肉芽肿性乳腺炎八例诊治反思

Experiences of Diagnosis and Treatment of 8 Patients with Granulomatous Mastitis

目的探讨肉芽肿性乳腺炎的诊断及治疗方法。方法回顾性分析手术病理证实的8例肉芽肿性乳腺炎临床资料。结果 8例均为单侧发病,5例为乳腺实性肿块,3例局部皮肤红肿伴波动感。5例实性肿块行钼靶X线检查提示乳腺炎症、恶性肿瘤待排除,其中1例考虑炎性乳癌,行细针穿刺活检见大量炎细胞,1例怀疑乳腺结核查找抗酸杆菌、结核DNA阴性,均经手术切除治愈;3例局部皮肤红肿伴波动感,经彩超检查及细针穿刺检查考虑乳腺脓肿,行切开引流并抗感染治疗无效,行扩大切除术治愈。8例术后诊断肉芽肿性乳腺炎。结论肉芽肿性乳腺炎临床少见,彩超及钼靶X线检查可助诊,确诊需手术病理检查,病变部位应完整切除以避免复发。

Objective To investigate the diagnosis and treatment of granulomatous mastitis.Methods The clinical data of 8 patients with granulomatous mastitis confirmed by postoperative pathology detection were retrospectively analyzed.Results 8 patients had unilateral disease,5 had substantial breast masses,and 3 had flare local skin associated with fluctuation.Molybdenum target X-ray examination in 5 patients with substantial masses showed that mastitis and malignant neoplasm were suspected to be excluded,among whom,1 was regarded as inflammatory breast cancer,and a large number of phlogocytes were found by fine needle puncture biopsy;1 suspected as having mammary tuberculosis with negative acid-fast bacillus and tuberculosis DNA was cured after a surgical ablation;3 patients with flare and fluctuation on local skin were regarded as having lacteal tumor by color ultrasound and fine needle puncture biopsy examination,with inefficient treatment of incision and drainage and anti-infection,and they were cured after enlarging ectomy;8 patients were diagnosed as having granulomatous mastitis postoperatively.Conclusion Granulomatous mastitis is rare in clinical diseases,color ultrasonography and molybdenum target X-ray examination is helpful in diagnosis,but the diagnosis should be made by pathology detection,and a complete resection of the lesion can prevent recurrence.