肉芽肿性小叶性乳腺炎的诊断与治疗进展

Progress in diagnosis and treatment of granulomatous lobular mastitis

目的 探讨肉芽肿性小叶性乳腺炎(granulomatous lobular mastitis,GLM)的病因、发病机制、诊断、鉴别诊断以及治疗的研究进展。方法 回顾国内外关于GLM相关研究的文献报道并结合临床经验,对此进行全面综述并分析。结果 GLM是一种临床上相对较少见的乳腺慢性炎性疾病,近些年来其患病人数不断增多,多发于经产的育龄期妇女,临床上表现为乳腺质硬肿块伴或不伴红肿及疼痛,严重者可伴结节性红斑及关节炎。目前认为GLM的病因主要与细菌感染尤其是克氏棒状杆菌及自身免疫相关。GLM的诊断应结合病史特征、临床表现、组织病理学表现、影像学表现和实验室检查,建立GLM诊疗多学科协作团队以提高诊断准确率和减少误诊。目前针对GLM的治疗方法主要以保守治疗和手术治疗为主,包括随访观察、抗生素治疗、糖皮质激素治疗、免疫抑制剂治疗、手术治疗、中医药治疗、联合治疗等。结论 目前GLM发病率呈上升趋势,其病因及发病机制尚无共识;其诊断需要多方面结合并建议多学科协作团队合作,以提高诊断准确率;其治疗选择和治疗时机仍无统一标准,缺乏规范化的治疗方案,以致于疾病易复发、疗效欠佳,在临床工作中选择治疗方案时应充分结合医生的经验及患者的意愿;未来仍需开展前瞻性高质量多中心的临床试验和循证医学实践,以进一步完善GLM的诊疗方案,提高对GLM的认识、制定临床诊断标准及规范诊疗行为是目前亟待解决的重要问题。

Objective To investigate the research progress of etiology,pathogenesis,diagnosis,differential diagnosis,and treatment of granulomatous lobular mastitis(GLM).Method A comprehensive analysis was conducted by reviewing the domestic and foreign literatures on GLM and combining with clinical experience.Results GLM was a relatively rare chronic inflammatory disease of the breast,and the number of patients had been increasing in recent years.It mainly occured in multiparous women of childbearing age.Clinically,it was characterized by a hard breast mass with or without redness and pain,and severe cases might be accompanied by nodular erythema and arthritis.Bacterial infection,especially Corynebacterium kroppenstedti and autoimmunity were considered to be the main causes of GLM.The diagnosis of GLM needed to combine with medical history,clinical manifestations,histopathological findings,imaging findings,and laboratory tests.A multidisciplinary team for diagnosis and treatment of GLM should be established to improve the diagnostic accuracy and reduce misdiagnosis.At present,the treatment methods for GLM were mainly conservative treatment and surgical treatment,including follow-up observation,antibiotic treatment,glucocorticoid treatment,immunosuppressive therapy,surgical treatment,traditional Chinese medicine treatment,and combined treatment.Conclusions At present,the incidence of GLM is on the rise,but its etiology and pathogenesis are still unclear.The diagnosis needs to combine with many aspects,and it is recommended that the multidisciplinary team could improve the accuracy of diagnosis.There is still no unified standard for the selection and timing of treatment.Clinicians'experience and patients'wishes should be taken into account when choosing treatment options in clinical practice.Prospective and high-quality multicenter clinical trials and evidence-based medicine practice are still needed to further improve diagnosis and treatment of GLM.