三种保守方法在治疗乳腺纤维囊性病中的临床观察和体会

Clinical observation and experience of three conservative methods in the treatment of breast fi⁃broadenosis

目的比较三种不同方法治疗乳腺纤维囊性病的短期效果和治疗体会。方法选择2018年1月~2020年6月在我院诊断为乳腺纤维囊性病伴乳房疼痛门诊患者,共85例影响日常生活的乳房疼痛的患者纳入研究,包括73例有周期性乳痛症状和12例非周期性乳痛症状。根据治疗方法分三组:乳管灌洗组(灌洗组,n=25)、三苯氧胺口服组(三苯氧胺组,n=30)和非甾体抗炎药双氯芬酸二乙胺乳胶剂组(NSAIDS外用组,n=30),用药3月。采用视觉模拟评分法(VSA)对疼痛进行评分,采用彩色多普勒超声评估治疗后乳腺纤维囊性病变变化。结果治疗后1月,3组患者疼痛呈不同程度缓解,灌注组和口服三苯氧胺组明显优于治疗前和NSAIDS外用组。3组患者中,VAS评分均在治疗后1月、2月、3月、4月和6个月明显下降,但3月、4月和6个月间变化不明显。随诊6月,彩色多普勒超声显示灌注组病变总体有缩小,尤其囊肿缩小明显,大部分囊肿透声变清;三苯氧胺组13例发现病变总体缩小,其中囊肿变小表现11例,囊肿透声变清10例,NSAIDS外用组只有4例出现病变缩小,3例有增大趋势,囊肿透声变清6例,其余总体改变不明显。3组患者BIRADS分级未发生改变。结论乳管灌洗方法、口服药物和外用NSAIDS的方法均可以明显改善乳腺纤维囊性病患者乳房疼痛,但均不能有效缓解病灶和病理改变。

Objective To compare short⁃term effects on fibroadenosis by three different methods.Methods The data of outpatients diagnosed with fibroadenosis from January 2018 to June 2020 were analyzed.A total of 85 patients with breast pain that affect daily life(60 patients with symptoms of cyclic mastalgia and 48 with noncyclic mastalgia)were assigned to three groups,galactophore lavage group(lavage group,n=25),toral tamoxifen group(tamoxifen group,n=30)and topical NSAIDs group(topical NSAIDs group,n=30),and treatment for 3 months.Visual analogue scale(VSA)was used to score pain,and color Doppler ultrasound was used to evaluate the changes in breast fibrocystic lesions after treatment.Results One month after treatment,mastalgia in patients of the three groups was relieved in varying degrees,and the lavage group and the tamoxifen group were significantly better than those before treat⁃ment and the topical NSAIDs group.VAS scores In the three groups decreased significantly at 1 month,2 months,3 months,4 months and 6 months after treatment,but there was no significant change at 3 months,4 months and 6 months.After 6 months of follow⁃up,color Doppler ultrasound showed that the lesions in lavage group shrank,especially the cysts shrank significantly,and most of the cysts became clear.In tamoxifen group,13 cases of lesions shrank,including 11 cases of cysts shrank,10 cases of cysts became clear.In NSAIDs group,4 cases shrank,3 cases increased,6 cases of cysts became clear.There was no change in BIRADS grade among the three groups.Conclusion Breast lavage,drug and topical NSAIDs can significantly improve mastalgia in patients with fibroadenosis,but not effectively alle⁃viate the lesions and pathological changes.