肉芽肿性小叶性乳腺炎105例临床诊治分析

Clinical Diagnosis and Treatment of 105 Cases of Granulomatous Lobular Mastitis

目的探讨肉芽肿性小叶性乳腺炎(granulomatous lobular mastitis,GLM)的临床特点和不同治疗策略的临床转归。方法回顾性分析2009年1月—2014年8月住院治疗的105例GLM患者的临床特征、诊治方法和治疗结果。结果中位随访时间71个月。90例(85.71%)患者接受了糖皮质激素治疗,其中5例(5.56%,5/90)经过单纯药物治疗治愈,85例(94.44%,85/90)接受皮质类固醇联合手术治疗。15例(14.29%,15/105)仅使用手术治疗。7例(6.67%,7/105)出现同侧复发,中位复发至手术时间间隔2个月(1~5个月),10例(9.52%,10/105)出现对侧发病,中位发病至手术时间间隔10个月(1~26个月)。结论皮质类固醇激素联合手术目前仍是治愈GLM的主要手段。对于选择性病例,可以考虑使用超声引导下真空辅助微创旋切技术或乳房重建技术保留乳房外形的美观。

Objective To investigate the clinical features of granulomatous lobular mastitis(GLM)and the clinical outcomes of different treatment strategies.Methods The clinical features,diagnosis and treatment methods and treatment outcomes of 105 patients with GLM who were hospitalized from January 2009 to August 2014 were retrospectively analyzed.Results The median follow-up time was 71 months.90 patients(85.71%)were received corticosteroid,5 patients(5.56%,5/90)were cured with steroid alone,while the rest 85 patients(94.44%,85/90)received corticosteroid combined surgery;15 patients(14.29%,15/105)were underwent surgeries.7 patients(6.67%,7/105)were occurred ipsilateral recurrence,median time to recurrence is 2 months(1 to 5 months),and 10 patients(9.52%,10/105)were occurred contralateral disease,median time to recurrence is 10 months(1 to 26 months).Conclusion The complete removal of lesions combined with corticosteroids is still the main strategy of curing GLM.For selective cases,ultrasound-guided vacuum-assisted minimally invasive surgery or breast reconstruction techniques can be considered to preserve the aesthetic appearance of the breast.