纤维乳管内视镜在乳头溢液性疾病诊治中的应用

Mammary ductoscopy for the evaluation and management of nipple discharge

目的评价纤维乳管内视镜在乳头溢液疾病诊断及介入治疗中的价值。方法2003年10月—2009年11月3280例乳头溢液患者进行了纤维乳管内视镜检查。对其中1018例乳管镜发现的占位病变患者及2例非占位病变患者进行了手术治疗；其余2260例非占位病变患者进行乳管镜下介入冲洗治疗。结果血性溢液、单孔溢液、单乳溢液以及病变主要位于总乳管及I～Ⅱ级乳管多提示是占位性病变；非血性溢液、多孔溢液、双乳溢液以及病变呈乳管内弥漫性分布多提示是非占位性病变。2260例介入冲洗治疗患者中，总治愈率为59．73％（1350／2260），总有效率为88．72％（2005／2260）。结论对血性溢液、单孔溢液、单乳溢液以及病变主要位于总乳管及I～Ⅱ级乳管者要考虑到占位性病变可能，利用纤维乳管镜对于非占位病变直接进行局部介入治疗效果明显。

Objective To determine the role of mammary ductoscopy in the evaluation and intraductal therapy for nipple discharge. Methods In this study 3280 patients with nipple discharge underwent mammary ductoscopy. Duetoscopy revealed space occupying lesions in 1018 patients who subsequently underwent surgery; 2260 patients with no-space occupying lesion underwent ductoseopically guided duct lavage. Results Space occupying lesion was often seen in patients with bloody discharge, single duct nipple discharge, discharge in unilateral breast and lesions located in general or level I - ]] duct. Non-bloody discharge, multiple duct with nipple discharge and bilateral breast involved and lesions at multi-level ducts were common in patients with no-space occupying lesions. Ductoscopically guided duct lavage was curative in 88.72% among 2260 cases undergoing lavage. Conclusions Space occupying lesion should be suspected in patients with bloody discharge, single duct nipple discharge and unilateral breast involving lesion and lesions located in the general or level I - II duct system;Mammary dactoscopy is useful tool in the intraductal therapy for non-space occupying lesions.