乳腺导管造影诊断溢液性乳腺疾病的临床实用价值

Diagnostic value of breast galactography on disease with nipple discharge

目的探讨乳腺导管造影诊断溢液性乳腺疾病的临床实用价值。方法 120例女性溢液性乳腺疾病患者,年龄22～65岁,平均年龄43岁。临床症状以乳头溢液为主。回顾分析乳腺导管造影资料,所有病例均行超声、患侧乳腺钼靶平片+导管造影检查,并做病理组织检查。比较乳腺导管造影诊断的差异。结果 120例中,超声发现病灶108例,阳性率为90.00%;乳腺钼靶平片发现病灶102例,阳性率为85.00%;乳腺导管造影发现病灶117例,阳性率为97.50%。超声、钼靶平片、导管造影检查诊断良、恶性肿瘤灵敏度分别为80.00%、85.00%、90.60%,3组比较差异有统计学意义(χ2=31.46,P<0.005)。手术病理证实:单纯导管内乳头状瘤37例,导管内乳头状瘤伴导管扩张33例,纤维囊性乳腺病伴导管扩张21例,导管内癌及乳头状瘤癌变29例。结论乳腺导管造影在诊断溢液性乳腺疾病中具有定位、定性的实用价值,对临床是否确定手术及切除范围提供了可靠、重要的诊断依据。

Objective To study the clinical value of breast galactography in disease with nipple discharge.Methods A total of 120 female patients with breast galactography were enrolled,who were 22-65 years old with a mean age of 43.All the cases underwent ultrasonography,mammograms and galactograms of affected side,the nipple discharge was the common clinical symptoms for all patients,and diagnosis was established pathologically.The diagnosis differences were compared based on mammary gland duct images.Results Of the 120 cases,ultrasonography detected lesions in 108 cases（positive rate was 90.00 %）,mammograms detected 102 cases（positive rate was 85.00 %）,while galactograms detected 117 cases（positive rate was 97.50 %）.The diagnostic sensitivity of ultrasonography,mammograms and galactograms in benign and malignant tumors was 80.00 %,85.00 % and 90.60 %,respectively.There was significant difference in 3 groups（χ2 = 31.46,P 0.005）.Operation and pathology confirmed 37 cases of intraductal papilloma,33 cases of intraductal papilloma with duct dilatation,21 cases of fibrocystic disease with duct dilatation and 29 cases of ductal carcinoma in situ and papilloma with cancerous change.Conclusion It is demonstrated that the galactograms not only have practical value for determining localization and nature in diagnosis of nipple discharge diseases,but also help to decide the need of operation and limit of excision.