜的成功插入技术，观察乳腺囊性增生症冲洗后的镜下表现。为早期发现乳管内占位性病变尤其是早期乳腺癌提供可能。方法首先应用乳管扩张剂对无乳头溢液的乳腺囊性增生者进行乳管扩张，然后行乳管镜检查。结果102例无乳头溢液的乳腺囊性增生症者，成功进镜78例（76．5％）。78例中，有4例是导管内乳头状瘤，2例导管癌，均经镜下诊断后手术治疗并病理证实。其余72例均行导管内冲洗，冲洗后管腔黏膜改变不明显的7例，手术活检5例为不典型增生，2例为细胞增生活跃。余65例均经多次冲洗后管腔黏膜光滑，色泽红润，恢复正常，其中94％的病例均能经3次冲洗后疗效满意，6％（4／65）的病例需增加冲洗次数。在治疗初期有1例并发局部感染，经青霉素等抗炎治疗后痊愈，无穿孔．乳头凹陷等其它并发症。结论无乳头溢液的乳腺囊性增生症者，在乳管扩张剂扩张后大多数能无阻力进镜，乳管扩张剂Ⅰ、Ⅱ号扩张效果无统计学差异；经过导管内的药物介入治疗，观察镜下的改变，能早期发现乳腺癌及不典型增生的乳腺病病人。早期诊断、早期治疗，减少和避免了乳腺癌及导管内疾病的误诊和漏诊。为临床早期诊断乳腺癌提供一个新的检查手段。

Objective To observe the intraductal structure after intervention therapy, to explore the method of fiberoptic ductoscopy successfully used in the no nipple discharge cystic cyclomastopathy patients, and to discover early disease especially early breast cancer. Methods Mammary duct examination was carded out by expansionary medicament in order to distend the nipple without discharge. Results Of 102 cases of cystic cyclomastopathy without nipple discharge examined by fiberoptic ductoscopy, 78 cases （76.5%） were successful. In the 78 cases, 4 cases were intraductal papilloma, 2 cases were intraductal cancer, and all were approved by pathology. Others 72 cases were treated with intervention therapy. After the treatment, 7 cases showed no change of duct membrane, 5 cases dysplasia, and 2 hyperplasia, and all were diagnosed by biopsy. Others 65 cases were intraductal membrane slick, color and luster got right. By 3 times intervention therapy, 94% patient duct of mammary were clear, only 6% patient needed to add the treated times. At the beginning of treatment, 1 case of local infection occurred and recovered by paniclin. There was no perforation, nipple sunken, and other complication. Conclusions Many no nipple discharge cystic cyclomastopathy patients inspected without resistance, after they were distended. The effect of expansionary medicament Ⅰ and Ⅱ has no difference at the statistics. Intraductal cancer and dysplasia are early discovered through intervention therapy and observed intraductal changes. Early diagnose and treatment could avoid and reduce the rate of misdiagnose.It provides a new method for early diagnose of breast cancer.