乳头血性溢液的临床病理特点与治疗

Clinicopathological features of bloody nipple discharge

目的探讨乳头血性溢液的临床病理特点和治疗方式,为乳头血性溢液的临床诊断和治疗选择最佳方案提供依据。方法回顾性分析435例病理性乳头溢液患者的临床资料。对比分析血性溢液与非血性溢液的临床病理特点和血性溢液病例中,良、恶性病变的临床资料以及不同的手术方式。结果血性溢液组58.9%的病例为导管内乳头状瘤,而非血性溢液组最为常见的是增生性疾病(38.7%)。血性溢液组乳腺癌占14.0%,非血性溢液组乳腺癌占7.0%。在影像学诊断上,MRI与乳管内视镜可更有效发现病变。乳管镜引导下的切除手术比亚甲兰染色法更准确和安全。结论血性溢液最常见的疾病是导管内乳头状瘤,而非血性溢液多是增生性疾病所致。若血性溢液合并有临床可触及的肿块则应警惕乳腺癌的存在。乳管镜引导下的切除手术可准确定位,是一种安全有效的方法。

Objective To identify the clinicopathological features of bloody nipple-discharge. Methods The medical records of 435 patients with pathologic nipple discharge （PND） who were admitted from June 2001 to May 2006 were reviewed; the findings of imaging study and methods of surgical intervention were also analyzed. Results Papilloma was the most common diagnosis （58. 9%） in patients with bloody nipple discharge, whereas hyperplasia was the most common diagnosis in patients with non-bloody nipple discharge. The incidence of carcinoma was 14.0% in patients with bloody nippledischarge compared with 7. 0% in patients with non-bloody nipple discharge. In breast image studies, MRI and mammary ductoscopy were more accurate than others. Mammary ductoscopy-directed duct excision for PND was safer and more effective procedure than intraductal injection of methylene blue dye to assist in major duct excision. Conclusion Patients with bloody nipple-discharge and a palpable mass are in high risk of breast cancer. Mammary ductoscopy for PND is a safe, effective procedure for maior duct excision.